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You've seen the warnings on wine and beer bottles: "According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects."

Alcohol crosses the placenta at nearly

100 percent strength. This means that by the time a woman begins to feel relaxed from her drink, the fetus has already lost consciousness from the amount of alcohol in its bloodstream. Alcohol changes the developing brain at a cellular level, causing organic brain differences. So what are the possible effects on the baby if a woman does drink alcohol during her pregnancy?

Fetal Alcohol Spectrum Disorder (FASD) describes the range of characteristics and disabilities seen in children who have had prenatal exposure to alcohol and other drugs. FASD is a lifelong physical disability, an organic brain difference, which causes behavioral and learning challenges.

People with Fetal Alcohol Spectrum Disorder are open, friendly, sensitive and verbal. However, they often lack the ability to speak out for themselves, to have insight into their own behavior, to understand their real needs and to communicate with others in order to get their needs met.

They are naïve and trusting, lacking sound judgment in solving life's problems. People with FASD need advocates, people who understand their disability and can help them in the process of leading healthy, productive lives.

FASD is a birth defect; however, the full presentation of the disability may not be apparent for many years. Fetal Alcohol Spectrum Disorder is generally an invisible physical disability that impacts those affected throughout their lives. The mental abilities of people with FASD vary from person to person, making each unique.

Advocacy for those with FASD needs to be on an individual basis and needs to be positively focused. Because alcohol-related brain damage affects thinking and perception, people with FASD may not see their own disability as it pertains to memory, thinking, behavior, attention or emotions.

Successfully working with FASD children requires a shift in thinking about their behaviors and challenges. Instead of being bad, they can be seen as challenged. Instead of unwilling, they are unable; over-stimulated rather than willfully disobedient. Lazy, willful and non-compliant behaviors translate into deficits in attention, inability to generalize information and poor memory. This change in perception is critical to understanding the challenges of FASD.

Correct diagnosis increases the options for parenting and professional interventions to support children and families. Environmental adaptations for the full range of handicapping conditions will support the achievement of the individual's full developmental potential.

Behavior can be used as a cue that something is not working. If one method does not work, it is most helpful to try another. Establishing routine in daily living provides the greatest degree of security, confidence and success in these children. Using multi-modal teaching strategies (teaching the same information in several different ways) increases learning ability and accuracy.

Breaking down schoolwork and chore expectations into small parts helps to prevent children from being overwhelmed. Other strategies for parenting and for working with alcohol-affected children include:

thinking younger (developmental age is typically younger than chronological age in alcohol/drug-affected children),

keeping needs focused on the child (changing the environment rather than trying to change the child),

focusing and building on strengths,

focusing on the concrete rather than the abstract,

using structure rather than control,

encouraging child involvement in plan development,

extending timelines to accommodate for processing and learning delays,

modeling desired behaviors,

assisting children in the development of social skills,

planning and practicing transitions,

eliminating factors which may be impacting behavior (such as hunger, fatigue and pain), and

recognizing shutdown (the point at which a child becomes over-stimulated by circumstances and is no longer able to function properly).

Common problems seen in the classroom with FASD children include lack of attention, incomplete assignments, disruptive behaviors and not getting along with peers. These symptoms of the disability become barriers to learning. It is critical to advocate for environmental adaptations for the host of handicapping conditions in order to support each individual FASD child's developmental and educational potential.

Community resources can address secondary behavioral symptoms of the disability (tantrums, shutdown, oppositional behavior). These symptoms occur where there is a poor fit between the child and his environment. The real "trick" is that when things stop working, try something different. Mental health services can provide counseling and skills training. Occupational therapy and physical therapy services can address sensory and fine motor deficits. Developmental disability services can provide mentoring support, skill training and socialization.

Children affected by prenatal alcohol and/or drug exposure are wonderful, warm, delightful and valuable children. Quite often these children experience much disruption in their lives, through multiple placements with both caregivers and educators. Often, these children are misunderstood and unidentified.

They go on to experience problems with school failures, petty crime and experience in the social service and legal systems. Success and quality of life come to these children when the adults in their lives begin to understand their challenges and actively engage in the process of creating a good fit for the child in his environment - at home, at school and in the community.

The tools most successfully used by parents, educators, and clinicians include patience, flexibility and creativity. Using these tools, together with increased understanding of alcohol and drug effects, brings help and hope for children challenged by the consequences of their prenatal exposure. Early identification, assessment and intervention can prevent disruption to a child's home status, his education, and his social well-being.

Over time, this early investment in services may prevent educational service, social service and legal service needs in the teen years, as well as provide a higher quality of life for the affected child. The result of early intervention services may well be lower taxpayer costs in providing teen and young adult interventions.

Each month, the Missoulian Health page features a column by the Healthy Start Council of the Missoula Forum for Children and Youth, a coalition of groups and individuals working collaboratively to help Missoula's kids grow up to be healthy and resilient. Sunburst Community Service Foundation/Family Concepts participate in the Healthy Start Council, and they provide services to children and families in the foster care system. Marcia Jo Tharp, M.S.W., is an FASD and child development specialist with Family Concepts. She can be reached at (406) 257-4040 or at her e-mail address fc.marcia@yahoo.com.

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