FASD Elephant (TM) Podcast

IHS 2009 National Behavioral Health Conference Hand-Outs-2

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 6 Aug 2009 00:45:00 GMT

Here is "Part Two," the power point presentation hand-out... I never give these out at a training, because studies have shown people remember more with a different kind of hand-out (in Part One), but I know people want the power point, too, so here it is.
MLH

IHS 2009 National Behavioral Health Conference Hand-Outs

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 6 Aug 2009 00:40:00 GMT

Hello all,
I am presenting two FASD trainings at the Indian Health Service's 2009 National Behavioral Health Conference next door to me in St. Paul, MN, tomorrow. I welcome those who attended, as well as those who are just interested. I'm publishing the hand-outs, though, because I don't know how many people will attend, and they might want to download a copy if they run out or if they want an extra copy. Enjoy, and I hope it goes well!

FASD Elephant (TM) #012a: Getting Back to Ready Hnd-out

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Sun, 12 Oct 2008 22:00:00 GMT

This is a supplementary hand-out that outlines all the information provided in Podcast #012 (FASD School Intervention: Getting Back to Ready). You may download this from the website, rss feed, or through your podcast player (e.g., iTunes).

Please feel free to make and distribute copies, but please do not alter it in any way. If you have questions or comments, then contact me at Michael_at_FASDElephant_dot_com.

FASD Elephant (TM) #012: FASD School Intervention: Getting Back to Ready

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Wed, 8 Oct 2008 22:00:00 GMT

Students with FASD sometimes have âmelt-downsâ in school. These melt-downs can baffle and anger teachers, staff, and parents, but they are simply the studentâs way of showing that they cannot cope with what is being asked of them or with what is going on at the moment.

When a melt-down begins, all goals should change to âgetting back to ready,â rather than trying to force compliance (which usually worsens the melt-down). Try the steps suggested in this podcast, and a free PDF hand-out comes with it in episode #012a.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) Re-Run: KTOO Interview with Morgan Fawcett, Flute Player

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 31 Jul 2008 13:00:00 GMT

Hello everyone,

It has been quite a while since the last podcast, but we are ramping up production and will have new ones soon.

In the meantime, here is a re-run podcast of an interview with Morgan Fawcett, a Native American flute player with FASD. You can now purchase his CDs from the internet, and I would really encourage you to do so and support his efforts in educating folks about FASD.

You may purchase his CDs at http://cdbaby.com/cd/morganfawcett and there is a terrific article about him here: http://www.nativefluteonline.com/sacredground/fawcett.html

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) Bonus Track 03: KTOO Interview with Morgan Fawcett, Flute Player

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Wed, 7 Nov 2007 17:00:00 GMT

Today's podcast is an interview conducted by KTOO of Juneau, Alaska (U.S.) with Morgan Fawcett. Morgan is a 15 year old Native flute player who also happens to have Fetal Alcohol Syndrome. He describes it this way, âWhen I play the flute, it lowers my blood pressure and eases stress away. With fetal alcohol spectrum disorder, you could be ADHD, but instead of being on Ritalin, I play the flute.â?

This seemed like a great way to introduce FASD interventions, since Morgan discovered this intervention for himself on his own. Morgan also writes flute songs and has a CD of his songs that he sells at concerts and gatherings. Unfortunately, I do not have an official way for people to contact Morgan or his grandparents to purchase a CD at this time, but I will post it as soon as I get it, because he donates half the proceeds to charities that support individuals with FASD. He is developing a website at www.nativefluteonline.com/one_heart/aboutme_borntoplay.html.

In the meantime, you can check him and his music out with this link to The World online news site for Oregon: http://www.theworldlink.com/multi_slide/morgan_music/

Because of my travel schedule with the U.S. holidays, this will be the only podcast for November. I will aim to have one in December, or perhaps send out a PDF update, but we'll get back on schedule for sure in January. I have an Occupational Therapist friend of mine lined up to talk about sensory interventions for FASD.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #011: The Secondary Disabilities of FASD

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 18 Oct 2007 02:00:00 GMT

People with FASD (including FAS) have both primary and secondary disabilities. Secondary disabilities are those disabilities that arise because of a mismatch between the brain damage and factors in the environment--they are not directly caused from the brain damage.

Streissguth, et al (1996) conducted a four year study on the secondary disabilities of 415 individuals with FASD and found six secondary disabilites:

Mental Health Problems - 90% of the 415 had mental health conditions of any type; 61% had ADHD and more than 50% had depression.
Disrupted School Experiences - Over 60% had disruptions in school... from suspensions to drop-out.
Trouble with the Law - 60% had trouble with the law, with shoplifting and theft the most common crime.
Confinement - 50% had been confined, either incarcerated, inpatient mental health hospitalization, or inpatient chemical dependency treatment.
Inappropriate Sexual Behavior - 49% had displayed inappropriate sexual behavior, most common was sexual advances, sexual touching, and promiscuity.
Alcohol and Drug Problems - 35% had chemical abuse problems.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #010: The Primary Disabilities of FASD

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 4 Oct 2007 01:10:00 GMT

People with FASD (including FAS) have both primary and secondary disabilities. Primary disabilities are those with which the person is born, such as seizures, sensory integration problems, etc. These are a direct result of the brain damage from prenatal alcohol exposure, and the topic of today's podcast.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) Special Article #002: Evaluation Preparation Checklist

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 27 Sep 2007 02:00:00 GMT

Sorry folks, but I have laryngitis this week. Tune in next Wednesday for the next installment of the FASD Elephant Podcast.

In the meantime, I found an interesting website from Germany that has an animated FAS Facial Feature program, in which you can manipulate the various FAS Facial Features and visually compare them to an unaffected face. The program also allows for other facial features that are sometimes common to FASD, but not diagnostic.

The website link is: http://www.fasworld.de/index.htm, and the main website (mostly in German) is http://www.fasworld.de (look for the "Baby Face Animation" link toward the bottom of the page).

Also, I am sending though a PDF File of the FASD Evaluation Checklist discussed in last week's podcast #009 (September 19, 2007).

FASD Elephant (TM) #009: Preparing for an FASD Evaluation

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 20 Sep 2007 02:31:00 GMT

Thinking about obtaining an FASD Evaluation? Today's podcast talks about how to prepare for one. These evaluations often have long waiting lists and take just as long to complete. Here is a guide on how you can prepare for an evaluation, make it as thorough as possible, and hopefully speed the process up a bit. More details at www.FASDElephant.com Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #008: The FASD Wheel (TM) - The Ten Brain Domains of FAS and FASD

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 13 Sep 2007 03:00:00 GMT

Today's podcast reviews the Ten Brain Domains of FAS and FASD in a little more depth; it is still an overview but gives more flesh to the domains in the context of completing an FASD Wheel.

This is the third of a multi-part series edited from a workshop on the FASD Wheel (TM) presented at the 2007 Brain Conference on the White Earth Indian Reservation in Mahnomen, MN... one of the largest annual conferences held in Minnesota.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #007: The FASD Wheel (TM) - Brain Functioning

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Sat, 8 Sep 2007 22:22:00 GMT

Today's podcast reviews brain functioning and how it can be affected by FASD.

This is the second of a multi-part series edited from a workshop on the FASD Wheel (TM) presented at the 2007 Brain Conference on the White Earth Indian Reservation in Mahnomen, MN... one of the largest annual conferences held in Minnesota.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #006: The FASD Wheel (TM) - Misattributions and Metaphors

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 6 Sep 2007 03:00:00 GMT

Today's podcast reviews useful metaphors and non-useful misattributions regarding FASD. This is the first of a multi-part series edited from a workshop on the FASD Wheel (TM) presented at the 2007 Brain Conference on the White Earth Indian Reservation in Mahnomen, MN... one of the largest annual conferences held in Minnesota. See www.FASDElephant.com for more details.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) Special Article #001: The Ten Brain Domains

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 30 Aug 2007 03:26:00 GMT

This week, I am sending the original article on the Ten Brain Domains from the Journal of FAS International for your review. The regular audio podcast will return next week.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #005: The Ten Brain Domains

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 23 Aug 2007 03:15:00 GMT

The Fetal Alcohol Diagnostic Program (FADP), in Duluth, MN, spearheaded by the Executive Director, Jeanette Lang, and her crack team, has developed the Ten Brain Domains, which provides clear definitions of brain dysfunction, specifies empirical data needed for accurate diagnosis, and defines intervention considerations that address the complex nature of FASD. The Ten Brain Domains include functional skills in the following areas:

Achievement,
Adaptive behavior,
Attention,
Cognition,
Executive functioning,
Language,
Memory,
Motor skills,
Sensory integration and soft neurological problems, and
Social communication.

These domains are reviewed in the podcast and will be further expanded upon in future podcasts.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #004: Other FASD Diagnoses

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Wed, 15 Aug 2007 16:00:00 GMT

Each key feature of FASD can vary widely across individuals exposed to prenatal alcohol. While consensus exists for the diagnosis of FAS across diagnostic systems (see last podcast), minor variations among the systems lead to differences in definitions and cut-off criteria for other diagnoses across the FASD continuum. The FASD conditions of Partial FAS (PFAS) and Alcohol-Related Neurodevelopmental Disorder (ARND) are reviewed today, as well as the University of Washington's 4-Digit Code designations of Static Encephalopathy and Neurobehavioral Disorder, which are essentially refinements of ARND.

Partial FAS (PFAS)

This diagnosis is easiest to explain and, in all practical purposes, the same as FAS. Central nervous system damage is present at the same level as FAS, and these individuals have the same functional disabilities but "look" less like FAS. Here are the criteria:

Moderate to severe FAS facial features are present (small eyes, flattened philtrum, thinned upper lip),
Central nervous system (CNS) damage is severe (either structural or neurological problems, or problems in three or more functional brain domains), and
Prenatal alcohol exposure is confirmed.

Alcohol-Related Neurodevelopmental Disorder (ARND)

This is where the diagnostics become muddy to the average layperson, so I want to keep it basic. For an ARND diagnosis, an individual must have confirmed prenatal alcohol exposure and evidence of clinically significant impairment in three or more of the following Ten Brain Domains: Achievement, Adaptive Behavior, Attention, Cognition/IQ, Communication/Language, Executive Functioning, Memory, Motor Skills, Sensory Integration/Soft Neurological Signs, and/or Social Communication. Growth deficiency and FAS facial features may be mild or nonexistent, and are irrelevant to the diagnosis.

Static Encephalopathy and Neurobehavioral Disorder

The 4-Digit Code separates ARND into "Static Encephalopathy," which literally means non-progressive brain damage, and "Neurobehavioral Disorder," which requires that only two Brain Domains are clinically impaired.

Additional Notes

The problem with FASD conditions is not about the facial features or growth deficiency. It is about the CNS damage that then creates functional problems in an individual's life. That is why the assessment of the Ten Brain Domains is so important and the most germain aspect to an FASD Evaluation: to find out how to help an individual function better.

Don't worry about getting caught up in the specifics all the diagnoses. Just know that if an individual had moderate to severe prenatal alcohol exposure AND has functional problems, then an FASD condition (disability) may be present.

This leads to another question that someone asked last week at a workshop I gave: "I had a few drinks before I knew I was pregnant, but stopped in the second month. My kid has terrific grades, but has low attention skills and poor social skills [Adaptive Behavior problems, from the Ten Brain Domains perspective].

Does this mean he has FASD?" No. While there is no recommended safe level of drinking alcohol while pregnant, this situation does not result in an automatic FASD diagnosis. The attention skills and behavior problems would have to be severe, and the most important thing is missing: A diagnostic team would need to be convinced that the problems were related to the alcohol exposure. Attention and social skills can be affected by so many factors in life (e.g., genetics, peer group, parenting style, etc.) that this are not diagnostic.

I would like to caution everyone not to "over-diagnose" just as much as I want to caution everyone to be knowledgeable about the potential negative effects of prenatal alcohol exposure.

Links discussed in the Show

Can be found at www.FASDElephant.com

Next week, we will review the Ten Brain Domains, which will start giving a better idea of what exactly CNS damage is. Until then....

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #003: The Fetal Alcohol Syndrome Diagnosis

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Wed, 8 Aug 2007 16:00:00 GMT

Any Fetal Alcohol Spectrum Disorder (FASD) is diagnosed by assessing the four key features that were first identified in Fetal Alcohol Syndrome (FAS) in 1973.

FAS requires a positive and severe finding in all four key features, but other FASD conditions may vary across a continuum of severity. FAS is the only expression of FASD that has garnered consensus among experts to become an official ICD-9 and ICD-10 diagnosis.

The four key features of FASD that are assessed with any diagnostic system include:

Growth Deficiency (height and/or weight)
FAS Facial Features (small eyes, flattened philtrum, thinned upper lip)
Central Nervous System (CNS) damage (either physical damage or functional problems)
Prenatal alcohol exposure level (confirmed, unknown, or no exposure)

The following criteria must be fully met for an FAS diagnosis:

Growth deficiency - Prenatal or postnatal height or weight (or both) at or below the 10th percentile at any point in life,
FAS facial features - All three FAS facial features present,
Central nervous system damage - Clinically significant structural, neurological, or functional impairment, and
Prenatal alcohol exposure - Confirmed or Unknown prenatal alcohol exposure.

Is FAS worse than other FASD conditions? No.

The fact is that other FASD conditions have more secondary disabilities.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #002: Fetal Alcohol Syndrome (FAS) History and Diagnostic Introduction

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 2 Aug 2007 03:30:00 GMT

History

The earliest known observation of possible links between maternal alcohol use and fetal damage may have been made in 1899 by Dr. William Sullivan, a Liverpool prison physician who noted higher rates of stillbirth for 120 alcoholic female prisoners than their sober female relatives and suggested the causal agent to be alcohol use (Sullivan, 1899).

This view contradicted the predominant theories of the day, which were that genetics caused mental retardation, poverty, and criminal behavior. A case study popular in the early 1900s by Henry H. Goddard involved the Kallikak family and shows the bias of the time period (Goddard, 1912), though later researchers conclude that the Kallikaks almost certainly had FAS (Karp, R.J., et al, 1995).

Fetal Alcohol Syndrome, or FAS, was named in 1973 by two dysmorphologists, Drs. Kenneth Lyons Jones and David W. Smith of the University of Washington Medical School in Seattle. They identified a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth deficiency and developmental delay" in eight unrelated children of three ethnic groups, all born to mothers who were alcoholics (Jones, K.L., et al, 1973).

While many syndromes are eponymous, or named after the physician first reporting the association of symptoms, Dr. Smith named FAS after alcohol, the causal agent of the symptoms. His reasoning for doing so was to promote prevention of FAS, believing that if people knew maternal alcohol consumption caused the syndrome, then abstinence during pregnancy would follow from patient education and public awareness. Nobody was aware of the full range of possible birth defects from FASD or its prevalence rate at that time, but admitting alcohol use during pregnancy can feel stigmatizing to birth mothers and complicate diagnostic efforts of a syndrome with its preventable cause in the name. Over time, the term FASD is coming to predominate.

Diagnostic Systems

Since the original syndrome of Fetal Alcohol Syndrome (FAS) was reported in 1973, four FASD diagnostic systems that diagnose FAS and other FASD conditions have been developed in North America:

The Institute of Medicine's guidelines for FAS, the first system to standardize diagnoses of individuals with prenatal alcohol exposure (Institute of Medicine (IOM), Stratton, K.R., Howe, C.J., & Battaglia, F.C. (1996). Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press.),
The University of Washington's "The 4-Digit Diagnostic Code," which ranks the four key features of FASD on a Likert scale of one to four and yields 256 descriptive codes that can be categorized into 22 distinct clinical categories, ranging from FAS to no findings,
The Centers for Disease Control's "Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis," which established general consensus on the diagnosis FAS in the U.S. but deferred addressing other FASD conditions, and
Canadian guidelines for FASD diagnosis, which established criteria for diagnosing FASD in Canada and harmonized most differences between the IOM and University of Washington's systems.

Each diagnostic system requires that a complete FASD evaluation include assessment of the four key features of FASD--prenatal alcohol exposure, FAS facial features, growth deficiency, and central nervous system damage. A positive finding on all four features is required for a diagnosis of FAS, the first diagnosable condition of FASD that was discovered. However, prenatal alcohol exposure and central nervous system damage are the critical elements of the spectrum of FASD, and a positive finding in these two features is sufficient for an FASD diagnosis that is not "full-blown FAS."

Diagnoses and diagnostic criteria will be described in detail in the next podcast.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

My Podcast Alley feed! {pca-6ab64b0bda8df39635beb79ecf0e0585}

FASD Elephant (TM) #001: Definitions and Terminology

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 26 Jul 2007 03:30:00 GMT

Today's episode covers the definiton of FASD and attempts to clear up the confusing terminology that has been used in the past.

Fetal Alcohol Spectrum Disorder (FASD) describes a continuum of permanent birth defects caused by maternal consumption of alcohol during pregnancy. Maternal alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damage neurons and brain structures, and/or cause other physical anomalies. While prenatal alcohol exposure does not automatically result in FASD, the U.S. Surgeon General advises pregnant women to abstain from alcohol use due to the risk of FASD.

The main effect of FASD is permanent central nervous system damage, in which developing brain cells and structures have been capriciously garbled, malformed, or underdeveloped by prenatal alcohol exposure. The risk of brain damage exists during each trimester, since the fetal brain develops throughout the entire pregnancy. Fetal alcohol exposure is regarded by researchers as the leading known cause of mental retardation in the Western world. In the United States alone, it is estimated that every year up to 40,000 infants are born with some form of FASD. The lifetime medical and social costs of each child are estimated to be as high as US$800,000 across the lifespan.

The term Fetal Alcohol Spectrum Disorder is not in itself a clinical diagnosis but describes the full range of disabilities that may result from prenatal alcohol exposure. Currently, Fetal Alcohol Syndrome (FAS) is the only expression of prenatal alcohol exposure that is defined by the International Statistical Classification of Diseases and Related Health Problems and assigned ICD-9 and ICD-10 diagnoses.

There are a number of other subtypes based on partial expressions of FAS, including Partial Fetal Alcohol Syndrome (PFAS), Alcohol-Related Neurodevelopmental Disorder (ARND), Alcohol-Related Birth Defects (ARBD), and Fetal Alcohol Effect (FAE). The latter two terms (ARBD and FAE) are not in general use today due to definitional vagueness.

There are four components to an FASD evaluation and diagnosis:

Growth deficiency (low height and/or weight, at birth or any point in lifetime)
FAS facial features (small eyes, smooth philtrum [groove between the nose and upper lip], flattened upper lip)
Central nervous system damage (there will be at least a couple podcasts just on this topic)
Prenatal alcohol exposure (drinking while pregnant)

Diagnostics will be covered in the next podcast.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) Bonus Track 02: KDWA Interview - Part 2

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Thu, 19 Jul 2007 01:51:00 GMT

This is a beginner's bonus track - the second half of an interview conducted on-air by KDWA on December 5, 2007, with myself and Alice Garceau, an adoptive mother of an FASD child. It was a good interview, and we continued with many FASD topics. If you haven't heard part one, go ahead and download it first. Next week, we will cover an overview of FASD, definitions, and the basics of terminology.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) Bonus Track 01: KDWA Interview (12-05-2007)

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Sat, 14 Jul 2007 20:01:00 GMT

This is an introductory bonus track - the first half of an interview conducted on-air by KDWA on December 5, 2007, with myself and Alice Garceau, an adoptive mother of an FASD child, and myself. Alice has been active in the FASD community for several years, runs a support group in the southern Twin Cities area, has been involved in several education videos and such about FASD (maybe we can post some at a later date), and has a lot of experience working with FASD. She was really a great person to meet.

It was a good interview, and we covered many topics concerning FASD. Next week, the second half will be released. Be sure to visit our friends at KDWA, at www.kdwa.com.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

FASD Elephant (TM) #000: Introduction to the Podcast

Michael@FASDElephant.com (Michael L. Harris, M.A., L.P.) — Wed, 4 Jul 2007 22:15:00 GMT

This is the introductory podcast about Fetal Alcohol Spectrum Disorders (frequently called by its acronym, FASD) and introduces the metaphor of the FASD Elephant^(TM), a new way to think about this complicated disability, which results in permanent brain damage to a fetus when drinking alcohol during pregnancy. In this episode, Michael Harris, (a licensed psychologist and now, a podcaster) introduces himself, gives a brief history of his clinical assessment and treatment experiences with FASD, and shares the story of the FASD Elephant^TM.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

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