Ep. 15: Becoming a Behaviour Detective
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Fetal Alcohol Spectrum Disorder (FASD)

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Learn about Fetal Alcohol Spectrum Disorder (FASD). What causes it? What are the effects? How can it be prevented?

TRANSCRIPT: Fetal Alcohol Spectrum Disorder (FASD)

Aimee-Elizabeth Parsons

Welcome. My name is Aimee-Elizabeth Parsons, and I am a member of the Disability Programs Specialized Services Team. My background is that of a teacher. I worked in the North when I first started my career, and then in Laval, I finished off with a post as a principal in a school for children that were neurotypical but also had disabilities and difficulties with behaviours. Presently, I am a PPRO on the disability team.

Catherine Langevin

Hi, my name is Catherine Langevin I have been a Clinical Advisor at DPSS for the Cree Health Board for about five years now. My background is in social work. Previously I worked for nine years in youth protection in the Rapid Lake community. My interest in Fetal Alcohol Spectrum Disorder started when I took training on FASD back in 2007 and I realized that possibly half of my caseload as a youth protection worker was probably affected by FASD and no one knew about the disorder. So I decided to take more training. Which brings me in front of you today to share some of my knowledge.

Aimee-Elizabeth Parsons

So before we get started, I would like to take a moment to acknowledge that FASD is a difficult topic to discuss. There have been many historical and ongoing injustices affecting Cree people that may contribute to the challenges surrounding addiction and mental health. I recognize that there is a lot that I do not fully understand about the effects of things like colonization, the Indian Act, residential schooling and the sixties scope, and we’re just scratching the surface here. But it’s important to acknowledge these events and recognize that their effects are ongoing and are still felt by Cree people today.

Catherine Langevin

Although our focus today is not to get deep into the roots of the historical and ongoing injustices that contribute at least partly to FASD, it’s important to mention for today we will be sticking to the areas that we do know about FASD. And in doing so, we hope to demystify at least some of the confusion or misinformation surrounding this complicated disability.

Aimee-Elizabeth Parsons

Let us begin our journey together. So just to start at DPSS or Disability Programs Specialized Services, we offer different kinds of trainings like prevention and intervention. Today we’re going to look at a global awareness. We’re going to define FASD, we’re going to talk about the cause, the characteristics challenges, diagnosis, interventions, and then there’ll be a period for questions.

Catherine Langevin

OK, so what is FASD? Fetal Alcohol Spectrum Disorder, FASD, is the name given so diagnostic to describe what happens to the brain and body of individuals prenatally exposed to alcohol. What that means is if the mother drinks alcohol at any point during the baby’s development, that alcohol goes through the placenta and it negatively impact the development of the baby’s brain. If we look at the picture, we can see on the left the brain of a neurotypical baby. Neurotypical is a term used to describe individuals of typical development so normal. On the right, we can see the brain of a child who is prenatally exposed to alcohol. We can see the difference between the two as one on the right is smaller and has less wrinkles, so less neurons.

It is important to state that the brain will not recover as the baby gets older. Since FASD is a lifelong disability, the child will not grow out of it. So let’s look at some terms you might have heard to describe FASD. You might have heard these terms before; Fetal Alcohol Syndrome, partial FAS, ARND – alcohol related neurodevelopmental disorder, or even fetal alcohol effects, FAE. All these terms were put under the umbrella term FASD and were used to describe how affected the individual’s brain was. So on an individual with their FAS would have been more affected than an individual with alcohol related neurodevelopmental disorder. So now the new Canadian guidelines of 2013, there’s three diagnoses that are possible. So the first one FASD with facial features that we will see in the next slide. This would be the equivalent of full blown FAS, which means that the person has all the facial features. The second one is FASD. without the facial features which means that the person’s brain is affected by alcohol. So you could see the behaviors, but it doesn’t show in their face. So they don’t have the facial features And the last one is at risk of neurodevelopmental disorder and FASD associated with prenatal exposure, which means that we can’t confirm that the mother drank while she was pregnant, but we can still see the behaviors.

So now let’s look at some of the facial features. There are three main facial features that doctors look for when diagnosing FASD. The filtrum. So if you touch your upper lip, you’ll see that there’s two bumps right here. This is called a filtrum for individuals with FASD with facial features, at the end of the spectrum this part will be flat, so no bumps. The other feature that they look at, the doctors look at is the space between the eyes that would be wider and also a thinner upper lip. Most noticeable during early childhood. The facial features of a child with FAS may change with age. These characteristics of the face are more apparent between eight months and eight years of age after the age of eight. Features are much, much less obvious. So because of the facial features in most individuals with FAS are not easy to easily recognize. Only a diagnostician should use these characteristics when diagnosing. Also FAS isn’t about having a different looking face. Lots of people have different looking face. It’s about brain differences.

Aimee-Elizabeth Parsons

So to keep you stimulated, we are going to ask five questions throughout the presentation. As we may not be together in person, please take a moment to write your answer down, and then when the answers are revealed, you can see how you did. So question number one: What percentage of children diagnosed with FASD have all of the facial features?

So we’ll give you a moment to think about that. If you have a piece of paper, write that down. If not, hold it in your head. So what percentage of children diagnosed with FASD have all of the facial features? Our answer: Only 10% of children with FASD show all facial features. So if only one out of ten or ten out of a hundred have the facial features, that means 90 people diagnosed with FASD. do not have an outward sign. Inwardly, their brain has been injured and we can’t see that. So we call FASD an invisible or a hidden disability.

Catherine Langevin

So what are the causes? FASD happens when the mother drinks alcohol during the pregnancy. There are a lot of different factors that can influence the diagnosis of FASD. So, for example, when the mother drank, was it the first or second or third trimester? Also, the amount of alcohol taken during the pregnancy is a one glass of wine a week or a bottle of beer a day. If we look at Éducalcool guidelines, there’s the same amount of alcohol in one beer, five ounces of wine and 1.5 ounces of hard stuff. Do we really know how much a person drinks? Take a look at this. Five ounces of liquid in a wine glass, and this is ten ounces of liquid in a wine glass. So two portions in this one. So if I drink two glasses of ten ounces already, this is over the limit. Do you see how dangerous a social drink can be if you’re pregnant? There’s also some other maternal factors, like the size of the woman, her metabolism, her built in tolerance dog. One of the biggest challenges we face is the lack of agreement among doctors. Some doctors will say, oh, it’s OK, you can have a drink once in a while while you’re pregnant. And others will say none at all. But the Canadian guidelines are really clear. There is no safe amount, no safe time, no safe type of alcohol to use during pregnancy. Now we’re going to show you the development of the baby during the pregnancy.

Different parts can be affected if there’s alcohol consumption The first trimester we see the facial features, the heart, the organs are developing. In the second trimester, the eyes, the lungs, the genitals develop in the third. The the baby mostly gains weight. If there’s alcohol exposure during that time, there’s a chance the baby will be smaller. But what’s important to consider to remember is that the brain develops throughout the whole pregnancy, which is why drinking at any time during pregnancy isn’t safe.

Is FASD preventable? FASD is preventable, if women do not consume alcohol during pregnancy. But what is complicated are the reasons why a mother drinks. FASD might be related to trauma, addictions or abuse. We also know that many pregnancies are unplanned. So mothers to be may not just not be aware that they’re pregnant. In order to prevent FASD, we have to consider all of these factors that influence alcohol consumption. And we have to provide support for women and girls to overcome these barriers towards healthy pregnancies.

Aimee-Elizabeth Parsons

So our question number two. So if you’re ready with your pencil and your piece of paper, does FASD only occur when a mother binge drinks? So let’s think about that. Does FASD only occur when a mother binge drinks? Catherine?

Catherine Langevin

Well, first of all, binge drinking for a woman is considered drinking four or more drinks in one occasion. So for portions it’s considered binge.

Aimee-Elizabeth Parsons

So wait a moment. So if I was to drink, so I’ve poured myself some drinks here, so I’ve got ten ounces here, I poured a nice glass, and I in a different shape glass. So if I were to drink these two glasses in one night, that would be considered binge drinking?

Catherine Langevin

Yes. And binge drinking is very damaging. For the fetus because of the level of alcohol in the blood gets high fast and it can affect the baby more. But just to be clear. Drinking small amounts over a long period of time can also have an effect on the child’s brain development. So the answer is no. It’s not just binge drinking that can cause FASD any drinking can affect the baby’s brain.

So, again, I’ll repeat myself. If you get anything out of this presentation, there is no known safe amount no safe time, no safe type of alcohol use during pregnancy.

Aimee-Elizabeth Parsons

So we’re going to go to our question number three. Can a father’s drinking cause FASD? That’s a really interesting question that comes up a lot. Can a father’s drinking cause FASD?

Catherine Langevin

So the father’s drinking cannot cause FASD but it can have an impact on the baby’s weight. So smaller babies, it can cause a father to produce less productive sperm. So it lowers the chances of getting pregnant and keeping the baby. And the father can also transfer his genetics to the child. So if the father is an alcoholic, the child has higher chances of being an alcoholic. But there’s also the environment that plays a big role.

Aimee-Elizabeth Parsons

OK, so the answer is that alcohol consumption by the male partner. So the dad does not have a direct cause to FASD But again, the fathers involved do have an impact. So our question number four, what is the prevalence of FASD in Canada? How many children do you think are diagnosed with fetal alcohol syndrome disorder in Canada?

Catherine Langevin

So in the past, the statistics were lower, so maybe one to three to a thousand. And it was mostly FAS at the end of the spectrum that was diagnosed because it showed on the child’s face like we saw before. In newer Canadian research, it goes up to an estimated 4% in the general population, which means it is more prevalent than Down syndrome or autism. Recent research also tells us that the percentage of children at that FASD is higher in foster care. The assumption that that is that often alcoholism is a factor that in many children needing to be placed Also, a child who has FASD may display behaviors and needs that a parent struggling with addiction will not have the ability to support. Under-diagnosing is a problem. Getting a diagnosis is difficult as we as we will explain later. It is also difficult for a woman to come forward and share that she drank during pregnancy. There’s still a huge stigma that has to be addressed. This will also be an important time to state clearly that FASD is not an indigenous diagnosis. But a world health problem.

Aimee-Elizabeth Parsons

Yes, Catherie, what I find super interesting about this as we were learning is that it is more prevalent than Down’s syndrome or autism So that’s really important fact for for people to remember.

Catherine Langevin

Mm hmm. So since it’s challenging to diagnose FASD, it can often be mistaken as ADHD, ASD. So ADHD Attention Deficit Hyperactivity Disorder. Autism Spectrum Disorder. Attachment Disorder. Oppositional Defiant Disorder. Because it affects the same area of the brain. It affects the frontal lobe. So executive functioning which we will look at later, it can look like ADHD because children FASD are often hyperactive.

It can look like some traits of autism as well. If, for example, the child has difficulty with loud noises or difficulty with materials, which which is called sensory issues that we’ll look at later on. Some children may have developed attachment disorder on top of that. If they have been moved from one family to the next and the bonding has not happened or it can look like oppositional defiance disorder when the child says no to everything defies authority, an accurate diagnosis can help with interventions, though. So now let’s look at other corrective characteristics to look for.

Aimee-Elizabeth Parsons

So the next step on our journey is to look at what the characteristics of FASD are So together we’re going to look at primary and secondary disabilities. So primary disabilities happen because of the injured brain. And secondary disabilities are related to the FASD. But the child was not born with it or with them. So primary disabilities being able to focus, hold and work with information in mind, filter distractions and switch gears is what we’re looking at when we talk about executive functioning. It’s like having an air traffic control system at a busy airport to manage the arrivals and departures of dozens of planes and multiple runways. In the brain, the air traffic control mechanism is called executive functioning. So it’s a group of skills that help focus on multiple airplanes of information at the same time and revise, fix the plan as necessary.

So I’m going to list a few more things. So it helps to plan, it’s our internal command system. It helps with our memory, our self-regulation. Verbal, So what we say, our self-control with our words, our self-control with our body, our self-control with our emotions, emotional regulation, and even our motivation. So all of these things together is executive functioning.

Catherine Langevin

So in summary, these functions are what helps you to be a functional adult. So get out of bed, get to work on time, pay your bills. Executive functions can also be your capacity to think ahead. For example, when you do your laundry, you need to think to separate the the dark from the whites. You’ll think “While I load the dishwasher, I have time to start supper.” Then you think to put the soap in, push start, et cetera. Well, for people with FASD or with a disability in executive functioning, it might be challenging to do without breaking down the task or without visuals.

Aimee-Elizabeth Parsons

So we also have adaptive behaviour. So these are things we do every day without thinking like our hygiene and our brushing our teeth. So these are skills that people need to function independently, at home, at school and in the community. So adaptive behaviors. So typical FASD characteristics in young children: so we’re going to see perhaps the child is slow to develop. We’re going to notice some delays in speech and vocabulary. They could be easily distracted, hyperactive or impulsive, difficulty processing information and comprehension like difficulty understanding. They might also have difficulty learning through experience and interacting with other children could be a problem. So trying to make friends, same age friends could be difficult. But I’d also like to point out that these are just red flags for many disabilities. So if you see any of these in your child, this juggling, it would be important to see your doctor. Typical FASD characteristics in youth: So the first one would be poor judgment or impulsivity.

Catherine Langevin

So, for example, a youth who steals from the store doesn’t get the tags off or steals from the store, even if the police are outside.

Aimee-Elizabeth Parsons

So this is a good example because it shows us that the child is not being sneaky or trying to hide the crime. It’s often a lack of understanding Next, poor sense of personal boundaries. So hugging is is great and it’s often appreciated. But most of us would not go and hug a stranger or a passenger on an airplane that we didn’t know. Also, we have to look at the space between people. Have you heard of personal space bubble? So a person with FASD may not understand how far they need to stand from someone when they’re talking to them. So personal space. Next would be problems understanding ownership or value of money.

Catherine Langevin

So like our story of stealing, there’s a lack of understanding of ownership and value of money, like selling an iPad for $5.

Aimee-Elizabeth Parsons

And and trouble for seeing two. So I’ll continue that story. The teen who sold his iPod for $5 because he wanted to buy something else at the store, but when he gets home and wants to gain his upset that his iPad is gone. So when the idea of selling his iPod came up and he decided on impulse, he really didn’t think it through what would happen later.

Catherine Langevin

And as you’ve heard of all these difficulties, it’s no wonder that school can lead to a lot of challenges. And as people don’t understand first and support to students in school, this can lead to school dropout.

Aimee-Elizabeth Parsons

Yeah. And and someone with FASD can also be easily pressured or influence. So we go back to that story about theft or iPad selling. It could have been someone who said, sell it to me and I’ll be your friend with the injury to the brain. So that person with FASD might not understand. Therefore, they’re going to be easily influenced, pressured or abused.

Catherine Langevin

And the last one is low self-esteem, feeling depressed. Individuals with FASD may may have low self esteem. I’ve heard of a teacher who counted how many times a child with FASD was reprimanded during one day: “Get off.” “Don’t do this.” “Don’t do that.” It was more than a hundred a day. So we can imagine that this child didn’t feel too good about himself and start to think that he was bad.

Aimee-Elizabeth Parsons

Overall difficulties for persons with FASD. So I really like showing this picture because it shows that the FASD brain has a lot going on, but it lacks organization. On the left we see a filing cabinet and on the right a scattered group of files. So someone with FASD could go on the land, for example, hunting with grandpa and learn a lot about the caribou and everything he learns. He puts in a file folder away in his memory. The next week in class, the teacher is talking about animals that begin with the letter C and the child doesn’t really have anything to share. Why? Because what he learned about the caribou he filed under hunting and the teacher was asking about animals to start with the letter C. So again, when we’re learning that child had to file the idea of caribou, he took in the information he’s got to put it somewhere. So we needed to store it and that he needs to recall it when necessary. And so he needs to use information appropriately in a specific situation. So that could be very difficult for someone with FASD.

Catherine Langevin

Here we have the picture of an 18 year old and his developmental age in different areas. So basically this says that this individual speaks very well. He has a physical maturity of an 18 year old. He reads at a high level but different areas of his brain are affected, like is emotional maturity, his comprehension and his understanding of abstract concepts like time and money. And if we think about it, about the emotional maturity, what does a six year old do when they’re not happy about something while they throw a tantrum? And for a big 18 year old to throwing a tantrum that can have a lot more consequences, like getting picked up by the police, for example. This kind of profile makes them look a lot more capable than they really are.

Aimee-Elizabeth Parsons

So that is another big takeaway from our presentation, is that people with FASD often look more capable than they are. This is not to be negative, but if you’re expecting eight year old behaviour and you see a five year old tantrum people often begin to think that this person is manipulative, not well behaved. Another example would be a girl who knew how to count one yesterday and today she can’t. Therefore, she must not want to. But really, they might have just a hard time accessing the information on that specific day. So let’s go back to that file folder. They may not be able to go and find the right file folder or be able to pull it out and share it with share it with you at the right time.

So again, people with FASD often look more capable than they are in certain areas. Secondary disabilities. Now that we’ve explained in giving us some examples of the challenges facing someone with FASD, you can begin to understand that if they don’t get help and we don’t get involved early, the problem can grow and get worse. So secondary disabilities are not present at birth but occur later in life as a result. Because of the primary disability associated with FASD. So if you don’t get help, things could get worse or more difficult. So let’s dig in to some secondary difficulties and disabilities. Dependent living: So the young, or not so young adults who are not ready to move out on their own. They have a difficult time managing rent, grocery money or making safe decisions. We could see school difficulties. We mentioned before all of the learning challenges that can lead to dropping out. Addictions for several reasons genetic disposition, alcoholism in the family, trauma of living with FASD. We also can see trouble with the law and imprisonment. The impulsivity and judgment difficulties we explained earlier can lead to bigger consequences. When you get older We also see difficulties maintaining employment, being hard to keep a job.

So if you have difficulty planning and you have a difficult time understanding or can’t get to work on time, so that makes it difficult to keep your job. We also might see sexually deviant behaviour. So not understanding what is OK in one area that is not OK in another area. There’s a lack of understanding. So how come we can kiss some people, but we can’t kiss other people?

So here we have another graph, and this graph shows a study done by a group of researchers who studied 415 patients with FASD, some across a two year period. And six main secondary disabilities were studied, mental health, disrupted school, trouble with the law, confinement, the sexual behaviour and addictions of drug and alcohol problems. So you see what we were just talking about in this study.

Catherine Langevin

So I’d like everyone to take a moment to read this slide. So let me explain. Getting angry at someone with an injured brain so far for not remembering not remembering, for not understanding, for messing up, for having a tantrum is like getting mad at someone with a broken leg for not running Most of us would not do that. Probably because they’re broken leg. The cast is visible, but FASD is brain based, so it’s invisible. So what is the protective factor? I’ll give you an example to increase my chances of not getting COVID. I’ll wear a mask and wash my hands. Get vaccinated. It doesn’t mean I will not get it, but my chances will be lower of getting it.

So the protective factors for FASD would be first an early diagnosis because it can help prevent some of the secondary disabilities that we talked about earlier, like school difficulties. Because when people around the children understand the children’s brain, chances are that they will adapt their interventions with them and they will see the disability. The second one is stability. Stability is good for any child, but even more for children, adults with FASD. For example, I came across a child who was in nine foster homes. No one could keep him because he was to behavioural. People expected him to behave a certain way, but they wouldn’t give him the tools to do so. And now, on top of his FASD he also developed attachment disorder. And the third one, and most importantly, getting as much information as you can is on FASD if someone is in your life shows signs.

Aimee-Elizabeth Parsons

So why diagnose? A medical diagnosis represents an opportunity to understand what is going on and hopefully limit secondary disabilities. Having a snapshot of the brain will definitely help build an intervention plan. Knowing what is going on can also help shift the mind from he or she want to he or she can’t without help. A diagnosis is not an easy process. Diagnosis needs to be done by a multidisciplinary team. So a team of different types of professionals. We would need a pediatrician, a speech and language pathologist, occupational therapists, neuropsych ologists. So we need to have the doctor, someone who understands how we speak and understand someone is going to look at our body movement and someone who’s going to take a snapshot of our brain. Presently, there are not many clinics that diagnose FASD, but we are working really hard to bring services back to the north.

Catherine Langevin

So when a child is diagnosed with an alcohol related disability, it says something very important about the mother. So it could be a diagnosis for two. Another challenge in diagnosis process is that it can be very painful for a mother to share that she drank while she was pregnant. Again, sometimes mothers don’t know they’re pregnant until the third month. So it’s important to listen to them without judgment and support them as a community. So how how can we prevent FASB as a community analyst? Tick approach is important. This means that everyone can support the mother in her sobriety. For example, the nurse and the CHR can be involved with the follow up. The father can decide to stop drinking, and maybe the grandparents take the mother and the bush on weekends when she feels more vulnerable.

There are other prevention tips like eating well and exercising, educating everyone about what alcohol can do to the unborn child. We can also use harm reduction approach, which means to try to support the mother with reducing her consumption instead of stopping it completely. We can also refer to women to who are struggling with addictions, to a treatment center or resources through need that worker. We can help them reconnect with their traditions, if that’s something that they wish, and build a support network around them to encourage them to stay sober. And speaking of networks, the father plays a really important role. The father’s drinking behaviors can influence maternal prenatal alcohol consumption and the healthy development of their babies. If dad drinks, there’s higher chances that mom will drink to. Some dads can decide to stay sober with their partners during the whole pregnancy. And that was proven to be helpful. Now we’re on to another question.

Aimee-Elizabeth Parsons

So our final question. Question number five is so do you need a diagnosis of FASD to use intervention strategies? And the answer is no. We can begin to build an intervention plan or look at strategies by looking and observing behaviors and starting to work together to see what can help. So what we’re going to explain in our next few slides is some interventions or seven strategies that will do no harm. So you do not have to have a formal diagnosis. So seven strategies that could help understanding and education would be the first one, probably because I’m an educator. But it’s really, really important. We often take people at face value and not at brain value. We often think people are doing it on purpose. We label people as lazy, unmotivated, manipulative. So it’s important to begin to understand FASD, break down the stigmas and learn about it. Doing exactly what you’re doing today by joining us here So understanding and education The second one, super, super important is kindness and compassion. We have talked a lot about trying to understand the individual with FASD but let’s take a moment to think about the caregiver and the family. Kindness and compassion are needed there, too.

So caregiver burnout is huge. So it’s important to practice ways of self-care. And here’s just a small list. Again, physical activity is super important for so many reasons. There’s different kinds of mindful breathing positive social interaction. When things are difficult, we often isolate. So it’s important to keep the interaction with other people a good belly laugh. Finding the humour in life is super important. Touch. We specially learned that through COVID, not being able to do it, but a hug to a family member is rejuvenating. It really makes us feel better. And there are times that we’re going to need to cry. And that’s OK too. And creative expression. So really, one of our colleagues says, take your broken heart and turn it into art. So those of you who write, draw, who paint to not give up on those forms of expression. Our third strategy that we’d like to bring up today is communication. Understanding the way we communicate is really important. First of all, you need to limit your words. You need to use clear, another word – concrete, simple words when explaining or giving instructions.

One step at a time. Check for understanding. And very difficult here. Don’t argue, debate or negotiate instead. So when you give an instruction, you’re going to go one step at a time. Pause. If successful, add another instruction. Use words that make sense. So an example, when I was teaching once, I said to my class, I would like you to pick a partner. And then they hear a student yell “Ouch!” Because a student had grabbed a friend by the arm just like you would grab a box of cereal off the shelf at the store. He had picked a partner What I should have said was ask someone to be your partner. When you ask a question or give an instruction, you really need to make sure the listener understands. Have them explain in their own words what you ask them, or you can give them a choice. So instead of saying, do you want a snack, you can offer a choice. Do you want a cookie or do you want a cake? Do you want an apple? Do you want a banana? So it’s important to give choice and check for understanding.

Catherine Langevin

So a complex task like cleaning your room, you may have to go with the individual and say, OK, let’s pick up the clothes now. Let’s put them in the dirty basket. Next we do this. So one step at a time. Another strategy that helps with a lot of these struggles is building a routine. Routines may help lower anxiety and stress. They might help a person to understand and follow instructions if they have poor memory or difficulty understanding. One way that might make these routines easier to understand is by using a visual schedules or pictures. A visual schedule is just a simple picture or drawing of what is going to happen next. For example, breakfast is at eight, so there’s a picture of the sun coming up and a bowl of cereal. Next at nine, it’s time to go to school, so there might be a picture of the bus. If you want to learn more about visual schedules, you can learn how to do this by working with your local SNY or checking on our website WW DOT Disability Program and Specialized Services dot org.

Aimee-Elizabeth Parsons

So remember someone with FASD might have difficulty with following routines, schedules, or instructions even when the tools and supports are in place. When this happens, remember to remind yourself people or an individual with FASD are not being willful, stubborn, and not listening on purpose. The development of the parts of the brain that help them to do these things was harmed during pregnancy.

So next, we’re going to look at number five sensory regulation. The challenge for those of us working with people with FASD is to become aware of all of the stimuli in the environment and consider how that may affect an individual with FASD. So I’m thinking about all the little things that make a difference between being comfortable and being irritated. So that stimuli, that fancy word I’m looking at smells Looking at the lights, I’m looking at touch. So maybe there’s a strong smell in the area. Maybe the lights are too bright. Maybe there’s touch so touch could be one to another. Or, you know, the tag at the back of my neck in the back of my shirt here. There could be too many people around. So what this means is we need to be aware of the sounds, smells, touch, light can have an impact on the body and the behaviour of the person we’re working with. So the picture here is a picture of feeling just right. So. So the lights are OK. There’s. There’s not a smell that’s bothering you. There’s not too many people in sometimes we’re not doing OK, and we need to adjust. So that’s a picture to sort of represent that. So the next intervention strategy is the strength based approach.

Catherine Langevin

So let’s take the word disability. And that word, there’s a word ability in order to work with someone who has a FASD, you need to understand that there are brain deficits, but also strengths. What is the individual good at? What do they like to do? What are their best qualities? People with FASD are often known as friendly, helpful, caring, creative. But we often focus too much on what they do wrong. One of the ways we can help is by pointing out what is going well. Just like you said before, by telling Donny how. I love how you put your booze on the mat. Another way we can be supportive is by modeling the behaviors that we want to see. So, for example, cleaning up their room.

Aimee-Elizabeth Parsons

And then the circle or fence. As I mentioned, it’s important to make a positive approach with someone with FASD. It would be important to designate so choose a safe person or a group of safe people that they can call whenever they have a question. These are the people who support them, the people who will guide them. The people that model. The behaviors that will help the person with FASD to achieve their goals. This is really important because these people will help with the judgment and decision making. That can be very hard for someone with FASD. Having the safe person or safe people on speed dial ensures that there we’re looking to the right people. Whenever you’re faced with a tough decision. So this activity would be “Who are the people in my circle?” Those are the people I’m going to ask for their opinion for their advice. And then there are people who are on the other side of the fence. We can be friends with those people, maybe, but they’re not the people. We’re going to ask when we have a difficult question So I’ll give you an example. A young man likes a girl and he knows that many boys and girls kiss each other when they like each other. He really wants to kiss this girl. In this class. He’s not sure what the next steps are. So do you want him asking a chosen person in that circle so someone that you’ve discussed is a safe person who has good ideas. Or remember that friend we talked about who sold his iPad for $5? Do you want him asking that friend for advice? So this activity is to help with the judgment and and really impulsivity and comprehension understanding And next, we have the external brain. So this picture represents our external outside brain. So the external brain is used as an image to represent some of the things we’ve just talked about. It’s the person or the tool that mentors, assists, guides, supervises or supports the individual to maximize their success. So the external brain could be a chosen person in the circle that we just talked about. It could be the shadow at school a family member, a person or any tool that helps the person with their difficulties. So a schedule, a routine visuals, phone apps, a timer that just names a few.

So once this external brain is in place, it’s important that it doesn’t get removed just because it seems like the individual is doing well on their own. Often as kids get older, caregivers will allow for more independence. But remember our example of that eight year old who had difficulty with his understanding and judgment. Don’t be too quick to take away supports for someone when they’re first. They may still need structure for the routine and the support. So they’re going to need that external brain. Remember that FASD is a brain based, lifelong disability, and we have to match expectations with those abilities.

Catherine Langevin

Yeah, so this table shows us a way to perceive individual with FASD differently. Even if it can be hard sometimes because of the end of the invisible disability. So complete shift in the mind frame he or she want to. He or she can’t. Somebody who tells lies, seeing them as making up stories. Somebody who we say is lazy, tries hard. But task can be challenging for him. And also, remember, every child and family is unique. Be aware of your own thoughts. Work together and keep learning.

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