Strategies for Assisting the Substance-Exposed Child

Prenatal Exposure to Drugs/Alcohol (2nd ed.)

Jeanette M. Soby; Charles C. Thomas, Publisher; Springfield, Ill., (800) 258-8980; 2006; ISBN: 0-398-07634-0; hardcover; 172 pages; $44.95

This is an important book for anyone, professional or parent, working with a child who suffers from fetal alcohol spectrum disorder (FASD) or fetal drug exposure (FDE). The treatise provides a solid foundation for professionals.

The text sets out to provide professionals, particularly in the education field, with the tools to develop individualized plans for children affected by prenatal exposure to alcohol and/or cocaine as well as other polydrug effects. It tries to synthesize knowledge from several disciplines, including cognitive psychology, neuroscience, education, biology, sociology, and speech, and considers both prenatal and postnatal environments.

The book is divided into three sections. The first presents typical characteristics of children prenatally exposed to alcohol, cocaine, or other drugs. The second section presents the cognitive process of learning, offering a point of comparison with normal children. The third section presents educational strategies for helping children who have been exposed prenatally.

Soby relies on medical and education research, as well as her own experience working in communities, with families, and in the educational and judicial systems. She also shares information from interviews with individuals in each of these systems.

She takes us through the history and prevalence of FASD, an umbrella term used to describe the range of effects that can result when a mother consumes alcohol during pregnancy. Soby takes the time to explain the physiologic processes involved with FASD in a straightforward manner. She describes the efforts needed to improve prevention and identification of FASD, both in the medical and educational realms.

Multiple challenges

The text underscores a litany of medical, social, and psychological problems that can emerge with children who have FASD. Soby describes these deficits in intricate detail. Children with FASD often do not qualify for special education services because they do not have a medical diagnosis, yet they face the same issues as do youths receiving special education, the text states.

While children with FASD often have facial abnormalities, children prenatally exposed to cocaine exhibit few physical manifestations. Prenatal ex-posure to cocaine more often causes neurologic deficits rather than motor deficits or poor growth patterns, Soby states. Questions about reversibility of damage and long-term effects remain largely unanswered because of a dearth of studies.

Soby also explains the behavioral effects of FASD and FDE, including impatience, immaturity, hyperactivity, lack of impulse control, lack of empathy, and distractibility. Recognizing an organic basis for behavioral/learning problems can direct therapy in an educational rather than cognitive/insight direction. Youngsters with FASD/FDE are likely to require prosocial instruction. They often are unable to acquire the social skills other children learn through observation.

Guidance for instruction

Teachers need to focus on attainable behavioral goals, the text states. Soby explains that the children are not trying to be difficult, but have underdeveloped social, functional, and intellectual capabilities and thus cannot integrate subtle information. The first step in a successful instructional program is matching behavioral expectations with a child's maturity level. Role-playing and modeling, as well as conversations and group discussions, constitute excellent ways to teach, as they help the children identify emotions and interpret the body language of others.

Soby states that the therapeutic focus should be on basic problem solving. Youngsters damaged by prenatal exposure likely have ineffective mental processes that disrupt their ability to extract information and use it effectively. Soby gives concrete examples of real-life situations to keep the text from becoming too technical. She includes examples of successful strategies based on structure, repetition, and consistency, and an instructional approach that taps into more than one of the primary senses.