Fetal Alcohol Syndrome: Special Education Case Study & Lesson Plan

About the Child: Pietro's Profile and Learning Needs

Pietro is a 7-year-old boy whose 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 — roughly one to three times a week, nearly every week. Pietro's parents put him up for adoption when he was approximately one year old. He was brought to a Catholic orphanage outside of Buenos Aires, where visiting child development specialists from the United Kingdom and the United States were performing charitable work. It was under their care that Pietro was first formally diagnosed with Fetal Alcohol Syndrome (FAS).

Pietro was subsequently adopted by a Puerto Rican and Argentine family residing in New York City. His adoptive family consists of a mother, father, and older sister named Tamara, who is 11 years old. The whole family lives together in the same home. Both parents work, but the nature of their professions allows them to work from home part time as well as in the field part time. 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 skill development as his peers. Activities that require many steps or an extended procedure upset him. 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 a desire for friends verbally to his teachers, specialists, and family, but often works and plays alone. Pietro can talk but has a limited vocabulary. He occasionally repeats himself and may use the same word as a substitute for other words that do not share the same meaning. His handwriting is not as clear as that of 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 specialists and therapists are individual. He also participates in 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 a keen interest in geography. His favorite subject in school is Social Studies. His experiences and interests also explain his desire for friends — he wants to socialize with children his own age. He plays with his sister at home and occasionally joins her when she has friends over for a playdate. Pietro learns much of how to be a friend and how to be a kid from Tamara. He also 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 pictures accompany text, or when Pietro is allowed to illustrate instructional content, he is much more likely to recall the material.

Pietro sees a physical therapist, occupational therapist, speech-language pathologist, and social worker as prescribed in his Individualized Education Plan (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 lunchtime), and finer dexterity, as evidenced 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 learner. Auditory instruction alone is minimally to moderately effective for Pietro; when combined with a visual aid or physical activity, his retention and learning increase. Pietro is moderately adaptable. When changes to his routine are introduced in advance by people he likes or trusts, the transition is smoother. He needs constant reminders, and his teachers and specialists sometimes use a special calendar to help him remember upcoming events. He constructed the calendar with the help of his sister and parents. It features stickers and pictures that he can place on it as visual reminders of an upcoming change. The calendar stimulates his creative interests and abilities while also promoting development in executive functioning.

Pietro's parents are very well informed about his medical and personal history. They stay in regular contact with his teachers and therapists and schedule regular appointments with physicians, dentists, optometrists, and submit Pietro for biannual psychological evaluations. It is clear he lives in a loving home. His parents are occasionally frustrated by Pietro's limitations that cause social difficulties, because he is a very friendly and loving boy who struggles to maintain friendships. This is an issue they address in school, in therapy, and at home. His parents also participate in actual and virtual support groups for parents of children with FAS. As Pietro approaches his eighth birthday, his parents, therapists, and teacher hope to improve his memory, his speech, and his socialization.

Social Studies Lesson Plan for Pietro

Objective: Provide instruction about the Americas. Students will be able to identify at least three different countries throughout the Americas on a map, categorize facts about a country, and share something they learned or something that attracts them to a particular country in the Americas.

Materials: Atlases, large world map, pictures of countries printed on standard paper; pencils, crayons, colored pencils, markers, blank paper; computer and Internet access.

Procedure: Provide a brief introduction to the lesson about the geography of the Americas. Show a short documentary found online about the Americas, with English subtitles. After the film, verbally recapitulate its content. Ask students basic recall questions to assess information retention and to invite them to share opinions. Students are already seated in groups of two to four. Assign a teacher or assistant teacher to each group as they perform the exercise. Allow for independent work while also encouraging interdependence when one child is excelling or falling behind the rest of the group. Before presenting to the class, students will practice sharing their work with each other within their small groups. The class will reconvene when most students are done or near completion. The teacher will call on just a few students to share with the class.

Understanding Fetal Alcohol Syndrome

Fetal Alcohol Syndrome (FAS) refers to the range of growth, mental, physical, and other problems that manifest in infants when a mother consumes alcohol at any point during her pregnancy. There are distinct patterns of mental and physical defects that develop in fetuses exposed to higher levels of alcohol consumption during gestation. Though some health care professionals in countries such as the United States have suggested that minimal amounts of alcohol — such as a glass of wine — may be permissible during certain stages of pregnancy, bodies such as the U.S. Surgeon General, 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 at any point during pregnancy. FAS is a 100% preventable condition and does not occur in women who refrain from consuming alcohol.

Everything a mother consumes passes 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 produce a range of outcomes including psychological instability, behavior problems, facial abnormalities, and other forms of physical deterioration.

Concern over the harmful effects of alcohol on the developing fetus can be traced as far back as the time of Aristotle, who observed that drunken women often bore children who were feebleminded (Warner & Rosett, 1975). Although this observation was rediscovered several times over the centuries — 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 alcohol exposure and birth defects drew serious scientific and medical attention (Abel, 1980).

Just as alcohol affects the central nervous system in adults, FAS affects the central nervous system of the fetus. A critical difference is that the likelihood of permanent damage increases exponentially in the fetus, and the damage occurs in far less time than it would in an adult. Brain damage in the fetus affects cognitive functioning in areas such as memory, attention, and impulse control, and creates a predisposition for substance addiction. The alcohol essentially malforms brain cells and/or hinders their full development. FAS is one of the leading causes of intellectual disability 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 the federal funding for FAS research necessary to develop cost-effective early identification and prevention strategies." (Abel & Sokol, 1987)

Some babies with FAS do not survive long enough to reach full term. Maternal alcohol consumption during pregnancy can cause FAS in any baby who is born; it can also cause miscarriage and stillbirth. Other signs of FAS in infants include small head size, poor coordination, below-average height, speech and language delays, vision and hearing problems, and health problems associated with the heart, kidneys, and/or bones.

Conclusion: Prevention, Education, and the Path Forward

Parents do not often have intimate knowledge of a disease unless they have personal experience with it or their profession or studies bring them into contact with relevant information. Therefore, parents need education on FAS just as much as children need treatment. When parents are informed and well supported, children have greater chances of health and success.

FAS also increases the likelihood of related mental, psychological, emotional, and behavioral disorders. Families caring for children with FAS should become more literate in these satellite disorders, as it is very likely that their child will have at least one additional disorder requiring its own treatment or intervention. Children with FAS, as well as children with related disorders, fall under Special Education, and their medical and psychological histories — along with prescribed treatments and interventions — would be documented in the child's Individualized Education Plan (IEP).

There are also psychological and neurological interventions available for children with FAS. Psychological interventions may include counseling, group and individual therapy, and advocacy or mediation. The neurological approach to FAS intervention advocates trying non-normative or otherwise innovative techniques. This perspective developed because of the permeating nature of FAS — sometimes a condition is so difficult to treat that the only way to make meaningful progress in care is to examine the disease and the patient from a different angle, or to use methods not normally applied to that specific disorder. Prevention, education, early intervention, and a stable home environment together represent the strongest foundation for improving outcomes for children living with Fetal Alcohol Syndrome.

References

Abel, E. L. (1980). Fetal alcohol syndrome: Behavior teratology. Psychological Bulletin, 87(1), 29–50.

Abel, E. L., & Sokol, R. J. (1987). Incidence of fetal alcohol syndrome and economic impact of FAS-related anomalies. Drug and Alcohol Dependence, 19, 51–70.

British Columbia Ministry for Children and Families. (1999). Parenting children affected by fetal alcohol syndrome: A guide for daily living. The Society of Special Needs Adoptive Parents, British Columbia.

Fast, D. K., Conry, J., & Loock, C. A. (1999). Identifying fetal alcohol syndrome among youth in the criminal justice system. Developmental and Behavioral Pediatrics, 20(5), 1–3.

Mattson, S. N., & Riley, E. P. (1998). A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical and Experimental Research, 22(2), 279–294.

Streissguth, A. P., Bookstein, F. L., Barr, H. M., Sampson, P. D., O'Malley, K., & Young, J. K. (2004). Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics, 25(4), 1–11.