Substance Abuse and Substance Abuse and Child Welfare Child Welfare Making decisions in the best Making decisions in the best interest of the child… interest of the child… Mark W. Weston, MA, LPC Mark W. Weston, MA, LPC Copyright, Children's Research Triangle, 2 006 Fetal Fetal Alcohol Alcohol Syndrome Syndrome Copyright, Children's Research Triangle, 2 006 Fetal Alcohol Syndrome Fetal Alcohol Syndrome “ “ The offspring of alcoholics have been found The offspring of alcoholics have been found defective not because of alcoholism of the defective not because of alcoholism of the parents but because the parents themselves parents but because the parents themselves came from a defective stock.” (Journal came from a defective stock.” (Journal American Medical Association, 132:419, 1946). American Medical Association, 132:419, 1946). Copyright, Children's Research Triangle, 2 006 Fetal Alcohol Syndrome Fetal Alcohol Syndrome  Low birth weight Low birth weight  Central nervous system effects Central nervous system effects  Facial dysmorphology Facial dysmorphology Copyright, Children's Research Triangle, 2 006 Fetal Alcohol Syndrome: Fetal Alcohol Syndrome: The Older Child The Older Child  Poor growth, weight gain Poor growth, weight gain  Central nervous system effects Central nervous system effects  Facial dysmorphology Facial dysmorphology Copyright, Children's Research Triangle, 2 006 Diagnostic Criteria Diagnostic Criteria I. I. Growth retardation Growth retardation II. II. Facial malformations (>1): short palpebral fissures, thin Facial malformations (>1): short palpebral fissures, thin upper lip, flat elongated philtrum, hypoplastic midface upper lip, flat elongated philtrum, hypoplastic midface III. III. Neurodevelopmental disorder Neurodevelopmental disorder FAS FAS Confirmed Confirmed or or unconfirmed unconfirmed history of prenatal alcohol exposure history of prenatal alcohol exposure Meets criteria in all three categories: I, II, III Meets criteria in all three categories: I, II, III ARND ARND Confirmed Confirmed history of prenatal alcohol exposure history of prenatal alcohol exposure Meets criteria in III Meets criteria in III NIAAA NIAAA Copyright, Children's Research Triangle, 2 006 FASD FASD Fetal Alcohol Spectrum Disorders Fetal Alcohol Spectrum Disorders “ “ an umbrella term describing the range of effects that can an umbrella term describing the range of effects that can occur in an individual whose mother drank during occur in an individual whose mother drank during pregnancy. These effects may include physical, pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with mental, behavioral, and/or learning disabilities with possible lifelong implications.” possible lifelong implications.” Bertrand et al, 2004 Bertrand et al, 2004 Copyright, Children's Research Triangle, 2 006 Epicanthal foldsfolds Flat nasal bridge Low set ears Flat philtrum Receding jawThin upper lip Short, upturned nose Flattened midface Short palpebral fissures Microcephaly Copyright, Children's Research Triangle, 2 006 Risk Factors Risk Factors  Dose of alcohol Dose of alcohol  Pattern of exposure - binge vs chronic Pattern of exposure - binge vs chronic  Developmental timing of exposure Developmental timing of exposure  Genetic variation Genetic variation  Maternal characteristics Maternal characteristics  Interaction with nutritional variables Interaction with nutritional variables  Synergistic reactions with other drugs Synergistic reactions with other drugs Copyright, Children's Research Triangle, 2 006 [...]... (interpreting input)  Memory (storing input for later use)  Output (appropriate use of language and motor skills)  Copyright, Children's Corpus Callosum Copyright, Children's Cerebral Dysmorphology Hippocampus receives sensory and motor information Corpus permits cerebral callosum hemispheres to share information Thalamus organizes behavior related to survival learning/ memory problems information does... fleeing, mating Copyright, Children's Secondary Disabilities Copyright, Children's Streissguth, et al., 1996 Neonatal Complications Low birth weight  Prematurity  Failure to thrive  SIDS  Dysmorphology  CNS damage  Copyright, Children's Problems in Behavioral Regulation        lack of behavioral inhibition poor attention to tasks impulsive behavior distractibility over activity poor modulation... early recovery  Mothers experience feelings of esteem, success in final product  Copyright, Children's Mother/Infant Play     Allows woman to interact with one child at a time Focus on positive parental behaviors Role modeling Tight structure with opening and closing rituals Copyright, Children's Parent Support Groups    Expressed concerns Problem-solving approach Genograms Copyright, Children's... distractibility over activity poor modulation of affect poor executive functioning Copyright, Children's Children need:     One adult who will always be there Words with which to characterize and express their emotions Protection from exposure to violence Inductive discipline Copyright, Children's Parenting Attitudes Mother-Child Relationship Evaluation (MCRE)  Acceptance  Over-protection  Over-indulgence . motor memory memory information information problems problems Corpus Corpus permits cerebral permits cerebral information information callosum callosum hemispheres. Syndrome  Low birth weight Low birth weight  Central nervous system effects Central nervous system effects  Facial dysmorphology Facial dysmorphology Copyright,