Best Practices: Fetal Alcohol Spectrum Disorder (FASD)

By: Kourtney J. Gorham at The University of Regina for EPSY 821 – Aptitude and Achievement Analysis (Instructor Rori Lee)

Best Practices: Fetal Alcohol Spectrum Disorder (FASD)

Introduction: FASD Definition, Symptoms, and Prevalence

According to the FASD Network of Saskatchewan (2017) and the Canadian FASD Research Network (2019), Fetal Alcohol Spectrum Disorder (FASD) is a lifelong disability caused by prenatal alcohol exposure (PAE) that can impact an individual’s behavioral, cognitive, physical, and sensory domains. FASD has both neurocognitive and neurobehavioral implications, as PAE damages the Central Nervous System (CNS) in the developing fetus (Brown, Connor, Adler, and Langton, 2012; Nash & Davies, 2017; Popova, Lange, Burd, & Rehm, 2015). While specific impairments may not be realized until later in life when environmental demands increase, challenges with fine and gross motor skills, daily living skills, physical and mental health, learning, memory, executive functioning, receptive communication, social skills, and self-regulation may occur (Brown et al., 2012; CanFASD, 2019; FASD Network, 2017; Kully-Martens et al., 2018). However, each individual will experience different strengths and challenges and thus, requires individualized supports to target their unique areas of need.

FASD often goes undiagnosed due to stigma, lack of awareness, and the fact that it is an invisible disability as many individuals have no physical markings (FASD Network, 2017; Nash & Davies, 2017). Furthermore, FASD may be misdiagnosed as it commonly co-occurs with Attention Deficit Hyperactive Disorder (ADHD) – 40-90% of cases (Glass et al., 2017), Autism Spectrum Disorder (ASD), Bipolar Disorder (BD), Major Depressive Disorder (MDD), Intellectual Developmental Disorder (IDD), Oppositional Defiance Disorder (ODD), Reactive Attachment Disorder (RAD), Specific Learning Disability (SLD) – 17-35% of cases (Glass et al., 2017), and other sensory and trauma-related concerns (FASD Network, 2017; Nash & Davies, 2017). This is problematic because appropriate supports may not be in place without appropriate diagnosis.

FASD impacts individuals from all socioeconomic classes and ethnic groups and is especially apparent in cultures where alcohol is culturally accepted. The FASD Support Network (2017) notes that, “in Saskatchewan, it is believed that 1 in 100 people may be affected by FASD” (p. 4). CanFASD (2019) reports that “4% or 1.4 million people in Canada have FASD” (n.p.). These high rates may occur because approximately half of all pregnancies are unplanned (Nash & Davies, 2017) and there is no known safe amount or time to consume alcohol when pregnant (CanFASD, 2019; FASD Network, 2017; Osterman, 2011; Zizzo & Racine, 2017), including during the first month when individuals may not be aware of their pregnancy.  Statistics show that, on average, 90% of women abstain from drinking alcohol during pregnancy (Kully-Martins et al., 2018; Nash & Davies, 2017; Singal et al., 2017). However, social inequalities, lack of awareness, and previous addictions may contribute to continued use in some cases (Migliorini et al., 2015), making PAE a societal reality.

Overall fetal development is impacted by the quantity and timing of alcohol exposure, maternal metabolism rate, and the overall nutritional status of the mother (Brown et al., 2012; Kalberg & Buckley, 2007). Thus, not all individuals who have been prenatally exposed to alcohol will be diagnosed with FASD and presentations vary among those with the diagnosis (Brown et al., 2012; Kalberg & Buckley, 2007). Individual profiles may differ because neuroanatomical changes in the brain interact with the person’s environment to produce behaviors, particularly social deficits (Kully-Martens, Denys, Treit, Tamana, & Rasmussen, 2012). Within the behavioral domain, dysmaturity, issues interpreting social cues, and low self-esteem may occur (FASD Network, 2017; Kully-Martens et al., 2012). Brown et al. (2012) note that individuals with FASD are susceptible to peer pressure due to impulsivity, executive functioning deficits, and issues making, selecting, and retaining positive friendships. Cognitive impairments may include short attention spans, failure to learn from mistakes, and struggling to sequence behavior to reach a goal (executive functioning) (FASD Network, 2017; Kalberg & Buckley, 2007). Within the physical and sensory domains, poor balance and coordination, sensory processing concerns, and failure to meet height and weight developmental milestones may occur (FASD Network, 2017). These symptoms, and many more, can lead to secondary challenges such as unemployment, addictions, run-ins with the law, underachievement, difficulty learning advanced concepts, and school-drop out (FASD Network, 2017; Popova et al., 2015). In fact, individuals with FASD are 19 times more likely to go to jail (Popova et al., 2015), this being amplified if their needs are unmet, early diagnosis did not occur, and environmental concerns are present (Brown et al., 2012). While there is no cure for FASD, treatment to reduce secondary concerns is crucial.

Diagnosing FASD

 A multidisciplinary team of specialists is required to make a FASD diagnosis (Birch, Carpenter, March, Mcclung, & Doll, 2016; Cook et al., 2016; FASD Network, 2017). This team may include a specially trained physician, an educational and/or clinical psychologist or social worker, a speech language pathologist, an occupational therapist, a psychiatrist, and/or a pediatrician (FASD Network, 2017). Furthermore, once a diagnosis is made, treatment planning may include referrals to other specialized service providers. Brown et al. (2012) recommend a minimum of three professionals including a neuropsychologist to do the comprehensive testing, a medical doctor to conduct a physical examination, and a psychologist to administer psychological assessments, observe the child in multiple environments if possible, and interview and integrate information from all applicable sources, such as caregivers and birth records (Coons-Harding, Flannigan, Burns, Rajani, & Symens, 2019; Kalberg & Buckley, 2007; Sattler, 2014).

A FASD diagnosis requires three significant deficits at least 1 standard deviation (SD) below the mean in at least three neurocognitive domains and/or global IQ deficits (Brown, Connor, & Adler, 2012). Typically impairments must be below the third percentile (Coons-Harding et al., 2019). In addition to this, facial features, growth delays, and CNS functional, structural, and neurological damage may be apparent (Brown et al., 2012; Walker, Edwards, & Herrington, 2016). The FASD Network (2017) describes three diagnoses on the FASD spectrum: FASD with sentinel facial findings, FASD without sentinel facial findings, and at risk for neurodevelopmental disorder and FASD. To diagnosis FASD with sentinel facial findings there must be three facial features and three domains of impairment but PAE does not need to be confirmed (FASD Network, 2017). The facial features include “a thin upper lip, short palpebral fissure (the opening between eye lids), and smooth/flattened philtrum (the groove between the nose and lip)” (FASD Network, 2017, p. 6). In the second type, three domains of impairment remain but facial features are not required. In the absence of facial features, PAE must be confirmed (FASD Network, 2017). The at risk designation involves three facial features or PAE confirmed and a clinical concern about development (FASD Network, 2017).

Unfortunately, there are many barriers to receiving a diagnosis such as long waitlists, lack of service providers for all age groups, social inequalities such as transportation or rural access difficulties, lack of education and understanding, and persisting stigmatization of mothers (Chamberlain, Reid, Warner, Shelton, & Dawe, 2016; FASD Network, 2017).  In Saskatchewan we currently do not have a specially trained physician to identify short palpebral fissures, making FASD with sentinel facial findings hard to diagnose (FASD Network, 2017). For children, diagnosis and assessment services can be acquired through Child and Youth Services centers in Prince Albert, Saskatoon, and Regina. Adults can be referred to Child and Youth Services in Regina, Dr. Gerald Block in northern and central Saskatchewan, or the Saskatoon Genetics/Teratology Clinic at the Royal University Hospital in Saskatoon (Government of Saskatchewan, 2019). Supports, with or without diagnosis, can be obtained from the FASD Support Network of Saskatchewan and Raising Hope/Regina Street Worker’s Advocacy Program. Furthermore, caregivers and educators can consult the Best Practices for Serving Individuals with Complex Needs: Guide and Evaluation Toolkit (2018) by the Alberta Clinical and Community-Based Evaluation and Research Team and the FASD Prevention Framework (2014) from the Saskatchewan Prevention Institute.

FASD Diagnostic Tools

A variety of tools are used to asses FASD: the FASD Behavioral Mapping Tool to assess dysmaturity (FASD Network, 2017); the Fetal Alcohol Behavioral Scale that screens for 36 behaviors under the communication, emotional, social skills, academic, motor skills, and functional domains (Brown et al., 2012); and the FASD 4-Digit Diagnostic Code to assess the key diagnostic features (Walker et al., 2016). In addition, a battery of psychological tests and observations are used to look at domain-specific impairments in one or more of the following areas: motor skills, cognition, language, academic achievement, memory (verbal, auditory, and spatial), attention, executive functioning, affect recognition, and adaptive behavior (social skills and communication) (Brown et al., 2012; Kalberg & Buckley, 2007). Kalberg and Buckley (2007) note that an individual’s overall IQ score matters less than their ability to function within their environment, making a complete battery of assessments and observations essential.

Domain-specific assessments vary but should follow the Canadian FASD Research Network’s 2015 guidelines, with direct measures being preferred (CanFASD, 2019; Coons-Harding et al., 2019). Coons-Harding et al. (2019) surveyed 23 FASD clinics in Alberta to determine the comprehensive battery of neuropsychological tests that were being used. In some instances, assessments that were not recommended in the 2015 guidelines and older test editions were used. However, the following list includes the best practice measures that were used under each domain, with the first assessment in the list being used more frequently than the last (Coons-Harding et al., 2019, p. 45-9):

  1. Motor Skills Domain: Bruininks-Oseretsky Test of Motor Proficiency – 2nd Edition; Beery-Buktenica Developmental Test of Visual-Motor Integration – 6th Edition; Grooved Pegboard/Purdue Pegboard Test; Finger Tapping/Oscillation Test; Hand Dynamometer/Hand Grip Strength Test; Peabody Developmental Motor Scales – 2nd Edition; Miller Function and Participation Scales and Movement Assessment Battery for Children – 2nd Edition for caregiver interviews
  2. Cognitive Domain: Wechsler Adult Intelligence Scale – 3rd Edition; Wechsler Intelligence Scale for Children – 5th Edition; and Wechsler Preschool and Primary Scale of Intelligence – 4th Edition  
  3. Language Domain: Peabody Picture Vocabulary Test – 4th Edition; Clinical Evaluation of Language Fundamentals – 5th Edition; Test of Narrative Language – 2nd Edition; Expressive Vocabulary Test – 2nd Edition; Preschool Language Scales – 5th Edition; Perceptive-Expressive Emergent Language Test – 3rd Edition; Renfrew Bus Story; and language samples
  4. Academic Achievement Domain: Wechsler Individual Achievement Test – 3rd Edition; Woodcock Johnson Tests of Achievement – 4th Edition; Wide Range Achievement Test – 4th Edition
  5. Memory Domain: California Verbal Learning Test – 2nd Edition; Rey Complex Figure Test and Recognition Trial; Wide Range Assessment of Memory and Learning – 2nd Edition; NEPSY-II Subtests; Wechsler Memory Scale Revised – 4th Edition; Children’s Memory Scale
  6. Attention Domain: Connors – 3rd Edition and Adult ADHD Rating Scales; Behavior Assessment System for Children – 3rd Edition; Connors Continuous Performance Test –3rd Editions; and observations, anecdotal evidence, and reports from educators/caregivers
  7. Executive Function Domains: Behavior Rating Inventory of Executive Functioning – 2nd Edition; NEPSY-11; Delis-Kaplan Executive Function System; Test of Problem Solving – 2nd Edition (Adolescent) and 3rd Edition (Children); Wechsler Working Memory Scales; Wisconsin Card Sort Task; Behavior Assessment System for Children – 3rd Edition; Rey Complex Figure Test/Rey-Osterreich Complex Figure
  8. Affect Recognition Domain: Behavior Assessment System for Children – 3rd Edition; Beck Depression Inventory – 2nd Edition; Beck Anxiety Inventory; and previous/current diagnosis
  9. Adaptive Behavior (Social Skills and Communication) Domain: Adaptive Behavior Assessment System – 3rd Edition; Social Language Development Test; Vineland Adaptive Behavior Scales – 3rd Edition

FASD Best Practice Supports                                                                            

Supports for FASD generally fall under the best practice realm, as many of the strategies are general or have not been researched enough to be deemed evidence-based. This is further complicated by misdiagnosis, underdiagnoses, comorbid conditions, resource gaps for certain ages, and the variability of FASD presentations (FASD Network, 2017; Griffin & Copeland, 2018; Olson, 2016). The Alberta Clinical and Community-Based Evaluation and Research Team outlined supports with expert consensus, good evidence, moderate evidence, and some evidence in Practices for Serving Individuals with Complex Needs: Guide and Evaluation Toolkit (2018). Strategies with expert consensus included transition-focused supports and future planning, staff education, trauma supports, interpersonal skills, age-appropriate services, consistency and structure, Functional Behavior Assessments (FBA), preventative medical and mental health care, supported recreational activities, managing sexually exploitative situations and risky behaviors, person-centered employment, financial aid and access support, support with the justice system, and individualization. Supports with good evidence included early diagnosis, focusing on caregiver wellbeing, stable home environments, consistency, collaboration, responsiveness, and proactivity. Supporting sensory processing, utilizing unique learning profiles, parent-assisted adaptive functioning training and other educational resources had moderate evidence. Individual support, agency collaboration, strengths-based approaches, and secure and safe housing had some evidence (Pei, Tremblay, Poth, Hassar, & Ricioppo, 2018). Similarly, the FASD Network (2017) recommends general strategies in the areas of memory, confabulation, cause and effect, time management, transitions, ownership, impulse control, social skills, sensory, and sleep. Examples of strategies include repeating instructions in multiple ways, increasing time, and utilizing visuals (memory); probing only if it is a dangerous story and utilizing social stories (confabulation); utilizing positive reinforcement, visual reminders of expectations, and decision mapping (cause and effect); implementing timers, calendars, schedules, and predictable routines (time management); utilizing forewarning, prior practice. and visual schedules (transitions); practicing borrowing items and labelling personal belongings (ownership); implementing role-playing scripts, perspective taking, and supervision as needed (impulse control); modelling behavior, providing mentorship that builds off strengths, and setting developmentally appropriate expectations (social skills); reducing distractions, utilizing adaptive seating, and movement breaks (sensory); and implementing a calming sleep routine that may include doctor recommendations (sleep) (FASD Network, 2017). While the supports are general, they should be selected based on individual needs and strengths.

Specific programs for FASD have been created, however often with limited research or acceptable norm groups. The Children’s Friendship Training (CFT) program was created by the CDC Cooperative Research Group and combines child friendship training with parental education. Children learn how to enter play, interact with peers, and resolve conflicts during 12 weekly 90-minute sessions. Techniques such as role play, homework assignments, and caregiver play coaching are used (Brown et al., 2012). Olson (2016) reported immediate positive “effects on social knowledge and skills, and problem behavior” (p. 1819) and Brown et al. (2012) noted that these positive gains were maintained three months later.

The Math Interactive Learning Experience (MILE) also has been shown to be effective with results lasting after six months (Kable, Taddeo, Strickland, & Coles, 2015; Kully-Martens et al., 2017). It was created by Kable in 2007 and piloted to 61 children ages three to ten in Georgia. In the program, students receive six weeks of one-on-one math instruction that is individualized based on their baseline data and includes interactive and physical exploration of objects, slower instruction, immediate feedback on errors, and metacognition techniques for problem solving through the Plan-Do-Review model or Focus-Act-Reflect (FAR) mnemonic. Parents receive six weeks of training. In Kable et al.’s (2015) self-report study, students had learned twelve new math concepts vs. three in the control group after two months but it was a small sample size and the parental piece may not have had any impact. In a Canadian study with 28 children ages four to ten, those who were older with confirmed PAE but no FASD diagnosis, and lower IQs made greater gains with MILE (Kully-Martens et al., 2018).

Additional programs are available for specific areas of need. Caribbean Quest is a computer program that targets attention and working memory and MacSween et al. (2015) note that the program led to significant improvements with auditory, visual, and working memory. The GoFar program aims to improve self-regulation and adaptive skills through computerized games, parent training, and the FAR mnemonic (Kable, Taddeo, Strickland, & Coles, 2016). The program occurs over ten weeks with phase one focusing on learning the FAR technique and phase two focusing on application of the strategy. It has online and in-person parent training options (Kable et al., 2016). However, the sample size was small and little research about the effectiveness is available.  Parents Under Pressure (PuP) focuses on self-regulation and mindfulness through the child-parent relationship (Reid et al., 2017). This program has preliminary support because there was a small sample size and issues with accurately measuring growth. It was built on the foundation “that self-regulation underpins adaptive functioning” (Reid et al., 2017, p. 46). Project Step Up promotes parental education and harm-reduction for youths with FASD using substances. It has satisfactory results for those with IQs over 70 but success may actually be attributed to supportive home environments (O’Connor, Quattlebaum, Castaneda, & Dipple, 2016; Olson, 2016). Step-by-Step is a one-on-one mentorship program for parents affected by FASD. It assists individuals with socioeconomic disadvantages but little research is available (Denys, Rasmussen, & Henneveld, 2011). While there are many available programs, continued research is needed to determine which programs can be considered evidence-based strategies.

 Conclusion

While there is no cure for FASD, targeted intervention and remediation of secondary concerns is promising. Medications are sometimes used to target comorbid conditions (Brown et al., 2012; Nash & Davies, 2017) but additional research is needed as stimulant medications have controversial results and may increase heart problems and seizures in this population (Brown et al., 2012) . Pei et al. (2017) note that recommendations made most to least are:  “education, medical, anticipatory guidance, accommodations, family support, mental health, developmental therapy, social services/child welfare, community/social/leisure programs, safety, reassessment, and other” (p. 176). However, they found that recommendations may be based on comorbid disorders or availability in the community rather than individualized need. Brown et al. (2012) recommend that no matter what program or strategy is used, the focus should be on replacing maladaptive behaviors. Additional research on strategies and programs for individuals with FASD will help determine evidence-based supports. Providing the subsequent supports and services to all those impacted by FASD is paramount in remediating lifelong secondary concerns and helping individuals be as successful as they can be.

Works Referenced

Birch, S., Carpenter, H., Marsh, A., Mcclung, K., & Doll, J. (2016). The knowledge of rehabilitation professionals concerning fetal alcohol spectrum disorders. Occupational Therapy In Health Care, 30(1), 69-79.

Brown, N., Connor, P., Adler, R., & Langton, C. (2012). Conduct-disordered adolescents with fetal alcohol spectrum disorder: Intervention in secure treatment settings. Criminal Justice and Behavior, 39(6), 770-793.

CanFASD: Canada FASD Research Network (2019). Diagnosis.Retrieved from: https://canfasd.ca/topics/diagnosis/

Chamberlain, K., Reid, N., Warner, J., Shelton, D., & Dawe, S. (2017). A qualitative evaluation of caregivers’ experiences, understanding and outcomes following diagnosis of FASD. Research in Developmental Disabilities, 63(C), 99-106.

Cook, J. L., Green, C. R., Lilley, C. M., Anderson, S. M., Baldwin, M. E., Chudley, A. E.,… Rosales, T. (2016). Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. Canada Fetal Alcohol Spectrum Disorder Research Network, 188(3), 191-7.  

Coons-Harding, K., Flannigan, K., Burns, C., Rajani, H., & Symens, B. (2019). Assessing for fetal alcohol spectrum disorder: A survey of assessment measures used in Alberta, Canada. Journal of Population Therapeutics and Clinical Pharmacology, 26(1), 39-55.

Denys, K., Rasmussen, C., & Henneveld, D. (2011). The effectiveness of a community-based intervention for parents with FASD. Community Mental Health Journal, 47(2), 209-219.

FASD Network of Saskatchewan Inc. (2017). Fetal alcohol spectrum disorder: A guide to awareness and understanding.

Glass, L., Moore, E., Akshoomoff, N., Jones, K., Riley, E., & Mattson, S. (2017). Academic difficulties in children with prenatal alcohol exposure: Presence, profile, and neural correlates. Alcoholism: Clinical and Experimental Research, 41(5), 1024-1034.

Government of Saskatchewan (2019). Fetal alcohol spectrum disorder services. Retrieved from: https://www.saskatchewan.ca/residents/health/accessing-health-care-services/health-services-for-people-with-disabilities/fetal-alcohol-spectrum-disorder-services#fasd-diagnosis-and-assessment-services

Griffin, M., & Copeland, S. (2018). Effects of a self-management intervention to improve behaviors of a child with fetal alcohol spectrum disorder. Education and Training in Autism and Developmental Disabilities, 53(4), 405-414.

Kable, J., Taddeo, E., Strickland, D., & Coles, C. (2016). Improving FASD children’s self-regulation: Piloting phase 1 of the GoFAR intervention. Child & Family Behavior Therapy, 38(2), 124-141.

Kable, J. A., Taddeo, E., Strickland, D., & Coles, C. (2015). Community translation of the math interactive learning experience program for children with FASD.  Research in Developmental Disabilities, 39, 1-11.

Kalberg, W., & Buckley, D. (2007). FASD: What types of intervention and rehabilitation are useful? Neuroscience and Biobehavioral Reviews, 31(2), 278-285.

Kully‐Martens, K., Denys, K., Treit, S., Tamana, S., & Rasmussen, C. (2012). A review of social skills deficits in individuals with fetal alcohol spectrum disorders and prenatal alcohol exposure: Profiles, mechanisms, and interventions. Alcoholism: Clinical and Experimental Research, 36(4), 568-576.

Kully-Martens, K., Pei, J., Kable, J., Coles, C., Andrew, G., & Rasmussen, C. (2018). Mathematics intervention for children with fetal alcohol spectrum disorder: A replication and extension of the math interactive learning experience (MILE) program. Research in Developmental Disabilities, 78, 55-65.

Macsween, J., Kerns, K. A., Macoun, S., Pei, J., Hutchinson, M., Rasmussen, C., & Bartle, D. (2015). Investigating the efficacy of computerized cognitive intervention for children with FASD and ASD. International Journal of Developmental Neuroscience, 47, 13.

Migliorini, R., Moore, E., Glass, L., Infante, M., Tapert, S., Jones, K.,… Riley, E. (2015). Anterior cingulate cortex surface area relates to behavioral inhibition in adolescents with and without heavy prenatal alcohol exposure. Behavioural Brain Research, 292, 26-35.

Nash, A., & Davies, L. (2017). Fetal alcohol spectrum disorders: What pediatric providers need to know. Journal of Pediatric Health Care, 31(5), 594-60.

O’Connor, M., Quattlebaum, J., Castañeda, M., & Dipple, K. (2016). Alcohol intervention for adolescents with fetal alcohol spectrum disorders: Project step up, a treatment development study. Alcoholism: Clinical and Experimental Research, 40(8), 1744-1751.

Olson, H. (2016). A renewed call to action: The need for systematic research on interventions for FASD. Alcoholism: Clinical and Experimental Research, 40(9), 1817-1821.

Osterman, R. (2011). Decreasing women’s alcohol use during pregnancy. Alcoholism Treatment Quarterly, 29(4), 436-452.

Pei, J., Baugh, L., Andrew, G., & Rasmussen, C. (2017). Intervention recommendations and subsequent access to services following clinical assessment for fetal alcohol spectrum disorders. Research in Developmental Disabilities, 60, 176-186.

Pei, J., Tremblay, M., Poth, C., Hassar, B. E., & Ricioppo, S. (2018). Best Practices for Serving Individuals with Complex Needs: Guide and Evaluation Toolkit. PolicyWise for Children and Families in collaboration with the University of Alberta. Retrieved from: https://canfasd.ca/wp-content/uploads/sites/35/2018/09/Best-Practices_June12018.pdf

Popova, S., Lange, S., Burd, L., & Rehm, J. (2015). Cost attributable to fetal alcohol spectrum disorder in the Canadian correctional system. International Journal of Law and Psychiatry, 41, 76.

Reid, N., Dawe, S., Harnett, P., Shelton, D., Hutton, L., & O’Callaghan, F. (2017). Feasibility study of a family-focused intervention to improve outcomes for children with FASD. Research in Developmental Disabilities, 67, 34-46.

Saskatchewan Prevention Institute. Fetal alcohol spectrum disorder (FASD) prevention framework (2014). Government of Saskatchewan.

Sattler, J. (2014). 6th Ed. Foundations of behavioral, social, and clinical assessment of children. La Mesa, California: Jerome M. Sattler, Publishers, Inc.

Singal, D., Brownell, M., Chateau, D., Hanlon-Dearman, A., Longstaffe, S., & Roos, L. (2017). The psychiatric morbidity of women who give birth to children with fetal alcohol spectrum disorder (FASD): Results of the Manitoba mothers and FASD study. The Canadian Journal of Psychiatry, 62(8), 531-542.

Walker, D. S., Edwards, W. E., & Herrington, C. (2016). Fetal alcohol spectrum disorders: Prevention, identification, and intervention. The Nurse Practitioner, 41(8), 28-34.

Zizzo, N., & Racine, E. (2017). Ethical challenges in FASD prevention: Scientific uncertainty, stigma, and respect for women’s autonomy. Canadian Journal of Public Health, 108(4), 414-417.

Early Literacy and Guided Reading Lesson Plans

Attached are three lesson plans I use for Early Literacy and Guided Reading intervention times. I recommend using Dawn Reithaug’s letter recognition and sound assessment and The Phonological Awareness Aligned to the Hierarchy assessment to form groups based on need. Then divide your learners into early literacy groups (red) and guided reading (yellow) and change groups according to assessment results. I like to check each month formally (summative) using the assessment. For daily (formative) checks, I recommend creating an excel document with all the children’s’ names and all the letters. Pick a letter each day to test them at random (make sure it has been explicitly taught before) and note if the child knows the sound and/or letter. For instance, Child A might be shown letter ‘m’ and Child B might be shown letter ‘c.’ You can do the same thing with basic sight words for your yellow group.

Early Literacy Lesson Plan 

Guided Reading Intervention Lesson Plan

Guided Reading Intervention Lesson Plan – Option 2

Note: I print multiple of these lesson plans out and put them in a folder, which I clip after each day. By keeping a similar format and having copies easily accessible I can plan my next lesson in 10 minutes (depending on the activity)! I can easily highlight what we will be doing the next day and note any letters that need reviewing based on the data or any adaptations for specific kids. It also helps to keep the “I Can Statements” up in the room to save time. Please view Resources for a First Year SST for specific early literacy and guided reading resources.

Happy planning!

Resources for a First Year SST

As a first year SST, I found myself wondering “what resources do I need to be a successful teacher and support?” These are the resources that have helped me get through the first few months (right after some awesome colleages and kids!):

Reading:

FAIR – researched based phonics activities/games. Great to cut-out, laminate, and file so they are easily accessible. So far I have utilized letter recognition/sounds and rhyme games with great success and engagement from the kids! Note: K level actually translated to Grade 1 in many cases (adapt/gage for your children as necessary).

Letterland – kids love the actions and really retain it. Videos on Youtube, as well as, the Sotrybook are great tools for basic classroom teaching and interventions.

This always helps too:

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#halloween #awesomestaff #teacherlife

Measured Mom – everything early literacy (and math!). Great, engaging activities to get student engaged during small-group instruction. It is a good idea to cut-out, laminate, and file some of these supports so they are easily accessible. I also made kids their own individual books and while they worked on those we played some games one-on-one. The kids loved it!

Raz-Kids – for levelled books for guided reading (totally worth it to get an account!)

Reading Assessments: 

Concepts of Print by Marie M. Clay – for basic/initial reading assessments

Fountas and Pinnell Benchmarking Kit 

Orchestrating Success in Reading by Dawn Reithaug – assessing the 5 main components of reading (great for LIT goals)

Reading Power by Adrienne Gear – great for LIT goals and reading instruciton

Autism:

Circles Curriculum – teaches social boundaries/relationships

Getting Unstuck – how to problem solve

Whole Body Listening – great tool for whole-class listening (pair with both positive reinforcement, such as a marble jar, and negative reinforcement, such as name with checks on board, and you will be set!)

Zones of Regulation – great for emotional thinking and tracking (self-monitoring)

Motivation:

A Love Letter to First-Year Teachers from We Are Teachers

And whatever you do, don’t forget to ask questions.. lots of them!

Compiling Tech. Resources

In ECMP 355 we have learned about many tools to facilitate 21st century education! From Blackboard to Pensieve to My Fitness Pal – it feels like we have covered it all. For my own benefit (and anyone else who is interested), here is an overview of what we have explored and some of my own favorites:

1. MOOCs

2. Blog/Writing/Classroom Places for Resources

  1. RSS Feeds/Bookmarking
  1. Communication/Assessment
  1. Social

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Photo Credit Globovisión via Compfightcc

6. Productivity/Plan

  1. Presentation/Assess
  1. Creative
  1. Media
  1. Coding
  1. Misc.

12. Autism Apps

13. Sign Language Apps/Sites

Today I also want to compile the resources from two articles: Snapshots Of Understanding? 10 Smart Tools For Digital Exit Slips and Apps That Rise to the Top: Tested and Approved By Teachers. Note: some resources repeat.

The first article discusses exit slips (an important element of assessment as… or assessment for if they are entrance slips). The article outlines these following technological options:

The second article outlines teacher-approved apps for:

1. Digital Storytelling/Presenting

2. Video Tools

3. Photo Editing

4. Augmented Reality

5. Reading/ELA/Library

*more ELA resources at kgorhamblog ELA Resources 

6. Commenting Tools

7. Coding

8. Note Taking/Organization

9. Digital Citizenship

10. Social Media

.11. Misc.

What other tools are out there? What is your favorite tool? What is a technology that you and your classroom couldn’t survive without!?

Internship Final Rating

Below are the results of the best internship I could have ever imagined! I couldn’t have dreamt up a better placement, more supportive cooperating teachers, and a better learning experience. I am so happy to have experienced various subjects in all grades K-12. I have grown so much over the last four months (as shown by my well-rounded teacher visual). My ratings for Professional Development increased from 2.67, to 3 and finally 3.67. My Interactions with Learners increased since September from a 2.55, to a 2.82, and finally a 3.55. My Planning/Evaluating/Assessing rating increased from a 2.65, to a 3.8. My Instructional Competence rating increased from a 1.43, to a 2.4, and finally a 3.6 this December. My Teaching Strategies came in at a 4 (100%) from a 2.25. Professionalism went from a 3.56 to a 3.88. Therefore, I was able to carry out my goal of a 3.50 score or more in all areas by following my October plan for success (working on intense behaviors, differentiating, using technology, etc.).  My strongest to weakest areas were as follows: Teaching Strategies, Professional Qualities, Planning/Evaluation/Assessment, Professional Development, Instructional Competence, and Interactions with Learners. Although my rating is very exceptional and well above my expectations, I know there is a lot of things I can continue to work on. You cannot be a teacher without being a lifelong learner. I will always have room to grow and lessons/plans will need to be adapted, especially in a student support role. I would like to continue my focus on using technology in the classroom, differentiating instruction, and handling intense behaviors appropriately. These goals are applicable as both a student support and classroom teacher (K-12). As this journey comes to a close, it is bittersweet but I know it is an end to a beginning of a long, happy career. I will miss this school, my colleagues, and all the lovely students! I cannot thank those at Mossbank school, the students, the staff, the community, and most importantly, my two wonderful cooperating teachers for such a terrific experience. Hopefully, Mossbank school and/or Prairie South will be a big part of my near future! Time sure flies when you are having fun! 🙂

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Well-Rounded Teacher – Internship Assessment #1

After my first month of teaching at Mossbank school, one of cooperating teachers and I rated my overall performance. We looked at areas of Professional Development (A), Interactions with Learners (B), Planning and Evaluation (C), Instructional Competence (D), Teaching Strategies (E), and Professionalism (F). It was nice to see how closely our assessments aligned.

My ratings were as follows:

1. Professionalism

2/3. Professional Development and Interactions with Learners

4. Planning and Evaluation

5. Teaching Strategies

6. Instructional Competencies

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My focus will be on Teaching Strategies and Instructional Competencies for the next couple of months. I will be focusing a lot on classroom management/behavior/procedures. I can’t wait to see how I grow over the next three months!

Assessment Philosophy and Learnings ECS 410

Philosophy of Assessment and Evaluation:

Zeroes/Behavior:

I believed in a system driven by grades. I thought zeroes were fair game and by removing them we were making 50’s become the new 0’s. Furthermore, I thought that pass/fail classes were a joke and learners would not try without an extrinsic motivation (grades). During the first class when you asked if we should mark behavior, I was all for it! I thought that marking behavior prepared students for the real world!

After reading for the learning journey blog posts, I have changed my mind. As Todd Rogers, a psychologist from U of A, suggests, “a zero indicates the student knows nothing about a topic when they might actually know plenty… the mark of incomplete is more honest” (Sands, “Educators defend no-zero rule”). I believe that 0’s mark a behavior. They punish students and give them the chance to opt out from completing the curriculum outcomes (which is the purpose of them being in that course). Often zeroes are a result of late marks, and in the “real world” time is flexible. It is important to note that“the no-zero approach puts the onus on the teacher to do everything possible to ensure students are learning what’s in the curriculum” (Sands, “Educators defend no-zero rule”). Students are still held accountable to do their work but their behavior is rated separately. If students do not do the main assignments in the term they cannot get a credit.

Fun fact: A newspaper article about cholesterol and wanting to get a zero to avoid a high cholesterol rating was what changed my opinion!

Redo’s:

Redo’s were something I was against. The first time we talked about this in class, I thought “How is that fair to the top students who got it the first time? Wouldn’t everyone have high marks then?” After some reflection I thought, “But wait, Kourtney, the goal is not for students to compete against each other for marks. It does not matter if they all have 80s. The goal is for everyone to get it at any time that they can.” Now I think that everyone deserves a second chance; Guskey notes that we can ignore “low quiz scores,” allow for redo’s, consider marks “from a previous marking period,” or weight course material differently (2011, p, 87-8). Shepard also shares this idea and states that redo’s allow for fair evaluation (2008, p. 44).

Student role in assessment process:

Before reading Making Classroom Assessment Work and attending ECS 410, I never considered letting students be part of the criteria-building process or informing them about what outcome they were trying to meet. I did not feel right about students coming to parent-teacher interviews.

I believe that students need to be part of the learning process! They need chances to self-assess, compile their own learning (portfolio or blog), and should always be present at conferences/interviews. This is because learning is lifelong and for their benefit! I also think students should get a chance to decide the weights of assignments because they know themselves best. Students should be aware of the outcomes.

Quotes:

  • Laurie Gatsky noted that “assessment should not be a secret.”
  • “Students can reach any target that they know about and that holds still for them” – Anne Davies
  • Students should be involved with “the process of preparing and presenting” because it “gives students the opportunity to construct their understanding and to help others make meaning of their learning” (Davies, 2011, p. 86).

Examples/Model:

  • We must show students “what is expected and what success looks like” (2011, p. 30).
  • Anne Davies notes that students need specific “descriptions of what needs to be learned” or referenced (2011, p. 27).
  • Kelly Gallagher also highlights this idea in Chapter 3 of Teaching Adolescent Writers.
  • Samples and models are needed for student success.

Practice Time/Descriptive Feedback/Less Grading:

       I have always believed strongly in descriptive feedback and practice time!

Quotes:  

  • Noskin (2013) stated that “assessments must be formative and frequent with timely feedback; a summative assessment should follow at the unit’s end” but not before then (p. 73).
  • Davies (2011) also states that “when students are acquiring new skills, knowledge, and understanding, they need a chance to practice” (p. 2).
  • Guskey notes that when feedback is given with grades, students’ “grades on subsequent assessments significantly improved” (2011, p. 86).
  • Anne Davies also emphasizes descriptive feedback in Making Classroom Assessment Work. She notes that “evaluative feedback gets in the way of many students’ learning” and students only “understand whether or not they need to improve but not how to improve” (2011, p.17-8).
  • “Increasing the amount of descriptive feedback, while decreasing evaluative feedback, increases student learning significantly” (Davies, 2011, p. 3).
  •  “The more specific, descriptive feedback students receive while they are learning, the more learning is possible” (Davies, 2011, p. 58).

Triangulation

I believe that we need to asses students on many things!

Quotes:

  • Anne Davies (Making Classroom Assessment Work) expresses that teachers must “gather evidence from a variety of sources, and that they gather evidence over time” (2011, p. 45).
  • Observations, products, conversations are some of the sources!
  • We can avoid pretending that a student’s whole performance or intelligence can be summed up in one number” – Peter Elbow.
  • Bernhardt (1992) states “that it is unreliable to base [evaluation] on a single sample of student writing” (p. 333). Thus, it is also unfair to evaluate students on “a single sit-down test” (Bernhardt, 1992, p. 333).
  • When students are faced with exams, or one time to shine, they are more worried “about what will be on the test rather than thinking about learning” (Shepard, 2006, p. 41). Grades, which are extrinsic rewards, “can reduce intrinsic motivation” (Shepard, 2006, p. 42).

Choice/Differentiation:

Anne Davies notes, “students learn in different ways and at different rates” (2011, p. 43) and I believe our teaching/assessment needs to reflect this. This includes differentiation, oral and verbal instructions, assignment choices, etc.

Quotes:

  •  “Many teachers teach every child the same material in the same way, and measure each child’s performance by the same standards… Thus, teachers embrace the value of treating each child as a unique individual while instructing children as if they were virtually identical” (Mehlinger, 1995).
  • Lillian Katz’s quote “when a teacher tries to teach something to the entire class at the same time, chances are, one-third of the kids already know it; one-third will get it and the remaining third won’t.  So, two-thirds of the children are wasting their time.”

Use of Assessment and Evaluation:

Diagnostic Today’s meet, exit and entrance slips, quick-write questions: what is going well? What needs to be changed? How do you feel out of five about your understanding of the novel.  

Formative- Thumbs up (instead of mini whiteboards from  “Classroom Experiment”), talking to students one-on-one and asking for their understanding or feedback on my teaching (idea from “Classroom Experiment”), bell work, paragraph responses, jigsaws, think-pair-shares, class discussions, group work, carousel activity, talking circle, Venn diagram on gender, cold call (instead of lollipop strategy from “Classroom Experiment”), jeopardy review, homework checks

Summative – Island art, presentations, worksheets (story plot line) and questions, inquiry letters, vocabulary worksheets 

Student Involvement – Student choice on dates and schedule of assignments. Student choice on assignment representations. Students got to self-assess their efforts and debate marks. Students were aware of the curriculum outcomes (orally and verbally introduced). 

Accommodations/Differentiations – I had to give certain students extensions. I was supposed to give zeroes but I did not do this. I would talk to them individually and then see what dates worked for them. One student had an anxiety disorder so her presentation was done individually. She only had to do it in front of three teachers and a friend instead of the whole class. Two students had to do an island art assignment on their own (missed the class day so they missed the group work) and I gave them extra time to accommodate less people.

4 Key Lessons

  1. YOU DO NOT NEED THE TEXT TO GET TO THE OUTCOMES! WE SPEND SO MUCH TIME ON COMPREHEND AND RESPOND (1 OUTCOME) BUT ONLY ABOUT 3 DAYS ON THE OTHER, LARGER, MORE COMPLICATED OUTCOMES. THESE ARE OFTEN JUST THROWN IN AND HAVE LITTLE TO DO WITH THE NOVEL. THE NOVEL ACTUALLY COMPROMISES THE OUTCOMES IN THESE CASES! ENGLISH INSTRUCTION NEEDS TO FOCUS ON STUDENT INTERESTS AND THE INQUIRY QUESTIONS/THEMES IN THE CURRICULUM. IT IS THEN THE JOB OF THE EDUCATOR TO MAKE THESE QUESTIONS AND INTERESTS MATCH THE OUTCOMES, INDICATORS, AND ASSESSMENT PRACTICES.A NOVEL IS A NOVEL. IT IS NOT A CLASS. “The text is not the unit” (Noskin, 2013, p. 72). 

    I PLAN TO STRUCTURE MY CLASS BASED ON THIS UNDERSTANDING!!

2. Beginning with the end in mind:

  • Did this on the unit plan and for the class. Started with the outcomes and what my weekly overviews would be.
  • Students engage when their interests are reflected. I intend to find out about my learners and match their interests to the curriculum outcomes. Taking a book and making outcomes fit is almost impossible and doing it the other way around makes more sense.3. Rubrics:
  • Rubrics are vital and allow you to mark students based on a standard/outcome, instead of compare each other
  • Students also figure out what they need to do
  • Make rubrics with 4 boxes (so they do not always get put in the middle)
  • Rubrics should not have numbers, letters, etc.

4. Finally we must slow down “to create a learning culture… instead of a grading culture” (Shepard, 2006, p. 41). I would rather have my students’ master two things than touch on 800 poorly. This is reflected in the curriculum and will guide my instruction/assessment. We do not need to hit every indicator to get to the outcome. Give students choice so they can hit the outcome really well in one or two ways!

 Challenges and Further Questions:

  • I found grade reporting to be difficult (especially since I had to mark everything). I wonder how I can do this in a more efficient manner.
  • I found that catching-up missing students was hard. I often got them to get the materials from their friends but they still missed out on instructional time. I have been researching flipped classrooms and I think this might be one way to work around this problem. This is because the instruction/lecture is posted online in a video or multi-media format that students can access at any time. Then when students are in class they do their work, meaning students can all be working on different things. This also ensures that homework is being handed in! What other strategies are there for welcoming students who often are missing back into your classroom?
  • How do we balance the fine line between helping/supporting and enabling/encroaching on independence?
  • How do you motivate students without the “mark threat?” I know this is terrible but often students are so focused on marks, it seems like the only way to get them to do their work. Maybe this is a sign that more engaging explorations need to be made in class so that students want to learn!
  • I am still unsure about co-constructing rubrics. I am not competent enough to do this… yet.
  • I believe in self-assessment. However, many professors have told me not to do it because students end up giving each other the wrong answers. How do you teach students to self-assess appropriately and make this activity beneficial? How much time should be set aside for self-assessment?
  • How does a teacher decide what summative assessment is more important than others? How are weights applied and how should this be determined?
  • I am still unsure of our no-failing policies. I have yet to find articles that say failing Grade One is detrimental and I feel like repeating grades should not be looked at as a bad thing. If you need an extra year to learn to read, then so be it! However, I know that professors and some educators have a different perspective that cannot go uncredited. I want to find more information about this topic so that I open myself up to both perspectives. Do you know of any resources, specifically about repeating grades?
  • When is it best to mark students? How long do you wait to do summative assessment?
  • What method can be used to replace the grading system?
  • How do we implement a consistent grading system that provides all students with an equal opportunity, regardless of where they live?
  • Reporting under outcomes seems like a great idea! If your gradebook is set up under outcomes and an assignment covers more than one outcome, where do you place it?
  • Would you make one rubric per outcome? Would that work if students were exploring the outcomes through various indicators and choices?
  • Another thing I struggle with is not comparing students to each other. I agree that students deserve to be held to a standard and that their learning is not a competition. But this is easier said than done. I found myself comparing work so that I could ensure myself that I was being fair. I really hope I get more confidence and skill with grading so that I stop doing this.

Ken O’Connor “15 Fixes to Broken Grades”

On March 6, 2014, we looked at Ken O’Connor’s “15 Fixes to Broken Grades.”

Thing I agree with:

– keeping behavior and grades separate

– support for students who submit work late (although I would do this within reason because your students need to work as hard as you. However, I think if students hand in late work they probably have extenuating circumstances and need our support).

– report absences separate from grades

– organize information by I Can Statements/Outcomes (I like this but I am still trying to figure this out. I think once I understand the outcomes better, this will be easier).

– provide clear expectations

– rely on quality assessments and not on those that do not meet the standards of quality (ie. get students to redo and then grade)

– use your professional judgment (ie. mean is not the only measure)

– use alternatives for zero (ie. incomplete, etc.)

– use summative evidence only in grade and keep formative assessment out of it

– include lots of formative assessment in teaching practice

– focus on recent achievement and allow for practice time

– involve students in their own assessment and make them part of the grading process (This is harder than it sounds!)

Things I am unsure of:

– do not compare students to each other but to a standard (I believe in this but I am not anywhere close to this level of success and mastery yet. Hopefully one day!)

– not including group scores in grades (I think this is sometimes appropriate. We can use our professional judgment to determine when it is fair and when it is not).

– apply fair consequences for academic dishonesty and reassess (ie. do not give a zero. I agree but I wonder, what is a fair consequence for stealing work or cheating? However, giving a zero would not correct the behavior I bet. But what does? This will be stressful. Hopefully the school I go to would have a policy).

Something I dislike:

– not giving bonus points unless the work has resulted in a higher level of achievement (I think bonus questions are fun and I think students who work hard should have that reflected in their grades. I’m not sure I even understand this point.)