Transcript FASD and Mental Health

FASD and Secondary Effects:
Longitudinal Study Conducted
by Dr Anne Streissguth,
Washington, D.C.
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Secondary Effects
• Result from negative consequences of primary
disabilities and can often change
• For example, while learning disabilities might be
a primary disability, depression may be the effect
of repeated failures because of those disabilities
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Research Study
• The following secondary effects were
ascertained from life history interviews of 415
FASD affected individuals using 450 questions
• Dr Anne Streissguth, et al, University of
Washington
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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
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Mental Health Issues
94% in secondary disabilities study had
mental health issues
• 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
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Possibility of Misdiagnosis
• 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
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(Dubovsky, 2002)
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Many People Aren’t Diagnosed
• Most people who are affected by FASD don’t
know it
– 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
• Suspension
• Expulsion
• Drop-out
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Potential Victimization
72% of individuals with FASD had been victims
of physical, sexual and/or emotional abuse
• Difficulty with sound judgment and decisionmaking, 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
• Poor concept of cause and effect
• Inability to predict consequences
• Inability to change actions in different situations
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Inappropriate Sexual Behaviour
Reported with 45% aged 12 and over
• 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
• 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
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Alcohol and Drug Problems
26% age 12-20; 48% ages 21-51 in secondary
disabilities study
• Biological vulnerability to substance use
• Use of substances to self-medicate
• Difficulties with issues of control
• Repeated failures in traditional addictions
treatment
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The Argument for Co-occurrence
• 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
• We know that stressors can exacerbate
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
• 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
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Profile of 80 birth mothers of
children with FAS
• 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
• 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?
Streissguth et.al. (1996)
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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
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82%
78%
70%
68%
57%
52%
49%
48%
48%
37%
24%
The 7 S’s of Supportive Housing
SELECTION
STRUCTURE
SUPPORT
STABILITY
SAFETY
SECURITY
SUPERVISION
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“Supportive” Housing for FASD
(Tina Antrobus)
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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
* Specifically for non-parenting adults with FASD
Staff Support
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Lowering Risk of Secondary
Disabilities (Streissguth et al 1996)
• 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
• Recognize and modify expectations
• Identify strengths, skills and interests
• Establish routines
• Build transitions into the routine
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Appropriate Supports for
Individuals with FASD
• 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
• Recognize FASD as a lifelong disability
• Form realistic expectations of the individual with
FASD and work with that individual to help them
have an improved quality of life
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Strategies that Work
• Concrete instructions
• Consistent messages
• Repetition
• Routine
• Simple tasks, explanations
• Supervision
• Decreased stimulation
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CARES Model
• Cues
• Attitude
• Repetition
• Expectations
• Support
(refer to www.annewright.ca; we CARES manual)
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Paradigm Shift
• Need to change expectations that all behaviour
can be changed
• FASD needs to be seen as an invisible disability
• Dependence is a factor of FASD
• People with FASD need things to be repeated
many times and to be reminded often
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Resources
• 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.
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Books
• 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.
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Thank you!
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