Transcript FASD and Mental Health - FASEout

FASD and Secondary
Disabilities
FASEout Project 2006
www.faseout.ca
Secondary Disabilities
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Result from negative consequences of
primary disabilities and can often change
For example, while learning disabilities
might be a primary disability, low selfesteem may be the effect of repeated
failures because of those disabilities
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Study
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The following secondary disabilities were
ascertained from life history interviews of
415 FASD affected individuals using 450
questions
Dr Anne Streissguth, et al, University of
Washington
FASEout Project 2006
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Secondary Disabilities
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Mental health problems
Disrupted school experiences
Easily victimized
Trouble with the law
Inappropriate sexual behaviour
Alcohol and drug problems
Problems with employment and living
independently
FASEout Project 2006
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Mental Health Issues
94% in secondary disabilities study had mental
health issues
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Affects children, adolescents and adults
FASD might not be considered or recognized – it’s not an
official “mental health diagnosis” - often does not receive
attention by mental health workers
Even when FASD is recognized, another diagnosis is
often used in order to get reimbursement for treatment
or services
FASEout Project 2006
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Possibility of Misdiagnosis
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Individuals may have undiagnosed or
misdiagnosed mental health disorders
Individuals may be diagnosed with a mental
health disorder without closely examining the
total picture; FASD can look like many other
mental health diagnoses
Adults may have many other disorders that come
from living with FASD without support
(Dubovsky, 2002)
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Many People Aren’t Diagnosed
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Most people who are affected by FASD
don’t know it
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They may have grown up thinking they were
different
They may be diagnosed with something else
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Likely Misdiagnosis for
Individuals with FASD
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ADHD
Oppositional Defiant Disorder
Conduct Disorder
Intermittent Explosive Disorder
Bipolar
Psychotic Disorders
Antisocial Personality Disorder
Borderline Personality Disorder
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Disrupted School Experience
43% of school aged FASD affected
individuals
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Suspension
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Expulsion
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Drop-out
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Potential Victimization
72% of individuals with FASD had
been victims of physical, sexual
and/or emotional abuse
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Difficulty with sound judgment and
decision-making, along with the desire to
please others, leaves them vulnerable to
exploitation, manipulation and abuse
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Trouble with the Law
61% of adolescents; 58% of adults in
secondary disabilities study had increased
involvement with the law
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Poor concept of cause and effect
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Inability to predict consequences
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Inability to change actions in different situations
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Inappropriate Sexual
Behaviour
Reported with 45% aged 12 and over
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Often due to poor judgment, lack of
impulse control
Supervise with animals and younger
children
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Unprepared Life Events
Lack of foresight, poor impulse control and
poor judgment often lead to unprepared
life events
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In a sample of 30 females with FASD who had
given birth, 57% no longer were caring for their
child(ren), 40% reported drinking during
pregnancy, 17% of the children were diagnosed
with FASD, and another 13% were suspected of
having FASD
FASEout Project 2006
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Alcohol and Drug Problems
26% age 12-20; 48% ages 21-51 in secondary
disabilities study
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Biological vulnerability to substance use
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Use of substances to self-medicate
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Difficulties with issues of control
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Repeated failures in traditional addictions treatment
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The Argument for Co-occurrence
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People with mental illness frequently use substances,
often to self-medicate
Many mental illnesses have a genetic component leading
to vulnerabilities in offspring
Substance use disorders may have a genetic component
leading to vulnerabilities in offspring
Therefore, the risk of a woman with a mental illness and
an alcohol use disorder giving birth to a child with FASD
and vulnerabilities for mental illness and substance use
is significant
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The Argument for Co-occurrence
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We know that stressors can exacerberate
underlying disorders
We are aware that individuals with FASD
experience multiple stressors in their lives
Therefore, the likelihood that a person
with FASD and these underlying
vulnerabilities would have a co-occurring
mental illness and/or substance use
disorder is significant
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The importance of recognizing
co-occurring FASD
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The cognitive impairments in FASD can interfere
with the ability to be successful with typical
treatment approaches
> lateral thinking
> difficulty with multiple directions
> difficulty following through with multiple
treatment plans
Difficulty with treatment based on verbal
receptive language skills
Difficulty with treatment based on processing
information outside of session
FASEout Project 2006
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Profile of 80 birth mothers of
children with FAS
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100% had alcohol use histories
96% had one to ten mental health disorders
>77%: PTSD
>59%: Major depressive disorder
>34%: Generalized anxiety
>22%: manic episode/bipolar disorder
>7%: schizophrenia
95% had been physically or sexually abused during their
lifetime
79% reported having a birth parent with an alcohol
problem
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Dependent Living
83% of those 21 and over in secondary
disabilities study were unable to live
independently
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Managing and understanding the value of
money was the most frequent difficulty: tend to
spend what they have
Repeatedly need help with money for food or
housing
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83% are unable to live
independently
(Regardless of IQ)
Why?
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Streissguth et.al. (1996)
FASD and Activities of Daily Living
Streissguth et al. Longitudinal Study (1996),
Sample of adults age 21+ were unable to:
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Manage money
Make daily living decisions
Obtain social services
Get medical care
Handle interpersonal relationships
Grocery shop
Cook meals
Structure leisure activities
Stay out of trouble
Maintain hygiene
Use public transportation
FASEout Project 2006
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82%
78%
70%
68%
57%
52%
49%
48%
48%
37%
24%
The Conundrum of FASD and Housing
All activities of daily living are done in,
around, and out of the place in which
you live.
If you don’t have a place to live . . .
The rest gets more difficult to manage.
FASEout Project 2006
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The 7 S’s of Supportive Housing
SELECTION
STRUCTURE
SUPPORT
STABILITY
SAFETY
SECURITY
SUPERVISION
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“Supportive” Housing for FASD
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Long Term Safe Permanent “Place to Call Home”
Awake Staff 24/7
Integrated Individualized Case Management
Meals Provided
Programs (Employment, Education, Leisure)
Comprehensive Supported Activities of Daily Living
Peer Support (Circle of Friends, mentor)
Family Involvement / Support
Addictions Services
No Eviction Policy
Health Care (GP, PHN, meds)
Mental Health
Transportation
Legal Resources
Staff Support
FASEout *Project
2006 for non-parenting adults with FASD
Specifically
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Lowering Risk of Secondary
Disabilities
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Living in a stable, nurturing home
Staying in the same household for at least
three years
Diagnosis by six years of age
Not being a victim of violence
Receiving services for disability
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Appropriate Supports for
Individuals with FASD
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Recognize and modify expectations
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Identify strengths, skills and interests
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Establish routines
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Build transitions into the routine
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Appropriate Supports for
Individuals with FASD
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Provide simple instructions or cues
Help to develop skills for expressing
feelings
Support social skills development
Involve as many senses as possible
Re-evaluate expectations and goals
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Attitudes and Expectations
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Recognize FASD as a lifelong disability
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Understand that the brain is damaged
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Form realistic expectations of the
individual with FASD and work with that
individual to help him or her have an
improved quality of life
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Things that Work
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Concrete instructions
Consistent messages
Repetition
Routine
Simple tasks, explanations, etc.
Supervision
Decreased stimulation
FASEout Project 2006
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CARES Model
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Cues
Attitude
Repetition
Expectations
Support
(for a copy refer to www.annewright.ca; we
CARES manual) FASEout Project 2006
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Paradigm Shift
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Need to change expectations that all behaviour
can be changed
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FASD needs to be seen as an invisible disability
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Dependence is a factor of FASD
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People with FASD need things to be repeated
many times and toFASEout
be reminded
often
Project 2006
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Fetal Alcohol Spectrum Disorder is a
lifelong mental and physical condition
that affects the individual, the family
and the community
FASEout Project 2006
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Resources
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Streissguth, A., Fred L. Bookstein, Helen M. Barr, Paul
Sampson, Kieran O’Malley, Julia Kogan Young. 2004.
“Risk Factors for Adverse Life Outcomes in Fetal Alcohol
Syndrome and Fetal Alcohol Effects.” Developmental and
Behavioral Pediatrics Vol. 25, No. 4.
Streissguth, Ann. Fetal Alcohol Syndrome: A guide for
families and communities. Baltimore, MD: Paul H.
Brooks, 1997.
Streissguth, A., H. Barr, J. Kogan, F. Bookstein.
Understanding the occurrence of secondary disabilities in
clients with Fetal Alcohol Syndrome (FAS) and Fetal
Alcohol Effects (FAE). Seattle: University of Washington,
1996.Streissguth, A. FASEout Project 2006
www.faseout.ca
Books
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Sara Graefe (ed.) Parenting Children Affected by Fetal
Alcohol Syndrome: A Guide for Daily Living, The
Adoption Council of Canada, 1994.
Ann Streissguth, Jonathan Kanter. The Challenge of Fetal
Alcohol Syndrome: Overcoming Secondary Disabilities,
University of Washington Press, 1997.
Bonnie Buxton. Damaged Angels: A mother discovers the
terrible cost of alcohol in pregnancy, Knopf, 2004.
FASEout Project 2006
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