1. National Organization on Fetal Alcohol Syndrome Erin Frey, MD

2. NOFAS FASD K-12 PREVENTION CURRICULUM LESSON PLANS

3. Fetal Alcohol Spectrum Disorders (FASD)

4. Fetal Alcohol Syndrome First described in 1973 First described in 1973 Definition Definition –Fetal Alcohol Syndrome (FAS) is the term given to a set of physical, mental and neurobehavioral birth defects caused by maternal alcohol consumption during pregnancy

5. 2005 Surgeon General’s Updated Recommendations: Women who are pregnant should not drink. Women who are pregnant should not drink. A woman who has already consumed alcohol during pregnancy should stop to avoid further risks. A woman who has already consumed alcohol during pregnancy should stop to avoid further risks. Women who are at risk for or are trying to become pregnant should not consume alcohol. Women who are at risk for or are trying to become pregnant should not consume alcohol. Health professionals should work with all women of child bearing age to reduce risk. Health professionals should work with all women of child bearing age to reduce risk.

6. FASARNDPFAS Fetal Alcohol Syndrome –only term diagnosed by health care providers Alcohol-Related Neurodevelopmental Disorder Partial Fetal Alcohol Syndrome

7. Fetal Alcohol Syndrome (FAS) represents only the “tip of the iceberg” relative to all alcohol-related effects Fetal Alcohol Syndrome (FAS) represents only the “tip of the iceberg” relative to all alcohol-related effects

8. FASD By The Numbers 1% of all births (40,000 newborns each year). 1% of all births (40,000 newborns each year). Lifetime cost for one individual with FAS is at least $2 million. Lifetime cost for one individual with FAS is at least $2 million. Cost to the nation up to $6 billion each year for FAS alone. Cost to the nation up to $6 billion each year for FAS alone. U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration 2007

9. US Census Bureau All Alcohol- Related Effects

10. Alcohol is a Teratogen An agent that interrupts or alters the normal development of the fetus An agent that interrupts or alters the normal development of the fetus “Of all the substances of abuse (including cocaine, heroin and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” “Of all the substances of abuse (including cocaine, heroin and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” Institute of Medicine, 1996

12. Manifestations of CNS Dysfunction Associated with FAS Attention/memory problems Attention/memory problems Hyperactivity Hyperactivity Learning disabilities Learning disabilities Behavior Problems Behavior Problems Microcephaly Microcephaly Language & speech problems Language & speech problems Altered muscle tone Altered muscle tone Poor fine & gross motor coordination Poor fine & gross motor coordination Mental retardation Mental retardation

13. FASD Through the Life Span School Issues and Concerns

14. Developmental Overview Early School Age Continued sleep problemsContinued sleep problems Making and keeping friendsMaking and keeping friends Reading social cuesReading social cues Boundary issuesBoundary issues Doesn’t understand stranger safetyDoesn’t understand stranger safety Easily frustrated/tantrumsEasily frustrated/tantrums Understanding cause/effect relationshipsUnderstanding cause/effect relationships Language/SpeechLanguage/Speech low receptivity/high fluencylow receptivity/high fluency Math problems (time/money)Math problems (time/money)

15. Developmental Overview School Age Attention and memory problems Attention and memory problems Learning problems (especially arithmetic) Learning problems (especially arithmetic) Uninhibited/impulsive Uninhibited/impulsive Distractible Distractible Lack of organizational skills Lack of organizational skills Developmental delays Developmental delays Poor coordination Poor coordination

16. FAS Developmental Overview Adolescence and Adults Anxiety and depression Anxiety and depression Lying and Stealing Lying and Stealing Antisocial behavior Antisocial behavior Poor judgment Poor judgment Mood swings Mood swings Naïve - victimization Naïve - victimization Socially inappropriate behaviors Socially inappropriate behaviors

17. FAS Adolescents & Adults Clinical Implications Poor judgment…………………easily victimized Poor judgment…………………easily victimized Attention deficits………….unfocused/distractible Attention deficits………….unfocused/distractible Arithmetic disability……….can’t handle money Arithmetic disability……….can’t handle money Memory problems….......doesn’t learn from experience Memory problems….......doesn’t learn from experience Difficultly abstracting……..doesn’t understand consequences Difficultly abstracting……..doesn’t understand consequences Disoriented in time and space….fails to perceive social cues Disoriented in time and space….fails to perceive social cues Poor frustration tolerance……..quick to anger Poor frustration tolerance……..quick to anger

18. Potential “Secondary Disabilities” Early school drop-out Early school drop-out Alcohol and drug abuse problems Alcohol and drug abuse problems Having children they can’t care for Having children they can’t care for Joblessness Joblessness Trouble with law Trouble with law Mental health problems Mental health problems Premature death Premature death

19. Why Teach About FASD Providing age appropriate education before conception can help reduce the risk of alcohol-exposed births. Providing age appropriate education before conception can help reduce the risk of alcohol-exposed births. Schools exercise a powerful influence over young people, making them ideal settings to educate about the dangers of drinking alcohol during pregnancy Schools exercise a powerful influence over young people, making them ideal settings to educate about the dangers of drinking alcohol during pregnancy Alcohol remains the number one drug of choice among the Nation’s youth Alcohol remains the number one drug of choice among the Nation’s youth

20. Approximately 20% of sexually active teenage girls (15-19) become pregnant each year in the U.S. Approximately 20% of sexually active teenage girls (15-19) become pregnant each year in the U.S. In 2004, the rate of past month binge drinking among pregnant women age 15 to 17 (8.8%) was more than twice that of pregnant women ate 26 to 44 (3.8%). In 2004, the rate of past month binge drinking among pregnant women age 15 to 17 (8.8%) was more than twice that of pregnant women ate 26 to 44 (3.8%). U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration 2007

21. K-12 Lesson Plans What Teachers Need to KnowWhat Teachers Need to Know –Learning about Fetal Alcohol Spectrum Disorders (FASD) –Signs and Symptoms of FASD –Common Identifiable Facial Features of FAS

23. K-12 Lesson Plans Sensitivity CautionSensitivity Caution –Discussing alcohol, tobacco, and other drugs (ATOD) with students Family LetterFamily Letter 12 Steps to Success For Students With FASD.12 Steps to Success For Students With FASD. Strategies for School StaffStrategies for School Staff Websites and ResourcesWebsites and Resources

24. FASD: What Everyone Should Know Alcohol use during pregnancy is the leading known preventable cause of mental retardation and birth defects in the United States. FASD affects an estimated 40,000 infants each year - more than Spina Bifida, Down Syndrome and Muscular Dystrophy combined. Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects can include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis. Fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (PFAS), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD) are terms used to describe the range of conditions associated with prenatal alcohol exposure. An FAS diagnosis indicates the most serious set of birth defects, including growth deficiency (physical), central nervous system dysfunction (mental or brain damage) and a characteristic set of facial dysmorphology or malformations. Who is at Risk? Any woman of childbearing age is at risk of having a child with an FASD if she drinks alcohol during her pregnancy. Alcohol can harm an embryo or fetus at any time, even before a woman knows she is pregnant. Many women drink early in pregnancy but stop drinking when they learn they are pregnant. Others cannot stop drinking without help. Women who have given birth to children with an FASD and continue to drink are at very high risk of having additional children with an FASD. What Are the Effects of FASD? Depending on the timing and frequency of maternal alcohol consumption outcomes associated with prenatal alcohol exposure may include:  Specific facial dysmorphology  Growth deficits  Brain damage including mental retardation  Heart, lung, and kidney defects  Hyperactivity and behavior problems  Attention and memory problems  Poor coordination or motor skill delays  Difficulty with judgment and reasoning  Learning disabilities “Of all the substances of abuse (including cocaine, heroin and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” Institute of Medicine, 1996. FASD also takes an enormous financial toll on affected families and society as a whole. Less than one-third of individuals affected prenatally by alcohol have the full FAS, yet FAS alone costs the United States $5.4 billion annually in direct and indirect costs. This is only a small portion of the total societal costs associated with FASD. How Can FASD Be Prevented? While there is no cure for FASD, it is 100 percent preventable when pregnant women abstain from alcohol. NOFAS prevents FASD by raising public awareness, training practitioners to screen women for alcohol disorders and teaching youth to make healthy choices, among many other strategies. 900 17th Street ▪ Suite 910 ▪ Washington, DC 20006 ▪ Phone: 202-785-4585 ▪ 1-800-66-NOFAS ▪ E-mail: info@nofas.org Muscular Dystrophy Spina Bifida Down Syndrome FASD Normal Brain FAS Affected Brain Harwood, Am. J. Med, Genet. 2002 National Organization on Fetal Alcohol Syndrome Educating the public, professionals and policymakers about alcohol use during pregnancy and supporting children and families living with the disorder FASD: What Everyone Should Know Alcohol use during pregnancy is the leading known preventable cause of mental retardation and birth defects in the United States. FASD affects an estimated 40,000 infants each year - more than Spina Bifida, Down Syndrome and Muscular Dystrophy combined. Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects can include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis. Fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (PFAS), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD) are terms used to describe the range of conditions associated with prenatal alcohol exposure. An FAS diagnosis indicates the most serious set of birth defects, including growth deficiency (physical), central nervous system dysfunction (mental or brain damage) and a characteristic set of facial dysmorphology or malformations. Who is at Risk? Any woman of childbearing age is at risk of having a child with an FASD if she drinks alcohol during her pregnancy. Alcohol can harm an embryo or fetus at any time, even before a woman knows she is pregnant. Many women drink early in pregnancy but stop drinking when they learn they are pregnant. Others cannot stop drinking without help. Women who have given birth to children with an FASD and continue to drink are at very high risk of having additional children with an FASD. What Are the Effects of FASD? Depending on the timing and frequency of maternal alcohol consumption outcomes associated with prenatal alcohol exposure may include:  Specific facial dysmorphology  Growth deficits  Brain damage including mental retardation  Heart, lung, and kidney defects  Hyperactivity and behavior problems  Attention and memory problems  Poor coordination or motor skill delays  Difficulty with judgment and reasoning  Learning disabilities “Of all the substances of abuse (including cocaine, heroin and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” Institute of Medicine, 1996. FASD also takes an enormous financial toll on affected families and society as a whole. Less than one-third of individuals affected prenatally by alcohol have the full FAS, yet FAS alone costs the United States $5.4 billion annually in direct and indirect costs. This is only a small portion of the total societal costs associated with FASD. How Can FASD Be Prevented? While there is no cure for FASD, it is 100 percent preventable when pregnant women abstain from alcohol. NOFAS prevents FASD by raising public awareness, training practitioners to screen women for alcohol disorders and teaching youth to make healthy choices, among many other strategies. 900 17th Street ▪ Suite 910 ▪ Washington, DC 20006 ▪ Phone: 202-785-4585 ▪ 1-800-66-NOFAS ▪ E-mail: info@nofas.org Muscular Dystrophy Spina Bifida Down Syndrome FASD Normal Brain FAS Affected Brain Harwood, Am. J. Med, Genet. 2002 National Organization on Fetal Alcohol Syndrome Educating the public, professionals and policymakers about alcohol use during pregnancy and supporting children and families living with the disorder

28. Skill Emphasis/Health Education Standard Standard 2 – Students will analyze the influence of family, peers, culture, media, technology and other factors on health behaviors. Standard 2 – Students will analyze the influence of family, peers, culture, media, technology and other factors on health behaviors. 2.2.1. Identify how the family influences personal health practices and behaviors 2.2.1. Identify how the family influences personal health practices and behaviors Standard 8 – Students will demonstrate the ability to advocate for personal, family, and community health. Standard 8 – Students will demonstrate the ability to advocate for personal, family, and community health. 8.2.1. Make requests to promote personal health. 8.2.1. Make requests to promote personal health. 8.2.2. Encourage peers to make positive health choices. 8.2.2. Encourage peers to make positive health choices.

29. Teaching Steps 1. Read the Story Read the Karli and the Star of the Week book to students.

30. Karli and the Star of the Week A colorfully illustrated story book that teaches youth to be tolerant and accepting of all individuals regardless of their capabilities or disabilities. A colorfully illustrated story book that teaches youth to be tolerant and accepting of all individuals regardless of their capabilities or disabilities. 31 Pages 31 Pages

31. 2.Discussion and Group Activity a.Ask students what they think about the story. b.Ask students to recall the disorder, Fetal Alcohol Syndrome, discussed in story. c.Ask students to think of something special about themselves d.Ask students to think of something special about someone else and one of their classmates e.Ask students to share something they need help with

32. 3. Conclusion – Poem

34. Skill Emphasis/Health Education Standard Standard 1 – Students will comprehend concepts related to health promotion and disease prevention. Standard 1 – Students will comprehend concepts related to health promotion and disease prevention. 1.5.1. – Describe the relationship between healthy behaviors and personal health. 1.5.1. – Describe the relationship between healthy behaviors and personal health. 1.5.2. – Identify examples of emotional, intellectual, physical, and social health. 1.5.2. – Identify examples of emotional, intellectual, physical, and social health. Standard 5 – Students will demonstrate the ability to use decision-making skills to enhance health. Standard 5 – Students will demonstrate the ability to use decision-making skills to enhance health. 5.5.1. – Identify health related situations that might require a thoughtful decision. 5.5.1. – Identify health related situations that might require a thoughtful decision. 5.5.3. – List healthy options to health related issues or problems. 5.5.3. – List healthy options to health related issues or problems. 5.5.5. – Choose a healthy option when making a decision. 5.5.5. – Choose a healthy option when making a decision.

35. Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce health risks.Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce health risks. 7.5.1. – Identify responsible personal health behaviors.7.5.1. – Identify responsible personal health behaviors. 7.5.2. – Demonstrate a variety of healthy practices and behaviors to maintain or improve personal health.7.5.2. – Demonstrate a variety of healthy practices and behaviors to maintain or improve personal health. 7.5.3. – Demonstrate a variety of behaviors to avoid or reduce health risks.7.5.3. – Demonstrate a variety of behaviors to avoid or reduce health risks. Standard 8 – Students will demonstrate the ability to advocate for personal, family and community health.Standard 8 – Students will demonstrate the ability to advocate for personal, family and community health. 8.5.1. – Express opinions and give accurate information about health issues8.5.1. – Express opinions and give accurate information about health issues 8.5.2. – Encourage others to make positive health choices.8.5.2. – Encourage others to make positive health choices.

36. Teaching Steps 1. Nutrition and Health Choices 2. Harmful Substances 3. Nutrition and Human Development 4. Effects of Alcohol, Tobacco, and Other Drugs (ATOD) on the Developing Fetus 5. Discuss Fetal Alcohol Spectrum Disorders

37. Activity #1 – CHOICES FOR A HEALTHIER LIFE Grade 3

39. Activity #2 – Healthier Living Word Search Grade 4

41. Activity #3 – Healthier Living Crossword Puzzle Grade 4 or 5

44. Skill Emphasis/Health Education Standard Standard 5 – Students will demonstrate the ability to use decision making skills to enhance healthStandard 5 – Students will demonstrate the ability to use decision making skills to enhance health 5.8.1. – Identify circumstances that can help or hinder healthy decision making.5.8.1. – Identify circumstances that can help or hinder healthy decision making. 5.8.6. – Choose healthy alternatives over unhealthy alternatives when making a decision.5.8.6. – Choose healthy alternatives over unhealthy alternatives when making a decision. Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce risks.Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce risks. 7.8.2. – Demonstrate healthy practices and behaviors that will maintain or improve the health of self and others.7.8.2. – Demonstrate healthy practices and behaviors that will maintain or improve the health of self and others. 7.8.3. – Demonstrate behaviors to avoid or reduce health risks to self and others.7.8.3. – Demonstrate behaviors to avoid or reduce health risks to self and others.

45. Standard 8 – Students will demonstrate the ability to advocate for personal, family, and community health.Standard 8 – Students will demonstrate the ability to advocate for personal, family, and community health. 8.8.1. – State a health enhancing position on a topic and support it with accurate information.8.8.1. – State a health enhancing position on a topic and support it with accurate information. 8.8.2. – Demonstrate how to influence and support others to make positive health choices.8.8.2. – Demonstrate how to influence and support others to make positive health choices.

46. Teaching Steps 1. Define Fetal Alcohol Spectrum Disorders (FASD) 2. How Common is FASD? 3. Reinforce A Strong No-Use Message 4. Describe How FASD Can Affect the Brain 5. What Are the Symptoms of FASD?

47. Activity #1 – Short-Term Memory Challenge In Class Activity

49. Activity #2 – FASD Community Advocacy Project Long-Term Assignment

50. Activity #3 – Question and Answer In Class Activity

51. Activity #4 – How Much Do You Know About Alcohol and Pregnancy? In Class or Take Home Activity Sheet or Quiz

53. Activity #5 – Brain Structure and Function Identification Exercise In Class Activity or Homework

56. Skill Emphasis/Health Education Standard Standard 1 – Students will comprehend concepts related to health promotion and disease prevention to enhance healthStandard 1 – Students will comprehend concepts related to health promotion and disease prevention to enhance health 1.12.1. – Predict how health behaviors can impact health status1.12.1. – Predict how health behaviors can impact health status 1.12.4. – Analyze how genetics and family history can impact personal Health1.12.4. – Analyze how genetics and family history can impact personal Health Standard 4 – Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or reduce health risks.Standard 4 – Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or reduce health risks. 4.12.1. – Utilize skills for communication effectively with family, peers, and others to enhance health.4.12.1. – Utilize skills for communication effectively with family, peers, and others to enhance health. 4.12.2. – Demonstrate refusal, negotiation, and collaboration skills to enhance health and avoid or reduce health risks.4.12.2. – Demonstrate refusal, negotiation, and collaboration skills to enhance health and avoid or reduce health risks.

57. Standard 5 – Students will demonstrate the ability to use decision- making skills to enhance health.Standard 5 – Students will demonstrate the ability to use decision- making skills to enhance health. 5.12.1. Examine barriers that can hinder healthy decision making.5.12.1. Examine barriers that can hinder healthy decision making. 5.12.2. – Determine the value of applying a thoughtful decision making process in health related situations.5.12.2. – Determine the value of applying a thoughtful decision making process in health related situations. 5.12.7. – Evaluate the effectiveness of health-related decisions.5.12.7. – Evaluate the effectiveness of health-related decisions. Standard 7 – Students will demonstrate the ability to practice health- enhancing behaviors and avoid or reduce risks.Standard 7 – Students will demonstrate the ability to practice health- enhancing behaviors and avoid or reduce risks. 7.12.1. – Analyze the role of individual responsibility for enhancing health7.12.1. – Analyze the role of individual responsibility for enhancing health 7.12.3. – Demonstrate a variety of behaviors to avoid or reduce health risks to self and others.7.12.3. – Demonstrate a variety of behaviors to avoid or reduce health risks to self and others. Standard 8 – Students will demonstrate the ability to advocate for personal, family and community health.Standard 8 – Students will demonstrate the ability to advocate for personal, family and community health. 8.12.2. – Demonstrate how to influence and support others to make positive health choices.8.12.2. – Demonstrate how to influence and support others to make positive health choices. 8.12.3. – Work cooperatively as an advocate for improving personal, family and community health.8.12.3. – Work cooperatively as an advocate for improving personal, family and community health.

58. Teaching Steps 1. Define Fetal Alcohol Spectrum Disorders (FASD) 2. How Common Is FASD? 3. Reinforce A Strong No-Use Message 4. What Is Considered A Drink? 5. What Role Do Partners, Friends and Family Members Play? 6. View the Law & Order: SVU Video

59. Activity #1 – Discuss the Video Classroom Activity

60. Activity #2 – Alternative Ending To Law & Order: SVU Video Homework Assignment

61. Activity #3 – Alcohol and Pregnancy Decision Making Case Studies

62. Activity #4 – How Much Do You Know About Alcohol and Pregnancy Activity Sheet/Quiz

66. Alcohol-Related Birth Defects 100% are preventable You can help educate a new generation and keep them free from alcohol exposed pregnancies.

68. Erin Frey, MD Program Director National Organization on Fetal Alcohol Syndrome 900 17th Street NW, Suite 910 Washington, D.C. 20006 Phone: 202.785.4585 ext. 203 Fax: 202.466.6456 frey@nofas.org www.nofas.org frey@nofas.org www.nofas.org