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Cunningham www.faseout.ca 2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec.

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Page 1: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD and Education An Ontario Perspective

Authored by

Mary K. Cunningham B.Ed. P.H.Ec.

Page 2: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Acknowledgements

• Mary Cunningham is a parent of a young adult with ARND. She has been learning about FASD from her daughter and her students since 1998.

• Diane Malbin, (Oregon) Donna Debolt (Lethbridge), Chris Margetson (Guelph), Bonnie Buxton (FASworld Toronto), Cheryl Duquette (Ottawa), Laura Spero(London)

• Alberta Government – Education ministry

Page 3: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Presenter Information

• Parenting consultant and FASD advocate• Retired from 30 years in education system as a

teacher, department head and consultant• Has two young adult children, one with ARND• Is married to another retired educator• Co-author of Parenting in Canada, 2003• Co-founder of ON Coalition for Parenting Ed.• Lives in Kitchener, ON

[email protected]

Page 4: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD and Education An Ontario Perspective

Part I-Educational Success for

Students Affected by FASD

Part II-Advocating Successfully

within the School System

Page 5: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD and Education An Ontario Perspective

Part IEducational Success for Students with

FASD

Page 6: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Educational Success for Students with FASD

1- Introduction

2- FASD 101 for Educators

3- What FASD Looks Like at School

4- Brain Damage = Behaviour

5- How Secondary Effects Develop

6- Success for Students with FASD

Page 7: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD is an umbrella term for:• Fetal Alcohol Syndrome

(FAS) (obvious to all)

• Partial Fetal Alcohol

Syndrome (pFAS)

• Alcohol Related Neurodevelopmental

Disorder (ARND)

• ARBD, Static Encephalopathy

Page 8: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD and Education?

Have I seen FASD yet?

Page 9: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Alcohol Use In Pregnancy

• 50% of pregnancies are unplanned

• 17% to 25% of women reported drinking alcohol during their last pregnancy

• 7% to 9% reported drinking alcohol throughout their last pregnancy

Canadian National Survey

Page 10: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

What about Dad?

• A father’s drinking does not cause FASD…BUT:

– Drinking and drug use can damage sperm causing subtle neurological damage such as impulsivity,learning disabilities, attentional problems & (lower birth weight)

– When a father drinks he influences the mother’s drinking

Page 11: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Co-occurring Mental Illnesses

• ADD/ADHD is often diagnosed• (Reactive) Attachment Disorder (R-AD)• Bi-Polar Disorder/Depression• Conduct Disorder (CD)• Oppositional Defiant Disorder (ODD)• Obsessive Compulsive Disorder (OCD)• Borderline Personality Disorder (BPD)• (Kathryn Page – 2002- Ctr. For Families, Children & Courts)

Page 12: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD in Education Facts

Health Canada notes that 1% of live births are FASD-affected. (This is probably low). This means at least 300,000 Canadians are living with FASD

FASD is one of the most common birth defects in North America

FASD is the most common cause of developmental delay in North America

IF YOU ARE AN EDUCATOR YOU HAVE DEALT WITH FASD

Page 13: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Most Students with FASD are Invisible

Page 14: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

The Usual FASD Story

• JK/SK – unduly quiet or aggressive and unruly (ADD/ADHD-like)

• May slip through cracks at first – Level 2 – “C” evaluations

• By 4-6 serious learning problems are obvious: reading, math, science

• May be a “Safe School” nightmare with frequent suspensions

Page 15: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

The Usual FASD Story

• By grade 7 or 8 is dropped by achieving friends who can see disabilities

• Picks up with peers with similar problems

• School skipping, no homework, school failure

• Petty crime, drugs, alcohol use, early sexual activities

• Early school dropout or expulsion – first sign of marginalized adulthood

Page 16: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

If you are an educator

• You have dealt with students who have FASD

• You will deal with students who have FASD for the rest of your career

• So, what’s to be done?

Page 17: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Reframe The Behaviour

IT IS NOT THAT THEY WON’T,

THEY CAN’T

Page 18: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Brain Damage = Behaviour Change (Donna Malbin with permission)

Prenatal Exposure to Alcohol Causes Prenatal Exposure to Alcohol Causes Permanent Damage to the Brain Permanent Damage to the Brain

Page 19: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD = Information Processing Disabilities

FASD is an extremely serious and debilitating information processing learning disability

A student could have any or all of these deficits:

1.    Input- recording of information from the senses  Input- recording of information from the senses

2. Integration- process of interpreting the input2. Integration- process of interpreting the input

3. Memory- storage of information for later use3. Memory- storage of information for later use

4. Output- producing answers, responses, completion of 4. Output- producing answers, responses, completion of workwork

Page 20: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Two Common Reactions Processing Difficulties

1- Total shut down and turn off

May be confused with ADD

2- Hyperactive acting out

May be confused with ADHD

ADHD is frequently misdiagnosed!

Page 21: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Brain Damage = Behaviour

• Our brain is like a computer “CPU” and it controls our behaviour

• When the “CPU” gets the wrong data or processes data incorrectly dysfunctional behaviour results

• A FASD-affected brain will not recover so those around it must adapt and serve as

“external” brains

Page 22: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

What might an information processing disorder feel like?

• Imagine: loud music is blaring, the lights are buzzing and you are wearing a scratchy wool sweater over your bare skin, (Dorothy Shwab, Manitoba)

• This is how it feels for a student with FASD

• Exactly what would you actually learn under these circumstances?

• How would you act under these conditions?

Page 23: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Primary Effects a Teacher Might See(A-L-A-R-M)

Adaptation - trouble stopping or starting activities

Language - talk a “great line”, but don’t “get it” when people

try to talk to them

Attention – ADD/ADHD frequently misdiagnosed

Reasoning – don’t understand abstract ideas, eg. math

Memory - ‘sketchy’-on and off, has big gaps, don’t learn from

experience…same mistakes over and over

IT IS NOT THAT THEY WON’T;

THEY CAN’T

Page 24: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Brain Damage Causes Dysmaturity

• A confounding but classic sign of FASD

• Student appears to be functioning at different, inconsistent ages, for example:

Chronologically 18 Socially 12Emotionally 8 Cognitively 9

• Research is starting to show that individuals with FASD tend to get as mature as they are going to, or get “caught up” by age 35, too late for the school system, but still a ray of hope for parents

Page 25: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Expressiveness (Talking)

Reading ability

How Old He/She MAY act in each skill area

SKILLS

Dysmaturity Concept – Students with FASD Frequently Show Many Different Ages

Adapted from research findings of Streissguth, Clarren et al by D. Malbin 94

Understanding Ideas

Emotional Maturity

Money & Time Concepts

Physical Maturity

Social Skills

Living (Life) Skills

Page 26: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Will Students Outgrow FASD?NO

They may have life-long problems with:

- Learning

- Remembering

- Thinking things through

- Getting along with others

Brain damage is permanent!

Page 27: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

The Worst Case Scenario:Secondary Effects Develop

Page 28: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Students With FASD Often:

• Are bullied and stigmatized

• Have trouble finding friends

• Do not achieve at school

• Disappoint people around them

• Are disappointed in themselves

• Develop very poor self esteem

Page 29: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Then FASD creates Secondary Behaviours (Malbin, 2004)

• Primary FASD behaviours are those that most clearly reflect underlying damage to brain structure and function (slides 29 ff)

• Secondary FASD behaviours are defensive and develop over time in response to a non-supportive environment, the individual suffers from a chronic inability to “fit in”

Page 30: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Secondary BehavioursAn Educator Might See at School

• Inappropriate humour• Class clown• Isolated, Few friends• Pseudo-sophisticated-

trying to pass as “OK”• Irritability,Resistance,

Fatigue, Arguments• Anxious,Fearful,• Overwhelmed• Poor Self Esteem• Unrealistic Goals

• Bullied, Teased• Fighting, Outbursts• Running away, Avoidance• Sexually ‘inappropriate’ to

point of being dangerous• Depressed, Suicidal• Co-occurring Diagnoses• School Failure, Expulsion

– grade 9/10

Page 31: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Secondary Effects of FASD (1996-Washington State)

0 20 40 60 80 100

Mental Health

Dependent LivingArrangements

EmployementDifficulties

Suspended/ Expelledfrom School

Trouble with the Law

Innappropriate SexualBehaviour

Alcohol/ DrugProblems

Percentage of Adults withFetal Alcohol SpectrumDisorder who have specificSecondary Disabilities

Page 32: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Review

• Alcohol in utero can cause both physical and neurological damage to the fetus

• Neurological (brain) damage is the root of most FASD problems faced by schools

• Brain damage causes very serious learning disabilities which lead to primary behaviours

• If left untreated primary behaviours turn into serious secondary behaviours and a marginalized adulthood (see Streissguth, 1996)

Page 33: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

The Best Case Scenario:Success for Students with FASD

Page 34: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Change the Paradigm

• If they could they would -”It is not that students with FASD won’t, they can’t”

• Understanding this will change your attitude and they will notice your support Behaviour = Brain Damage

• Diabetics need insulin, paraplegics need wheel chairs, students with FASD have permanent brain damage and need you to deal with this irreversible fact

• “Learn to love the student you got, not the one you wanted”

Page 35: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

There IS a silver lining…

ALL STUDENTS WITH FASD

HAVE INNATE STRENGTHS

AND COMPETENCIES

Page 36: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Recognize ability not disability!

• ALL people with FASD excel in some or all of the following areas:

ART MUSIC POETRY

MECHANICS “HANDS-ON” SKILLS

WORKING WITH CHILDREN & ANIMALS

COMPUTERS & TECHNOLOGY

COMPETITIVE SPORTS

Page 37: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Multiple Intelligences

• Howard Gardner is the theorist behind “MI”, this is especially useful for students with FASD

• Everybody has some of each of the 9 intelligence groups. Find out what you are good at and work at

getting better. Don’t beat yourself up about your weaknesses.

• Multiple Intelligence development is especially important for students with FASD. Good for self esteem development too

• “Google” Howard Gardner + Multiple Intelligences

Page 38: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Multiple Intelligences

Verbal – Interpersonal – Visual

Kinesthetic - Musical – Naturalistic

Intrapersonal - Mathematical – Existential

Every student has some of each.

Discover and develop your best ones!

Page 39: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Typical Strengths and Abilities

• Hands on learners

• Kinesthetic, energetic

• Learn by doing and repeatedly shown

• Good long term visual memory

• Value fairness and can be rigidly moral, comforted by rules and orderliness

• Express themselves

well verbally

• Good with animals, children, mechanics, computers, and the arts

• Friendly, affectionate,

loving, loyal, gentle,

determined, sensitive

and compassionate

Page 40: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Teaching Students with FASD• FASD strategies will not hurt students so

when in doubt or waiting for diagnosis go ahead and use these strategies

• The ideas in this presentation are an introduction only and teachers should be aware that an endless repertoire can be developed. There is no magic formula.

• All these Special Education strategies are just good teaching. They work for almost any student with learning disabilities.

Page 41: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

In General

• Head off trouble, nip escalating stimulus overload before the child explodes

• Provide constant supervision, preventing a crisis is easier than cleaning it up

• These students need “external brains”

• All the expectations in curriculum won’t be met, teach life skills and blend in academics

• Teaching life skills that others learn by osmosis must be multimodal,repeated and compelling (ESSENTIAL)

Page 42: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Some Starter Strategies

• Reduce stimulation, provide quiet places for them to de-stress as needed

• Go slowly-”10 s children in a 1 s world”

• Hands on learning, focus on strengths

• Foster interdependence not independence

• Repeat, re-teach, repeat, re-teach, repeat…

• Carpe diem- Enjoy today, do a day at a time

Page 43: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

More Starter Strategies

• Do not ask “why” – they don’t know

• If things go wrong try differently, not harder

• Make transitions as easy as possible

• Use visuals as often as possible

• Break everything into steps, do one at a time

• Remember that students with impairments teach life lessons to everybody else

Page 44: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

External Brains (S. Clarren)

• Help the child reframe their world

• Provide crutches for an invisible disability

• Provide pro-active and intervention strategies

• Assist the child to process information and to respond more appropriately

If you are physically disabled you need a wheelchair.If you are blind you need a seeing eye dog.If you are a child with FASD you need an external brain.

Page 45: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

“Teaching Students with FASDBuilding Strengths, Creating Hope”

• The following website is INVALUABLE: www.education.gov.ab.ca/k_12/specialneeds/fasd.asp

• Western Canada is “light years” ahead of us in all aspects of FASD understanding, prevention and intervention (education)

• Do not try to re-invent the wheel, go to the above Alberta website for the newest and best resource on successful education for students with FASD

• You may print for free – 165 pages in length

Page 46: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

“Teaching Students with FASDBuilding Strengths, Creating Hope”

• Introduction

• Chapter 1: What is FASD?

• Chapter 2: Key Program Planning Concepts

• Chapter 3: Positive Classroom Climate

• Chapter 4: Students’ Needs

• Appendices A, B & C (excellent resources)

• Bibliography and Index

Page 47: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Ideally……..

We will substantially reduce the incidence

of FASD in the future…….

How?

By spreading the Zero 4 Nine message

Page 48: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Zero 4 Nine Messages

• No known amount of alcohol can be consumed safely during pregnancy.

• There is no known safe time to drink alcohol in a pregnancy

• A pregnant woman has a choice, her baby does not.

• A pregnant woman may need help from her spouse and peers not to drink.

• Avoid alcohol when planning a pregnancy or breast feeding*

Page 49: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD Prevention in Education

• The place to get the “0 for 9” message out so it will stick is to students before can drink legally

• OCMPE – The Ontario Coalition for Mandatory Parenting Education wants all high school students take and pass a parenting course before graduation; FASD messaging will be embedded.

• Fewer babies in the stream!

Page 50: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

For More Information

• Please feel free to contact the presenter at [email protected] or 519-893-7393 (Kitchener, Ontario)

• The internet is a valuable source of information, search under “fetal alcohol spectrum disorder”www.education.gov.ab.ca/k_12/specialneeds/fasd.asp (excellent resource)

Page 51: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

The End of Part OneRECESS!

Page 52: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD and Education An Ontario Perspective

Part II

Advocating Successfully

within the School System

Page 53: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Successful Advocacy inthe School System

1-Advocacy and Advocates

2-Parent and School Relationships

3-Getting a Diagnosis of FASD

4-FASD Has NO Special Ed category!

5-Emphasize the Positive

6-Strategies for Successful Education

Page 54: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD Advocacy?• Advocacy is active support; especially the act of pleading or arguing for something

• An advocate is a person who pleads for a cause or promotes ideas

• Students with FASD need advocacy and advocates to have any success in today’s schools

Page 55: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Who Can Advocate for Students?

• Teachers

• Parents and/or caregivers

• Anyone else who works with students in a school – professionals, paraprofessionals

- others working in the school

• Anyone who understands schools and FASD has the potential to be a good advocate for a student with FASD

Page 56: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Involve the Whole School……

Ideally ALL the people who work in a school from the administrators and teaching staff to the custodians, community coaches and lunch room supervisors will understand the realities of FASD and be prepared to recognize and properly support students who may have (or just look like they might have) FASD.

Page 57: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Whole School Efforts

• FASD 101 professional development for everybody

• Use of whole school programs like TRIBES ™

• “With All Due Respect” Ronald Morrish (Font Hill, ON)

Page 58: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Involve the Whole Community

1. Establish an FASD Task Force and Support Team at the board level

2. Educate all school staff personnel about FASD.3. Build community awareness about FASD.4. Be prepared to support parents and teachers caring for FASD

children.5. Implement changes in the school environment and academic

programming6. Get diagnostic facilities in the community.7. Refer children for FASD testing.8. Revisit administrative procedures regarding safe schools.9. Set up a personal advocate for each child with FASD

Page 59: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

A Delicate Balancing Act

• The squeaky wheel gets the grease?

OR• The squeaky wheel gets changed?

• One always catches more flies with sugar than vinegar

• Each school will have different limits

Page 60: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Most FASD experts such as Diane Malbin or Donna Debolt acknowledge that many parents of

children with FASD give the impression of being ‘crazy’

Most parents will obsess to get their children served

Page 61: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Parent/School Relationship

• “FASD parents” are the ultimate, 24 hour front-line workers and desperately need your support

• These parents only appear to be crazy; they are almost overwhelmed and super stressed

• Professionals are often tempted to assume that (undiagnosed) FASD is the result of ineffective parenting and family dysfunction.

• The family with FASD is often dysfunctional because of FASD not the other way around

Page 62: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Duquette et al Research• School Experiences of Students with Fetal Alcohol

Spectrum Disorder Duquette, Cheryll and Emma J. Stodel (U of Ottawa) in Exceptionality Education Canada, vol 15, #2, 2005, pp.51-75

• Examined ‘factors leading to persistence in school among students with FASD from perspectives of the students & their parents’

• Relatively small sample (24), all children adopted• The “high maintenance parent” appeared to foster

success; parental advocacy is strongly linked with persistence and graduation among students with FASD

• Parents studied FASD & then educated teachers

Page 63: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Elements Related to School Success (Duquette et al)

• Caring teachers who understood FASD and made accommodations led to more success

• Parents obtained psychological testing and used diagnoses to access services and to provide an underlying reason for student difficulties

• Specialized programs and paraprofessionals, when needed, were related to success

• Most parents advocated strongly and provided ‘encouragement’ at home

Page 64: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Parent Advocates

• Need to remember that teaching has been designated as just slightly less stressful than air traffic control – the most stressful occupation in that study

• Teachers are responsible for all the students in their classes not just your child – who may be taking a lot more energy than the others

Page 65: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Summer holidays DO NOT make up for 10 months of extremely stressful teaching.

They merely allow most teachers to continue teaching the next September

Page 66: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Educators on the other hand will do well to remember that every student has parents and/or caregivers who understand their individual needs

better than anyone else

Page 67: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

An involved parent or caregiver for a child with FASD is generally going to know a lot about FASD

and should be considered as an “expert”

Page 68: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

It should never come to this…

Page 69: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Parents, schools fight $1.8 Billion special needs war – Dec. 5/05 (Star)HELEN HENDERSON LIFE COLUMNIST (THE STAR)

 Gordon Martin is 9 years old. Over the past two years, he has arrived home from school on several occasions with feces in his lunch bag and disturbing marks on his skin. In October, he was expelled for disruptive behaviour.  

His mother has been banned from all school board properties and accused of uttering profanities and making false allegations against staff and students. The Martins moved to a smaller house, cashed in their retirement savings and got help from community garage sales to pay for a specially trained support therapist to help in class with their son, who is autistic. The school asked the therapist to stay out of the classroom.  

Gordon's mother says his behaviour at school — X School in X was a response to how he was treated there. The school calls her complaints "baseless."  Welcome to the war zone that is special education in Ontario………

………As in many cases examined by the Star, communication between family and school board broke down completely, an issue the working committee intends to address. "We have to do better at communicating," says co-chair Kathleen Wynne, parliamentary assistant to (Gerrard) Kennedy.  

"Maybe we need a third party who knows how to get past the emotion, because common sense gets lost in emotion" — parents whose children have gone through the system or retired teachers, for example.    

Page 70: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Does my Student have FASD?

• Teachers should only assess and NOT diagnose

• All of the primary behaviours related to FASD can have other causes and every “problem student” does not have FASD - this is a critical concept

• FASD can be picked up even in ECE settings

• If you see several or all behaviours request an immediate psycho-educational assessment

• While you are waiting use FASD strategies. They will help almost all learning disabled students

Page 71: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Most Students with FASD are Invisible

Page 72: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Physical Birth Defect IndicatorsMost can be also caused by factors other than alcohol

• Brain damage

• Heart defects

• Blood vessel defects

• Hearing/ear problems• Kidney deformities

• Uro-genital defects

• Small head size

• Scoliosis (skeletal)

• Long, smooth philtrum

• Short palpebral fissures

• Thinned upper lip

• Skeletal (eg.clinodactyly)

• Club foot

• Cleft lip and palate

• Dental abnormalities

• Growth abnormalities

Page 73: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Primary Behaviours Related to Neurological Damage

• Learning• Attention• Judgment• Memory• Performance (varies)• Impulsivity• Abstract Concepts• Communication • “Lack of Conscience” (A-L-A-R-M

• Cognition/aural slow• Inability to generalize• Executive Functioning• Social Perception• Boundaries (touching)• Sleeping Problems• Eating Problems• Learning is affected

PLUS)

Page 74: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Getting A Diagnosis

• Psycho-educational testing is the first step

• If ‘psych’ testing suggests major learning disabilities the next step is medical testing

• FASD diagnostic testing is done by a full interdisciplinary medical team

• A medical diagnosis of FASD diagnoses the child but the mother is also included so a diagnosis of FASD is a “diagnosis for two.”

Page 75: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Diagnosis – The Earlier the Better!

• Diagnosis should bring special programs for a child (and disability support for an adult)

• Labelling may bring some understanding of self and helps stop self-blame

• Demonstrates that the individual needs special treatment. Intervention MUST follow diagnosis

• Increases social awareness of FASD which may eventually reduce the stigma associated with it

• Individuals diagnosed early get fewer secondary behaviours related to chronic frustration

Page 76: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Missing an Early Diagnosis

• Unless they have serious behaviour problems pre-school and primary students with FASD will often be missed because their cognitive limitations have not yet been challenged

• Parents MUST be believed when they describe what is going on at home – the earliest clues will be found there

Page 77: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Psycho-educational Testing

• Average IQ for full FAS is 74

• IQ range for full FAS is 20-130

• Average IQ score for FASD is 90

• However, an IQ score in the normal range is misleading as many people with FASD are unable to perform at levels indicated by their IQ scores. (Streissguth, 1996)

• Educational success is more than just IQ

Page 78: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Psycho-educational Testing

• A full battery of psycho-educational tests is needed, Verbal and Peformance IQ testing will be part of this testing

• Full battery psycho-educational testing will reveal very obvious skewing if FASD exists

• If possible, testing which tests two functions at the same time will often reveal highly useful results

• Plan an IEP which maximizes strengths and minimizes weaknesses

Page 79: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

The Ideal Situation

• Ideally the child with FASD will get early diagnosis and his/her Parents/Caretakers, Physician, Educators, Therapists, Social Support Workers and mentors will meet at the school level and begin to develop a realistic, life-long plan of communication and care to minimize the development of secondary disabilities

• We all need to work towards this situation

Page 80: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD as a Learning Disability

• In Ontario FASD is not recognized as a specific learning disability

• Many parents feel their children would be better served if FASD was treated as a

specific learning disability

• In light of the Auton decision (June 2004) in the Supreme Court of Canada it is unlikely to be recognized as a specific learning disability any time soon

Page 81: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD as a Learning Disability

• Governments are beginning to realize they definitely can not afford to recognize FASD which is almost twice as common as ASD and far more costly in the long run

• Recognizing FASD as a specific learning disability would open a “Pandora’s Box”

Page 82: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

FASD as a Learning Disability

• Recognizing FASD as a Special Education category could open the door to recognition as a disability and Sections 7 and 15(i) of the CCRF could kick in

• Your child or student needs help NOW not when the “right thing” finally happens.

• You child can’t wait while you lobby!

Page 83: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Then Why Diagnose FASD?

• A student’s educators MUST know they are dealing with FASD

• USE EXISTING Ontario Special Education categories with FASD in mind– They will work

• An advocate must help teachers to understand how to deal with the behaviour caused by brain damage. Be prepared to teach educators about FASD

Page 84: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

WE CAN EFFECTIVELY SERVE STUDENTS WITH FASD IN

ONTARIO!

Page 85: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Celebrate Strengths, Minimize Weaknesses

• This is the good news and reason to hope: a basis for intervention and educational success exists

• Fostering innate strengths and minimizing weaknesses is the basis of success for students with FASD

• Success has been shown to prevent defensive secondary behaviours in affected students

Page 86: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Individual Education Plans• Plan an IEP from the ‘psych’ test results, if possible

plan it WITH the teacher(s) and caregivers

• Teachers, who are mere mortals, must be able to follow this plan without jeopardizing their other 20+ students or their own health

• Re-assess IEP frequently and fine tune if possible

• Include others for support: caregivers, EA, mentors, buddies, anyone in ‘circle of support’ (external brains)

Page 87: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Learning Styles• Most students with FASD are first and foremost

tactile or “hands-on” learners. This helps with their need to move. Learning in context is easiest and most efficient for most of them

• Visual learning is the next easiest style for most students with FASD. “A picture is worth a 1000 words” has a whole new meaning for FASD!

• Least of all, students with FASD are auditory learners. This does not work well for most of them (but teachers will still have to talk.)

Page 88: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Typical Strengths and Abilities

• Hands on learners

• Kinesthetic, energetic

• Learn by doing and repeatedly shown

• Good long term visual memory

• Value fairness and can be rigidly moral, comforted by rules and orderliness

• Express themselves

well verbally

• Good with animals, children, mechanics, computers, and the arts

• Friendly, affectionate,

loving, loyal, gentle,

determined, sensitive

and compassionate

Page 89: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Educational Environments for Students with FASD

1- Special class or school just for students with diagnosed FASD (David Livingston in Winnipeg)

(video available, profiled on The National)

2- Home Schooling www.edu.gov.on.ca/extra/eng/ppm/131.html

3- Regular Classroom with integrated special education and withdrawal where necessary

With proper planning most students with FASD can be accommodated in a regular classroom (challenging but doable)

Page 90: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Most Important – Reframe the Behaviour you see

• If they could they would -”It is not that students with FASD won’t, they can’t”

• Understanding this will change your attitude and they will notice – you support them

• Behaviour = Brain Damage

• Diabetics need insulin, paraplegics need wheel chairs

• Students with FASD have permanent brain damage and need you to respect them for what they are, they can’t survive without this

Page 91: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Interventions for SuccessDealing with FASD Information Processing Deficits

• Structure is critical- structure with clear and predictable routines is paramount,gentle transition

• Supervision/Monitoring – external brain may be needed 24/7- or be a telephone call away

• Simplicity-simple, brief directions – repeat them

• Steps- break everything down, written/visuals

• Context- if teaching a skill do it where it will happen – generalization is often difficult

Page 92: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Start with the Classroom Environment

The classroom learning environment has the

most effect on students’ abilities to learn within the settings we provide. This includes its organization, its management, and its emotional components.

Use the acronym

S-C-O-R-E-S

Page 93: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Scores

• Supervision

Close supervision to keep students safe

and out of trouble - 24/7 (Recess too!)

• Structure

Teach students that every day has a consistent and routine structure to it

• Simplicity

Keep rules, routines and directions simple

Give directions orally and in visual form

Page 94: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

SCores• Communication -Regular and frequent communication between home and school -Students are taught and reminded how to communicate

feelings and needs to teacher, peers and others

• Consistency -Routines, rules and consequences are consistent -Steps to complete a task are given in the same way every time

Page 95: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

ScOres

• Organization The school helps students to become organized

by teaching and reinforcing sequential organization strategies – repeat, repeat, repeat

Classroom is organized – a place for everything and everything in its place

The lessons and the day are organized

Page 96: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

ScoRes

• Rules- Simple, concrete and easy to follow eg.– “Don’t hit” ; rather than abstract eg. “Be kind” or “Stay safe”- All staff use the same words for each rule and follow

the same rules- Check to see whether students know and understand

what the rules mean- Consequences are followed up- Consequences applied immediately and consistently

taking into consideration students disabilities

Page 97: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

ScorEs

• Expectations

-Focus on life skills/social skills vs academics

-Realistic, attainable, and easily understood

-Modified/take into consideration the special needs of students

-Clearly specify what is to be expected and accomplished on any given assignment

-Limit the amount of work, including homework

Page 98: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

ScoreS• Self Esteem-Students feel accepted, valued and safe

-Positive encouragement is given in a consistent way each day

-Student’s strengths are explored to help them cope with the frustration of things they cannot do

-Students are reassured that they are not bad even though their behaviour is unacceptable and needs improvement

Page 99: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

More Classroom Strategies

• Minimize visual/sensory overload

• Tone down colors – paint walls light blue/grey

• Reduce/remove clutter

• Clearly define areas- use lines on floor or colored tiles

• Provide visual cues – sequencing

• Keep classroom as simple as you can

Page 100: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Attention Strategies• Use as few words as you can

• Use auditory/visual cues and prompts

• Focused teaching areas (One activity only)• Use separate seating/carrels/dividers

• Repeat/Reteach/Repeat

• Reinforce, Recognize, Encourage and Support

• Vary background sounds and activities – soft music or silent activity followed by physical activity

Page 101: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Strategies for Transitions• Prepare for transitions – use visual and/or auditory

cues

• Have an agenda for the day on the board for the students to see

• Routine!!

• If you are aware of a change in routine, alert ahead of time and practice new steps

• Practice – Repeat – Re-teach

• Have a digital clock visible

• Warn or remove before fire drills

Page 102: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

“Discipline” Strategies

• Focus on solutions not problems

• Positive incentives

• Reinforce the value of failure

• Recognize and celebrate little successes

• Firm, consistent, clear rules

• Consistent follow through

• Emphasize responsibility for own choices

• Encourage positive self-talk

• De-emphasize cause/effect

Page 103: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Strategies for Dealing with Hyperactivity

• Recognize triggers – read body language – nip outbursts in the bud

• Brain Gym

• Provide regular breaks and allow cocooning in a quiet place

• Provide clay, kushy balls or anything soft to be held and manipulated by hand for the child to keep at his desk so that he/she may sit a little longer

• Make use of weighted vests (dentist)

Page 104: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

“Teaching Students with FASDBuilding Strengths, Creating Hope”

• The following website is INVALUABLE: www.education.gov.ab.ca/k_12/specialneeds/fasd.asp

• Western Canada is “light years” ahead of us in all aspects of FASD understanding, prevention and intervention (education)

• Do not try to re-invent the wheel, go to the above Alberta website for the newest and best resource on successful education for students with FASD

• You may print for free – 165 pages in length

Page 105: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

What’s Next for FASD?

Current Trends in FASD :

• Intervention - Understanding FASD and helping individuals with FASD and their care-givers to be Successful

• Prevention – Messaging – “Zero 4 Nine”, There is no safe level of alcohol in pregnancy, etc.

• Research- FASD is quickly becoming a hot research topic – early times as yet

Page 106: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

For More Information

• Please feel free to contact the presenter at

[email protected]

or 519-893-7393 (Kitchener, Ontario)

• The internet is a valuable source of information, search under “fetal alcohol spectrum disorder”

• www.education.gov.ab.ca/k_12/

specialneeds/fasd.asp (excellent resource)

Page 107: Cunningham  2008 FASD and Education An Ontario Perspective Authored by Mary K. Cunningham B.Ed. P.H.Ec

Cunningham www.faseout.ca 2008

Thank you for your attention to and interest in helping to understand, prevent and intervene in the

lives of those living with FASD

Mary K. Cunningham