Secondary Disabilities and Fetal Alcohol Spectrum Disorder

Dr. Brenda Stade, PhD, APN St. Michaels Hospital, Toronto.

Stade 2008 www.faseout.ca

Introduction: Secondary Disabilities

Often secondary disabilities emerge in adolescence and adulthood Secondary disabilities are believed to result from complications of undiagnosed or untreated primary disabilities

Stade 2008 www.faseout.ca

Introduction: Secondary Disabilities

Mental health problems

Disrupted school experiences

Easily victimized Trouble with the law Confinement
Stade 2008 www.faseout.ca

Introduction: Secondary Disabilities (cont.)

Inappropriate sexual behaviour Alcohol and drug problems

Needing dependent living situations

Problems with employment

Stade 2008 www.faseout.ca

Secondary vs. Primary Disabilities

Are they the same or are they different?

Stade 2008 www.faseout.ca

Executive functions of the prefrontal cortex

working memory selfmonitoring

planning
time perception internal ordering

regulation of emotion
motivation inhibition

Stade 2008 www.faseout.ca

Secondary vs. Primary Disabilities

Impulsive and uninhibited Passive and withdrawn one minute, switching to volatile temper tantrums the next

Unpredictable; may need 24 hour supervision

Depression, Extreme Anxiety

Stade 2008 www.faseout.ca

Secondary vs. Primary Disabilities

Hyperactive in non-goal directed activity
Unable to stay focused on task: to follow rules, finish household chores, school assignments or keep commitments Genuine innocence and detached attitude

Stade 2008 www.faseout.ca

Secondary vs. Primary Disabilities

Impulsive sexually inappropriate, stealing Short-sighted May expect immediate gratification Engaging and charismatic yet creative at reframing reality.

Stade 2008 www.faseout.ca

Impact of FASD

Stade 2008 www.faseout.ca

Experience of Living with FASD

10-year-old stated:
Learning is hard. The teachers dont explain things (in a manner that allows her to understand).

Stade 2008 www.faseout.ca

Experience of Living with FASD

18-year-old stated: They (teachers, employers) expected me to do things I couldnt. I have a hard time doing some things. Others (kids his age) do things easier, get through work .

Stade 2008 www.faseout.ca

Experience of Living with FASD

21-year-old stated: It (FAS) really does effect quality of life. It affects, school working, friendships. How does it affect me? Differently. I do things differently..My brain is rewired differently (than others).

Stade 2008 www.faseout.ca

Experience of Living with FASD

8-year-old stated: (Its) hard, hard to keep out of trouble, and I am not that smart. Everybody makes fun of me.

Stade 2008 www.faseout.ca

Hope for Positive Outcomes

21 year old stated: The disability happened, its a disadvantage. It is not a disability. I dont like to use it as an excuse (for not participating in life).

Stade 2008 www.faseout.ca

Hope for Positive Outcomes

19 year old stated: I dont have the best brain. But it still works.

Stade 2008 www.faseout.ca

Protective Factors
Being raised in a nurturing stable environment

Diagnosis before age 6

Having a diagnosis of FAS rather than ARND

(Streissguth et al., 2004)

Stade 2008 www.faseout.ca

Interventions: Diagnosis

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Why Diagnose?
New understanding leads to new strategies at home and other environments Opens doors for services Better medical management.

Stade 2008 www.faseout.ca

Interventions: Psychosocial

Stade 2008 www.faseout.ca

Interventions: Psycho-social
Mental Health Programs behavioural, social skill development Counselling: family doctors, social workers, nurses, adolescent paediatricians, psychiatrists, psychologists Support Groups

Stade 2008 www.faseout.ca

Interventions: Psychosocial
Activities that foster confidence and social development ? Medication

Stade 2008 www.faseout.ca

Interventions: Learning

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Interventions: Facilitate Learning

Psychological Assessment Modification of School/Job Training Programs:

Small Size of 8 to 10
Individual Educational Plan Resource Teacher Job Coach
Stade 2008 www.faseout.ca

Six Strategies for Teaching Individuals with FASD

1. Structure and routine is critical 2. Less talk and more multi-sensory learning opportunities 3. Be concrete and dont assume anything. Teach and re-teach
Stade 2008 www.faseout.ca

Six Strategies for Teaching Individuals with FASD

4. Facilitate language. Use specialists to help with language development. 5. Gross motor programming is important These students need to move. 6. Reduce stimulation, use visual cues.
Stade 2008 www.faseout.ca

Interventions: Facilitate Job Success

Work environment that is accepting of areas of weakness not just areas of strength Structure Supervision Modified Work Hours
Stade 2008 www.faseout.ca

Interventions: Facilitate Independence

Identify housing that matches the individuals needs Economic support and protection

The External Brain

A community that cares
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Interventions: Strategies for Success

Stade 2008 www.faseout.ca

Strategies for Success

Observe patterns of behaviours

Identify strengths, skills and interests

Reframe the interpretation of behaviours

Provide structure rather than control

Establish routines and consistency
Stade 2008 www.faseout.ca

Strategies For Success

Build transitions into every routine Model behaviours Provide simple instructions or cues Identify behaviours which indicate the accumulation of frustrations Help develop skills for expressing feelings
Stade 2008 www.faseout.ca

Strategies for Success

Provide specific support for social skill development Understand the various forms of communications Include as many sensory modalities as possible to facilitate integration of information and experience
Stade 2008 www.faseout.ca

Strategies for Success

Consider information processing abilities Reevaluate expectations and goals for the individual: Clarify whose needs are being met by the goals

Clarify goals and values for education/job training and independence

Stade 2008 www.faseout.ca

Strategies for Success

Advocate - Anticipate Co-ordinate Accept Integration of culturally relevant values and traditions

Environment

Stade 2008 www.faseout.ca

Thank you!

Stade 2008 www.faseout.ca