The lecture focuses on the great importance of clinical and therapeutic intervention in improving behaviors, parent-child relationships and more, in Fetal Alcohol Syndrome cases.

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2. Children with Fetal Alcohol Syndrome in Adoptive and Foster Families:
Improving Child and Family Outcomes and Adjustment
Irit Bar-Netzer , Psy.D.
UCEDD, CHLA, USA
6th International Conference on Disabilities
July 6-9, 2015 – Tel Aviv, Israel
ibar@chla.usc.edu
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4. Overview of Fetal Alcohol Spectrum disorders
• Diagnostic and Description
• Fetal Alcohol syndrome Disorders (FASD) is an umbrella term describing the range of effects
that can occur in an individual whose mother drank alcohol during pregnancy
• FAS (Fetal Alcohol Syndrome) Describes as congenital mental and physical abnormalities that
result from FAE accompanied by slow growth and distinctive facial features
• FAE (Fetal Alcohol Effects) describes as mental and behavioral effects of FAS without any
physical signs
• ARBD (Alcohol Related Birth Defects) describes the effects link to prenatal alcohol exposure,
including heart, skeletal, kidney, and eye malformations in the absence of apparent
neurobehavioral or brain disorders
• ARND (Alcohol related Neurodevelopmental disorder refers to a complex range of disabilities
in neurodevelopment and behavior, adaptive skills, and self-regulation. Individuals with
ARND do not have the FAS facial abnormalities, but may have developmental disabilities
including structural and or/functional CNS dysfunction with behavioral and learning
problems.
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5. Identification of Secondary Disability and Risk Factors
• 94% Mental Disorder
• 61%Disaruptive at school
• 60% Trouble with the law
• 50% Confinement (in detention, jail, prison, psychiatric or alcohol inpatient settings)
• 49% Inappropriate sexual behaviors
• 35%Drug and alcohol problem (Streissguth el at., 1996)
Facts about FAS and FASD
• FASD is the leading known preventable cause of mental retardation and birth defects
• FASD affects 1 I 100 live births or as many as 40,000 infants each year
• Children do not outgrow FASD. The physical and behavioral problems can last for a lifetime.
• FAS and FASD are found in all racial and socio-economic groups.
• FAS and FASD are not genetic disorders. Women with FAS or effected by FASD have healthy babies if they
so not drink alcohol during their pregnancy.
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6. Protective Factors To Improve the Chances of an Individual Achieving Developmental
Potential
• Early diagnosis
• Living in a Stable Home with nurturing parents and minimum changes in
household.
• Protection from witnessing or being victimized by violence receiving
developmental and behavioral health services
• Attending proper education setting
• Receive support ((Streissguth et al., 1966)
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7. Challenges in Early Identification
• Early diagnosis will improve outcome for children with FASD but it is difficult because
FASD is a birth defect that primarily affects the brain.
• The effects of FASD may not be recognized or may be mislabeled as stubbornness or
“bad” behaviors by : Caregivers, teachers, family . These characteristics are believed to
be preventable with appropriate supports(SAMHSA 2004)
• Children with FASD may develop secondary symptoms that include :
• Fatigue, tantrums
• Frustration, irritability, anger, aggression
• Fear, anxiety, avoidance, withdrawal
• Shutting Down, lying, running away
• Legal problems
• Trouble at home , school, and community
• Isolation
• Mental health problems (depression, self injury, suicidal tendencies)
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8. • Do not learn from negative reinforcement because can not generalize rules . They
demonstrate impulse control
• Demonstrate lack of social skills such as;
• Listening
• Asking for help
• Waiting for turn
• Sharing (SAMHSA 2004)
• Children with FASD do not qualified for services they have IQ higher than 70 despite performing
poorly.
Children with FASD mistaken to children with ADHD/ADD:
1.Children with AHAD more difficult focusing sustaining attention from one task to another
Children with FASD find it harder to shift attention from one task to another and solve problems with
flexibility
2.Children with ADHD have trouble retrieving information they learned verbally
Children with FASD have problems encoding and remembering verbally learned information
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9. • DSM-5 the APA found that medications used to treat ADHD produce mixed
results when used for children with FASD
• Children with FASD appeared to have differential response to
Methylphenidate and Dexamphetamine. For example psychostimulants which
often reduce inattention symptoms in children with ADHD are not as effective
for children with FASD (AA 2012)
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10. FASD Throughout the Lifespan
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11. Common Strengths
Many people with FASD have strengths which mask their cognitive challenges
• Highly verbal
• Bright in some areas
• Artistic, musical, mechanical,
• Athletic
• Friendly, outgoing affectionate
• Determined, persistent
• Willing
• Helpful
• Generous
• Good with younger children
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12. strategies and Intervention
• Children and adolescents with FASD act in ways that seem inappropriate to their age.
• Edcucators and parents need to review the child’s behavior within the context of the AFSD
diagnosis
• Methods that work with other children to help them “act their age” won’t work with these children
who take longer to grow up and require alternative behavior management., parenting skills,
medication and teaching methods.
For those who teach and parent children and youth diagnosed with FASD, it is important to know:
• How to get correct assessment.
• How to access educational services and community resources.
• Effective methods of parenting and teaching adapted to needs of youth with FSAD.
• Support system that bolster the family as well as the child or youth with FASD.
When intervention is to working with student with FASD, it is best to:
• Stop the action!
• Observe.
• Make eye contact with the child.
• Listen to find out where he/she is stuck.
• Ask: What is hard? What would help?
• Strategies to keep in mind
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13. Innovative Interventions for Children with FASD
In the recent years, there has been increase in the efforts to design and test
interventions for individual with FASD to address:
• Social behavioral challenges
• Design to address psychiatric functioning (Paley & O’Connor 2011)
The Programs are based on reducing conditions secondary to FASD
ENHANCE THE LIVES OF FAMILIES AFFECTED BY FASD
1. Enhance Social Skills
Understanding the problem
Increase awareness for social cues
Peer exchange play group
In home play dates
Conflict avoidance and negotiation
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14. 2. Training to improve Behavioral and mathematical functioning with FASD
Deficits in mathematical training have been consistently reported for children affected by alcohol
Georgia Study
Short term individual instruction together with caregiver and teachers training.
Goal : to provide consistent teaching mathematical concepts across therapeutic home and school
environment
Results: Parent training was well received and associated with reports improved behavior by
children . Effective teaching method could improve learning for children with deficits related to
alcohol exposure (Bertrand 2009)
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15. 3. Neurocognitive
Neurocognitive habilitation with FASD who are in foster care or have been adopted
Children in foster care/adopted more likely than general population to have children with FASD
It is reported that approximately 80% of children with FASD do not stay with their birth families (Barth
Child Welfare, 2001)
Neurocognitive approach focus on the followings:
Education
Support
Improve children’s executive functioning through improve self regulation techniques
Tools to improve memory
Cause and effects reasoning
Sequencing planning
Problem solving
Improvement in executive functioning (Berytand 2009)
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16. 4. Parent Child Interaction
Therapy adopted to reduce problems with FASD
Discuss difficult behavior among children with FASD and their caregivers
Share good moment among children and caregivers
Actively participate in play therapy
Role play
Open communication
Develop trust
Develop two groups one for parents and one for children
Outcome:
Decrease parents stress
Reduce behavior problems among children with FASD –particularly young children
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17. • 5. Behavioral consultant
• To improve outcomes for families raising children with FASD
• Help with caregivers raising pre-school age children
• Find use of effective parenting skills
• Acquire specialized knowledge
• Make appropriate linkages to appropriate school and community resources
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18. 6. Pharmacological Interventions
Because children with FASD are at elevated risk for:
disruptive behavior problems
Mood disorders
Substance use and abuse
It is important at time to receive pharmacological interventions
Frankel and Colleagues 2006 found that the efficacy of social skills training was enhanced in
population 6-14 years old with FASD when children were given Noradrenaline. The drugs
suppressed the activity of Dopamine and Serotonin would support improvement of child ability
to participate in life activities.
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19. Tips for Adopting or Fostering Children Prenatally Exposed to Alcohol
• Work with informed professional in quality adoption agencies.
• Explore your feelings about alcohol and drug abuse, particularly among pregnant women.
• Discuss the child’s background with your social worker so that you have a realistic picture of the
birth parents’ substance use and related lifestyle.
• Ask for written summaries of the child’s diagnoses, medical complications, treatment services, and
necessary follow up care.
• Ask for information on services and resources to meet the child’s needs, including eligibility for
adoption subsidies and Medicaid.
• Find out how to reduce the impact of the child’s biological risks by providing nurturing, responsive,
and healthy caregiving environment.
• Recognize that you must be prepared for and able to tolerate the uncertainties that are part of
adopting a child prenatally exposed to drugs and alcohol.
• Resist negative stereotypes of children prenatally exposed to drugs and alcohol, which ignore the
individuality of each child and the role of a healthy environment.
• Recognize the importance of timely identification of problems and early intervention.
(Adapted from Edelstein, S. 1995. Children With Prenatal Alcohol and/or Other Drug Exposure:
Weighing the Risks of Adoption. Washington, DC:CWLA Press)
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