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 July 6, 2015

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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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Overview of Fetal Alcohol Spectrum disordersDiagnostic and DescriptionFetal Alcohol syndrome Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancyFAS (Fetal Alcohol Syndrome) Describes as congenital mental and physical abnormalities that result from FAE accompanied by slow growth and distinctive facial featuresFAE (Fetal Alcohol Effects) describes as mental and behavioral effects of FAS without any physical signsARBD (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 disordersARND (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.5

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Identification of Secondary Disability and Risk Factors94% Mental Disorder61%Disaruptive at school60% Trouble with the law50% Confinement (in detention, jail, prison, psychiatric or alcohol inpatient settings)49% Inappropriate sexual behaviors35%Drug and alcohol problem (Streissguth el at., 1996)

Facts about FAS and FASDFASD is the leading known preventable cause of mental retardation and birth defectsFASD affects 1 I 100 live births or as many as 40,000 infants each yearChildren 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.6

Protective Factors To Improve the Chances of an Individual Achieving Developmental PotentialEarly diagnosisLiving 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 servicesAttending proper education settingReceive support ((Streissguth et al., 1966)7

Challenges in Early IdentificationEarly 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, tantrumsFrustration, irritability, anger, aggressionFear, anxiety, avoidance, withdrawalShutting Down, lying, running awayLegal problemsTrouble at home , school, and communityIsolationMental health problems (depression, self injury, suicidal tendencies)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 turnSharing (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 anotherChildren with FASD find it harder to shift attention from one task to another and solve problems with flexibility2.Children with ADHD have trouble retrieving information they learned verballyChildren with FASD have problems encoding and remembering verbally learned information

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DSM-5 the APA found that medications used to treat ADHD produce mixed results when used for children with FASDChildren 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)10

FASD Throughout the Lifespan11

Common StrengthsMany people with FASD have strengths which mask their cognitive challenges

Highly verbalBright in some areasArtistic, musical, mechanical,AthleticFriendly, outgoing affectionateDetermined, persistentWillingHelpfulGenerousGood with younger children

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strategies and InterventionChildren and adolescents with FASD act in ways that seem inappropriate to their age.Edcucators and parents need to review the childs behavior within the context of the AFSD diagnosisMethods that work with other children to help them act their age wont 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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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 challengesDesign to address psychiatric functioning (Paley & OConnor 2011)

The Programs are based on reducing conditions secondary to FASD ENHANCE THE LIVES OF FAMILIES AFFECTED BY FASD

Enhance Social SkillsUnderstanding the problemIncrease awareness for social cues Peer exchange play groupIn home play datesConflict avoidance and negotiation

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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 environmentResults: 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)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 FASDIt 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:EducationSupport Improve childrens executive functioning through improve self regulation techniquesTools to improve memoryCause and effects reasoning Sequencing planningProblem solvingImprovement in executive functioning (Berytand 2009)

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4. Parent Child InteractionTherapy adopted to reduce problems with FASD

Discuss difficult behavior among children with FASD and their caregiversShare good moment among children and caregiversActively participate in play therapy Role playOpen communicationDevelop trust

Develop two groups one for parents and one for children

Outcome:Decrease parents stressReduce behavior problems among children with FASD particularly young children 17

5. Behavioral consultant

To improve outcomes for families raising children with FASDHelp with caregivers raising pre-school age childrenFind use of effective parenting skillsAcquire specialized knowledgeMake appropriate linkages to appropriate school and community resources18

6. Pharmacological Interventions

Because children with FASD are at elevated risk for: disruptive behavior problemsMood disordersSubstance use and abuseIt 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.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 childs 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 childs diagnoses, medical complications, treatment services, and necessary follow up care.Ask for information on services and resources to meet the childs needs, including eligibility for adoption subsidies and Medicaid.Find out how to reduce the impact of the childs 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) 20

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