What types of intervention and rehabilitation are useful? (2007) - Kalberg et. al. - Article

Summary with the article: What types of intervention and rehabilitation are useful? (2007) - Kalberg et. al. This study focusses on interventions and rehabilitation techniques for children

Several factors determine the developmental outcomes of children who are prenatally exposed to alcohol, such as maternal age, timing and quantity of alcohol exposure, the nutrition pattern of the mother and the parents’ intelligence and education level. It’s quite difficult to determine what prenatal alcohol exposure cause adverse neurobehavioral findings. Also, environmental aspects, genetic factors and the health of the mother have to be considered when assessing possible outcomes. Fetal Alcohol Spectrum Disorder (FASD) describes the full spectrum of affects seen in children whose mother drank during pregnancy, including the most common disorder found in FASD: Fetal Alcohol Syndrome (FAS).

Assessing learning profiles

Finding out how best to help a child in school, community and home is the ultimate goal of educating children with alcohol disposure. Giving this children the opportunity to function at a regular school by providing the necessary support and alterations is called inclusion. In order to accomplish this, a clear learning profile for each child should be determined. Appropriate school interventions provide the necessary skills to become an independent adult, which begins with an early focus on functional and academic functional abilities of the child. Usually, children suffering from FAS come to the attention of the educational systems because they exhibit behavioral or learning problems at school, not because they have a known diagnosis of FAS. The IQ scores of children with FAS are widely spread, with an average of two standard deviations below the mean. However, the scores range from severely retarded to high average. 50% of children with FAS are mentally retarded, whereas many of the other 50% are ineligible for special services because their abilities fall within the average range of intelligence.

Neurobehavioral issues are not limited to children exposed to great amounts of alcohol: although they may not show the physical symptoms of the full syndrome, children exposed to moderate amounts of alcohol also experience neurobehavioral difficulties, especially in their executive function abilities. Executive functioning deficits are well known symptoms of prenatal alcohol exposure, what’s reflected in problems with complex working memory, planning, cognitive flexibility, reasoning and selective inhibition. These deficits are highly correlated with behavioral problems found in children with FAS. By using neuropsychological tests to assess executive functioning, the effects of alcohol exposure on developmental outcomes can be better explained. Furthermore, obtaining information about executive functions such as memory, attention, inhibitory control and problem-solving helps to develop interventions complying with the specific needs of a child.

As a result of deficits in executive functioning, two types of functional issues can be categorized. First, cognition based difficulties may manifest in the child’s inability to understand and hold in memory the specific sequences of daily living and the academic processes. Therefore, children with FAS may need an environmental tool which helps to stay on track during the routine of an ordinary day. Also, the skills of social engagement and interaction must be taught because children with FAS often fail to acquire them on their own. Difficulties with working memory, planning a task, solving novel problems and maintaining attention may manifest itself as the inability to follow a teachers’ directions and rules. Organizational skills are also challenged in children suffering from FAS, as is the ability to shift attention and encode new information. Moreover, the difficulties with working memory make that children have a hard time taking in new verbal information through auditory channels. Because they have relatively good vocabularies, this phenomenon is called the Speech/Comprehension paradox. They are good at expressing themselves but their comprehension levels lag behind. Therefore, children with FAS often appear to be more capable than they really are.

Second, emotional related difficulties often cause inability to inhibit responses. Acting before considering the consequences of the behavior is a well-known symptom of FAS. These children often are socially intrusive, blurt out inappropriate communication and therefore have a lot of trouble making friends and maintaining relationships.

It is necessary to assess the real life abilities of a child in order to understand its functional challenges and strengths. The assessment process should include comprehensive observations in different natural situations, at different times. This way it’s possible to determine the impact of different environmental conditions on the abilities of the child, and understand what conditions may be necessary for the child to perform optimally. Furthermore, observation should provide information about many important domains such as attention, behavior, skills, social interactions, independence, functional language and strengths and interests of the child.

Providing structure is a very important environmental intervention that’s helpful for children with FAS. By structuring the teaching environment, the child knows better what’s expected of him, although adults have to be mindful about when structure turns into control. Functional routines, which provide structure for predicting and understanding what activities will take place, provide opportunities for parents and teachers to give systematic instruction. By identifying which practical skills, routines and activities can be taught by routine practice, functional routines like bathing and dressing can be learned.

Intervention strategies

Visual structure can be provided by decreasing both visual and auditory distraction, the use of individualized daily schedules and using task structures that provide visual organization. A commonly used example of a visual structuring tool is a schedule. A schedule gives children with FAS information that helps them anticipate and predict what will happen next in a sequence, thereby reducing anxiety during transitions and providing motivation by giving the child a reference for how long the day will be. It promotes the flexibility of a child’s thinking because schedules can change. Furthermore, it stimulates independence because the child learns to rely on the schedule (a thing) instead of a teacher (a person).

Task structure makes a child with FAS understand what the task-expectations are, how many tasks need completion, when a task is finished and what task comes next. A correctly completed task as an example can be helpful.

Another suggested intervention is Cognitive Control Therapy. This skill-building intervention improves a child’s abilities to understand his own learning style and learning challenges. When children have this ability, they can assess whether a cognitive strategy (comparing, avoiding, approaching etc.) worked or didn’t work when learning new information. The following cognitive controls are targeted by this metacognitive therapy:

  1. Body ego-tempo regulation: the manner in which an individual mentally regulates body movements and represents the body-self.

  2. Focal attention: the manner in which an individual scans a field of information

  3. Field articulation: the manner in which an individual selectively attends its attention to a particular stimulus while ignoring others

  4. Leveling-sharpening: the way of comparing information from the past with perceptions of present information.

  5. Equivalence range: manner in which an individual categorizes and conceptualizes information.

Early results show that people benefit from this therapy.

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Articlesummary with Assessment for Intervention: a practice-based model by Pameijer - 2016
Summary Behavioral Interventions in Cognitive Behavior Therapy by Farmer - 1st Edition
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