Competency VI: Treatment for Individuals with FASD through the lifespan We all must row with the oar we are given - old English proverb * FASD is the direct result of maternal consumption of alcohol during pregnancy * Core disabilities include: * Cognitive * Activity and attention * Processing * Learning and Memory * Organization * Abstraction * Adaptive * Social Interaction * FASD involves life-long disabilities * Management and care will change, according to the age and presenting disability/problem * Protective factors include: * Early diagnosis * Stable home environment * No exposure to violence * Early Intervention and services * Individuals with prenatal alcohol exposure will need to see various professionals throughout their lifetime. These include, but are not limited to: * Medical Professionals: * Developmental Pediatrician * Neurologist * Primary Care Physician * Immunologist * ENT * GI * Ophthalmologist * Endocrinologist * Psychiatrist * Nurse * Dentist > Allied Health Professionals * Audiologist * Speech Therapist * Nutritionist * Psychologist/Therapist * Social Worker * OT/PT * LDTC * Alternative therapies practitioners Medical treatment is individualized depending on presenting disability. **Be aware that traditional medicine may not be effective for individuals with alcohol exposure.** For ADHD, success has been found with: * Adderall XR * Concerta * Stratera * Ritalin LA * Dexedrine SSRI’s: * Zoloft * Prozac * Celexa * Wellbutrin * Lexapro * Paxil Sleep: * Melatonin * Ambien * Desyrel * Clonadine Therapeutic Intervention for Domains Problems with Executive Functioning: * Information processing * Storage retrieval Try: * Cognitive rehabilitation * Concrete learning experiences – REPEAT, REPEAT, REPEAT Problems with Neuromotor Functioning: * Motor and sensory domains * Feeding difficulties * ADHD Try: * Cue-based feeding * Regular schedules * Play activities * Sensory integration therapy * Regulation and relaxation strategies Problems with Speech and Language: * Processing and responding to incoming information * Superficial conversational fluency Try: * Language stimulation * Target speech production * Reduce competing auditory stimuli Problems with Social/ Emotional: * Attachment * Depression * Anxiety * Low self-esteem Try: * Therapy * Social skills group * Anger management * Frequent praise General Suggestions: * Thorough diagnostic work-up * Hands on learning * Always check that individual understands directions * Use computers * Short term consequences * Remove tags from clothing, if bothersome * Use literal language * Review and REPEAT * Limit plans and implementation * Multiple system/multi-level/modalities * Respite care * Address grief of individual and family * Family and sibling support Key components to any intervention: * STRUCTURE * REPETITION * CONSISTENCY * BREVITY * PERSISTENCE > Begin intervention early and continue across lifespan > Modify environment to best support child’s needs > Remember to use non-judgmental wording: a child “with FAS”, not “an FAS child” > FAS is a disability the person has, NOT what the person is INFANCY Interventions could include: * Parenting techniques and support groups * Feeding interventions * Medical management of immune problems * Early Intervention OTHER: * Minimize sensory input (low lights, soft music) * Alternate positions * Swaddle for calming * Consistent feeding/bed times * Small mini meals TODDLERS Interventions could include: * Parenting assistance –parent support groups * Sensory integration activities * Early intervention * Medical management OTHER: * Provide various motor skill opportunities * Playful exploration * Watch cues for sensory overload * Assist with transitions * Make safe play areas * Provide structure in daily routines PRESCHOOLERS Interventions could include: * Preschool Handicapped classes * Parent support and education * Medication monitoring * Sensory integration activities OTHER: * Extra supervision and time to complete tasks * Provide consistency * Gradual approach to learning new skills * Use of cues –visual, auditory, tactile * Establish consistent, simple rules * Daily routine * Encourage self-esteem SCHOOL AGE: Interventions could include: * Special education * Therapy –individual and/or family * Medical management * Peer counseling * Social skills training * Sex education * Nutrition * Alcohol and drug counseling * Parental assistance SCHOOL AGE (cont.) OTHER: * Develop rewards and discipline system * Use consistent, daily routines * LESS IS MORE – reduce sensory stimulation ADOLESCENTS Interventions could include: * Special education * Therapy * Social skills * Anger management * Family counseling * Parent support groups * Sex education/birth control * Alcohol and drug counseling * Probation assistance * Vocational rehabilitation ADOLESCENTS (cont.) OTHER: * Allow increased responsibility and decision making * Monitor friends * Focus on daily living skills * Maintain realistic expectations * Abilities are probably not at CA, but 2/3 CA * Think “stage” not age ADULTS Interventions could include: * Counseling: individual, family, drug and alcohol * Vocational rehabilitation * Anger management * Support groups * SSI/Disability * Sex education/birth control * Assisted living OTHER: * Many adults need 24/7 supervision and the services should be tailored to the adult’s individual needs and abilities * Encourage independence * An external brain is needed ALTERNATIVE THERAPIES * Many traditional therapies do not have long-term effects with individuals with prenatal alcohol exposure * Alternative therapies and medicines are being investigated for use with FAS * Before trying any, please consult your physician or psychologist Some therapies that have been successful include: * Biofeedback/neuro-feedback * Vitamins/herbal treatments * Recreational therapies * Relaxation therapy/visual imagery * Creative art and dance therapy * Yoga/exercise Always Remember * Lifespan assistance may be needed for many families * Assistance should include parenting, support groups, respite care and therapeutic interventions, which are culturally sensitive * Medical maintenance may be needed and will need to be adjusted as the individual matures * FASD is a lifelong birth defect; brain damage effects will continue through the lifespan * The range and severity of effects is very broad and interventions must be individualized * And finally….….