FASD and Early InterventionFASD and Early Intervention

Jo Nanson, Ph. D.Jo Nanson, Ph. D.

What happens after screening? What happens after screening?

If an infant is found to be positive for If an infant is found to be positive for prenatal exposure to alcohol of other prenatal exposure to alcohol of other drugs, what could happen next? drugs, what could happen next?

Assumption that all exposed infants are at Assumption that all exposed infants are at riskrisk

Unless there is population-based Unless there is population-based screening, this assumption is unprovenscreening, this assumption is unproven

Relationship between exposure and Relationship between exposure and affectedness affectedness

Prenatal screening is too new to have any Prenatal screening is too new to have any data yet on the relationship between data yet on the relationship between exposure and affectedness exposure and affectedness

Until there is population-based screening Until there is population-based screening and follow up, the relationship is unknownand follow up, the relationship is unknown

Using screening in high risk situations only Using screening in high risk situations only gives false perspective on this relationshipgives false perspective on this relationship

Early Intervention Early Intervention

Early intervention programs in general Early intervention programs in general provide for three groups of children:provide for three groups of children:

Those at known risk (e.g. Down syndrome, Those at known risk (e.g. Down syndrome, FAS, etc.) FAS, etc.)

Those at biological risk (e. g. Very low birth Those at biological risk (e. g. Very low birth weight, term asphyxia) weight, term asphyxia)

Those at social risk (low income, mental Those at social risk (low income, mental illness of the parent) illness of the parent)

Early Intervention Early Intervention

No data on early intervention in FASDNo data on early intervention in FASD Animal research suggests that other brain Animal research suggests that other brain

structures and function are improved structures and function are improved following early intervention is alcohol following early intervention is alcohol exposed animals exposed animals

In other groups, early intervention is very In other groups, early intervention is very effective in reducing handicapping effective in reducing handicapping conditionsconditions

Early Intervention Early Intervention

More is betterMore is better Center based programs generally have Center based programs generally have

better outcome than home based programsbetter outcome than home based programs More intensive programs have better More intensive programs have better

outcomeoutcome Sleeper effects: early intervention is Sleeper effects: early intervention is

powerful prevention for juvenile delinquency powerful prevention for juvenile delinquency Few of the youth I see from the courts have Few of the youth I see from the courts have

had early intervention had early intervention

Remediation of prenatal alcohol Remediation of prenatal alcohol effectseffects

Intrarod Distance (cm)

1

3

5

2 3 4 5 6

AE

GC

SCRC

1

3

5

2 3 4 5 6

IC

**

*

Female Rat Performance on Parallel Bars

Num

ber

of s

lips

Klintsova AY., 1998

Early Intervention after maternal Early Intervention after maternal screening screening

Unless FAS is diagnosed at birth, after a Unless FAS is diagnosed at birth, after a positive maternal screen, offering early positive maternal screen, offering early intervention assumes that the child is at intervention assumes that the child is at environmental risk. environmental risk.

There is tendency to assume that these There is tendency to assume that these children will be apprehended from the birth children will be apprehended from the birth mother mother

Guiding Principles Guiding Principles

HopeHope RespectRespect UnderstandingUnderstanding CompassionCompassion Cooperation Cooperation

Screening and Child Protection Screening and Child Protection

It is not clear that child protection authorities It is not clear that child protection authorities would always intervene if a maternal screen would always intervene if a maternal screen were positive were positive

Not clear that there are resources to cope if Not clear that there are resources to cope if every positive screen were turned over to every positive screen were turned over to child protectionchild protection

Screening and Child Protection Screening and Child Protection

Relationship between health care system Relationship between health care system and child protection in dealing with positive and child protection in dealing with positive test results is not cleartest results is not clear

Should Child Protection be able to request Should Child Protection be able to request screening?screening?

Should test results be disclosed without Should test results be disclosed without consent?consent?

Should screening occur without consent?Should screening occur without consent?

Screening and Child Protection Screening and Child Protection

Debates are currently under way regarding Debates are currently under way regarding the ethics of disclosing pap screening the ethics of disclosing pap screening results to the Cancer Clinicresults to the Cancer Clinic

Using Health data to track school Using Health data to track school attendance attendance

Implementation of new federal and Implementation of new federal and provincial legislation provincial legislation

Early Intervention Options Early Intervention Options

Healthy and Home Healthy and Home Follows all neonatal dischargesFollows all neonatal discharges Uses nurses and lactation consultantsUses nurses and lactation consultants See a variety of home situationsSee a variety of home situations Can refer to other programs Can refer to other programs Limited time of follow up Limited time of follow up

Early Intervention Options Early Intervention Options

Kids First Kids First Only sees children from high risk areas of Only sees children from high risk areas of

the community, based on income levelsthe community, based on income levels Uses a variety of staffUses a variety of staff Works only with high risk families Works only with high risk families Can follow children for a longer time Can follow children for a longer time

Early Intervention Options Early Intervention Options

Early Childhood Intervention Programs Early Childhood Intervention Programs Long history of working with a variety of Long history of working with a variety of

children from all risk groups, starting with children from all risk groups, starting with infantsinfants

Sees any child referred regardless of Sees any child referred regardless of incomeincome

Can follow for a long time Can follow for a long time Has a waiting list Has a waiting list

Early Intervention Options Early Intervention Options

Head StartHead Start Available to aboriginal children on and off Available to aboriginal children on and off

reservereserve Only covers a limited number of childrenOnly covers a limited number of children Does not start with infants Does not start with infants

Early Intervention Options Early Intervention Options

Parent aids Parent aids Works directly in the home Works directly in the home Works on variety of parenting skillsWorks on variety of parenting skills Focus on the parent not the infantFocus on the parent not the infant Can follow for a long timeCan follow for a long time Often seen as an adversary by high risk Often seen as an adversary by high risk

parent. parent.

Early Intervention Options Early Intervention Options

Out of home care Out of home care Extended family is preferred to foster careExtended family is preferred to foster care Often difficult to monitorOften difficult to monitor Goal is always to return the child home, yet Goal is always to return the child home, yet

little is done to maintain the parent-child little is done to maintain the parent-child relationshiprelationship

Foster families and biological parents often Foster families and biological parents often have adversarial relationships have adversarial relationships

Early Intervention Options Early Intervention Options

Out of home care Out of home care Saskatchewan lacks options for fostering Saskatchewan lacks options for fostering

families as opposed to childrenfamilies as opposed to children Foster families are not seen as a resource Foster families are not seen as a resource

to the biological family, or vice versa to the biological family, or vice versa Saskatchewan lacks family centered Saskatchewan lacks family centered

addiction treatment addiction treatment

Early Intervention Options Early Intervention Options

Early intervention may provide secondary Early intervention may provide secondary prevention by encouraging parents to delay prevention by encouraging parents to delay or prevent future pregnancies or prevent future pregnancies

May encourage parents to seek drug and May encourage parents to seek drug and alcohol treatment alcohol treatment

Summary Summary

Relationship between exposure and Relationship between exposure and affectedness is unclearaffectedness is unclear

Ethical issues remain to be resolvedEthical issues remain to be resolved Relationship between health care and child Relationship between health care and child

protection is tenuousprotection is tenuous

Summary Summary

Early intervention likely reduces the effects Early intervention likely reduces the effects of prenatal alcohol exposureof prenatal alcohol exposure

May help the parent to develop a healthier May help the parent to develop a healthier life style before the next pregnancy is life style before the next pregnancy is attemptedattempted

May help parents to space or limit May help parents to space or limit pregnancies to the ones they really want pregnancies to the ones they really want

Every child should be a wanted child !Every child should be a wanted child !