behavioral & environmental strategies for working with fetal alcohol-exposed youth
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Behavioral & Environmental Strategies for Working with
Fetal Alcohol-Exposed Youth
Introduction
Jody Allen Crowe –served as teacher, principal, superintendent.
18 years experience in tribal schools Minnesota and western states.
Director of Studio Academy High School Executive Director – Healthy Brains for
Children
Dilemma
Not a doctor, psychologist, psychiatristA manLearned what I know on reservationsEducator – the only profession that analyzes the brain function of every child over a long period of
time.
Seeing-Eye Brain
What are the mitigating factors in your client’s lives?
Of all the mitigating factors in your
client’s life, what can you control?
Environment
Food
Yourself
What are we talking
about?
Ethanol kills brain cells of the fetus.
The ‘Inconvenient Truth”
Alcohol is a Teratogen
Permission to use photo on file.
Alcohol Added to Unhatched Eggs
Sulik et al
When does the damage occur?
Eyes Weeks 3 1/2 to full term
Central Nervous System2 weeks to full term Ears
Weeks 4 1/4 to 20
Teeth Weeks 6 3/4 to full term
Palate Weeks 6 ¾ to 16
Upper limbsWeeks 2 1/2 to 9
External genitalia Weeks 7 to full term
Lower limbs Weeks 3 to 9
Heart Weeks 2 1/2 to 9
Jody Allen Crowe 2010
CELLS THAT SHOULD FORM MIDLINE STRUCTURES OF THE BRAIN AND FACE ARE
KILLED BY ALCOHOL
Developingbrain and
face
Heart
Mouse embryo (viewed from the front) at a stage corresponding
to a 22-23 day old human.
A close-up view of an alcohol-exposed mouse embryo shows cells killed by alcohol
that have taken up a dark blue stain.
6
General Intellectual Performance
FSIQ VIQ PIQ40
55
70
85
100
115
Sta
nd
ard
sco
re
IQ scale
NC
PEA
FAS*
**
**
**
Mattson, S.N., 1997.
Neuropsychological Performance
FSIQ Read Spell Arith PPVT BNT ATotal VMI PegsD CCT40
50
60
70
80
90
100
110
120
Measure
CON
PEA
FAS
Mattson, et al., 1998
2
1
3
1
2
3
Group0
2
4
6
Ru
le V
iola
tion
s
NC
PEA
FAS
P<0.001
Move only one piece at a time using one hand and never place a big piece on top of a little piece
Starting position
Ending positionMattson, et al., 1999
Executive functioning deficits
Stages of Prenatal Exposure to Alcohol
0 1 2 3 4 5
No prenatal exposure to
alcohol
Prenatal exposure to alcohol with
loss of potential not observable
with current tools
Prenatal exposure to
alcohol resulting in detectible lowered
academic, social and emotional
intelligence.
Prenatal exposure to
alcohol resulting in observable
exhibitions of brain damage
behaviors, which result in
academic failure,
psychological diagnoses,
criminal behaviors, depression
Prenatal exposure to
alcohol resulting in
physical manifestation
and observable exhibitions of
Stage 3 academic and
social brain damage
behaviors
Prenatal exposure to
alcohol resulting in miscarriage,
stillborn, SIDS, death
due to organ failure
damage from prenatal
exposure to alcohol.
Crowe 2010
Stages of Prenatal Exposure to Alcohol
0 1 2 3 4 5
No prenatal exposure to
alcohol
Prenatal exposure to alcohol with
loss of potential not observable
with current tools
Prenatal exposure to
alcohol resulting in detectible lowered
academic, social and emotional
intelligence.
Prenatal exposure to
alcohol resulting in observable
exhibitions of brain damage
behaviors, which result in
academic failure,
psychological diagnoses,
criminal behaviors, depression
Prenatal exposure to
alcohol resulting in
physical manifestation
and observable exhibitions of
Stage 3 academic and
social brain damage
behaviors
Prenatal exposure to
alcohol resulting in miscarriage,
stillborn, SIDS, death
due to organ failure
damage from prenatal
exposure to alcohol.
Crowe 2010
There is no ‘Silver Bullet.’There are no ‘Standard Operating
Procedures.’There is no template.
But,there are commonalities and
there are ‘Best Practices.’
Behaviors that cause disrupted school experiences can be linked to functions of the
brain called
Executive Functions
Phineas Gage and Executive Functions of the Brain
Before the accident
hard-working, responsible, and popular with his workers
well-balanced mind a shrewd, smart businessman
very energetic and persistent in executing all his plans of operation
Fitful, irreverent, gross profanity Obstinate, impatient, did not like adviceGrandiose plans with no follow-throughA child in intellect, with animal passions of a strong man.
Shocking device
Impulse Study using RatsFrontal Lobe Damage/Executive Functions
Impulse Study using RatsFrontal Lobe Damage/Executive Functions
Shocking device
Moral CompassProblem solvingImpulse controlSelf MonitoringRegulation of Sexual UrgesInhibitions Verbal self-regulationRegulation of emotion JudgmentReasoningFocused AttentionEmpathy
Executive Functions of the Frontal Lobes
Connecting an action to a consequence
Limbic System of the Brain
Damage to the corpus collosum interferes with the ability to pass information from the left to
right hemispheres and between various components of the brain.
Limbic System of the Brain
The basal ganglia, a group of structures around the thalamus, are important for voluntary
movement and voluntary thought, a funnel, so to speak, where thought gathers.
Limbic System of the Brain
Thalamus plays a major role in regulating arousal, levels of awareness, and activity.
Limbic System of the Brain
Hypothalamus is one of the most worked parts of the brain. It is responsible for regulation of
hunger, thirst, pain, pleasure, sexual satisfaction, anger, etc.
Limbic System of the Brain
Amygdala plays a response role. Electrical stimulation of this area cause rage and anger,
while a removal of this area will cause indifference towards such stimuli as fear, anger
and sexual pleasure.
Limbic System of the Brain
Hippocampus is used in converting short-term memory information into long-term.
Exhibition of Limbic System Damage
Interferes with the ability to pass information from the left to right hemispheres and between various components of the brain.
Lowered ability to retain information in memory. Lowered reaction to fear of strangers and dangerous
events or situations. (Instant friends) Limited control of appetite, emotions, temperature, and
pain sensations. Perseverative behaviors, “thick thinking.” Lowered ability to process emotional reactions. Sensory integration issues.
Couple a day
Binge drinker
Heavy everyday drinker
No drinking
Occasional drink
Stopped at 6 weeks
First Trimester
Chart Title
Examples of Variability from Brain Damage Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Jody Allen Crowe 2010
Couple a day
Binge drinker
Heavy everyday drinker
No drinking
Occasional drink
Stopped at 6 weeks
First Trimester
Chart Title
Examples of Variability from Brain Damage Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Jody Allen Crowe 2010
Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Jody Allen Crowe 2010
Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Jody Allen Crowe 2010
Couple a day
Binge drinker
Heavy everyday drinker
No drinking
Occasional drink
Stopped at 6 weeks
First Trimester
Chart Title
Examples of Variability from Brain Damage
Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Jody Allen Crowe 2010
Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Our court system is looking at this adolescent through this lens.
When functionally, we should be looking at this…..
Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Couple a day
Binge drinker
Heavy everyday drinker
No drinking
Occasional drink
Stopped at 6 weeks
First Trimester
Chart Title
Stage 3 or 4
Jody Allen Crowe 2010
Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Couple a day
Binge drinker
Heavy everyday drinker
No drinking
Occasional drink
Stopped at 6 weeks
First Trimester
Chart Title
Jody Allen Crowe 2010
Examples of Variability from Brain Damage
Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
You might be working with this profile.Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Jody Allen Crowe 2010
So we ask ourselves.
Most will be able to identify consequence when prompted or after the fact.
Many have an immediate impulsive response without considering consequence.
Some can’t make a connection between parts of the brain that link an action to a
consequence.
Is this behavior Willful Disobedience or Brain Damage Behavior?
Maybe you can relate
Some common behaviors needing behavioral management
ADHD Arguing –Preseverative Behavior
Bad temper-violent behavior Lack of empathy Verbal outbursts
Lying Sexual promiscuity
Sexual predator Alcohol and drug use Depression/self abuse Threats of violence
Not accepting responsibility for actions
Arguing with an adolescent is like mud wrestling with a
pig. You both get dirty and the pig loves it.
If you want to change an adolescent’s behavior, you have to change how your behavior.
What Can You Do?
Always think brain damage first.
Whenever confronted by behaviors that are characteristics of prenatal exposure to alcohol, ask yourself if this is a result of brain damage.
Environment
EnvironmentWill a change in environment change the behavior?
Review all incidents to see if adults contributed to the student behavior.
Is the behavior a result of the inability to habitate?Inability to adjust to stimuli. (sounds, light, hot, cold, smell)
Interaction , proximity to others, language used by others.
Environment Control Strategies
Minimize chaos.
Minimize transitions.
Check to see that reading levels of displayed posters and reading materials are at the level of the
clients.
Minimize unexpected sensory inputs as much as possible.
Understand behaviors brought on by inability to habituate sensory inputs.
Systemic Consistency
No more than 5 expectationsDefine expectations - ex. respectTeach expectationsPost expectations in common areas Identify the consequences of not meeting
the expectationAll staff consistently follow systemFollow through
Acknowledge positive behaviors
At least a 3 to 1 positive to negative response from adult
What is learned in one environment may not transfer to
another environment.
Regardless of the Behavioral Program, you need to understand:
-the function of the behavior-how your actions impact the
behavior-what responses work with which
behaviors
Understanding the Function of the Behavior
We think they think the way we think they should
think.We have to change how we think they think.
Understanding the Function of the Behavior
Every behavior has a function – some behaviors are a function of brain damage
Raging –function is to remove the individual from a situation that is stressing the brain, for example the
inability to habituate.
Is it willful or brain damage behavior?Willful behavior can be based on faulty brain damaged
thinking.
Lying – brain damage behavior – sometimes hard to determine function
Your actions1. Communication
The brain damage may have interfered with the brains ability to process information quickly.
The brain may be coping with what you are saying without noticing the nonverbal communication, or may be
trying to decipher the nonverbal without being able to follow the verbal communication.
Its not only what you say, it is how you say it.
Be Careful using Figurative Speech in a conversation with a Concrete Thinker
Hyperbole-exaggerationI have told you a million times today
I’ll get to you in a second.
MetaphorDid I throw you a curve?
Did that throw you for a loop?
Sarcasm- verbal ironywhere the intended meaning of a statement differs from the
meaning that the words appear to express. I need this like a hole in the head!
Don’t let the door hit you on the way out.
Nonverbal communication
Do not assume the adolescent can read non-verbal communication.
Many prenatally exposed brains struggle with reading non-verbal communication.
If you use non-verbal communication for behavioral management, teach before using.
Check for understanding.
Sequence of Directions
A common difficulty is following sequenced directions.
Give one direction at a time.
Provide visual cues for a sequence of directions.
Why don’t you act your age?
You don’t remember. Yes, you do. We just did that yesterday!
How many times do I have to tell you?
What do you think I am? A bookstore?
Remember, your behavior might be the trigger event. Shaming and blaming language may push the damaged brain into actions that lead to trouble for the adolescent.
Shaming and Blaming Language
Your Actions2. Responses to behaviors
The most effective strategy to change behaviors are:
Verbal reminder and Prompts in a non-shaming, non-blaming manner
You are giving the damaged brain the opportunity to re-set.
Become the “Seeing Eye Brain”
Responses, cont.
Use prompts and reminders
for all behaviors except aggressiveness. In these cases, use verbal reprimand and cool
down strategies.
Chasnoff
Responses, cont.
Token economies work for: Withdrawal, shyness (over controlled
behaviors) Task completion Disobedience Attention problems, off task, impulsiveness
(under controlled behaviors)
Responses, cont.
If dealing with this brain damage
is frustrating for you, think of how frustrating it is for the adolescent.
Adjust Your Expectations
Responses, cont.
Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Remember, you have the option to look at your clients like this
Or like this.Chronological Age
Emotional Age
Expressive Language
Social Maturity
Executive Functions
Sexual Maturity
Math Skills
Memory Skills
Reading Decoding
Reading Comprehension
0
10
20
Jody Allen Crowe 2010
Attitude
Be positive rather than punitive. Be supportive and respectful.
Encourage healthy, respectful behaviors rather than look for behaviors to punish.
Watch what behavior you model.
Responses, cont.
Use Consequences With Care Consequences must be concrete and simple
and must be applied immediately and consistently.
The adolescent may not learn, or may forget or make the same mistake again.
Adapt consequences to the child’s functional age rather than actual age.
Responses, cont.
Reprimands and praise
If done in front of others, expect a response that is designed so the recipient will not “lose face” in front of the others.
Many times praise in front of others is counter productive.
One on one or quiet contact in presence of others more effective.
Restraints Always be prepared to protect others and the
adolescent with restraint if need be. Review any restraint event to see if the adult’s
behavior contributed to the behaviors that led to the restraint.
As soon as the adolescent is compliant, move to cool down.
Determine the function of the behavior that led to the restraint. The function might be the need for physical
contact.
The Theory turned into PracticeSchool wide Behavioral Management System
Non-Shaming, Non Blaming Common language Ask questions to bring the brain back to focus Never try to argue or use logic when the
adolescent is raging When the adolescent is coming down from a rage,
explain the expectations to another adult without talking directly to the child
Agree to step in when another adult is not using the common language or is confrontational
QuestionsDefine and clarify each question
before using system Was that noise?
Was that out of place? Was that physical contact?
Was that off task?
Use of questions designed to give brain a prompt to move back into appropriate behavior pattern.
Physical Positioning
Proximity
Confrontational
Non-confrontational
Behavior Chart
Normal behavior
QuestionsIs that out of place?Is that noise?Is that off task?Is that physical contact?
Triggerevent
Do not argue!Use only direct
statements. Using logic does not work.
Ask questions three times before changing to statement.
Behavior Modification
Use self analysis toolDetermine increments of time
2
G
G P
P
1
P
G
0
Student
Teacher
Score
Increase increments of time as the student shows the ability to analyze and manage their own behavior
Thoughts Understand medication does not cure, but in many
cases creates a better learning experience Understand every child is at a different spot on the
Spectrum Always think ‘Brain Damage’ Understand academic difficulties are real and a
source of secondary disabilities
Never assume what is learned in one situation or environment will
transfer to another situation or environment.
Always remember this is lifelong brain damage.
Understand the damaged brain, when under stress or in unfamiliar circumstances, may revert to the illogical thinking that brought him/her into this
setting in the first place.
A small percentage of prenatally exposed children, adolescents, and adults are violent.
But……
Most violent children, adolescents, and adults have been prenatally exposed to alcohol.
In my professional opinion:
BEAM
Behavior Environmental Adaptation Model
The 15 BEAM Rules of FASD Behavior Management
Also known as the Fasstar Trek Model
© 2004 Teresa Kellerman
Websites
http://www.healthybrainsforchildren.org http://www. mofas.org http://www.come-over.to/FASCRC/ http://www.come-over.to/FAS/BEAM.htm http://www.come-over.to/FAS/FASbrain.htm http://www.faslink.org/
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jodyallencrowe@healthybrainsforchildren.org
www.healthybrainsforchildren.org
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