Dr. Lori Vitale Cox, 2006 Fetal Alcohol Spectrum Disorder Fetal Alcohol Spectrum Disorder Dr. Lori...

Dr. Lori Vitale Cox, 2006Dr. Lori Vitale Cox, 2006

Fetal Alcohol Spectrum Fetal Alcohol Spectrum

DisorderDisorder

Dr. Lori Vitale CoxDr. Lori Vitale Cox

[email protected]@nb.nb.ca

506-523-8312506-523-8312

mailto:[email protected]


Fetal Alcohol Spectrum Fetal Alcohol Spectrum Disorder-FASDDisorder-FASD

Spectrum of Neurological and Spectrum of Neurological and Physical DisabilitiesPhysical Disabilities

Takes in A Range of Physical and Takes in A Range of Physical and Behavioral Abnormalities Behavioral Abnormalities

Caused by Prenatal Exposure to Caused by Prenatal Exposure to AlcoholAlcohol


Is FASD A Health Problem Is FASD A Health Problem In Canada?In Canada?

Incidence FASD in North AmericaIncidence FASD in North America Estimated 1%-10% Per 1000Estimated 1%-10% Per 1000

Higher Prevalence In Communities Higher Prevalence In Communities Where There Are High Rates Of Where There Are High Rates Of Substance AbuseSubstance Abuse

Problem In Any Community Where Problem In Any Community Where Women In Their Childbearing Years Women In Their Childbearing Years Consume AlcoholConsume Alcohol


Researchers Estimate:Researchers Estimate:

Tens Of Thousands Of Canadian Tens Of Thousands Of Canadian Adults Affected Fetal Alcohol Adults Affected Fetal Alcohol Spectrum Disorders Never Diagnosed Spectrum Disorders Never Diagnosed

((Donovan 1992, Boland et al Donovan 1992, Boland et al 1998)1998)


Fetal Alcohol Syndrome Fetal Alcohol Syndrome DisorderDisorder

Most Preventable Birth DefectMost Preventable Birth Defect One of the Top 3 Causes of One of the Top 3 Causes of

Developmental DisabilitiesDevelopmental Disabilities Ability Levels Lower OverallAbility Levels Lower Overall Often Within ‘Normal’ RangeOften Within ‘Normal’ Range

Kaplan and Saddock’s Synopsis of Psychiatry (1998)Kaplan and Saddock’s Synopsis of Psychiatry (1998)


Diagnostic CategoriesDiagnostic Categories

New Canadian GuidelinesNew Canadian Guidelines FASFAS- Fetal Alcohol Syndrome- Fetal Alcohol Syndrome

With Disclosure Or Evidence Maternal DrinkingWith Disclosure Or Evidence Maternal Drinking Without DisclosureWithout Disclosure

PFASPFAS- Partial Fetal Alcohol Syndrome- Partial Fetal Alcohol Syndrome

Fetal Alcohol EffectsFetal Alcohol Effects ARNDARND-Alcohol Related Neurodevelopmental -Alcohol Related Neurodevelopmental

DisorderDisorder


Primary DisabilityPrimary Disability

DeathDeath Growth DeficiencyGrowth Deficiency Characteristic Physical Changes Characteristic Physical Changes Brain-Central Nervous System DamageBrain-Central Nervous System Damage

Related to Pregnant Pattern and Quantity Related to Pregnant Pattern and Quantity Mothers Drinking WhileMothers Drinking While


Primary Disability/Physical Primary Disability/Physical ChangesChanges

May Have Defining Facial FeaturesMay Have Defining Facial Features Smaller Eyes/Eyes Wider ApartSmaller Eyes/Eyes Wider Apart Long Smooth Phyltrum-Area Between Long Smooth Phyltrum-Area Between

Nose and Upper LipNose and Upper Lip Thin Upper LipThin Upper Lip

May Be Smaller in Size and Stature May Be Smaller in Size and Stature as Child as Child


Associated Physical Associated Physical DisabilitiesDisabilities

Changes in the Ear--Middle Ear Changes in the Ear--Middle Ear ProblemsProblems

Changes in the Eyes—Cross Eyes, Lazy Changes in the Eyes—Cross Eyes, Lazy Eye, Drooping LidsEye, Drooping Lids

Heart ProblemsHeart Problems Spinal BifidaSpinal Bifida Seizure DisordersSeizure Disorders Skeletal ProblemsSkeletal Problems


Associated Physical Associated Physical DisabilitiesDisabilities

‘‘Failure To Thrive’-As an Infant Failure To Thrive’-As an Infant Sleep ProblemsSleep Problems Eating ProblemsEating Problems Increased or Decreased Sensitivity to Increased or Decreased Sensitivity to

Pain, Cold, Heat, Touch, Noise etc.Pain, Cold, Heat, Touch, Noise etc.


CNS ChangesCNS Changes

But Often No Outward Physical Sign But Often No Outward Physical Sign Just Brain or Central Nervous System-Just Brain or Central Nervous System-CNS-ChangesCNS-Changes


Alterations-Brain & Alterations-Brain & BehaviorBehavior

Mattson and Riley Found: Mattson and Riley Found: The Absence Of FAS Facial Features The Absence Of FAS Facial Features

Does Not Preclude Alterations In Does Not Preclude Alterations In Brain And Behavior (Brain And Behavior (Mattson and Riley Mattson and Riley 2001)2001)

Noticeable Brain Changes In Non-Noticeable Brain Changes In Non-Dysmorphic Individuals-Those Dysmorphic Individuals-Those Without Characteristic Changes In Without Characteristic Changes In Face-Using Functional MRI’sFace-Using Functional MRI’s


Mattson and Riley (1996-Mattson and Riley (1996-2001)2001)

Reduction Volume, Change Shape, Reduction Volume, Change Shape, Location:Location: Corpus CallosumCorpus Callosum

Reduction In Volume: Reduction In Volume: Basil Ganglia, Hippocampus, AmagdylaBasil Ganglia, Hippocampus, Amagdyla Overall Cerebrum and CerebellumOverall Cerebrum and Cerebellum


Pre-Natal Exposure & the Pre-Natal Exposure & the BrainBrain

Alcohol Exposure Seems To Damages Alcohol Exposure Seems To Damages Certain Areas of The Brain While Certain Areas of The Brain While Other Areas Appear UnaffectedOther Areas Appear Unaffected


Alcohol and the BrainAlcohol and the Brain

Cerebellum—Coordination, Cerebellum—Coordination, Movement, Behavior and MemoryMovement, Behavior and Memory

Basil Ganglia-Spatial Memory/ Basil Ganglia-Spatial Memory/ BehaviorsBehaviors Perseveration, Task Initiation, Innability Perseveration, Task Initiation, Innability

to Switch Gears, Work Towards Goals, to Switch Gears, Work Towards Goals, Perceive Time, Predict Behavioral Perceive Time, Predict Behavioral OutcomesOutcomes


Alcohol and BrainAlcohol and Brain

Corpus Collosum-Processing Corpus Collosum-Processing Information From Right Brain to the Information From Right Brain to the LeftLeft

Hippocampus-Part of the Limbic Hippocampus-Part of the Limbic System Involved in Memory and in System Involved in Memory and in EmotionEmotion


Brain Function/Mind Brain Function/Mind FunctionFunction

Dysfunction In These Brain StructuresDysfunction In These Brain StructuresMEANS MEANS

Changes In Executive Functioning, Changes In Executive Functioning, Memory, Logic, AttentionMemory, Logic, Attention

Difficulty Functioning and Behaving Difficulty Functioning and Behaving


Mattson and Riley (1996)Mattson and Riley (1996)

Individuals Exposed Without Facial Phenotype-Individuals Exposed Without Facial Phenotype-Outward Physical SignsOutward Physical Signs

Displayed Neurobehavioral Deficits Displayed Neurobehavioral Deficits Verbal LearningVerbal Learning MemoryMemory Language Language AttentionAttention Visual-Spatial AbilityVisual-Spatial Ability Lower Overall Cognitive AbilityLower Overall Cognitive Ability


FASD and UnderstandingFASD and Understanding Difficulty Abstract ReasoningDifficulty Abstract Reasoning Difficulty Cause and Effect LogicDifficulty Cause and Effect Logic Ability to Process, Organize, Retrieve, Ability to Process, Organize, Retrieve,

and Remember Information Often and Remember Information Often ImpairedImpaired

Difficulty With Sensory Integration Difficulty With Sensory Integration


FASD and BehavingFASD and Behaving

Difficulty With Boundaries-Sense of Difficulty With Boundaries-Sense of SelfSelf

Attention ProblemsAttention Problems Impulse Control or Regulation Impulse Control or Regulation

ProblemsProblems Perseveration-Difficulty ‘Changing Perseveration-Difficulty ‘Changing

Gears’ Gears’


Damage To Fetus Depends Damage To Fetus Depends On:On:

Maternal NutritionMaternal Nutrition Mother’s Age at GestationMother’s Age at Gestation Quantity Alcohol & Pattern of Quantity Alcohol & Pattern of

Drinking Drinking Timing of Drinking in Relation Timing of Drinking in Relation

Fetal Development Fetal Development Genetic makeup of Fetus Genetic makeup of Fetus


Research Indicates:Research Indicates:

If Individuals Drink Or Take Drugs If Individuals Drink Or Take Drugs Before They Know They Are Pregnant Before They Know They Are Pregnant They Can Protect Their Baby They Can Protect Their Baby By Stopping Drinking And DruggingBy Stopping Drinking And Drugging By Eating Healthy FoodsBy Eating Healthy Foods By Taking Supplements-Folic Acid and By Taking Supplements-Folic Acid and

Anti-Oxidant Vitamins May Have Anti-Oxidant Vitamins May Have Beneficial Effect— Beneficial Effect— New Research New Research MotherRisk MotherRisk


Adolescent & Adult Adolescent & Adult Diagnosis Still DifficultDiagnosis Still Difficult

Present Diagnostic Guidelines Still Relies:Present Diagnostic Guidelines Still Relies: On Facial Changes Most Prominent On Facial Changes Most Prominent

Between Ages 2- 11Between Ages 2- 11 These Disappear Become Less Prominent These Disappear Become Less Prominent

In TimeIn Time On Confirmation of Maternal DrinkingOn Confirmation of Maternal Drinking

Difficult to Establish For Many Exposed Difficult to Establish For Many Exposed Adults and AdolescentsAdults and Adolescents


Why is this a Problem?Why is this a Problem?

Without Diagnosis No Without Diagnosis No Possibility Of: Possibility Of:

InterventionIntervention Prevention Prevention

Intervention

Prevention

Diagnosis


How Can We Prevent How Can We Prevent What We Do Not See?What We Do Not See?

Recognition-Diagnosis-Intervention-Recognition-Diagnosis-Intervention-PreventionPreventionRecognition

Diagnosis

Intervention

Prevention


FASD Is Often Misdiagnosed FASD Is Often Misdiagnosed Constant Frustration for Constant Frustration for

EveryoneEveryone For Individuals Who Suffer For Individuals Who Suffer

Disability Disability For Their FamiliesFor Their Families For SocietyFor Society

Lack Of Appropriate Services and Supports


Individuals With FASDIndividuals With FASD

Have Challenging Behaviours & Have Challenging Behaviours & Difficulty in LearningDifficulty in Learning

Perceived as Being ProblemsPerceived as Being Problems

Not Perceived as Having A Problem Not Perceived as Having A Problem


Problems Functioning:Problems Functioning:School-WorkSchool-Work

Cognitive Problems Cognitive Problems Limited Listening Skills But Often Very Limited Listening Skills But Often Very

Talkative So Other People Don’t RecognizeTalkative So Other People Don’t Recognize Inability To Follow Directions-More Than 1 Inability To Follow Directions-More Than 1

At a TimeAt a Time Does Not Learn From MistakesDoes Not Learn From Mistakes Does Not Generalize LearningDoes Not Generalize Learning


Problems Functioning:Problems Functioning:School-WorkSchool-Work

Social ProblemsSocial Problems Easily IrritatedEasily Irritated Socially Inappropriate Behaviors-Doesn’t Socially Inappropriate Behaviors-Doesn’t

Respond To Normal Social CuesRespond To Normal Social Cues Problems With RelationshipsProblems With Relationships

Sleeping Problems-Up All Night-Sleep All Sleeping Problems-Up All Night-Sleep All DayDay

Tends To Be Late, Absent Tends To Be Late, Absent


Challenging BehaviorsChallenging Behaviors Social Problems Social Problems

Possible Sexual Boundary ProblemsPossible Sexual Boundary Problems Possible Problems With Confabulation-Possible Problems With Confabulation-

Lying Without DeceptionLying Without Deception Possible Problems With Concept of Possible Problems With Concept of

Ownership-Stealing Without DeceptionOwnership-Stealing Without Deception Lack of Responsibility For Actions-Lack of Responsibility For Actions-

Blames Others For MistakesBlames Others For Mistakes


Problems FunctioningProblems Functioning

Emotional ProblemsEmotional Problems Confused, Distorted Thinking-Often Confused, Distorted Thinking-Often

AnxiousAnxious Dangerous, Unsafe BehaviorsDangerous, Unsafe Behaviors Attention Problems-DistractibilityAttention Problems-Distractibility Impulsivity, Self ControlImpulsivity, Self Control Anger Management ProblemsAnger Management Problems Substance Abuse ProblemsSubstance Abuse Problems


1992-6 Secondary Disability 1992-6 Secondary Disability

StudyStudy

Ann Streissguth et al (1996) Followed Ann Streissguth et al (1996) Followed 473 Individuals- FASD--Longitudinal 473 Individuals- FASD--Longitudinal StudyStudy

90% Mental Health Problems90% Mental Health Problems 60% Trouble with the Law60% Trouble with the Law 50% Confined Jail or Mental Hospital 50% Confined Jail or Mental Hospital 50% Inappropriate Sexual Behaviour50% Inappropriate Sexual Behaviour 30% Drug and Alcohol Problems30% Drug and Alcohol Problems


Spiralling ProblemsSpiralling Problems

90% of Individuals With FASD 90% of Individuals With FASD Develop Secondary Disabilities in Develop Secondary Disabilities in the Absence of Intervention the Absence of Intervention Appropriate Levels of Support.Appropriate Levels of Support.


Layers of TraumaLayers of Trauma

At the Core Neurological Problems– At the Core Neurological Problems– FASD, ADD/ ADHD, Specific Learning FASD, ADD/ ADHD, Specific Learning or Memory Disabilitiesor Memory Disabilities

Other Layers: Other Layers: First Layer: Attachment Disorder-First Layer: Attachment Disorder-

Multiple Unstable Placements-Often Multiple Unstable Placements-Often Associated With AggressionAssociated With Aggression


Layers of TraumaLayers of Trauma

22ndnd Layer: Post Traumatic Stress Layer: Post Traumatic Stress Disorder –Sexual, Physical Abuse, Disorder –Sexual, Physical Abuse, Witnessing Violence/SuicideWitnessing Violence/Suicide

33rdrd Layer: Their Own Substance Layer: Their Own Substance Abuse-Self MedicationAbuse-Self Medication

44thth Layer: Jail, Institutionalization, Layer: Jail, Institutionalization, Social Abuse in Terms of Social Abuse in Terms of Inappropriate Response To FASD Inappropriate Response To FASD DisabilityDisability


Beliefs Dictate BehaviorsBeliefs Dictate Behaviors

Accurate Identification Of Etiology of Accurate Identification Of Etiology of FASD Important For Effective-FASD Important For Effective-Appropriate InterventionsAppropriate Interventions

Diagnosis And Subsequent Diagnosis And Subsequent Treatment That Ignores Organicity Of Treatment That Ignores Organicity Of FASD Could Lead To Exacerbating FASD Could Lead To Exacerbating The Behavioral Problems. The Behavioral Problems.


Misinterpretation Of Misinterpretation Of BehaviorsBehaviors

If Psychologists/Physicians Untrained If Psychologists/Physicians Untrained Easy To Misdiagnose Easy To Misdiagnose

Social Workers-Adoptive Parents Untrained Social Workers-Adoptive Parents Untrained Easy Misinterpret Behaviors/Give UpEasy Misinterpret Behaviors/Give Up

Justice Professionals Untrained Justice Professionals Untrained Easy To Punish Behaviors as CriminalEasy To Punish Behaviors as Criminal

Teachers/Employers UntrainedTeachers/Employers Untrained Easy To Expel, to Fire or to Refuse to HireEasy To Expel, to Fire or to Refuse to Hire


Professional Training Professional Training EssentialEssential

If Professionals UntrainedIf Professionals Untrained Easy To Unknowingly Perpetrate Easy To Unknowingly Perpetrate

Administrative Violence On Administrative Violence On Individuals Whose Problem Individuals Whose Problem Behavior Is Result Of Disability Not Behavior Is Result Of Disability Not DeviancyDeviancy


How Many People Are In Prison How Many People Are In Prison When They Simply Need Higher When They Simply Need Higher

Levels of Support For Longer Levels of Support For Longer Times In Order To Work and Live Times In Order To Work and Live

Productive Lives?Productive Lives?


Strategy-Start With Self Strategy-Start With Self and Peersand PeersFirst StageFirst Stage

Educate SelfEducate Self Each of Us is a Window To Understanding Each of Us is a Window To Understanding

Teacher, Social Worker, Physician, Foster Teacher, Social Worker, Physician, Foster Parent, Nurse, Judge, Lawyer, Neighbor, Parent, Nurse, Judge, Lawyer, Neighbor, Friend, Teacher Ass’t, Native Elder, Friend, Teacher Ass’t, Native Elder, Psychologist, Counselor, Youth Worker, RCMP, Psychologist, Counselor, Youth Worker, RCMP, Journalist, Correction Officers Journalist, Correction Officers

Educate Peers-Fellow Professionals, Educate Peers-Fellow Professionals, Workers, FriendsWorkers, Friends


Second StageSecond Stage

Recognition and Referral:Recognition and Referral: Recognition Unacceptable Behaviour Recognition Unacceptable Behaviour

Result Of Untreated DisabilityResult Of Untreated Disability Recognition Huge Lag Between Cognitive Recognition Huge Lag Between Cognitive

& Physical Growth& Physical GrowthWork To Change Practice:Work To Change Practice: Ability Levels Average, Low Average, Ability Levels Average, Low Average,

Borderline-Normally Do Not Qualify For Borderline-Normally Do Not Qualify For Special Service or TreatmentSpecial Service or Treatment


Developmental Developmental ImpairmentsImpairments

Change Eligibility Requirements: Use Change Eligibility Requirements: Use Adaptive MeasuresAdaptive Measures

Adaptive Behavior Measures Indicate Adaptive Behavior Measures Indicate Severe Developmental ImpairmentsSevere Developmental Impairments

Impairment Functional Living Skills: Impairment Functional Living Skills: e.g. Comprehension, Communicatione.g. Comprehension, Communication


Timelines And FASDTimelines And FASD

Individual With FASDIndividual With FASD Age 18Age 18ComprehensionComprehension Age 6Age 6Money/Time ConceptsMoney/Time Concepts Age 8Age 8Emotional MaturityEmotional Maturity Age 6 Age 6 Physical MaturityPhysical Maturity Age 18Age 18Reading AbilityReading Ability Age 16Age 16Social SkillsSocial Skills Age 7Age 7Living Skills Living Skills Age 11Age 11


Timelines And FASDTimelines And FASD

Individuals With Alcohol Related Individuals With Alcohol Related Disabilities May Not Usually Ready To Live Disabilities May Not Usually Ready To Live Independently At 18 Independently At 18

Gradual Catch-Up Noted Young Adults Gradual Catch-Up Noted Young Adults With FASDWith FASD

25-30 May Be More Realistic Timeline25-30 May Be More Realistic Timeline 18 Year Old With FASD Who Looks Like An 18 Year Old With FASD Who Looks Like An

Adult May Actually Be More Like A 8 or 9 Adult May Actually Be More Like A 8 or 9 Year Old On The Inside Year Old On The Inside


Implications For PracticeImplications For Practice

Social WorkersSocial Workers Support Services Continue Beyond 18 Support Services Continue Beyond 18

For Young Adults With FASDFor Young Adults With FASD

CounsellorsCounsellors Cognitive Therapies Need To Be Cognitive Therapies Need To Be

ChangedChanged Individuals With FASD Can Talk The TalkIndividuals With FASD Can Talk The Talk Difficult To Walk The Walk Without SupportDifficult To Walk The Walk Without Support


Implications For Implications For InterventionIntervention

Correction Officers, Psychologists, Correction Officers, Psychologists, Addictions Workers, ParentsAddictions Workers, Parents:: Behaviour Modification Needs to Be Behaviour Modification Needs to Be

ModifiedModified Reward/Praise Must Be Immediate or SoonReward/Praise Must Be Immediate or Soon

Positive Try-Again Attitude (No Blame)Positive Try-Again Attitude (No Blame) ‘‘Falls’ Do Not Signify Lack of DesireFalls’ Do Not Signify Lack of Desire


Individuals FASD Have Individuals FASD Have PotentialPotential

They Need Support To Use Their Abilities They Need Support To Use Their Abilities To Set Reasonable Goals For SelfTo Set Reasonable Goals For Self To Manage MoneyTo Manage Money To Organize Time-Tape Schedule On FridgeTo Organize Time-Tape Schedule On Fridge Some Need Support To Care For Themselves-Some Need Support To Care For Themselves-

Teach Proper Hygiene-Tape Schedule In Teach Proper Hygiene-Tape Schedule In Bathroom Bathroom

To Care For Their Families-Mothers With FASD To Care For Their Families-Mothers With FASD Need In-Home CoachingNeed In-Home Coaching

To Understand Social Systems-Like CourtTo Understand Social Systems-Like Court


Use Practical AidsUse Practical Aids

Use Schedules-SimplifiedUse Schedules-Simplified Use Digital ClockUse Digital Clock Break Down Tasks-Task AnalysisBreak Down Tasks-Task Analysis Use Pictures To Explain—i.e. Court Use Pictures To Explain—i.e. Court

System, WorkSystem, Work


Use Practical SupportsUse Practical Supports

Teach Picture-Symbol System For Teach Picture-Symbol System For Communication If NecessaryCommunication If Necessary

Use Role Plays, Contextual LearningUse Role Plays, Contextual Learning Teach the Use Of Calculators, Teach the Use Of Calculators,

ComputersComputers Use Social Stories To Teach Use Social Stories To Teach

BehaviorsBehaviors


FASD & Sexual IssuesFASD & Sexual Issues

Use Simplified Books With Pictures Use Simplified Books With Pictures Explain In Concrete Terms Explain In Concrete Terms Discuss Possibility Of Long-Term Birth Discuss Possibility Of Long-Term Birth

Control Like Depo-Provera, IUD’s, Control Like Depo-Provera, IUD’s, Norplant- Because of ImpulsivityNorplant- Because of Impulsivity

Teach About STD’s and ProtectionTeach About STD’s and Protection Close Supervision and Structured Close Supervision and Structured

Social Activities Late Teens and Social Activities Late Teens and TwentiesTwenties


We Can Change OutcomeWe Can Change Outcome

Primary Disability Can Not be Cured Primary Disability Can Not be Cured But We Can Change OutcomeBut We Can Change Outcome

Build On Strengths Build On Strengths With the Proper Diagnosis and With the Proper Diagnosis and

Support, Individuals with FASD can Support, Individuals with FASD can Learn to FunctionLearn to Function

Prevent Or Heal Secondary Disabilities Prevent Or Heal Secondary Disabilities


Adapt Environment Instead Adapt Environment Instead Of PersonOf Person

If Someone Is Physically Challenged We If Someone Is Physically Challenged We Adapt or Modify Environment To Support Adapt or Modify Environment To Support NeedsNeeds

If Someone Has Developmental Disability If Someone Has Developmental Disability We Can Change Outcome By Providing We Can Change Outcome By Providing Appropriate Environment To Support Appropriate Environment To Support NeedsNeeds


Research: Work and Research: Work and HousingHousing

Research Indicates Lack Of Research Indicates Lack Of Appropriate Living & Working Appropriate Living & Working Environments-Lack of Appropriate Environments-Lack of Appropriate Skill TrainingSkill Training

Only 18% of Individuals FASD Lived Only 18% of Individuals FASD Lived Independently Independently

Only 10% Able To Live Independently Only 10% Able To Live Independently Without Employment Problems Without Employment Problems


Individuals FASD Can Individuals FASD Can LearnLearn

Animal Studies-Functional Behaviour Animal Studies-Functional Behaviour and Learningand Learning

Alcohol Exposed Chicks Look NormalAlcohol Exposed Chicks Look Normal Failed The Detour Learning Test Day Failed The Detour Learning Test Day

1-31-3

Food Chicks

Gla

ss

Day 4 Learned


Learning And FASDLearning And FASD

We Can Help Individuals With We Can Help Individuals With FASD Learn and Grow By FASD Learn and Grow By Creating Environments In Which Creating Environments In Which They CanThey Can


Turn Weaknesses To Turn Weaknesses To StrengthsStrengths

Perseveration Perseveration Persistence Persistence

Hyperactivity Hyperactivity Hyper-Energetic Hyper-Energetic

Inflexibility Inflexibility Commitment Commitment

Daredevil Daredevil CourageCourage

Lack Boundaries Lack Boundaries OpennessOpenness

Distorted Logic Distorted Logic Unique UnderstandingUnique Understanding


Weaknesses To Weaknesses To StrengthsStrengths

Self-CenteredSelf-Centered Strong Sense of Strong Sense of Self Self

Distorted Perception Rich Fantasy LifeDistorted Perception Rich Fantasy Life Confabulation Confabulation Great StorytellingGreat Storytelling

Oversensitivity Oversensitivity Highly Sensitive Highly Sensitive

ImpulsivityImpulsivity SpontaneitySpontaneity


Difference In OutcomeDifference In Outcome

Same Primary DisabilitySame Primary Disability

Prenatal Exposure To AlcoholPrenatal Exposure To Alcohol

Assessment and DiagnosisAssessment and Diagnosis

Appropriate School Appropriate School Interventions Interventions

Stable Home LifeStable Home Life


FASD Is A Life-Long FASD Is A Life-Long DisabilityDisability

Older Youth Like D.F. Who Are FASD Need: Older Youth Like D.F. Who Are FASD Need: DiagnosisDiagnosis Team Work For Guidance-RelationshipsTeam Work For Guidance-Relationships Supportive StructuresSupportive Structures Routines that become HabitsRoutines that become Habits Consistency Consistency SupervisionSupervision Opportunities To Learn And WorkOpportunities To Learn And Work

Sheltered Work-Job CoachesSheltered Work-Job Coaches Assisted Independent LivingAssisted Independent Living Therapeutic Interventions In and Out of Justice Therapeutic Interventions In and Out of Justice

System System


Every Person Is A Gift To Us From Creator


Each Of Them Has A Purpose


We Can Help Them Find That We Can Help Them Find That Purpose By Believing In Purpose By Believing In

ThemThem

Dr. Lori Vitale Cox, 2006 Fetal Alcohol Spectrum Disorder Fetal Alcohol Spectrum Disorder Dr. Lori...

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