Techniques for Optimizing

Success in Identifying and

Working with American

Indian/Alaska Native Children

6th International Meeting on Indigenous Child

Health - Resilience: Our Ancestors’ legacy,

our children’s strength

Ottawa, Ontario March 20, 2015

Candace Shelton, M.S., LISAC

Canshelton@aol.com

(520) 881-8182

Faculty/Presenter Disclosure

• Candace Shelton has no relevant financial

relationships with the manufacturer(s) of

commercial services discussed in this

CME activity

• Candace Shelton does not intend to

discuss an unapproved/investigative use

of commercial product/device in my

presentation

Potential for conflict(s) of interest

• Candace Shelton has received payment from the American

Academy of Pediatrics

• [Supporting organization name]

[developed/licenses/distributes/benefits from the sale of, etc.]

a product that will be discussed in this program: [insert

generic and brand name here].

COMPLETION INSTRUCTIONS: Outlines potential conflict between disclosures

on slide 1 and your presentation; this slide will be completed by the planning

committee.

Mitigating Potential Bias

The planning committee for [conference name] has deemed

there to be no potential for bias or conflict of interest in relation

to the speaker(s) declaration(s) and the workshop content.

COMPLETION INSTRUCTIONS: This slide will be the same for all faculty who

are required to present Slide 2.

We Must Acknowledge FASD is Present in Our Communities

• Awareness – educate our women of

childbearing age

• Recognition of the effects of prenatal

alcohol exposure cause brain damage

• Intervention for those women who are

addicted, pregnant and need support to

stop drinking

• Treating those affected with respect and

provide the support they need to succeed

Fetal Alcohol Spectrum Disorders (FASD)

• Umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy

• May include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications

• Not a diagnosis

+

FASD Facts

• 100 percent preventable

• Leading known cause

of preventable mental

retardation

• Not caused on purpose

• Can occur anywhere and

anytime pregnant women

drink

• Not caused by biologic

father’s alcohol use

• Not a new disorder

Cause of FASD

• The sole cause of FASD is women drinking alcoholic beverages during pregnancy.

• Alcohol is a teratogen.

“Of all the substances of abuse (including cocaine,

heroin, and marijuana), alcohol produces by far the

most serious neurobehavioral effects in the fetus.”

—IOM Report to Congress, 1996

FASD and Alcohol

• All alcoholic beverages are harmful.

• Binge drinking is especially harmful.

• There is no proven safe amount of alcohol use

during pregnancy.

FASD and the Brain

• Prenatal alcohol exposure causes brain

damage.

• Effects of FASD last a lifetime.

• People with an FASD can grow, improve,

and function well in life with proper

support.

FAS and the Brain

FAS and the Brain

A

B

C

A B C

A. Magnetic resonance imaging showing the side view of a 14-

year-old control subject with a normal corpus callosum; B. 12-

year-old with FAS and a thin corpus callosum; C. 14-year-old

with FAS and agenesis (absence due to abnormal development)

of the corpus callosum.

Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into

FAS. Alcohol Health & Research World 18(1):49–52.

FAS and the Brain

A

These two images are of the brain of a 9-year-old girl with

FAS. She has agenesis of the corpus callosum, and the

large dark area in the back of her brain above the

cerebellum is essentially empty space.

Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into

FAS. Alcohol Health & Research World 18(1):49–52.

How an individual acts determines “success” or “failure”

• Literal thinking

Do exactly as told

Difficulty with sense of time

Difficulty with sense of space

Difficulty with recognizing the

consequences of their actions

Difficulty with managing money

Difficulty in level or point systems

Diagnosing Fetal Alcohol Syndrome

• Prenatal maternal alcohol use • Growth deficiency • Central nervous system abnormalities • Dysmorphic features

• Short palpebral fissures • Indistinct philtrum • Thin upper lip

Caucasian African American

Source: Astley, S.J. 2004. Diagnostic Guide for Fetal Alcohol Spectrum

Disorders: The 4-Digit Diagnostic Code, Third Edition. Seattle: University

of Washington Publication Services, p. 114.

Overall Difficulties for Persons With an FASD

• Taking in information

• Storing information

• Recalling information when necessary

• Using information appropriately in a specific situation

• Lower IQ

• Impaired ability in reading, spelling and

arithmetic

• Lower level of adaptive functioning: more

significantly impaired than IQ

Primary Disabilities in Persons With an FASD

Typical Difficulties for Persons With an FASD

• Are overly sensitive to sensory input

• Upset by bright lights or loud noises

• Annoyed by tags in shirts or seams in socks

• Have problems sensing where their body is in

space (clumsy)

• Do not complete tasks or chores and may appear

oppositional

• Have trouble determining what to do in a given

situation

• Do not ask questions - they want to fit in

Typical Difficulties for Persons With an FASD

• Say they understand when they do not

• Have verbal expressive skills that often exceed

their level of understanding

• Misinterpret others’ words, actions or body

movement

• Go off with strangers

• Repeatedly break rules

• Do not learn from mistakes or natural

consequences

• Frequently do not respond to point and level

systems

• Give in to peer pressure

• Function unevenly in school, work and

development

• Experience multiple losses

• Are seen as lazy, uncooperative and

unmotivated

• Have hygiene problems

• Cannot entertain themselves

• Have trouble changing tasks

• Do not pick up on social cues

Typical Difficulties for Persons With an FASD

• Attention-Deficit/Hyperactivity Disorder

• Schizophrenia

• Depression

• Bipolar disorder

• Substance use disorders

Likely Co-occurring Disorders with an FASD

• Sensory integration disorder

• Reactive Attachment Disorder

• Separation Anxiety Disorder

• Posttraumatic Stress Disorder

• Traumatic Brain Injury

• Risk for Borderline Personality Disorder

• Medical disorders (e.g.,seizure disorder, heart abnormalities, cleft lip and palate)

Likely Co-occurring Disorders with an FASD

• ADHD

• Oppositional Defiant Disorder

• Conduct Disorder

Possible Misdiagnoses for Individuals with an FASD

• Adolescent depression

• Bipolar disorder

• Intermittent Explosive Disorder

• Autism/High Functioning Autism

• Reactive Attachment Disorder

• Traumatic Brain Injury

• Antisocial Personality Disorder

• Borderline Personality Disorder

Possible Misdiagnoses for Individuals with an FASD

Paradigm Shift

“We must move from viewing

the individual as failing if s/he

does not do well in a program to

viewing the program as not

providing what the individual

needs in order to succeed.”

—Dubovsky, 2000

Strategies To Improve Outcomes for Individuals With an FASD

Educate the Community

Strategies for Sensory Integration

Issues

• Simplify the individual’s environment.

• Provide a lot of one-to-one physical presence.

• Take steps to avoid sensory triggers.

Strategies To Improve Outcomes for Individuals With an FASD

• Provide one direction or rule at a time and

review rules regularly.

• Use a lot of repetition.

• Check for understanding

• Use literal language

• Teach use of calculators and computers

• Look for misinterpretations of words or actions

and discuss when they occur

• Use short-term consequences specifically related

to the behavior

Strategies To Improve Outcomes for Individuals With an FASD

• Establish achievable goals

• Provide skills training and use role playing

• Use first-person language (child with FAS not

FAS kid)

• Address issues of grief and loss

• Do not blame people for what they cannot do

• Set the person up to succeed

• Use a strength based approach, build on the

strengths of persons with an FASD

Strengths of Persons With an FASD

• Friendly

• Sensitive

• Likable

• Loyal

• Desire to be liked

• Helpful

• Good with younger

children*

• Determined

• Have points of

insight

• Not malicious

• Have a strong

sense of fairness

• Funny and sweet

FAS

Dubovsky, Drexel University College of Medicine (1999)

What the Ancestors Believed

LIFE IS SACRED

A Well Community Believes

PREGNANCY IS SACRED

SLBK

Sacred Gift

Resources

• SAMHSA FASD Center for Excellence:

fascenter.samhsa.gov 866-786-7327

• Centers for Disease Control and Prevention FAS

Prevention Team: www.cdc.gov/ncbddd/fas

• National Institute on Alcohol Abuse and

Alcoholism (NIAAA): www.niaaa.nih.gov/

• National Organization on Fetal Alcohol

Syndrome (NOFAS): www.nofas.org

• These sites link to many other Web sites.