Dr. Brenda Stade et al, A Workshop on FASD: Early Years Professional Development Workshop 1 Fetal...

Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop

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Fetal Alcohol Spectrum DisorderFetal Alcohol Spectrum Disorder

Dr. Brenda Stade, Mary Cunningham, Dr. Brenda Stade, Mary Cunningham,

Doug Nugent; St. Michael’s HospitalDoug Nugent; St. Michael’s Hospital


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OutlineOutline IntroductionIntroduction Early Identification and AssessmentEarly Identification and Assessment

Diagnostic guidelines and assessmentDiagnostic guidelines and assessment Screening Screening Rational for early diagnosisRational for early diagnosis

Cognitive, Behavioral, Social Development and Cognitive, Behavioral, Social Development and Nutrition of Children, Birth to Age 6 yearsNutrition of Children, Birth to Age 6 years

Issues and StrategiesIssues and Strategies Focus on FamiliesFocus on Families


33

IntroductionIntroduction

In Canada the In Canada the incidence of Fetal incidence of Fetal Alcohol Spectrum Alcohol Spectrum Disorder (FASD) Disorder (FASD) has been has been estimated to be 1 estimated to be 1 in 100 live births.in 100 live births.


44

Introduction

Caused by prenatal exposure to Caused by prenatal exposure to alcohol.alcohol.

FASD is the leading cause of FASD is the leading cause of developmental and cognitive developmental and cognitive disabilities among Canadian disabilities among Canadian children. children.


55

Introduction: Fetal Alcohol Spectrum Disorder Defined

Growth RestrictionGrowth Restriction Facial AnomaliesFacial Anomalies CNS DysfunctionCNS Dysfunction Prenatal Alcohol Prenatal Alcohol

ExposureExposure


66

Introduction

Cost of FASD annually to Canada Cost of FASD annually to Canada of those 1 to 21 years old, was of those 1 to 21 years old, was $344,208,000 (95% CI $344,208,000 (95% CI $311,664,000; $376,752,000).$311,664,000; $376,752,000).

(Stade, 2004).(Stade, 2004).


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Introduction: EtiologyIntroduction: Etiology

Alcohol readily crosses the placenta Alcohol readily crosses the placenta and results in similar levels in the and results in similar levels in the mother and fetus.mother and fetus.

Rate of elimination is slower in the Rate of elimination is slower in the fetus.fetus.

Most teratogenic effect during Most teratogenic effect during organogenesis and development of organogenesis and development of the nervous system.the nervous system.


88

EtiologyEtiology When neuronal activity is abnormally When neuronal activity is abnormally

suppressed during the developmental suppressed during the developmental period, the timing and sequence of period, the timing and sequence of synaptic connections is disrupted, and synaptic connections is disrupted, and this causes nerve cells to receive an this causes nerve cells to receive an internal signal to commit suicide, a form internal signal to commit suicide, a form of cell death known as "apoptosis". of cell death known as "apoptosis".

Addiction BiologyAddiction Biology 2004 Jun;9(2):137-49 2004 Jun;9(2):137-49..


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EtiologyEtiology Teratogenesis is grossly dose related, although Teratogenesis is grossly dose related, although

the threshold dose is still unknown and related to the threshold dose is still unknown and related to maternal/fetal susceptibility.maternal/fetal susceptibility.

Risk to fetus greatest with more than 7 standard Risk to fetus greatest with more than 7 standard drinks per week (1 standard drink = 13.6 grams drinks per week (1 standard drink = 13.6 grams of absolute alcohol). of absolute alcohol).

Binge drinking of more than 5 ounces (142 Binge drinking of more than 5 ounces (142 grams) per occasion vs. 4 or more drinks per grams) per occasion vs. 4 or more drinks per occasion. occasion.


1010

Standard drinks = 0.5 oz Standard drinks = 0.5 oz alcoholalcohol

12 oz (341 mL) can of beer (5% alcohol)

12 oz (341 mL) bottle of cooler (5% alcohol)

5 oz (142 mL) glass of wine (12% alcohol)

1.5 oz (43 mL) distilled spirits (40% alcohol)

3 oz (85 mL) fortified wine e.g. sherry or port (18% alcohol )


1111

EtiologyEtiology

No safe time to drink during No safe time to drink during pregnancy.pregnancy.

No known safe amount.No known safe amount.


1212

Risk FactorsRisk Factors

Maternal Age and ParityMaternal Age and Parity Chronicity of AlcoholismChronicity of Alcoholism Socioeconomic StatusSocioeconomic Status Polydrug UsePolydrug Use EthnicityEthnicity Fetal Susceptibility.Fetal Susceptibility.


1313

Diagnostic GuidelinesDiagnostic Guidelines


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Important Features of Important Features of Diagnostic GuidelinesDiagnostic Guidelines

Minimize false negatives and false Minimize false negatives and false positivespositives

Precisely define diagnostic criteriaPrecisely define diagnostic criteria Consider genetic and family historiesConsider genetic and family histories Multidisciplinary approach.Multidisciplinary approach.


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Rational for Early DiagnosisRational for Early Diagnosis

Accurate and timely diagnosis is Accurate and timely diagnosis is essential: essential: to improve outcomes to improve outcomes decrease risk of secondary disabilitiesdecrease risk of secondary disabilities increase opportunities for preventionincrease opportunities for prevention ensure more accurate estimates of ensure more accurate estimates of

incidence and prevalence.incidence and prevalence.


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Canadian Guidelines for Canadian Guidelines for DiagnosisDiagnosis

CMAJ, March 2005CMAJ, March 2005 The Diagnostic ProcessThe Diagnostic Process

Screening and referralScreening and referral Physical exam and differential diagnosisPhysical exam and differential diagnosis Neurobehavioural assessmentNeurobehavioural assessment Treatment and follow-upTreatment and follow-up

Team membersTeam members Program director/Co-ordinatorProgram director/Co-ordinator Physician (trained in diagnosis)Physician (trained in diagnosis) PsychologistPsychologist Social workerSocial worker OT, Speech, psychiatrist, geneticist, addiction worker, OT, Speech, psychiatrist, geneticist, addiction worker,

community support workers, teachers etc.community support workers, teachers etc.


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Physical ExamPhysical Exam General physical to rule out other disordersGeneral physical to rule out other disorders Growth (at or below 10Growth (at or below 10thth percentile) percentile) Facial features.Facial features.


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Growth RestrictionGrowth Restriction

Growth restriction is demonstrated Growth restriction is demonstrated by height and weight at or below the by height and weight at or below the tenth (10th) percentile. tenth (10th) percentile.

Growth restriction may be apparent Growth restriction may be apparent prenatally and/or postnatally.prenatally and/or postnatally.


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Diagnosis:Diagnosis:Growth RestrictionGrowth Restriction


2020

Facial FeaturesFacial Features

Short palpebral fissuresShort palpebral fissuresSmooth or flat philtrumSmooth or flat philtrumThin upper lip.Thin upper lip.


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2323

Associated AnomaliesAssociated Anomalies

Cardiac anomalies Cardiac anomalies Joint and limb anomaliesJoint and limb anomalies Neurotubal defectsNeurotubal defects Anomalies of the urogenital system Anomalies of the urogenital system Hearing disordersHearing disorders Visual problemsVisual problems Severe dental malocclusions.Severe dental malocclusions.


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Canadian Guidelines for Diagnosis

-Neuro-behavioural Assessment Domains to be assessed by psychologist or Domains to be assessed by psychologist or

team:team: Hard and soft neurological signsHard and soft neurological signs Brain structureBrain structure Cognition (IQ)Cognition (IQ) CommunicationCommunication Academic achievementAcademic achievement MemoryMemory Executive functioningExecutive functioning Attention deficit/hyperactivityAttention deficit/hyperactivity Adaptive behaviour, social skills, social Adaptive behaviour, social skills, social

communication.communication.


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Early InfancyEarly Infancy

TremorsTremors Poor suckPoor suck Hypotonic/Hypertonic Hypotonic/Hypertonic IrritabilityIrritability Feeding problemsFeeding problems Developmental delay.Developmental delay.


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Early ChildhoodEarly Childhood

Cognitive ProblemsCognitive Problems Motor IssuesMotor Issues Behavioral PresentationBehavioral Presentation Sensory DysfunctionSensory Dysfunction Speech DelaySpeech Delay HyperactivityHyperactivity Socialization Difficulties.Socialization Difficulties.


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Maternal Alcohol History in Maternal Alcohol History in PregnancyPregnancy

Key to establishing an accurate diagnosisKey to establishing an accurate diagnosis Require confirmation based on clinical Require confirmation based on clinical

records, self-report, reliable observation.records, self-report, reliable observation.


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Classification of FASDClassification of FASD

1.1. Fetal Alcohol Syndrome (FAS)Fetal Alcohol Syndrome (FAS)

2.2. Partial Fetal Alcohol Syndrome (PFAS) Partial Fetal Alcohol Syndrome (PFAS) with confirmed maternal alcohol with confirmed maternal alcohol exposure exposure

3.3. Alcohol-Related Neuro-Developmental Alcohol-Related Neuro-Developmental Disorder (ARND) with confirmed maternal Disorder (ARND) with confirmed maternal alcohol exposure.alcohol exposure.


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Diagnostic CriteriaDiagnostic Criteria

FASFAS Evidence of growth impairmentEvidence of growth impairment 3 facial anomalies3 facial anomalies 3 central nervous system domains impaired3 central nervous system domains impaired Confirmed or unconfirmed alcohol exposure.Confirmed or unconfirmed alcohol exposure.


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Partial FASPartial FAS 2 facial anomalies2 facial anomalies 3 central nervous system domains impaired3 central nervous system domains impaired Confirmed alcohol exposure.Confirmed alcohol exposure.


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ARNDARND 3 central nervous system domains impaired3 central nervous system domains impaired Confirmed alcohol exposure.Confirmed alcohol exposure.


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ScreeningScreening


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Screening and Primary Care Screening and Primary Care ReferralReferral

Referral of individuals to FASD Referral of individuals to FASD diagnostic clinics:diagnostic clinics:

Evidence of prenatal exposure to alcohol (or Evidence of prenatal exposure to alcohol (or probable) with suspected or confirmed CNS probable) with suspected or confirmed CNS dysfunction ordysfunction or

Presence of 3 characteristic facial features Presence of 3 characteristic facial features with growth deficits with or without known with growth deficits with or without known prenatal alcohol exposure.prenatal alcohol exposure.


3434

ConclusionConclusion

Diagnosis requires a multi-disciplinary Diagnosis requires a multi-disciplinary approachapproach

Diagnosis is complex and guidelines are Diagnosis is complex and guidelines are well defined and cannot be a gestalt well defined and cannot be a gestalt approachapproach

Confirmed prenatal alcohol exposure is Confirmed prenatal alcohol exposure is required for a diagnosis of Partial FAS and required for a diagnosis of Partial FAS and ARNDARND

Screening does not equate to diagnosis.Screening does not equate to diagnosis.


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Cognitive, Behavioral, Social Cognitive, Behavioral, Social Development and Nutrition of Development and Nutrition of Children from Birth to Age 6 Children from Birth to Age 6


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CognitiveCognitive


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CognitionCognition

Attention problems and memory Attention problems and memory deficits often make learning deficits often make learning difficult in the young child.difficult in the young child.


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CognitionCognition

Infants and young children with FASD Infants and young children with FASD live with differing levels of cognitive live with differing levels of cognitive abilitiesabilities

All programs to develop cognitive All programs to develop cognitive abilities should be child specific.abilities should be child specific.


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CognitionCognition

How does the individual child with FASDHow does the individual child with FASD

learn?learn?

Some are primarily visual learners, some Some are primarily visual learners, some are tactile learners, some kinesthetic, and are tactile learners, some kinesthetic, and some learn best by listening.some learn best by listening.

(Mountford,A. The Golden Hoop of Life).(Mountford,A. The Golden Hoop of Life).


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Cognition: StrategiesCognition: Strategies

If a child learns best through music …If a child learns best through music …

If a child learns through body movement …If a child learns through body movement …

If a child learns best through listening …If a child learns best through listening …

If a child is a tactile learner …If a child is a tactile learner …

(Mountford, A. The Golden Hoop of Life).(Mountford, A. The Golden Hoop of Life).


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May need to use short sentencesMay need to use short sentences Break down information and Break down information and

instructioninstruction Repetition, Repetition, RepetitionRepetition, Repetition, Repetition Teach one concept at a time.Teach one concept at a time.


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“ “ It took him four weeks at age four to It took him four weeks at age four to learn the colour red. We decided in learn the colour red. We decided in February he was going to learn his colours. February he was going to learn his colours. So everyday of the month I dressed him in So everyday of the month I dressed him in red. red. The teacher had to say ‘X you’re wearing a The teacher had to say ‘X you’re wearing a red shirt today. Show me your shirt. It’s red shirt today. Show me your shirt. It’s red’. ‘X you’re wearing red pants today’. red’. ‘X you’re wearing red pants today’. Something had to be red”.Something had to be red”.


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Treasure hunts Problem-solving activities Visual-spatial games Story building Math skills: visual teaching.


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CognitionCognition

Impacting on the development of Impacting on the development of cognitive skills is the child’s ability to cognitive skills is the child’s ability to process his sensory world.process his sensory world.


4545

SensitivitySensitivity


4646

Sensory ProcessingSensory Processing

Many infants and young childrenwith FASD have difficulty processing and organizing sensory information they receive from their own bodies and the outside world.


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Sensory Processing

Sensory processing is a developmental process

Takes place in the central nervous system

Involves ability to take in informationthrough the senses, organize it in our brains and use it to respond appropriately.


4848

Sensory Processing

The brain must properly process information from the senses to develop: concentration organization learning ability specialization of each side of the body and

brain self-esteem self-control.


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How does sensory processing How does sensory processing abilities impact on day-to-day life of abilities impact on day-to-day life of a child with FASD?a child with FASD?


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Normal Sensory IntegrationNormal Sensory Integration

Schwab, D. (2001).


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Sensory Processing Sensory Processing DysfunctionDysfunction


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Sensory ProcessingSensory Processing HypersensitiveHypersensitive

Touch (Touch Processing)Touch (Touch Processing) Noise (Auditory ProcessingNoise (Auditory Processing Visual Input (Visual Processing).Visual Input (Visual Processing).

Dysfunction in Behavioural Outcomes Dysfunction in Behavioural Outcomes of Sensory Processing.of Sensory Processing.


5353

Sensory Processing StrategiesSensory Processing Strategies Place your child first or last in linePlace your child first or last in line Wash clothes a couple of times before Wash clothes a couple of times before

wearingwearing Use soft beddingUse soft bedding Remove tags from clothesRemove tags from clothes Avoid: Avoid:

ties under the chinties under the chin thick seams in clothingthick seams in clothing clothes that are scratchyclothes that are scratchy

Avoid tickling.Avoid tickling.


5454

Sensory Processing StrategiesSensory Processing Strategies

Weighted VestsWeighted Vests Deep MassageDeep Massage Bear HugsBear Hugs Activities using a number of muscles Activities using a number of muscles

groups.groups.


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Tone down the room’s effects on all Tone down the room’s effects on all sensessenses

Avoid decorated roomsAvoid decorated rooms Walls should be single colour and Walls should be single colour and

very palevery pale Avoid clutter.Avoid clutter.


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Provide a place/space where the Provide a place/space where the child can have a “quiet place” to bechild can have a “quiet place” to be

Avoid crowds and places with many Avoid crowds and places with many people, lots of noise and high activity people, lots of noise and high activity levellevel

At daycare, preschool, and school At daycare, preschool, and school group activity should avoid large group activity should avoid large groups.groups.


5757


Group play – use little matsGroup play – use little mats Recognize why a child may refuse to Recognize why a child may refuse to

participate in a gameparticipate in a game Occupational Therapy.Occupational Therapy.


5858


HyposensitiveHyposensitive PainPain Hot or ColdHot or Cold


5959

Strategies: HyposensitiveStrategies: Hyposensitive

SupervisionSupervision Avoid overdressing in summerAvoid overdressing in summer Ensure dressed adequately in winterEnsure dressed adequately in winter Ensure child monitored and receives Ensure child monitored and receives

adequate care when ill.adequate care when ill.


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BehavioursBehaviours

Behavioural and Emotional Behavioural and Emotional Responses may reflect the child’s Responses may reflect the child’s outcomes of sensory processing. outcomes of sensory processing.


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Behaviour: HyperactivityBehaviour: Hyperactivity

Due to the child’s sensory processing Due to the child’s sensory processing difficulties he or she may have a difficulties he or she may have a constant need for activity.constant need for activity.


6262

StrategiesStrategies

Fidget ItemsFidget Items Short periods of Short periods of

sitting stillsitting still HammockHammock Teaching during Teaching during

activityactivity Music.Music.


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Difficult BehavioursDifficult Behaviours

What is needed is a change in What is needed is a change in thinking from discipline to redirection thinking from discipline to redirection or re-teachingor re-teaching

Prevention – sensory strategies, Prevention – sensory strategies, transitioning.transitioning.


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StrategiesStrategies

Be firm but supportiveBe firm but supportive Choose one or two critical behaviors at a Choose one or two critical behaviors at a

time to work ontime to work on Ignore minor negative behaviourIgnore minor negative behaviour Keep the mood positive. Give five timesKeep the mood positive. Give five times

more praise to every one correction.more praise to every one correction. Identify warning signs re: “melt down”Identify warning signs re: “melt down” Teach child to self-monitor.Teach child to self-monitor.


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Difficult BehavioursDifficult Behaviours

Calming strategies:Calming strategies: Comfort cornerComfort corner Tents and cavesTents and caves Very short time outsVery short time outs Deep pressure.Deep pressure.


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Crying: InfancyCrying: Infancy

Crying is an infant’s way of Crying is an infant’s way of expressing his/her needs.expressing his/her needs.

Infants prenatally exposed to alcohol Infants prenatally exposed to alcohol may seem like they are crying may seem like they are crying constantly. constantly.


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Avoid, if you can, letting a baby get Avoid, if you can, letting a baby get to a state of frantic crying. to a state of frantic crying.

Get to know strategies that work Get to know strategies that work best, and tell other caregivers how best, and tell other caregivers how the baby likes to be handled.the baby likes to be handled.


6868


Wrap the infant snugly in a receiving Wrap the infant snugly in a receiving blanket – when not sleepingblanket – when not sleeping

Use a sootherUse a soother Bathing may settle some, quiet music may Bathing may settle some, quiet music may

help othershelp others Rocking the infant up and down rather Rocking the infant up and down rather

than back and forth has been found to be than back and forth has been found to be soothing for some infants.soothing for some infants.


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Crying: Young ChildCrying: Young Child

Crying is a method of communication Crying is a method of communication for all young childrenfor all young children

In the child with FASD be alert for:In the child with FASD be alert for: sensory overloadsensory overload inability to communicate inability to communicate mood problems.mood problems.


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Crying: Young ChildCrying: Young Child Modify environmentModify environment Ensure child can communicate needs Ensure child can communicate needs

– pictures, sign language– pictures, sign language Assessment by a mental health Assessment by a mental health

professional.professional.


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Health & IllnessHealth & Illness


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Health and IllnessHealth and Illness

Generally, FASD is not defined by Generally, FASD is not defined by associated physical disability or associated physical disability or illness.illness.


7373


Some children with FASD are born with organ anomalies.


7474

Organ AnomaliesOrgan Anomalies

Cardiac anomalies Cardiac anomalies Joint and limb anomaliesJoint and limb anomalies Neurotubal defectsNeurotubal defects Anomalies of the urogenital system. Anomalies of the urogenital system. Hearing disordersHearing disorders Visual problemsVisual problems Severe dental malocclusions.Severe dental malocclusions.


7575


Zhang and others (2005) Zhang and others (2005) demonstrate the adverse effects of demonstrate the adverse effects of alcohol on immune competence and alcohol on immune competence and the increased vulnerability of the increased vulnerability of ethanol-exposed offspring. ethanol-exposed offspring.


7676


The infant should not be exposed to environmental irritants such as tobacco smoke

Protect the infant from exposure to viruses.


7777


Young children with FASD are Young children with FASD are particularly prone to upper particularly prone to upper respiratory illnesses and ear respiratory illnesses and ear infectionsinfections

Monitoring and ensure treatment as Monitoring and ensure treatment as necessary.necessary.


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Motor deficits are not uncommon in Motor deficits are not uncommon in infants and young children with infants and young children with FASD.FASD. Infant & Pre-school stimulation Infant & Pre-school stimulation

programsprograms Occupational Therapy.Occupational Therapy.


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SleepSleep


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Sleep DisturbancesSleep Disturbances

Sleep disturbances among Sleep disturbances among individuals with FASD are not individuals with FASD are not uncommon.uncommon.

Younger children often have trouble Younger children often have trouble falling asleep and waking.falling asleep and waking.


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Sleep DisturbancesSleep Disturbances

They may have trouble settling and They may have trouble settling and wake often throughout the night.wake often throughout the night.

Night terrors among individuals with Night terrors among individuals with FASD can continue throughout life.FASD can continue throughout life.


8282

Sleep StrategiesSleep Strategies

Establish rituals for saying good nightEstablish rituals for saying good night Start a calming bedtime routine an Start a calming bedtime routine an

hour before bedtimehour before bedtime A light snack before bed may be A light snack before bed may be

beneficial for some children.beneficial for some children.


8383


Decrease sensory stimulation in the Decrease sensory stimulation in the bedroombedroom

White noise when the child is in bed White noise when the child is in bed may be calming to some but may be calming to some but distracting to othersdistracting to others

Night-lights help some young Night-lights help some young children but for some can lead to children but for some can lead to night terrors.night terrors.


8484


Start young to promote the child Start young to promote the child sleeping in his or her own bedsleeping in his or her own bed

Melatonin may be beneficialMelatonin may be beneficial Childproof the house for night Childproof the house for night

wandererswanderers As much as possible wake the child in As much as possible wake the child in

the same predictable way every the same predictable way every morning.morning.


8585

NutritionNutrition


8686

Growth and FASGrowth and FAS

1.1. Substantial literature on the Substantial literature on the association between association between maternal alcohol maternal alcohol consumption during consumption during pregnancy and decreased pregnancy and decreased neonatal weight, length and neonatal weight, length and head circumference.head circumference.

2.2. Unsure of the effect of Unsure of the effect of alcohol on growth alcohol on growth parameters later on in life.parameters later on in life.

McFadyen, K. (2005)McFadyen, K. (2005)


8787

Studies: Growth and FASDStudies: Growth and FASD

1.1. Russell (1991) Russell (1991) Differences in head circumference and ht at 6 Differences in head circumference and ht at 6

yearsyears

2.2. Sampson (1994) Sampson (1994) No detectable differences from 8 mos to 14 No detectable differences from 8 mos to 14

yearsyears

3.3. Day (2002)Day (2002) 11stst trimester exposure predicted significant trimester exposure predicted significant

reductions in wt, HC, and lengthreductions in wt, HC, and length 22ndnd trimester exposure predicted significant trimester exposure predicted significant

reductions in wt and skinfold thickness.reductions in wt and skinfold thickness.


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Nutrition and FASDNutrition and FASD Infants and young children with Infants and young children with

FASD must have there growth FASD must have there growth followed regularlyfollowed regularly

Those with poor growth/growth Those with poor growth/growth restriction should be followed by restriction should be followed by a dieticiana dietician

Motor dysfunction resulting in Motor dysfunction resulting in poor suck and swallow requires poor suck and swallow requires OT interventionOT intervention

““Picky eaters” requires Picky eaters” requires patience, persistence, and patience, persistence, and imagination.imagination.


8989

Essential Fatty AcidsEssential Fatty Acids


9090

What we know….What we know….

1.1. Essential fatty acids (EFA) are Essential fatty acids (EFA) are necessary for the formation necessary for the formation of healthy cell membranes, of healthy cell membranes, proper development and proper development and function of the brain and function of the brain and nervous system -nervous system -

2.2. Omega 3 and Omega 6 fatty Omega 3 and Omega 6 fatty acids must be provided from acids must be provided from food as they cannot be food as they cannot be synthesized by the body.synthesized by the body.



9191

ESSENTIAL FATTY ACIDS

OMEGA 3 FATTY ACIDS OMEGA 6 FATTY ACIDS

Green leafy vegetables, Green leafy vegetables, flax, flaxseed oil, canola flax, flaxseed oil, canola oil, walnuts, Brazil nuts, oil, walnuts, Brazil nuts, fish oil, fish, tofu, and fish oil, fish, tofu, and eggseggs

Vegetable oils Vegetable oils (soybean, safflower, (soybean, safflower, and corn oil), nuts and and corn oil), nuts and seedsseeds


9292

What we know continued…What we know continued…

Some evidence indicates that Some evidence indicates that

fatty acid deficiencies or imbalances fatty acid deficiencies or imbalances may contribute to the negative may contribute to the negative sequelae of some childhood sequelae of some childhood

neuro-developmental disorders.neuro-developmental disorders.



9393

EFA SupplementationEFA Supplementation

1.1. There have been no studies to date There have been no studies to date looking at EFA supplementation and looking at EFA supplementation and children with FASD.children with FASD.

2.2. Some studies have demonstrated Some studies have demonstrated the benefits of EFA in children with the benefits of EFA in children with other neuro-developmental other neuro-developmental disorders – but other research have disorders – but other research have found no effect.found no effect.


9494

Thoughts…..Thoughts…..

1.1. Pregnancy stresses maternal EFA Pregnancy stresses maternal EFA status because the mother must status because the mother must supply fatty acids needed for fetal supply fatty acids needed for fetal and placental growth.and placental growth.

2.2. Alcohol can disturb placental Alcohol can disturb placental transport.transport.

3.3. Alcohol increases fatty acid Alcohol increases fatty acid catabolism – resulting in ???catabolism – resulting in ???


9595

What we do not know….What we do not know….

1.1. Whether supplementation of Whether supplementation of essential fatty acids may benefit in essential fatty acids may benefit in children with FASDchildren with FASD

2.2. Optimal dosage of fatty acidsOptimal dosage of fatty acids

3.3. Optimal composition (Omega 3 and Optimal composition (Omega 3 and Omega 6 fatty acids)Omega 6 fatty acids)

4.4. Dose – response relationshipDose – response relationship

5.5. Duration or treatment.Duration or treatment.


9696

In the End……In the End……

Encourage the young child with FASD Encourage the young child with FASD to eat a variety of foods from the to eat a variety of foods from the four food groups. four food groups.

To increase intake of EFA’s offer fish, To increase intake of EFA’s offer fish, eggs, nuts, seeds and use vegetable eggs, nuts, seeds and use vegetable oils.oils.

Monitor growth.Monitor growth.



9797

Social Skills & FriendshipsSocial Skills & Friendships


9898

Social Skills and FriendshipsSocial Skills and Friendships

Social skill Social skill development should development should begin early for begin early for children with FASD.children with FASD.

Distractibility, Distractibility, aggressiveness and, aggressiveness and, and impulsivity can and impulsivity can interfere with social interfere with social development.development.


9999


Social skills programSocial skills program Practice, model, rehearse social skills.Practice, model, rehearse social skills.

Foster activities that the child likes Foster activities that the child likes and is good atand is good at

Brief activities in small groups.Brief activities in small groups.


100100


Invite other children to the home and Invite other children to the home and adapt the situation so it is fun for the adapt the situation so it is fun for the other childrenother children

Educate young children that they Educate young children that they may learn or respond to situations or may learn or respond to situations or stimuli somewhat differently than stimuli somewhat differently than others.others.


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CaregiversCaregivers


102102

Strategies for CaregiversStrategies for Caregivers

Keep remembering they are not Keep remembering they are not willfully trying to make you willfully trying to make you exhausted or crazyexhausted or crazy

Forgive yourself when you lose your Forgive yourself when you lose your tempertemper

Allow yourself to grieveAllow yourself to grieve Advocate for their needs Advocate for their needs

It will make you feel better about them It will make you feel better about them and yourself.and yourself.


103103

Strategies for CaregiversStrategies for Caregivers

Do something for yourself every Do something for yourself every dayday

Find someone you can talk toFind someone you can talk to Try to get in as many breaks as Try to get in as many breaks as

possible – friends, family, respitepossible – friends, family, respite Monitor yourself for signs of Monitor yourself for signs of

increased stress and depression.increased stress and depression.


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Thank-YouThank-You

Thank-you Thank-you for listening!for listening!


105105

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