fasd caregiver curriculum 1.2 neurological fasd

PHAC Splash Slide The Caregiver Curriculum on FASD©

The Effects of Alcohol on the Developing Brain: The Neurological Effects of FASD Curriculum Development Team:

Dorothy Badry, PhD, RSW Jamie Hickey, BA, MSW (c) Faculty of Social Work University of Calgary

Project Funder: Public Health Agency of Canada (2011-‐2014)

CHILDWELFARE.CA

& Child WelfareCommunity of Practice

The Impact of Fetal Alcohol Spectrum Disorder Module 1.2

The Neurological Effects of FASD

How to use this module

•  Open in PowerPoint or PowerPoint viewer •  Click the “Slideshow” tab then click the “From Beginning” menu buLon that appears below

•  Use your mouse to click on the arrows and items on the slides to navigate

•  For longer modules, terms that appear in blue within the table of contents with an underline can be clicked to navigate the module.

How to use this module, conPnued

The main navigaPon buLons work like this…

Go back to the very start Go to the end

of this module

Go forward Go back

Go to the Table of Contents

How to use this module, conPnued

There are also 2 special navigaPon buLons…

This buLon will return you to a list if you are asked to click to learn more about different topics

This buLon will return you to the main chapter if you click on a colored box to see an example

Table of Contents

•  The Neurological Effects of FASD •  A Constantly Changing Brain •  What Areas of the Brain are Damaged by Prenatal Alcohol Exposure?

•  Where can I learn more?

The Neurological Effects of FASD The neurological effects of FASD can vary in both type and severity. Many factors will impact not only the type and severity of physical brain damage, but also the behavioural symptoms that appear. Children prenatally exposed to alcohol oVen display what doctors refer to as diffuse brain damage. Diffuse brain damage means that the damage is widespread and impacts numerous areas. The diffuse nature of the brain damage that occurs with FASD may help to explain the large variety of symptoms and effects. Environmental factors can also affect both the development of the brain and the behavioural symptoms of brain damage. During the early years the brain craves sPmulaPon. This desire for sPmulaPon is one of the reasons that infants and young children learn things so rapidly. In the first six years of life children learn the concepts and skills of trust, relaPonship building, self-‐control, emoPonal regulaPon, language, social interacPon, cause-‐and-‐effect, aLachment and safety, among other concepts.

Image courtesy of Stuart Miles/freedigitalphotos.net

The Neurological Effects of FASD In order for children to achieve the maximum possible development, they require a safe, secure, supporPve and stable home environment. Unfortunately many infants and children with FASD, parPcularly those entering the foster care system, have experienced problems in the home and have not been exposed to ideal developmental condiPons. Like other children exposed to unstable or unsafe home environments, children with FASD may struggle with aLachment, have trouble controlling their emoPons and display troubling behaviours.

Image courtesy of imagerymajesPc/freedigitalphotos.net

The Neurological Effects of FASD

As a caregiver for a child with FASD, you can support the best possible outcome by providing a home environment with the following characterisPcs. Click on each characterisPc to learn more about what they mean!

•  Safety •  Security •  Support •  Consistency •  Enrichment •  Stability

Safety

Infants and children with FASD may struggle with concepts of safety that equal-‐age peers already understand. Consistent supervision and excepPonal child-‐proofing may be required. (Click on the picture of the list below to return to the list of characterisPcs)

Security When dealing with problem behaviours remember that the behaviour is the problem, not the child. Provide children with reassurance that you will not “send them away” for being “bad”. Reaffirm that the child is good and worthy of love and affecPon, even if their behaviour is unacceptable. Teach the child skills and techniques to calm down and manage their emoPons. (Click on the picture of the list below to return to the list of characterisPcs)

Support Provide posiPve aLenPon and encouragement when the child engages in appropriate behaviours. Adjust the environment to provide posiPve choices as alternaPves to negaPve behaviours Hang the child’s artwork on the walls, comment posiPvely and join the child in singing, dancing and creaPve play. Assist the child with any school projects and take note of any foundaPonal skills that the child may be struggling with. Teach these foundaPonal skills through games and fun acPviPes. (Click on the picture of the list below to return to the list of characterisPcs)

Consistency Infants and children with FASD do best when the household runs on a schedule with acPviPes that follow a consistent paLern. Prepare the child in advance for acPvity transiPons and scheduled events. Establish household rules and reinforce these rules consistently between all family members. Some children with FASD may benefit from having household rules and rouPnes clearly displayed with pictures (Click on the picture of the list below to return to the list of characterisPcs)

Enrichment Provide ample opportuniPes for safe exploraPon and creaPve play. Create opportuniPes for children to assist you with tasks (i.e. sPrring or measuring ingredients, planPng seeds in the garden or sorPng laundry). Important: Remember that children and youth with FASD may require more supervision and assistance to help with these tasks! (Click on the picture of the list below to return to the list of characterisPcs)

Stability DisrupPons in placement cause tremendous stress on all children, parPcularly those who lack the skills of emoPonal regulaPon, like children with FASD. Look for opportuniPes to provide stability wherever possible (and realisPc). Speak with your child’s caseworker to determine what opPons are in the best interest of the child. (Click on the picture of the list below to return to the list of characterisPcs)

The Brain Can Adapt The human brain has a remarkable ability to compensate when an area is injured or damaged. The ability of the brain to adapt and compensate for injury is called plasTcity. Early intervenPon programs and supporPve home environments can promote increased plasPcity for children affected by prenatal alcohol exposure. As a caregiver, the most important thing you can do to support brain development is to provide a loving and supporPve environment that nurtures the child’s unique talents and abiliPes.

Image courtesy of dream designs/freedigitalphotos.net

Neurological Effects of FASD

As menPoned earlier, the neurological effects of FASD can vary greatly from child to child. However, some types of brain injury are more common with an FASD diagnosis. The following secPon will outline a few of the brain areas that are most suscepPble to damage from prenatal alcohol exposure, the funcPons normally performed by each area and some of the behavioural problems that may result.

The Brain is Constantly Changing It is important to note that some effects may not appear during infancy or early childhood. While brain structures are formed prior to birth, the brain conPnues to develop throughout childhood and adolescence. Even aVer in adulthood, the connecPons between neurons will conPnuously change. Many effects may only show up as the brain is asked to complete more complex tasks. For many children and adolescents with FASD symptoms may be more pronounced in the school environment, parPcularly in later grades when longer aLenPon spans and more academic skills are required.

Roadmap of the Brain

In order to understand the full effects of brain damage on behaviour it must be understood that all brain areas are connected. While it may be said that certain brain areas are “responsible” for specific tasks these areas do not operate alone.

How do brain areas work together?

Click here to learn more!

The Brain is Like a Computer… Looking at the brain as a computer it becomes easier to see how different areas work together. If you turn on the computer and no picture appears on the monitor you might assume that the problem is with the monitor screen. However the problem with the screen could be due to a number of issues: •  The monitor screen might be cracked so the picture

cannot display •  The monitor cord could be broken so the picture

signal cannot reach the screen •  The computer chip that tells the monitor what

picture to display could be broken •  The computer power system could have shorted out •  The wall outlet that the computer is plugged in to

might not be working

Image courtesy of Dan/freedigitalphotos.net

The Brain is Like a Computer… Just like the computer example, brain funcPon relies on many systems working together. For example, let’s say a child has difficulPes with verbal expression. This difficulty could be the result of: •  Damage to area(s) of the brain responsible for understanding speech–

because the child does not understand speech they cannot speak coherently or understand quesPons asked of them

•  Damage to the brain area(s) responsible for producing speech– the child can understand speech and may be able to write a response but the brain is unable to form their own speech

•  Damage to facial motor control nerves – the child lacks the muscle control needed to form the syllables and sounds needed to speak

•  Damage to the areas of the brain responsible for aLenPon – the child can understand and produce speech but lacks the aLenPon span necessary to understand and respond to quesPons

•  Lack of social engagement – the child has a lack of desire (or a lack of ability) for social engagement and, as a result, does not verbally express themselves

•  Anxiety – the child experiences severe social anxiety and refuses to speak

Image courtesy of arztsamui/freedigitalphotos.net

How Can I Find the Problem? With so many processes, how do you find out which one is causing the problem? One method would be to look for common issues. A child who has trouble chewing and speaking may have facial muscle control problems. A child that speaks freely at home but refuses to speak to strangers could be anxious. Your child’s health care team can also help you pinpoint the process. Speak to your child’s pediatrician and ask for a referral if needed. In some cases a physician may order a medical scan or tests to look for an underlying cause, however in many cases the focus will be on improving funcPon instead of finding the cause. For example, a child with facial muscle control problems might be referred to a speech therapist to see if funcPon can be improved before more invasive medical scans and tests are performed.

Apply Your Knowledge… Think of a concern that your child currently displays. Just as in the previous examples, think of the processes involved and write down how each of these processes might contribute to the problem. Now try troubleshooPng. Does your child have common issues? Does the problem only show up under certain situaPons? When you have completed this exercise you may want to keep a copy of it to show your child’s health team. (click the light bulb to return to the module!)

What Areas of the Brain are Damaged by Prenatal Alcohol Exposure?

Prenatal alcohol exposure can affect any structure within the brain, but there are some structures that are more prone to damage. On the next page, you will find a list of the brain areas most commonly affected by FASD. Hold your cursor over each area to learn what funcPons it is responsible for.

What Areas of the Brain are Damaged by Prenatal Alcohol Exposure?

•  Frontal Lobe •  Corpus Callosum •  Hippocampus •  Hypothalamus •  Cerebellum •  Basal Ganglia •  Amygdala

Frontal Lobe

The frontal lobe is oVen referred to as the “central execuPve” of the brain. ExecuTve funcTons controlled by the frontal lobe include things like planning, judgment, Pme-‐management, interpersonal skills, understanding consequences, impulse control and informaPon integraPon.


Corpus Callosum

The corpus callosum is responsible for communicaPon between the two hemispheres of the brain. Without the corpus callosum the brain cannot integrate informaPon and sensory input from each hemisphere.


Hippocampus

The hippocampus plays an important role in learning, memory and navigaPon. Individuals with damage to the hippocampus may have difficulty forming or accessing memories. The ability to navigate or remember routes may also be impacted. The hippocampus is part of the limbic system. The limbic system is involved in the producPon and regulaPon of emoPons.


Hypothalamus

The hypothalamus controls many of our basic insPncts. Individuals with damage to the hypothalamus may experience differences or concerns with eaPng or appePte behaviours, emoPons (especially ‘fight or flight’), sensaPon (including pain) and internal temperature regulaPon.


Cerebellum

The cerebellum is the moPon center of the brain. It is responsible for coordinaPon and movement. The muscle rigidity and movement issues caused by cerebral palsy are a result of damage to the cerebellum. Damage to the cerebellum can cause muscle control problems, coordinaPon difficulPes and tremors.


Basal Ganglia

Individuals with damage to the basal ganglia may experience difficulPes in perceiving Pme. The basal ganglia also plays a role in spaPal memory, like the hippocampus.


Amygdala

The amygdala is also part of the limbic system. The amygdala plays a central role in emoPons. The amygdala regulates emoPons (including fear and anxiety), social behaviour and aggression.


Curious to learn more? Check out these great videos from the Alberta FASD Learning Series! •  FASD 101: Diagnosis and Support of FASD -‐

hLp://www.youtube.com/watch?feature=player_embedded&v=x-‐FHYTCqH8E •  Building Brain Boxes -‐

hLp://www.youtube.com/watch?feature=player_embedded&v=LkuL9SmaSic •  Opening the Brain Boxes -‐

hLp://www.youtube.com/watch?feature=player_embedded&v=pbzoFZGDyvg

References •  Mitchell, S., Andrew, G., & Cheyenne. (2013). FASD Awareness and PrevenPon: Engaging

Alberta Pharmacists. [Pharmacist Curriculum] •  Bertrand J, Floyd RL, Weber MK, O’Connor M, Riley EP, Johnson KA, Cohen DE, NaPonal Task

Force on FAS/FAE. Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Atlanta, GA: Centers for Disease Control and PrevenPon; 2004.

•  Chudley, A. E., Conry, J., Cook, J. L., Loock, C., Rosales, T., & LeBlanc, N. (2005). Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Canadian Medical Associa.on Journal, 172(5 suppl), S1-‐S21.

•  Provincial FASD Outreach Program. (2013) Learning About FASD. Retrieved from: hLp://www.fasdoutreach.ca/elearning/learning-‐about-‐fasd

•  Koren, G., Nulman, I., Chudley, A. E., & Loocke, C. (2003). Fetal alcohol spectrum disorder. Canadian Medical Associa.on Journal, 169(11), 1181-‐1185.

•  Streissguth, A. P., & O'Malley, K. (2000, July). Neuropsychiatric implicaPons and long-‐term consequences of fetal alcohol spectrum disorders. In Seminars in clinical neuropsychiatry (Vol. 5, No. 3, pp. 177-‐190).

•  E. Riley, S. Clarren, J. Weinberg and E. Jonsson, Fetal Alcohol Spectrum Disorder, Management and Policy PerspecPves, eds. Wiley-‐Blackwell 2011

The Caregiver Curriculum on FASD •  Title: Caregiver Curriculum on FASD (Fetal Alcohol Spectrum Disorder) 2014 •  Author: Dorothy Badry & Jamie Hickey in collaboraPon with the Tri Province FASD

Research Team •  Format: pdf and Power point -‐ online topics and modules on the website

fasdchildwelfare.ca •  Publisher: Faculty of Social Work, University of Calgary; Faculty of Social Work,

University of Manitoba & Children’s Aid Society of Toronto-‐Child Welfare InsPtute

•  This project was funded by the Public Health Agency of Canada. •  ISBN 978-‐0-‐88953-‐375-‐2© •  Use of Material: This material can be freely shared and used with acknowledgment

using the citaPon below. •  CitaTon: Badry, D., Hickey, J. & the Tri Province FASD Research Team (2014). Caregiver Curriculum on

FASD. Online: fasdchildwelfare.ca; Faculty of Social Work, University of Calgary; Faculty of Social Work, University of Manitoba & Children’s Aid Society of Toronto-‐Child Welfare InsPtute. Funder: Public Health Agency of Canada.

fasd caregiver curriculum 1.2 neurological fasd

Documents