impacts, implications and interventions in the school setting

Neonatal Abstinence Syndrome: Impacts, Implications and Interventions in the

School Setting

Allison Cooke Douglas

Resource Center Manager @ Harmony Family Center

Sinead Doherty Family Therapist

@ Harmony Family Center

The Scope and Impact of Neonatal Abstinence Syndrome (NAS) in Tennessee

https://bettertennessee.com/

Heroin and other opiates, including methadone, can cause significant withdrawal in the baby, with some symptoms lasting as long as four to six months. The following are the most common symptoms of neonatal abstinence syndrome. However, each baby may experience symptoms differently. Symptoms of withdrawal in full-term babies may include:

• Tremors (trembling) • Irritability (excessive crying) • Sleep problems • High-pitched crying • Tight muscle tone • Hyperactive reflexes • Seizures • Yawning, stuffy nose, and sneezing • Poor feeding and suck • Vomiting • Diarrhea • Dehydration • Sweating • Fever or unstable temperature

https://www.stanfordchildrens.org



11 % in Knox County



“In the United States, a baby is born dependent on opiates every 30 minutes. In Tennessee, the rate is three times the national average.” –NPR News

Prenatal Substance Exposure


NAS

Prenatal Substance Exposure


NAS

Adverse Childhood Experiences (ACEs)

Common Outcomes

• Mental Health Challenges: Mood Dysregulation and Anxiety

• Sensory Issues

• Lack of Executive Functioning/Self-Regulation Skills

Mental Health Challenges: Mood Dysregulation and Anxiety

Dissociative Behaviors • Defiance • Excessive Sleepiness • “Zoning Out”

Disruptive Behaviors • Meltdowns • Aggression • Inattention/Fidgeting

Somatic Complaints

School Refusal

Forgetfulness

Labile Mood

Sensory Issues Overly Sensitive to Touch, Noise, Smells, etc.

• Complains about tags in clothing, removes shoes at inappropriate times

• Acts out when classroom is loud or chaotic

• Withdraws from touch or closeness • Disruptive behavior during transitions

Seeks Sensory Input from the Environment

• Has difficult sitting still or keeping body in control

• Runs into people or objects • Touches things and people impulsively • Puts objects in mouth • Risky behavior

Lack of Executive Functioning/Self-Regulation Skills

Executive functioning is the cognitive ability to control and regulate ourselves in our day-to-day lives. • Ability to manage emotions and behaviors in

in accordance to the demands of the situation

• Ability to resist highly emotional reactions to upsetting stimuli

• Ability to self-soothe when distressed

• Ability to adjust to changes in expectations and handle frustrations appropriately

• Ability to, in age appropriate ways, direct behavior toward goals, despite the unpredictability of the world and our own feelings

Mya Age 11

Focus

Impulse Control

Flexibility &

Managing Emotions

7:45 a.m. Heads to the office to turn in permission slip, but is distracted by a group pf friends and ends up in the cafeteria. 8:15 a.m. Attempts to leave her classroom when she sees her math teacher is a sub, when called out, says, “I don’t like you, you aren’t the boss of me.” 10:20 a.m. Challenged by the science lesson, but does not tell the teacher. Stares at the wall and refuses all work. 11:45 a.m. Remembers something her grandfather told her and blurts out during instruction. When teacher does not respond, speaks even louder. 12:05 p.m. After getting in trouble for talking in class, complains of a stomachache and asks to go to the nurse’s office.

Managing Emotions

Mental Health Challenges: Mood Dysregulation and Anxiety

• Change our lens Don’t assume mal-intent Ask questions that reflect this

• Adults Must be Regulated

• Create Relationships

• Regulate and calm The cortex can’t be reached in distress Create a calm environment for dysregulated kids

Interventions

• Reflect and validate

• Collaborate Become part of the child’s “team” Refer when needed

Report from the Field: Mental Health Challenges

Interventions Sensory Issues

• Create Ample Opportunity for

Sensory Activities

• Remove Students from Sensory Overload

• Help Child Label Sensory Needs • Create Sensory Plans for Easily

Overwhelmed Children

• Collaborate

Report from the Field: Sensory Issues

Interventions

Lack of Executive Functioning

• Regulate, Regulate, Regulate Meeting a child’s needs is not a reward for poor behavior, it is a necessity for any behavioral change.

• Executive Functioning is Learned “When we practice executive functioning skills circuits rapidly connect the cortex to other parts of the brain, which helps us manage incoming information and respond with intention, not on impulse” -Harvard Center for the Developing Child

• Rhythm is Regulating Rocking chairs Swinging Music

• Calm Body, Calm Mind Time and space to cool down Regulating Activities

Cook’s Hookup promotes relaxation and focus.

1. Cross left ankle over right

ankle and left hand over right.

2. Settle into position and allow body to rest

3. Inhale, keeping tongue flat on the roof of the mouth. Exhale and relax tongue.

4. Close eyes or gaze downward, holding position for four to eight breaths.

Image from Everyday Bliss for Busy Women by Maryam Webster, M.Ed

Report from the Field: Executive Functioning

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