Fetal Alcohol Syndrome

¶ … Fetal Alcohol Syndrome Special Education About the Child Pietro is a 7-year-old boy. His biological parents are Argentine and Colombian. He was born approximately six weeks prematurely because of his mother's consumption of alcohol throughout the duration of her pregnancy. According to medical reports, his mother did not consume heavy quantities of alcohol, but she did consume nominal amounts on a regular basis, such as one to three times a week, nearly every week. Pietro's parents put him up for adoption when he was approximately 1-year-old.

He was brought to a Catholic orphanage outside of Buenos Aires. There were visiting child development specialists from the United Kingdom and the United States performing work at the charity, and it is under their care where Pietro was first formally diagnosed with FAS. Pietro was subsequently adopted by a Puerto Rican and Argentine family residing in New York City, NY. His adoptive family consists of a mother, father, and older sister, Tamara, who is 11 years old. The whole family lives together in the same home.

Both of the parents work, but because of the nature of their professions, they are able to work from home on a part time basis as well as work in the field on a part time basis. Tamara attends a normative middle school. The family also has a network of immediate family, extended family, neighbors, colleagues, and friends. Compared to other children his age, Pietro does not have as much language or social skills as his peers. Activities that require many steps or an extended procedure upset Pietro.

He may cry, throw objects, or hide inside or underneath objects to cry or be quiet. Sometimes he will stop talking, go limp, and become extremely unresponsive. He expresses desire for friends verbally to his teachers, specialists, and family, but often works and plays alone. Pietro can talk, but has limited vocabulary. He occasionally repeats himself and may use the same word to substitute for other words that do not have the same meaning.

His handwriting is not as clear as his normative peers, but he enjoys drawing and shows some skill in the arts. Pietro often requires one on one attention or assistance from his teachers and other support staff. Most of his sessions with his specialists/therapists are one on one. He does have both individual and group counseling with his social worker during school hours. Pietro remembers living in South America, but only vaguely.

He knows he was not born in the United States and he understands the difference between his biological family and his adoptive family. Because of this awareness, Pietro demonstrates keen interest in geography. His favorite subject in school is Social Studies. His experience and interests also explain his desire for friends. He wants to socialize with children his age. He plays with his sister at home and occasionally is able to play with her while she has a friend(s) over for a playdate.

Pietro learns much of how to be a friend and how to be a kid from Tamara. Pietro demonstrates interest and skill in other school subjects. Compared to his normative peers, he processes information more slowly and needs additional prompting for information retention. When there are pictures to accompany the text, or if Pietro is allowed to illustrate instructional content, he is much more likely to recall the content. Pietro sees a physical therapist, occupational therapist, speech pathologist and social worker as prescribed in his IEP.

He is physically smaller and less physically developed than his normative counterparts. Over the course of the school year, Pietro has improved in terms of grip (holding objects including writing instruments), muscle endurance (he helps carry and pass out lunches to other students during lunch time), and finer dexterity (as evidence by his improvement in the arts and his ability to play his PSP). Pietro learns best with a combination of styles. He is a visual, kinesthetic, and experiential learning. Auditory is minimally to moderately effective alone for Pietro.

In conjunction with a visual aid or physical activity, his retention and learning increase. Pietro is moderately adaptable. When changes to his routine are introduced to him in advance by people that he likes or trusts, the transition is more smooth for him. He needs constant reminders and sometimes his teachers & specialists use a special calendar for Pietro to help him remember. He constructed the calendar with the help of his sister and parents.

There are stickers and pictures that he can place on the calendar as visual reminders of an upcoming change in his life. The calendar stimulates his creative interests/abilities as well as promotes development in executive functioning. Pietro's parents are very informed about his medical and personal history. They stay in regular contact with Pietro's teachers and therapists. They schedule regular appointments with health care professionals such as physicians, dentists, optometrists, as well as submit Pietro for bi-annual psychological evaluations. It is clear he lives in a loving home.

His parents are occasionally frustrated by Pietro's mental limitations that cause him to have social problems because he is a very friendly and loving boy that has difficulty maintaining friendships. This is an issue they work on in school, in therapy, and at home. His parents are also a part of actual and virtual support groups for parents with children with FAS. As Pietro approaches turning 8 years old, his parents, therapists, and teacher hope to improve his memory, his speech, and his socialization.

Lesson Plan for Pietro -- Social Studies Objective -- provide instruction about the Americas; students will be able to identify at least 3 different countries throughout the Americas on a map; students will categorize facts about a country; students will share something they learned or something that attracts them to a particular country in the Americas.

Materials -- atlases, large world map, pictures of countries on printer sized paper; pencils, crayons, colored pencils, markers, blank paper; computer and Internet Procedure -- Provide a brief introduction to the lesson about the geography of the Americas. Show a short documentary found online about the Americas, shown with English subtitles. After the film, verbally recapitulated the film. Ask students basic recall questions to demonstrate information retention and to share opinions. Students are already sitting in groups of 2-4 students.

Assign a teacher or assistant teacher to each group of students as they perform the exercise. Allow for independent work, but also encourage interdependence when one child is excelling or behind the rest of the group. Before presenting to the class, students will practice sharing their work to each other in their small groups. Class will come back together when most students are done or close to completion. Teacher will call on just a few students to share with the class.

About the Disease Fetal Alcohol Syndrome (FAS) refers to the range of growth, mental, physical, and other problems that manifest in infants when a mother consumes alcohol during any point during her pregnancy. There are distinct patterns of mental and physical defects that developed in the fetuses with higher levels of alcohol consumption (of the mother) during gestation.

Though in some countries such as the United States of America, there exist health care professionals that advise women that a minimal amount of alcohol such as wine is permissible during certain stages of pregnancy, bodies such as the Surgeon General of the U.S.A., the U.S. National Library of Medicine, the Mayo Clinic, and the Centers for Disease Control and Prevention (CDC), wholly recommend that pregnant women should not consume any amount of alcohol during any point of her pregnancy.

FAS is a 100% preventable disease and does not occur in women who refrain from alcohol consumption. Everything that a mother consumes passes along to her fetus through the placenta, including alcohol. FAS can result in stunted fetal development and lower birth weight. Children with FAS have essentially suffered brain damage while in utero. Their damaged neurons and other brain injuries have a range of results including psychological instability, behavior problems, facial disfigurations, and other forms of physical deterioration.

Concern over the deleterious effects of alcohol on the developing fetus can be traced back to the time of Aristotle, who observed that drunken women often bore children who were feebleminded (Warner & Rosett, 1975). Although this observation has been rediscovered several times hence, most notably during England's gin epidemic of the 18th century (Warner & Rosett, 1975), it was not until the early 1970s that the relationship between prenatal exposure to alcohol and birth defects drew serious scientific and medical attention.

(Abel, FAS, 1980 Just as in adults who consume alcohol, FAS affects the central nervous system of the fetus. A critical difference, which may be obvious but nonetheless important, is that the difference between the damage alcohol produces on the nervous system of an adult and a fetus is that the likelihood of permanent damage increases exponentially and the damage is done is far less time for the fetus.

Brain damage in the fetus affects aspects of cognitive functioning such as memory, attention, impulse control, and a predisposition for drug addiction, such as in the case of babies born to mothers who abuse crack cocaine and crystal meth. The alcohol essentially malforms brain cells and/or hinders the full development. FAS is one of the leading causes of retardation in western societies: Mental retardation is a cardinal feature of FAS and is now recognized as the leading known cause of mental retardation in the Western world.

Conservatively estimated for the United States, the economic cost associated with FAS-related growth retardation, surgical repair of organic anomalies (e.g. cleft palate, Tetralogy of Fallot), treatment of sensorineural problems, and mental retardation, is $321 million per year. FAS-related mental retardation alone may account for as much as 11% of the annual cost for all mentally retarded institutionalized residents in the United States. Current treatment costs for FAS-related problems are about 100 times federal funding for FAS research necessary to develop cost-effective early identification and prevention strategies.

(Abel and Sokol, Incidence of FAS, 1987) Some babies with FAS do not live long enough to mature to full term. Consumption of alcohol during pregnancy surely leads to FAS to some degree if the baby is born; FAS can also cause miscarriage and stillbirth. Other signs of FAS in babies include small head size, poor coordination, below average height, speech & language delays, vision & hearing problems, as well as health problems associated with the heart, kidney, and/or bones.

Most of the tests to determine the presence of FAS are performed by physicians after the child's birth, although there are a few tests that can be done while the child is in utero. The blood alcohol levels of the pregnant mother can be tested during pregnancy. This is one test that can assist in the diagnosis of FAS. Physicians can additionally perform brain imaging scans such as a CT scan or an MRI after the baby is born as a way to see if the child has FAS.

Physicians often also check for signs of a heart murmur or other abnormalities of the heart during pregnancy with use of an ultrasound for example, and subsequent examinations after the baby is born. Doctors tests for deficiencies in areas such as vision, hearing, motor control/skills, and cognitive development, among other factors, after the baby is born. To rule out the possibility of other disorders, particularly on the genetic level, doctors may also refer the family to a geneticist for solid confirmation of FAS.

There are several criteria by which medical facilities assess and formally diagnose FAS. The child must show signs of deficiencies in physical growth. The child must also show signs of facial abnormalities or deformities associated with FAS. There must be damage to the central nervous system present in the child. Finally, there must be evidence of prenatal exposure to alcohol. Consumption of alcohol during pregnancy is the only cause of FAS. This is why it is 100% preventable with some discipline, self-control, and selflessness.

When the child shows definitive signs of all four criteria, the child is formally diagnosed with Fetal Alcohol Syndrome. The physical, psychological, and social effects will come at a great cost, economically and otherwise, and the effects of FAS persist over the course the child's lifetime. The only cure for FAS is prevention, which strictly means no alcohol during pregnancy. It really is as straight forward and simple as that. Once the child has FAS, there is no cure for it.

The child will always have FAS and carry the effects of the disease with him/her throughout life. There are, however, several kinds of interventions and other forms of treatment that can assist children and families with living with FAS. Because FAS affects areas of cognition such as attention, hyperactivity, and memory, medical interventions associated with disorders such as Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are often used for children diagnosed with FAS. These medical interventions include the use of pharmaceuticals.

Behavioral interventions for children with FAS are nearly always necessary, while the degree of the interventions vary on an individual basis. These behavioral interventions often call upon learning theory as well as behavior modification and education that is outcome-based. Similar interventions are performed for children who have ADD, ADHD, Autism, and Asberger's. There is further overlap for these interventions for children who have Oppositional Defiance Disorder (ODD) and Reactive Attachment Disorder (RAD).

Therefore, there are many precedents available for healthcare professionals, education professionals, and parents to call upon for assistance in caring for children with FAS. Besides not consuming alcohol to prevent FAS, the best treatment for FAS is early intervention. The earlier FAS is detected, the earlier interventions and treatment can begin. This increases the child's chances for a more normative development, though again, FAS persists throughout life.

If interventions commence sometime between birth and three years, the child's chances for health increase a great deal than if caught and diagnosed at later stages of development. As soon as possible the child and the child's family need to be involved with special education services as well as social services. There is an array of programs available at the local, state, and national levels for children and families with disorders such as FAS.

Interventions for FAS include involvement in these services and activities, which may include support groups for the family members. Just as any other child, children with FAS need stable loving home environments. These kinds of homes and families are ideal for every child, but especially children who are more dependent and less resilient, such as kids with FAS. Stability and maturity are factors in parents that affect the health and success of their child directly.

The presence of violence in the home is additionally a factor that contributes to the health of any child, but perhaps more so with children who have FAS. Violence is often accompanied by substance abuse, which with the presence of FAS, is more likely to take the form of alcoholism. Children with FAS who grow up in violent homes with the additional presence of substance abuse have significantly higher threats to their health. Physical violence will only weaken their already weakened or malformed physical state.

Psychological abuse will exacerbate the psychological and emotional problems with which the child was born. Children with FAS who grow up in unstable homes are more likely to be violent teens and adults; they will be more likely to have inappropriate sexual behaviors; they will commit criminal acts resulting in legal troubles; they do not develop substantial adaptive behaviors; and they have extreme difficulty forming health emotional attachments, as more than 80% of children or people with FAS are not raised by their biological parents.

(Streissguth et al., Risk Factors, 2004) Furthermore, alcohol abuse in the child's home increases the chances that the child will abuse alcohol and suffer further retardation and damage to the central nervous system. The presence of alcohol in the home of a child with FAS also increases the likelihood of the presence or emergence of secondary or even tertiary disorders, some of which have been described in moderate detail earlier in this report.

The child is more likely to abuse alcohol, become violent, become criminal, and recreate similar circumstances into which they were born and raised. These are just some of the numerous reasons why prevention and interventions are crucial to the treatment of FAS. Health care professionals may prescribe drugs as part of the medical treatment of FAS and related disorders.

Though the specific drugs and dosages will vary on a case by case basis, because there are similar traits of FAS, the categories of drugs prescribed to people with FAS are confined to mostly stimulants, anitdepressants, neuroleptics, and drugs that target and combat anxiety. A variety of medical specialists are a part of the lives of children with FAS. Some specialists children may encounter within a special education program are a physical therapist, occupational therapist, speech-language pathologist, and a social worker or counselor.

In addition to the child's primary care provider, as a direct consequence of the child's FAS, he/she may also have a plastic surgeon, geneticist, nutritionist, audiologist, opthalmologist, and psychiatrist as part of their team of health care professionals outside of school and the home. Alternative forms of therapy have also proven effective in conjunction with and in some cases instead of normative treatment. Such alternatives include auditory training, art therapy, animal-assisted therapy, and eastern practices such as acupuncture, reiki, yoga, and meditation.

Behavior and education therapies have proven scientifically effective for children with FAS. There is a therapy called friendship training. This therapy is partially socialization treatment. Children with FAS and particularly adolescents with FAS have severe troubles developing and maintaining healthy peer relationships. This therapy provides instruction for interaction, conversation, socialization inside and outside of the home, and playdates. Friendship for everyone is.