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The FASD Umbrella

Did you realize that even one drink of alcohol could harm an unborn child? This damage typically involves the brain, which develops throughout the full nine months of gestation. In general, the more prenatal exposure to alcohol, the more damage to the developing brain within the fetus. However, we also know that even small amounts of alcohol on a regular basis or occasional binge drinking during pregnancy can affect brain development and related cognitive-behavioral functioning.

Thus, mothers who drink only in the first weeks of pregnancy before they learn they are pregnant may expose their unborn children to the damaging effects of alcohol just like mothers who binge-drink and/or drink regularly throughout pregnancy. Some drugs can cause cognitive-behavioral dysfunction as well (e.g., cocaine). The resulting conditions are classified as fetal alcohol syndrome disorders. FASD is the leading cause of mental retardation. However, most individuals with FASD have typical intelligence, They just don't always have the ability to use the intelligence they have.

Unfortunately, there are very few specialists in the United States who are trained to diagnose and treat these conditions because education about FASD is not part of the standard curriculum in any medical school or graduate psychology program. FASD is a set of physical and mental birth defects that results when a mother drinks alcohol during her pregnancy. When a pregnant woman drinks any alcohol, such as beer, wine, or mixed drinks, so does her baby. The baby eats and drinks what the mother does, so it is imperative that the mother maintain a healthy regimen as much as possible. Alcohol passes through the placenta right into the developing baby. The baby may suffer lifelong damage as a result.

FASD is characterized by brain damage, facial deformities, and growth deficits. Heart, liver, and kidney defects are also common, as are vision and hearing problems. Individuals with FASD have difficulties with learning, attention, memory, and problem solving. FASD is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications.

A baby with FASD may be born with a small head and identifiable facial features. He or she may have abnormalities or deformities of the limbs, hands or feet. Heart, liver and kidney problems are common, as well as vision and hearing problems. Children with FASD may experience slow growth and coordination. They may have difficulty staying focused, recognizing and understanding patterns, predicting "common sense" outcomes or mastering math and reading. Children do not "outgrow" FASD and its serious consequences. They become adolescents and adults who may have difficulties with learning, attention, memory and problem solving.

FASD has lifelong implications. There are a broad range of characteristics to watch for at different ages. Infants may experience low birth weight, irritability, sensitivity to light, noises and touch, poor sucking abilities essential in nursing and bottle feeding, slow development, poor sleep-wake cycles; and increased ear infections. Toddlers impacted with FASD may exhibit poor memory capability, hyperactivity, lack of fear and extreme risk-taking behaviors, no sense of boundaries and a need for excessive physical contact.

When a child first enters school, parents and teachers may notice in the child a short attention span, poor coordination and difficulty with both fine and gross motor skills. In third through seventh grades, there may be signs of trouble keeping up with school, low self-esteem from recognizing they are different from their peers and trouble with socialization. Teenagers will show poor impulse control, may have trouble distinguishing between public and private behaviors, and must be consistently reminded of concepts on a daily basis.

Do children outgrow FASD? Unfortunately, no. Children who grow into adulthood with FASD will need to deal with many daily obstacles, such as affordable and appropriate housing, transportation, employment and learning personal money handling. In order to ensure a child affected by FASD is off on the right foot in life, establish a relationship with a pediatrician and consult him or her with any problems or questions.

An infant may need soft music and singing to help soothe them. Rocking, frequent holding, low lights, automatic swings and wrapping them snugly in a soft blanket also can be helpful for irritability and close contact needs. Consult a nutritionist to develop a food plan or discuss supplement use for babies with low birth weight or prematurity. Speak to a specialist about evaluating a child's hearing and effectively treating infections since ear infections may become more frequent.

See an occupational therapist for assistance in helping an infant or toddler with rolling over, crawling and walking development. Also be ready as a parent to help a baby in crawling, grabbing and pulling to develop coordination, strength and balance. A speech therapist will be essential to consult for speech delays. Consult audio media, toys and other tools for children experiencing speech delays, as well as speak and read aloud with lots of expression to stimulate the baby’s speech and hearing development.

Toddlers may experience continued motor skill delays, so work with an occupational or physical therapist. Use toys that focus on manipulating joints and muscles. If the toddler is distracted easily, establish a routine and use simple structure. Simplify rooms in the home and reduce noises or other stimulation so the toddler doesn’t become too frustrated or overly stimulated. Dental problems are possible so, consult a pediatric dentist. The child impacted with FASD may not be able to sit still, so be sure to prepare the child for the exam and allow more time for the appointment.

Small appetites or sensitivity to food texture are common in FASD. Serve small portions that are lukewarm or cool and have some texture. Allow plenty of time during meals and decrease distractions such as television, radio or multiple conversations.

As school age draws near, if your child cannot sleep at night, shorten naps or cut them out completely so the child can sleep all night and get up in time with a good amount of rest, a good breakfast and time to get ready. To encourage socialization and making friends, consider pairing the child with another who is one or two years younger. Provide activities that are short and fun for everyone involved and accentuate the child with FASD’s strong points, but still challenges them.

Boundaries are important for the child and teenager with FASD, so create a stable, structured home with clear routines and plenty of repetition. Medication may be helpful and necessary for attention problems. Seek a doctor’s advice. Keep the child's environment as simple as possible, and structure time with brief activities.

If the child is easily frustrated and prone to tantrums and outbursts, remove the child from the situation and use calming techniques such as sitting in a rocker, giving a warm bath or playing quiet music. Repetition will help teach essential cause and effect lessons, consistency and clear consequences for behavior are important as well.

Anxiety and depression may be prevalent in adolescence. Medication may be helpful, as well as counseling or encouraging the teen to participate in sports, clubs or other structured activities like music or art lessons. Monitor the activities of the child and discuss dealing with strangers since boundaries and internal alarm development may be difficult. Lying, stealing or antisocial behavior can be dealt with in family counseling if it occurs, as well as setting simple and consistent rules with immediate consequences.

In adulthood, finding appropriate housing for adults affected by FASD is extremely challenging. Contact the appropriate state department of disabilities to pursue appropriate residential services and get on every waiting list possible that offers housing options. Encourage an adult with FASD to get involved in classes or social clubs for adults with disabilities.

Peer connections are crucial to dealing and meeting challenges. Provide as much structure as possible with a bit of room for growth, steady routine and plenty of activities. Investigate medication options and counseling, and keep updated as reactions to medications, counseling and routines change.

Many adults with FASD, but not all, will need help in handling financial matters. Work closely with the adult so personal dignity and responsibility can be learned, but not become too overwhelming. In terms of higher education and employment, trade schools, job training programs or job coaches may be needed. Be sure to select jobs that offer structured, routine activities that won't cause overload or stress, as well as accentuate what the individual likes doing and excels at.

The main things to remember are acceptance, patience and structure. Be firm when boundaries are broken. Be patient and inform the child or adult in advance if a routine in their life is about to change due to travel, work, etc. Accept that an individual of any age with FASD is a person first, entitled to grow and develop the best way they know how and to support that development well into adulthood so they become the best well-rounded individuals in the community as possible. Flexible expectations for the future are key.

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