FETAL ALCOHOL SPECTRUM DISORDER:
Review of “Instructional Tips: Supporting the Educational Needs of Students with Fetal Alcohol Spectrum Disorders” by Susan Marie Ryan. The journal article was published in Teaching Exceptional Children Plus.
The purpose of this article is to equip in-class teachers with the knowledge to “meet the learning, behavioral, and social needs” of students who have FASD. The article resulted from a 4-year study that involved interviews and observations of 25 teachers in Alaska who had students with FASD.
Introduction:
The article begins with a brief introduction about the available research and statistics:
• Fetal Alcohol Syndrome (FAS) was first proposed in 1968.
• The article focuses on Fetal Alcohol Spectrum Disorder FASD which is an umbrella term which encompasses 4 related diagnoses, including FAS
• Since 1968 there has been a progress in number of reported cases of FASD- in the USA, 10 of 1000 children are diagnosed with FASD annually.
I included this table from the article because I thought it did an excellent job of concisely explaining FASD students:
The article then proceeds to provide 8 “Instructional Tips:”
1. Think Person/Child First:
The author recommends that the individual must be recognized before the diagnoses. She states that each person is unique and not a series of listed signs and symptoms. She also states that it is important to remember that the child has unique interests and likes and that these should be the focal point of working with a child with FASD. The clear message is the “child first.”
2. Build a Relationship with Student’s Family
The author emphasized her findings that parent/teacher relationships are paramount in supporting students with FASD. She reported some effective ways that her research uncovered- parent/teacher nightly/daily journals, assisting with establishing home-learning strategies, have elders and people into the community join in class activities. She also advices to make student feedback contain both positive and constructive feedback.
3. Develop Partnerships and Build Collaboration Between Families, Schools, and Community Agencies, and Implement Wrap-Around Services.
The author points out that sometimes students with FASD have extremely chaotic lives; multiple foster care, various agencies involved in child’s life and perhaps judicial/criminal agency involvement. She states that under these conditions, teachers should work hard to develop/maintain relationships with external groups in order to create cohesion and full knowledge. Ryan refers to one such system she observed: the wrap-around support system. This philosophy supports fostering collaboration with the agency on a long-term basis which would be supervised by the in-school team and inherited each year by each new teacher. The system focuses on the need for continual/long-term support between the teachers, in-school-team and various agencies.
4. Develop Social Skills
The author states that one of the most serious and negative consequences of FASD is the student often lacks acceptable social skills. Ryan’s research showed the positive impact that teaching social skills had on students with FASD. She sites several individual teaching strategies she discovered from her research, ranging from JK to high school. Accumulatively, Ryan concluded that teaching social skills should be “embedded” through the day and must be taught within the context of day to day lived experiences, not in isolation.
5. Provide a Structured Environment
Ryan’s research showed that students with FASD functioned much better in a structured, routine environment. Teachers that she interviewed also stressed the importance of consistent application of rules and consequences. One teacher stated, ““Provide enough structure to help the student with FASD stay in control, but at the same time to hold the student accountable for taking some responsibility for self-control and for setting realistic goals.”
6. Use Repetition and Consistency
During her research, Ryan found that all 25 teachers agreed upon the importance of repeating rules, lesson instructions and providing information in small chunks and checking for understanding. Ryan provides a number of useful strategies: create picture schedule of day or tasks, individually check for understanding by asking student to repeat back and work with parents to reaffirm task instructions.
7. Modify the Classroom Environment and Modify the Curriculum
This is probably the most important but most situation tip: Ryan offers examples of a number of ways that modifications can be made.
Here are some:
• Intentional seating plans (FASD student at front)
• Placing student with intentional peers to promote “good modeling.”
• Breaking tasks into segments and chunk information into smaller sections and check for understanding regularly
• Gentle reminders to focus and positive reinforcement
• Use of visual cues and pictographs
• Enlist help of parents to help student come to school organized and prepared
• Shortening time of task or give more frequent breaks
• Debrief with students and ask for student feedback on learning and understanding
8. Make a Referral to Special Education and to an FAS Diagnostic Clinic
Ryan states that it is important that in-class teachers work with special education teachers and in-school team. In particular, she stated that it is important to recommend interventions for students you suspect of having FASD.
Conclusion:
The author concludes by re-stating the above outlined points. She also points out the importance of continual teacher-reflection on the effectiveness/ individual response to these strategies.
Ryan, S.M. (2006). Instructional tips: Supporting the educational needs of students with fetal alcohol spectrum disorders. TEACHING Exceptional Children Plus, 3(2) Article 5. Retrieved [date] from http://escholarship.bc.edu/education/tecplus/vol3/iss2/art5
Review of “Instructional Tips: Supporting the Educational Needs of Students with Fetal Alcohol Spectrum Disorders” by Susan Marie Ryan. The journal article was published in Teaching Exceptional Children Plus.
The purpose of this article is to equip in-class teachers with the knowledge to “meet the learning, behavioral, and social needs” of students who have FASD. The article resulted from a 4-year study that involved interviews and observations of 25 teachers in Alaska who had students with FASD.
Introduction:
The article begins with a brief introduction about the available research and statistics:
• Fetal Alcohol Syndrome (FAS) was first proposed in 1968.
• The article focuses on Fetal Alcohol Spectrum Disorder FASD which is an umbrella term which encompasses 4 related diagnoses, including FAS
• Since 1968 there has been a progress in number of reported cases of FASD- in the USA, 10 of 1000 children are diagnosed with FASD annually.
I included this table from the article because I thought it did an excellent job of concisely explaining FASD students:
The article then proceeds to provide 8 “Instructional Tips:”
1. Think Person/Child First:
The author recommends that the individual must be recognized before the diagnoses. She states that each person is unique and not a series of listed signs and symptoms. She also states that it is important to remember that the child has unique interests and likes and that these should be the focal point of working with a child with FASD. The clear message is the “child first.”
2. Build a Relationship with Student’s Family
The author emphasized her findings that parent/teacher relationships are paramount in supporting students with FASD. She reported some effective ways that her research uncovered- parent/teacher nightly/daily journals, assisting with establishing home-learning strategies, have elders and people into the community join in class activities. She also advices to make student feedback contain both positive and constructive feedback.
3. Develop Partnerships and Build Collaboration Between Families, Schools, and Community Agencies, and Implement Wrap-Around Services.
The author points out that sometimes students with FASD have extremely chaotic lives; multiple foster care, various agencies involved in child’s life and perhaps judicial/criminal agency involvement. She states that under these conditions, teachers should work hard to develop/maintain relationships with external groups in order to create cohesion and full knowledge. Ryan refers to one such system she observed: the wrap-around support system. This philosophy supports fostering collaboration with the agency on a long-term basis which would be supervised by the in-school team and inherited each year by each new teacher. The system focuses on the need for continual/long-term support between the teachers, in-school-team and various agencies.
4. Develop Social Skills
The author states that one of the most serious and negative consequences of FASD is the student often lacks acceptable social skills. Ryan’s research showed the positive impact that teaching social skills had on students with FASD. She sites several individual teaching strategies she discovered from her research, ranging from JK to high school. Accumulatively, Ryan concluded that teaching social skills should be “embedded” through the day and must be taught within the context of day to day lived experiences, not in isolation.
5. Provide a Structured Environment
Ryan’s research showed that students with FASD functioned much better in a structured, routine environment. Teachers that she interviewed also stressed the importance of consistent application of rules and consequences. One teacher stated, ““Provide enough structure to help the student with FASD stay in control, but at the same time to hold the student accountable for taking some responsibility for self-control and for setting realistic goals.”
6. Use Repetition and Consistency
During her research, Ryan found that all 25 teachers agreed upon the importance of repeating rules, lesson instructions and providing information in small chunks and checking for understanding. Ryan provides a number of useful strategies: create picture schedule of day or tasks, individually check for understanding by asking student to repeat back and work with parents to reaffirm task instructions.
7. Modify the Classroom Environment and Modify the Curriculum
This is probably the most important but most situation tip: Ryan offers examples of a number of ways that modifications can be made.
Here are some:
• Intentional seating plans (FASD student at front)
• Placing student with intentional peers to promote “good modeling.”
• Breaking tasks into segments and chunk information into smaller sections and check for understanding regularly
• Gentle reminders to focus and positive reinforcement
• Use of visual cues and pictographs
• Enlist help of parents to help student come to school organized and prepared
• Shortening time of task or give more frequent breaks
• Debrief with students and ask for student feedback on learning and understanding
8. Make a Referral to Special Education and to an FAS Diagnostic Clinic
Ryan states that it is important that in-class teachers work with special education teachers and in-school team. In particular, she stated that it is important to recommend interventions for students you suspect of having FASD.
Conclusion:
The author concludes by re-stating the above outlined points. She also points out the importance of continual teacher-reflection on the effectiveness/ individual response to these strategies.
Ryan, S.M. (2006). Instructional tips: Supporting the educational needs of students with fetal alcohol spectrum disorders. TEACHING Exceptional Children Plus, 3(2) Article 5. Retrieved [date] from http://escholarship.bc.edu/education/tecplus/vol3/iss2/art5
Here are a number of my peers examinations:
Article: Enhancing the Schooling of Students with Traumatic Brain Injury
This article begins with information about traumatic brain injuries (TBI), such as it is the most common cause of death, and more than one million children are diagnosed with this each year (Keyser-Marcus et al., 2002). It is not possible to group TBIs together, as what is affected in the brain by the injury may be different from one student to another. Before allowing a student to return to school they must be assessed to see if they are ready. In doing so the assessor must communicate with educators, guidance counselors, medical professionals, and family members (Keyser-Marcus et al., 2002). There are different tests that the student must go through in order to see if they are ready to re-enter the school system. These include neuropsychological assessments, academic testing observations from instructors, and reports that students complete themselves (Keyser-Marcus et al., 2002).
As mentioned previously each TBI is different, so we must assess the student’s ability to understand how we can accommodate them. The article states that the following areas are the most common areas that are affected. They are concentration and attention, memory, executing functioning, and communication (Keyser-Marcus et al., 2002).
Concentration and Attention
Students with TBI have difficulty paying attention and concentrating in the classroom and with social skills (Keyser-Marcus et al., 2002). Similar to students with ADHD, students with TBI may not be able to filter out unnecessary noise and concentrate on the important pieces of information (Keyser-Marcus et al., 2002). To help students within the classroom who tend to get distracted easily, teachers can allow the student to have more breaks from the class, to sit near the front of the class during lessons and in a minimal distraction area during the work time, and break assignments into smaller more manageable components (Keyser-Marcus et al., 2002).
Memory impairments
Due to the impact on the brain, memory skills are sometimes difficult and is the most common affected area among students with TBI (Keyser-Marcus et al., 2002). To help students with memory, they can use tape recorders, checklists, and different aids to record assignments or other important information, i.e. an agenda (Keyser-Marcus et al., 2002), Teachers can also provide checklists in class for students (Keyser-Marcus et al., 2002), so they know what to do next, and how to stay on task.
xecutive functioning
Executive functioning is when a student is able to stay organized and complete a plan (Keyser-Marcus et al., 2002). For students with TBI, executive functioning will become difficult (Keyser-Marcus et al., 2002). The way to help students with this part of learning would be similar to memory impairment strategies. In addition, the article states “color coding activities may be helpful [as well as] structuring choices” (Keyser-Marcus et al., 2002). Students can use colour coding for different classes, or to prioritize homework. For example, if the assignment is coloured in red that means it is due tomorrow, but if it is green, the student still has some time to complete the assignment. If the student is using this technique it is important for them to write down when the assignment is due ahead of time so they do not forget.
Communication
Struggles with communication may differ for students with TBI; they could have difficulties understanding what is being said or simply have difficulties communicating their own words (Keyser-Marcus et al., 2002). A classroom teacher should encourage students to practice speaking orally and writing down their answers. Students can also use assistive technologies for writing assignments or tests (Keyser-Marcus et al., 2002); a great tool is speech-to-text and text-to-speech.
Overall, to help students with TBI learn, teachers should encourage them to use different ways of scheduling, and review these schedules constantly (Keyser-Marcus et al., 2002). Classroom teachers may also have to reduce the environmental factors that impact the student’s abilities to learn and do work in their classroom (Keyser-Marcus et al., 2002). For assessment purposes, teachers should consider minimizing the information on the test, allow the student to complete the test orally, and allow extra time for assessments (Keyser-Marcus et al., 2002).
This article provides a lot of insight about how to help students with traumatic brain injuries in a school setting. Every TBI case is different, so educators cannot just give general accommodations as we have to assess each student differently. The final sentence of this article really stood out to me. It states “[…] the most effective programs depend on our willingness to learn about the specific consequences of the injuries and our attempts to tailor the instruction and curriculum to meet the needs of those students” (Keyser-Marcus et al., 2002). This quote reminds me that we must make accommodations and modifications to each student’s individual needs, and not generally for all exceptionalities.
Citation
Keyser-Marcus, L., Briel, L., Sherron-Targett, P., Yasuda, S., Johnson, S., & Wehman, P. (2002). Enhancing the Schooling of Students with Traumatic Brain Injury.TEACHING Exceptional Children, 34(4), 62-67. doi:10.1177/004005990203400409
ourette's Syndrome: Characteristics and Interventions
What is it?
Tourette’s syndrome (TS) is a neurobiological disorder which causes people to have involuntary motor and vocal movements as well as sounds called tics. The tics are what define the syndrome. The different sounds and movements can lead to academic, social-emotional and physical challenges.
Summary of key points:
Tics are discovered at around ages 6 or 7 and occur more often with boys. About 1 in every 2 500 people have TS. Some common tics are blinking, the jerking of different body parts, throat clearing in the early years of TS. As a child matures, the tics may develop into tics that affect facial gestures or movements. Tics may also appear to disappear in early adulthood; however people with TS have it for their lifetime. Children may hold tics in during the day and release them when they are out of school. This can lead to an intensification of tics. Many kids with TS also have another diagnosis such as ADHD/ADD, learning exceptionalities, OCD or Asperger syndrome. Many students with TS have average intelligence, but will need accommodations to make sure they reach their potential.
Strategies to help your student with academics:
*if an IEP is not in place, arrange for proper testing
*chunk assignments
*if handwriting is a problem, allow alternatives such as oral testing and multiple choice tests and allow the child to use a computer for written output
*have the student sit where they are closest to you in case they need redirection
*use verbal directions with visuals
*have a workstation set aside for the student to help minimize any distractions
*arrange time limits for assignments that are reasonable
*reduce the number or questions assigned in daily work to focus on quality and not quantity
*test taking could be in another space away from noise and classmates to eliminate possible stress
Strategies to help your student with social-emotional issues:
*with permission of the student and his or her parent(s), let the student’s classmates and the school personnel know all about TS
*find out what the student’s strengths are, and try to group students together based on these common strengths to encourage connections among peers
*advocate for you students by finding them avenues to make interact with other students and to make friends
*be open to listening to both sides when there is a confrontation by refraining from judging
*routine is best
*praise, praise, praise
*try to teach about basic social skills within the curriculum
Strategies to help your student with physical concerns:
*encourage water drinking to help prevent dryness
*with input from the student, have a safe and private space where a student can release his/her tics
*other professionals may need to be consulted if the student begins to show self-injurious tics as they may need medication to help
*ask an OT for ideas to help with independence, such as Velcro for shoes and perhaps to replace zippers
*with the family’s permission, ask the OT or SERT to complete a Sensory Profile on the student you’re concerned with to provide you with information that could tell you how a student receives, organizes and responds to information.
*learn all you can about the child’s motor skills
Prestia, Kelly (2003). Tourette’s Syndrome: Characteristics and Interventions. Intervention in School and Clinic, vol.39, 2, 67-71.
Medical Conditions - Fetal Alcohol Syndrome
I wanted to look at Fetal Alcohol Syndrome because there are many undiagnosed cases up here. They go undiagnosed because of the lack of resources that our available to our students. I looked at “Teaching Students With Developmental Disabilities: Tips From Teens and Young Adults With Fetal Alcohol Spectrum Disorder”. This article was a fantastic, easy-to-read document that explains what Fetal Alcohol Syndrome is as well as provides comprehensive tips on how to help students.
The authors state that FASD can go undiagnosed but the cases that do not go undiagnosed are sometimes because of the physical characteristics that are attributed to students who have FASD. They note that, “FAS rates range from 0.2 to 1.5 cases per 1000 live births in different areas of the United States,” (Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., Teaching Students With Developmental Disabilities: Tips From Teens and Young Adults With Fetal Alcohol Spectrum Disorder, p. 28) Some of the characteristics of students that they state are, “students with FASD have difficulties with impulsivity and executive functions (e.g., attention, planning, organizing, self-regulation, and self-monitoring) and are often first diagnosed with attention deficit/hyperactivity disorder (ADHD)” (Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., p. 28). They also can be quoted by saying, “these students’ processing and memory difficulties may result in a diagnosis or learning disabilities” (Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., p. 28).
One key fact that I found interesting is that most students with FASD have IQs in the normal range and most are educated in regular classrooms both as full-time and part-time students. The article has a comprehensive chart stating both learning and behavioural characteristics focused on students with FASD.
This article references conversations with teens and youths by explaining some of the “effects of FASD in school; [as] ‘knowing I have limitations, and I have to ask more questions to understand something’ and ‘a personal obstacle that I must learn to live with. No pill can fix what I have. I can only learn to live the best life I can with what I have.” (Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., p. 30). This moved me as a professional. Not all students will have the same outlook but it is important to note that these students are not angered or upset with their diagnosis and are positive about living with it. As teachers we have to maintain and foster this positivity.
The authors have included sections about both the worst and the best teachers that the students have had and the characteristics that they shared. The worst teachers they said would yell at them, brush them off, single them out and were poorly organized and sarcastic. The best teachers exhibit most of the strategies that we have laid out throughout this course. Some of the key points that they outlined about the best teachers are:
- Teachers were patient and willing
- Provided accommodations
- Broke concepts down
- Talked slowly
- Gave clear expectations
- Demonstrated what had to be done
- Used hands-on materials
- Provided in-class instruction from teacher and peers
- Maintain a structured environment
- Teach shorter lessons with student involvement
- Make lists - give one instruction at a time
- Praise and positive reinforcement
- Modify assignments so that students could work independently on them
This article provided many great strategies that could be easily implemented into the classroom.
Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., Teaching Exceptional Children: Teaching Students With Developmental Disabilities: Tips From Teens and Young Adults With Fetal Alcohol Spectrum Disorder Vol 39, No. 2, pp. 28-31, 2006
rticle: Variable Structure / Variable Performance: Parent and Teacher Perspective on a School-Age Child with FAS
Key Points from Chosen Article
Students with FAS and FAE are most successful when they are taught and practise behaviours that are applicable to both school life and home life. Successful IEPs (construction and implementation of) must consider the exceptional student’s life at school and at home, and their respective environments. The importance of the way in which the parents/guardians view their child’s condition and its impacts and the impacts of his/her school and home environments on their child is vital in building a well-rounded and successful IEP.
Students living with FAS and FAE behave differently on a day-to-day basis, which consequently affects their ability to comprehend and follow through with instructions. To maximize their potential in this area, parents and teachers are encouraged to implement consistent routines and classroom/behaviour management.
Vygotsy’s concepts of the zone of proximal development (hereon referred to as ZPD) and scaffolding are important to consider when working with students with FAE and FAS. ZPD refers to what a student can do on his/her own versus what a student is capable of doing with guidance from a teacher, parent or other care partner. Scaffolding refers to “ways in which an adult adjusts or modifies the type of support provided to the child as he or she moves the child through the zone to a higher level of performance” (Timler and Olswang 49). This notion stresses the significance of the collaboration process between school staff, in particular the special education teacher, and the parents/guardians; if teachers work with the exceptional student and his/her environment in a way that is different from the parents, there will be discrepancies in instructional strategies and behaviour management, which leaves room for inconsistencies between home and school life. As we have learned, inconsistencies in these areas for students living with FAS and FAE are not conducive to optimal success.
In order to avoid strife or hostility between the family of a student with FAE/FAS and his/her educators, both parties must have a concrete understanding of how the other party perceives the student’s behaviours, learning styles and work habits. It is crucial that both parties are also well-informed on what they each think the child should be learning and the ways in which they should be learning it. Ultimately, thorough and consistent communication is necessary to provide the most successful learning environment possible in and outside of school.
It is not uncommon that a lack of understanding of the student’s environmental structures in school and at home is a main reason for discord between parents and teachers.
Students living with FAS/FAE are most successful when they are immersed in a setting that provides much structure, familiar routines, persons of authority who model behaviour which they wish to see in the student, and minimal distractions.
While it is important to try to minimize discrepancies between observations made by parents and teachers and the ways in which they respectively manage behaviour, work habits and learning styles, they can also be beneficial to provide insight to the other party that they otherwise would not have obtained.
Differences in environmental contexts can dramatically affect the way in which a student living with FAS/FAE performs in and outside of school.
Works cited
Timler, Geralyn R. and Lesley B. Olswang. “Variable Structure/Variable Performance: Parent and Teacher Perspectives on a School-Age Child with FAS.” Journal of Positive Behaviour Interventions 3.1 (2001): 48-56. The University of Washington. Web. 21 May 2016.
Fetal Alcohol Syndrome
I decided to read an article concerning Fetal Alcohol Syndrome because I would like to learn more about it and because I suspect one of my students may have this syndrome. The title of the article is Students With Fetal Alcohol Syndrome: Updating Our Knowledge, Improving Their Programs, by Darcy Miller. I really liked how this article was laid out in that it gave a brief overview of a student in Grade 4 who exhibited the signs of Fetal Alcohol Syndrome (FAS) and then gave a very clear outline of what FAS is.
“The diagnosis of FAS is based on growth deficiencies, facial anomalies, cognitive deficits or abnormalities, and the amount of alcohol exposure during gestation”. Mr. Miller also references a 4-digit code that is used to diagnose the level of impairment or severity of the above mentioned areas. Level 1 would indicate no evidence of impairment and level 4 would indicate definite or severe evidence of impairment. “Using the four-digit code in diagnosis can result in 256 possible combinations…”.
What is interesting and challenging for educators is that FAS is not formally recognized as a category under the Individuals with Disabilities Education Act (IDEA), and that FAS is often discussed as a subset of other disabilities. I also found it interesting that there used to be a term, Fetal Alcohol Effects (FAE), that denoted students who displayed mild effects of FAS but that this term was considered too vague. The term Fetal Alcohol Spectrum Disorder (FASD) is now used more often and encompasses the full range of fetal alcohol spectrum disorders. “The characteristics associated with FAS range from mild to severe, and differentially impact language/communication, social/behavioral, academic/cognitive, and adaptive functioning”. Table 1 in the article has a good visual descriptor of this. (I tried to include it but had difficulty here).
I also found it interesting that there are many misconceptions about FAS. One being that students with FAS who have strong oral language skills have good social communication skills. “Despite being able to say a lot, many students with FAS have deficits in social communication; they don’t know how to use language to negotiate everyday tasks, demands, and social interactions. “Special education teams need to look beyond verbal fluency and vocabulary, and assess these students’ language comprehension and pragmatics, expressive and receptive understanding, as well as social communication skills”. The recommendation then, is direct instruction in social skills and language expectations.
As far as other interventions for children with FAS, it is important to address the social/behavioural component by pinpointing specific areas of concern. These students typically have anger management issues and will need positive behavioural supports which “provide accommodations for behaviours that won’t change or that change very slowly”.
Another misconception is that students with FAS are also “mentally retarded”. In reality, these students have varied academic and cognitive profiles with both strengths and weaknesses. However, these students do, in fact, tend to have overall difficulties understanding abstract concepts. It is suggested by Miller that the school resource personnel need to conduct in-depth academic and cognitive assessments in order to develop appropriate interventions.
Finally, with respect to adaptive behaviour, once again there can be a range of difficulties for the children with FAS. These can range from organization skills to having difficulty completing tasks independently and understanding basic safety rules. Through the various research and parent reports, it is clear that many students with FAS continue to require assistance and support after high school, therefore, adaptive behaviour is a very important component in the overall picture of the student with FAS. Clearly this is a very difficult and challenging condition but with ongoing new research and a collaborative team approach, these students can be helped in many positive ways.
Students With Fetal Alcohol Syndrome: Updating our Knowledge, Improving Their Programs
As FASD is a diverse continuum, issues range from almost imperceptible to profound. It is somewhere in the middle that the issues attract the attention of parents, educators, medical and social work professionals, and eventually the justice system. Most of the issues that attract sufficient attention are behavioral and performance issues.
It is probable that 10% to 15% of children are significantly enough affected by prenatal alcohol exposure to require special education. As they become adults, FASD does not disappear but the issues of youth translate into ongoing problems in family relationships, employment, mental health and justice conflicts. The cost to the individuals affected, their families and society are enormous and as a society, we cannot afford to ignore them.
The incidence of FASD exceeds 10% of our children. FASD is the full spectrum of disorders caused by prenatal exposure to alcohol. The incidence of Fetal Alcohol Syndrome (with the classic facial features) is about 1%. Facial features are determined around the third week of pregnancy, so if the mother was not drinking at that time, the facial features can be quite normal, but the neurological damage can be as severe.
Based on Statistics Canada's "Canadian Community Health Survey" and their Birth and Population statistics for the concurrent period, it is likely that 37% of babies have been exposed to multiple episodes of binge drinking (5+ drinks per session) during pregnancy. An additional 42% have been multiply exposed to 1 to 4 drinks per session during pregnancy.
Approximately 20% of Canadian school age children are receiving special education services, most for conditions of types known to be caused by prenatal alcohol exposure.
What is Fetal Alcohol Syndrome (FAS)?
Fetal Alcohol Syndrome is a pattern of mental and physical defects that develop in a fetus while a mother consumes high levels of alcohol during pregnancy.
How does alcohol effect the unborn baby?
An unborn baby is nurtured through the mother's placenta. When the mother drinks, alcohol passes freely through the placenta to the fetus. When the mother has alcohol in her bloodstream, there will be alcohol in the baby's bloodstream too. As the fetus's liver is still developing, it does not work as quickly as the mother's liver in breaking down the alcohol. Therefore, alcohol stays in the unborn baby's body longer.
Risk Factors
Symptoms
Article: Enhancing the Schooling of Students with Traumatic Brain Injury
This article begins with information about traumatic brain injuries (TBI), such as it is the most common cause of death, and more than one million children are diagnosed with this each year (Keyser-Marcus et al., 2002). It is not possible to group TBIs together, as what is affected in the brain by the injury may be different from one student to another. Before allowing a student to return to school they must be assessed to see if they are ready. In doing so the assessor must communicate with educators, guidance counselors, medical professionals, and family members (Keyser-Marcus et al., 2002). There are different tests that the student must go through in order to see if they are ready to re-enter the school system. These include neuropsychological assessments, academic testing observations from instructors, and reports that students complete themselves (Keyser-Marcus et al., 2002).
As mentioned previously each TBI is different, so we must assess the student’s ability to understand how we can accommodate them. The article states that the following areas are the most common areas that are affected. They are concentration and attention, memory, executing functioning, and communication (Keyser-Marcus et al., 2002).
Concentration and Attention
Students with TBI have difficulty paying attention and concentrating in the classroom and with social skills (Keyser-Marcus et al., 2002). Similar to students with ADHD, students with TBI may not be able to filter out unnecessary noise and concentrate on the important pieces of information (Keyser-Marcus et al., 2002). To help students within the classroom who tend to get distracted easily, teachers can allow the student to have more breaks from the class, to sit near the front of the class during lessons and in a minimal distraction area during the work time, and break assignments into smaller more manageable components (Keyser-Marcus et al., 2002).
Memory impairments
Due to the impact on the brain, memory skills are sometimes difficult and is the most common affected area among students with TBI (Keyser-Marcus et al., 2002). To help students with memory, they can use tape recorders, checklists, and different aids to record assignments or other important information, i.e. an agenda (Keyser-Marcus et al., 2002), Teachers can also provide checklists in class for students (Keyser-Marcus et al., 2002), so they know what to do next, and how to stay on task.
xecutive functioning
Executive functioning is when a student is able to stay organized and complete a plan (Keyser-Marcus et al., 2002). For students with TBI, executive functioning will become difficult (Keyser-Marcus et al., 2002). The way to help students with this part of learning would be similar to memory impairment strategies. In addition, the article states “color coding activities may be helpful [as well as] structuring choices” (Keyser-Marcus et al., 2002). Students can use colour coding for different classes, or to prioritize homework. For example, if the assignment is coloured in red that means it is due tomorrow, but if it is green, the student still has some time to complete the assignment. If the student is using this technique it is important for them to write down when the assignment is due ahead of time so they do not forget.
Communication
Struggles with communication may differ for students with TBI; they could have difficulties understanding what is being said or simply have difficulties communicating their own words (Keyser-Marcus et al., 2002). A classroom teacher should encourage students to practice speaking orally and writing down their answers. Students can also use assistive technologies for writing assignments or tests (Keyser-Marcus et al., 2002); a great tool is speech-to-text and text-to-speech.
Overall, to help students with TBI learn, teachers should encourage them to use different ways of scheduling, and review these schedules constantly (Keyser-Marcus et al., 2002). Classroom teachers may also have to reduce the environmental factors that impact the student’s abilities to learn and do work in their classroom (Keyser-Marcus et al., 2002). For assessment purposes, teachers should consider minimizing the information on the test, allow the student to complete the test orally, and allow extra time for assessments (Keyser-Marcus et al., 2002).
This article provides a lot of insight about how to help students with traumatic brain injuries in a school setting. Every TBI case is different, so educators cannot just give general accommodations as we have to assess each student differently. The final sentence of this article really stood out to me. It states “[…] the most effective programs depend on our willingness to learn about the specific consequences of the injuries and our attempts to tailor the instruction and curriculum to meet the needs of those students” (Keyser-Marcus et al., 2002). This quote reminds me that we must make accommodations and modifications to each student’s individual needs, and not generally for all exceptionalities.
Citation
Keyser-Marcus, L., Briel, L., Sherron-Targett, P., Yasuda, S., Johnson, S., & Wehman, P. (2002). Enhancing the Schooling of Students with Traumatic Brain Injury.TEACHING Exceptional Children, 34(4), 62-67. doi:10.1177/004005990203400409
ourette's Syndrome: Characteristics and Interventions
What is it?
Tourette’s syndrome (TS) is a neurobiological disorder which causes people to have involuntary motor and vocal movements as well as sounds called tics. The tics are what define the syndrome. The different sounds and movements can lead to academic, social-emotional and physical challenges.
Summary of key points:
Tics are discovered at around ages 6 or 7 and occur more often with boys. About 1 in every 2 500 people have TS. Some common tics are blinking, the jerking of different body parts, throat clearing in the early years of TS. As a child matures, the tics may develop into tics that affect facial gestures or movements. Tics may also appear to disappear in early adulthood; however people with TS have it for their lifetime. Children may hold tics in during the day and release them when they are out of school. This can lead to an intensification of tics. Many kids with TS also have another diagnosis such as ADHD/ADD, learning exceptionalities, OCD or Asperger syndrome. Many students with TS have average intelligence, but will need accommodations to make sure they reach their potential.
Strategies to help your student with academics:
*if an IEP is not in place, arrange for proper testing
*chunk assignments
*if handwriting is a problem, allow alternatives such as oral testing and multiple choice tests and allow the child to use a computer for written output
*have the student sit where they are closest to you in case they need redirection
*use verbal directions with visuals
*have a workstation set aside for the student to help minimize any distractions
*arrange time limits for assignments that are reasonable
*reduce the number or questions assigned in daily work to focus on quality and not quantity
*test taking could be in another space away from noise and classmates to eliminate possible stress
Strategies to help your student with social-emotional issues:
*with permission of the student and his or her parent(s), let the student’s classmates and the school personnel know all about TS
*find out what the student’s strengths are, and try to group students together based on these common strengths to encourage connections among peers
*advocate for you students by finding them avenues to make interact with other students and to make friends
*be open to listening to both sides when there is a confrontation by refraining from judging
*routine is best
*praise, praise, praise
*try to teach about basic social skills within the curriculum
Strategies to help your student with physical concerns:
*encourage water drinking to help prevent dryness
*with input from the student, have a safe and private space where a student can release his/her tics
*other professionals may need to be consulted if the student begins to show self-injurious tics as they may need medication to help
*ask an OT for ideas to help with independence, such as Velcro for shoes and perhaps to replace zippers
*with the family’s permission, ask the OT or SERT to complete a Sensory Profile on the student you’re concerned with to provide you with information that could tell you how a student receives, organizes and responds to information.
*learn all you can about the child’s motor skills
Prestia, Kelly (2003). Tourette’s Syndrome: Characteristics and Interventions. Intervention in School and Clinic, vol.39, 2, 67-71.
Medical Conditions - Fetal Alcohol Syndrome
I wanted to look at Fetal Alcohol Syndrome because there are many undiagnosed cases up here. They go undiagnosed because of the lack of resources that our available to our students. I looked at “Teaching Students With Developmental Disabilities: Tips From Teens and Young Adults With Fetal Alcohol Spectrum Disorder”. This article was a fantastic, easy-to-read document that explains what Fetal Alcohol Syndrome is as well as provides comprehensive tips on how to help students.
The authors state that FASD can go undiagnosed but the cases that do not go undiagnosed are sometimes because of the physical characteristics that are attributed to students who have FASD. They note that, “FAS rates range from 0.2 to 1.5 cases per 1000 live births in different areas of the United States,” (Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., Teaching Students With Developmental Disabilities: Tips From Teens and Young Adults With Fetal Alcohol Spectrum Disorder, p. 28) Some of the characteristics of students that they state are, “students with FASD have difficulties with impulsivity and executive functions (e.g., attention, planning, organizing, self-regulation, and self-monitoring) and are often first diagnosed with attention deficit/hyperactivity disorder (ADHD)” (Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., p. 28). They also can be quoted by saying, “these students’ processing and memory difficulties may result in a diagnosis or learning disabilities” (Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., p. 28).
One key fact that I found interesting is that most students with FASD have IQs in the normal range and most are educated in regular classrooms both as full-time and part-time students. The article has a comprehensive chart stating both learning and behavioural characteristics focused on students with FASD.
This article references conversations with teens and youths by explaining some of the “effects of FASD in school; [as] ‘knowing I have limitations, and I have to ask more questions to understand something’ and ‘a personal obstacle that I must learn to live with. No pill can fix what I have. I can only learn to live the best life I can with what I have.” (Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., p. 30). This moved me as a professional. Not all students will have the same outlook but it is important to note that these students are not angered or upset with their diagnosis and are positive about living with it. As teachers we have to maintain and foster this positivity.
The authors have included sections about both the worst and the best teachers that the students have had and the characteristics that they shared. The worst teachers they said would yell at them, brush them off, single them out and were poorly organized and sarcastic. The best teachers exhibit most of the strategies that we have laid out throughout this course. Some of the key points that they outlined about the best teachers are:
- Teachers were patient and willing
- Provided accommodations
- Broke concepts down
- Talked slowly
- Gave clear expectations
- Demonstrated what had to be done
- Used hands-on materials
- Provided in-class instruction from teacher and peers
- Maintain a structured environment
- Teach shorter lessons with student involvement
- Make lists - give one instruction at a time
- Praise and positive reinforcement
- Modify assignments so that students could work independently on them
This article provided many great strategies that could be easily implemented into the classroom.
Duquette, C., Fullarton, S., Hagglund, K., Stodel, E., Teaching Exceptional Children: Teaching Students With Developmental Disabilities: Tips From Teens and Young Adults With Fetal Alcohol Spectrum Disorder Vol 39, No. 2, pp. 28-31, 2006
rticle: Variable Structure / Variable Performance: Parent and Teacher Perspective on a School-Age Child with FAS
Key Points from Chosen Article
Students with FAS and FAE are most successful when they are taught and practise behaviours that are applicable to both school life and home life. Successful IEPs (construction and implementation of) must consider the exceptional student’s life at school and at home, and their respective environments. The importance of the way in which the parents/guardians view their child’s condition and its impacts and the impacts of his/her school and home environments on their child is vital in building a well-rounded and successful IEP.
Students living with FAS and FAE behave differently on a day-to-day basis, which consequently affects their ability to comprehend and follow through with instructions. To maximize their potential in this area, parents and teachers are encouraged to implement consistent routines and classroom/behaviour management.
Vygotsy’s concepts of the zone of proximal development (hereon referred to as ZPD) and scaffolding are important to consider when working with students with FAE and FAS. ZPD refers to what a student can do on his/her own versus what a student is capable of doing with guidance from a teacher, parent or other care partner. Scaffolding refers to “ways in which an adult adjusts or modifies the type of support provided to the child as he or she moves the child through the zone to a higher level of performance” (Timler and Olswang 49). This notion stresses the significance of the collaboration process between school staff, in particular the special education teacher, and the parents/guardians; if teachers work with the exceptional student and his/her environment in a way that is different from the parents, there will be discrepancies in instructional strategies and behaviour management, which leaves room for inconsistencies between home and school life. As we have learned, inconsistencies in these areas for students living with FAS and FAE are not conducive to optimal success.
In order to avoid strife or hostility between the family of a student with FAE/FAS and his/her educators, both parties must have a concrete understanding of how the other party perceives the student’s behaviours, learning styles and work habits. It is crucial that both parties are also well-informed on what they each think the child should be learning and the ways in which they should be learning it. Ultimately, thorough and consistent communication is necessary to provide the most successful learning environment possible in and outside of school.
It is not uncommon that a lack of understanding of the student’s environmental structures in school and at home is a main reason for discord between parents and teachers.
Students living with FAS/FAE are most successful when they are immersed in a setting that provides much structure, familiar routines, persons of authority who model behaviour which they wish to see in the student, and minimal distractions.
While it is important to try to minimize discrepancies between observations made by parents and teachers and the ways in which they respectively manage behaviour, work habits and learning styles, they can also be beneficial to provide insight to the other party that they otherwise would not have obtained.
Differences in environmental contexts can dramatically affect the way in which a student living with FAS/FAE performs in and outside of school.
Works cited
Timler, Geralyn R. and Lesley B. Olswang. “Variable Structure/Variable Performance: Parent and Teacher Perspectives on a School-Age Child with FAS.” Journal of Positive Behaviour Interventions 3.1 (2001): 48-56. The University of Washington. Web. 21 May 2016.
Fetal Alcohol Syndrome
I decided to read an article concerning Fetal Alcohol Syndrome because I would like to learn more about it and because I suspect one of my students may have this syndrome. The title of the article is Students With Fetal Alcohol Syndrome: Updating Our Knowledge, Improving Their Programs, by Darcy Miller. I really liked how this article was laid out in that it gave a brief overview of a student in Grade 4 who exhibited the signs of Fetal Alcohol Syndrome (FAS) and then gave a very clear outline of what FAS is.
“The diagnosis of FAS is based on growth deficiencies, facial anomalies, cognitive deficits or abnormalities, and the amount of alcohol exposure during gestation”. Mr. Miller also references a 4-digit code that is used to diagnose the level of impairment or severity of the above mentioned areas. Level 1 would indicate no evidence of impairment and level 4 would indicate definite or severe evidence of impairment. “Using the four-digit code in diagnosis can result in 256 possible combinations…”.
What is interesting and challenging for educators is that FAS is not formally recognized as a category under the Individuals with Disabilities Education Act (IDEA), and that FAS is often discussed as a subset of other disabilities. I also found it interesting that there used to be a term, Fetal Alcohol Effects (FAE), that denoted students who displayed mild effects of FAS but that this term was considered too vague. The term Fetal Alcohol Spectrum Disorder (FASD) is now used more often and encompasses the full range of fetal alcohol spectrum disorders. “The characteristics associated with FAS range from mild to severe, and differentially impact language/communication, social/behavioral, academic/cognitive, and adaptive functioning”. Table 1 in the article has a good visual descriptor of this. (I tried to include it but had difficulty here).
I also found it interesting that there are many misconceptions about FAS. One being that students with FAS who have strong oral language skills have good social communication skills. “Despite being able to say a lot, many students with FAS have deficits in social communication; they don’t know how to use language to negotiate everyday tasks, demands, and social interactions. “Special education teams need to look beyond verbal fluency and vocabulary, and assess these students’ language comprehension and pragmatics, expressive and receptive understanding, as well as social communication skills”. The recommendation then, is direct instruction in social skills and language expectations.
As far as other interventions for children with FAS, it is important to address the social/behavioural component by pinpointing specific areas of concern. These students typically have anger management issues and will need positive behavioural supports which “provide accommodations for behaviours that won’t change or that change very slowly”.
Another misconception is that students with FAS are also “mentally retarded”. In reality, these students have varied academic and cognitive profiles with both strengths and weaknesses. However, these students do, in fact, tend to have overall difficulties understanding abstract concepts. It is suggested by Miller that the school resource personnel need to conduct in-depth academic and cognitive assessments in order to develop appropriate interventions.
Finally, with respect to adaptive behaviour, once again there can be a range of difficulties for the children with FAS. These can range from organization skills to having difficulty completing tasks independently and understanding basic safety rules. Through the various research and parent reports, it is clear that many students with FAS continue to require assistance and support after high school, therefore, adaptive behaviour is a very important component in the overall picture of the student with FAS. Clearly this is a very difficult and challenging condition but with ongoing new research and a collaborative team approach, these students can be helped in many positive ways.
Students With Fetal Alcohol Syndrome: Updating our Knowledge, Improving Their Programs
As FASD is a diverse continuum, issues range from almost imperceptible to profound. It is somewhere in the middle that the issues attract the attention of parents, educators, medical and social work professionals, and eventually the justice system. Most of the issues that attract sufficient attention are behavioral and performance issues.
It is probable that 10% to 15% of children are significantly enough affected by prenatal alcohol exposure to require special education. As they become adults, FASD does not disappear but the issues of youth translate into ongoing problems in family relationships, employment, mental health and justice conflicts. The cost to the individuals affected, their families and society are enormous and as a society, we cannot afford to ignore them.
The incidence of FASD exceeds 10% of our children. FASD is the full spectrum of disorders caused by prenatal exposure to alcohol. The incidence of Fetal Alcohol Syndrome (with the classic facial features) is about 1%. Facial features are determined around the third week of pregnancy, so if the mother was not drinking at that time, the facial features can be quite normal, but the neurological damage can be as severe.
Based on Statistics Canada's "Canadian Community Health Survey" and their Birth and Population statistics for the concurrent period, it is likely that 37% of babies have been exposed to multiple episodes of binge drinking (5+ drinks per session) during pregnancy. An additional 42% have been multiply exposed to 1 to 4 drinks per session during pregnancy.
Approximately 20% of Canadian school age children are receiving special education services, most for conditions of types known to be caused by prenatal alcohol exposure.
What is Fetal Alcohol Syndrome (FAS)?
Fetal Alcohol Syndrome is a pattern of mental and physical defects that develop in a fetus while a mother consumes high levels of alcohol during pregnancy.
How does alcohol effect the unborn baby?
An unborn baby is nurtured through the mother's placenta. When the mother drinks, alcohol passes freely through the placenta to the fetus. When the mother has alcohol in her bloodstream, there will be alcohol in the baby's bloodstream too. As the fetus's liver is still developing, it does not work as quickly as the mother's liver in breaking down the alcohol. Therefore, alcohol stays in the unborn baby's body longer.
Risk Factors
- Alcohol harms the fetus at any time during pregnancy, even before the woman knows she is pregnant.
- As a result, poor growth while the baby is in the womb may occur.
- Kidneys: may often be small or underdeveloped
- Heart: Can have a defect in the wall between the atria or the ventricles.
- Eyes: abnormalities of the vessels in the retina, lazy eye, or underdevelopment of the eyeball.
- Auditory System: Frequent ear infections or a sensory neural hearing loss may occur.
- Skeletal System: shortening of the fingers, vertebra, or long bones, curvature of the spine, or underdevelopment of the nails.
Symptoms
- Facial Features
- Growth Problems
- Central Nervous System Problems
- Structural
- Neurological
- Functional
- Cognitive deficits/ developmental delays
- Executive functioning deficits
- Motor functioning delays
- Attention problems/hyperactivity
- Problems with social skills
- Small size and weight before and after birth (pre- and postnatal retardation)
- Specific appearance of the head and face with at least two of the three following groups of signs: small head size, small eyes and/or short eye openings and/or underdevelopment of the upper lip, indistinct groove between the lip and nose, and flattened cheekbones
- Brain involvement with evidence for delay in development, intellectual impairment, or neurologic abnormalities
- Documentation of all three facial abnormalities (smooth philtrum, thin vermillion border, and small palpebral fissures);
- Documentation of growth deficits; and
- Documentation of central nervous system abnormalities (structural, neurological or functional, or combination thereof).
- Blood alcohol level in pregnant women who show signs of being drunk (intoxicated)
- Brain imaging studies (CT or MRI) after the child is born
- Pregnancy ultrasound
- Common challenges for educators who teach students with FASD include:
- Hyperactivity, impulsivity, attention and memory deficits;
- Inability to complete tasks, disruptiveness;
- Poor social skills;
- Need for constant supervision; and
- Disregard for rules and authority.
- Using concrete, hands-on learning methods
- Establishing structured routines
- Keeping instructions short and simple
- Providing consistent and specific directions
- Repeating tasks again and again
- Providing constant supervision
- Miller, Darcy. (2006). Students with fetal alcohol syndrome: Updating our knowledge, improving their programs
- Hankin, Janet. "Fetal Alcohol Prevention Research." National Institute on Alcohol Abuse and Alcoholism. 1 Aug. 2002. Web. 12 Apr. 2015. http://pubs.niaaa.nih.gov/publications/arh26-1/58-65.htm
- "Prevention of Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) in Canada." Canadian Paediatric Society. 1 Apr. 1997. Web. 12 Apr. 2015. http://www.cps.ca/documents/position/prevention-fetal-alcohol-syndrome
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