fetal alcohol spectrum disorders (fasd) brought to you by anchorage school district nurses kim...

Fetal Alcohol Spectrum DisordersFetal Alcohol Spectrum Disorders (FASD) (FASD)

Brought to you by Anchorage Brought to you by Anchorage School District NursesSchool District Nurses

Kim Beckett, Ruth Bogert, Luann Fogels, Jan Ilutsik, Paula Mottola,Amy Owens, Barb Pennington, Kathy Seybert, and Susie Whited

FASD is an umbrella term used to FASD is an umbrella term used to define the following disorders:define the following disorders:

Fetal Alcohol Syndrome (FAS)Fetal Alcohol Syndrome (FAS) Partial Fetal Alcohol Syndrome (PFAS)Partial Fetal Alcohol Syndrome (PFAS) Fetal Alcohol Effects (FAE)Fetal Alcohol Effects (FAE) Alcohol-Related Neurodevelopment Alcohol-Related Neurodevelopment

Disorder (ARND)Disorder (ARND) Alcohol-Related Birth Defect (ARBD)Alcohol-Related Birth Defect (ARBD)

What is FASD?What is FASD?

FASD is permanent brain damage caused FASD is permanent brain damage caused by prenatal exposure to alcohol. It is a by prenatal exposure to alcohol. It is a lifelong disability and one that requires the lifelong disability and one that requires the affected child be supported in a stable and affected child be supported in a stable and structured environment to maximize his or structured environment to maximize his or her potential.her potential.

Number of People with a FASDNumber of People with a FASD

No one knows for certain how many No one knows for certain how many individuals are born each year individuals are born each year

with a FASD.with a FASD.

No one knows how manyNo one knows how many

individuals are living withindividuals are living with

a FASD.a FASD.Photo property of SAMHSA.

SAMHSA FASD Center for Excellence: SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov

Do You have a Student with FASD Do You have a Student with FASD in your Classroom?in your Classroom?

It is likely that there are It is likely that there are children with FASD in every children with FASD in every school system. school system.

A school system with10,000 A school system with10,000 students might have 80 to students might have 80 to 100 students with learning 100 students with learning problems related to FASD.problems related to FASD.

SAMHSA FASD Center for Excellence: asdcenter.samhsa.govSAMHSA FASD Center for Excellence: asdcenter.samhsa.gov

Cause of FASDCause of FASD

The sole cause of FASD is women drinking The sole cause of FASD is women drinking alcoholic beverages during pregnancy.alcoholic beverages during pregnancy.

Alcohol is a teratogen.Alcohol is a teratogen. There is no proven safe amount of alcohol There is no proven safe amount of alcohol

use during pregnancy.use during pregnancy.

“Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”

—IOM Report to Congress, 1996

.


FASD FactsFASD Facts Leading known cause of Leading known cause of

preventable mental preventable mental retardation.retardation.

Not caused on purpose.Not caused on purpose. Can occur anywhere and Can occur anywhere and

anytime pregnant women anytime pregnant women drink. drink.

Not caused by biologic Not caused by biologic father’s alcohol use.father’s alcohol use.

Not a new disorder.Not a new disorder.


Simplified Fetal Development ChartSimplified Fetal Development Chart

Physical Abnormalities associated Physical Abnormalities associated with FASD with FASD

EYE:EYE: crossed eyes, poor vision, optic nerve abnormalitiescrossed eyes, poor vision, optic nerve abnormalities

EAR:EAR: outer ear abnormalities, low set ears, sensory, neural hearing loss, frequent ear outer ear abnormalities, low set ears, sensory, neural hearing loss, frequent ear infectionsinfections

MOUTH and JAW:MOUTH and JAW: dental problems, dysfunctional movements of tongue and larynx dental problems, dysfunctional movements of tongue and larynx SKELETAL DEFECTSSKELETAL DEFECTS: missing bones, clubfoot, hand and finger deviations: missing bones, clubfoot, hand and finger deviations

ORGAN PATHOLOGY:ORGAN PATHOLOGY: heart problems, urogenital and genital anomalies, malformed or heart problems, urogenital and genital anomalies, malformed or missing kidneymissing kidney

SENSORY DEFICITS:SENSORY DEFICITS: tactile defensiveness or need for tactile stimulation tactile defensiveness or need for tactile stimulation hypersensitivity to sound, taste, light, smellhypersensitivity to sound, taste, light, smell

IMMUNE SYSTEM:IMMUNE SYSTEM: allergic reactions, altered susceptibility to infections allergic reactions, altered susceptibility to infections

FASD and the BrainFASD and the Brain

Prenatal alcohol exposure causes brain Prenatal alcohol exposure causes brain damage.damage.

Effects of FASD last aEffects of FASD last a

lifetime.lifetime.

People with FASD canPeople with FASD can

grow, improve, and function well in life with grow, improve, and function well in life with proper support.proper support.


Areas Most Affected by Prenatal Areas Most Affected by Prenatal Alcohol IngestionAlcohol Ingestion


Permission to use photo on file. SAMHSA FASD Center for Excellence: SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov


A B C

A. Magnetic resonance imaging showing the side view of a 14-year-old control subject with a normal corpus callosum; B. 12-year-old with FAS and a thin corpus callosum; C. 14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum.

Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.



A

These two images are of the brain of a 9-year-old girl with FAS. She has agenesis of the corpus callosum, and the large dark area in the back of her brain above the cerebellum is essentially empty space.

Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52. SAMHSA FASD Center for Excellence: SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov

Permanent Permanent Lifelong Lifelong

Brain Brain DamageDamage

+ =

Alcohol KILLS a growing brain!

ParentsParents

Parents are often aware that there is something Parents are often aware that there is something different about the way their child behaves and different about the way their child behaves and learns but may not know exactly why that is.learns but may not know exactly why that is.

Early experiences in school are often the first time Early experiences in school are often the first time

that specific concerns are raised and a family is that specific concerns are raised and a family is encouraged to seek medicalencouraged to seek medical

or psychological evaluations.or psychological evaluations.

Typical Difficulties for Students with Typical Difficulties for Students with a FASDa FASD

Memory ProblemsMemory Problems

MultiplicationMultiplication

Time sequencingTime sequencing

?


Information Processing Information Processing ProblemsProblems

Say they understand when Say they understand when they do not they do not

Have verbal expressive skills that often Have verbal expressive skills that often exceed their level of understandingexceed their level of understanding

Misinterpret others’ words, actions, or body Misinterpret others’ words, actions, or body movementsmovements

Have trouble following multiple directionsHave trouble following multiple directions

YES!

(How do you straighten up?

Make sure the bed/chair is straight?)

Straighten up your room and put your toys away. Do you understand?


Sensory Integration IssuesSensory Integration Issues

Are overly sensitive to sensory inputAre overly sensitive to sensory input• Upset by bright lights or loud noisesUpset by bright lights or loud noises• Annoyed by tags in shirts or seams in Annoyed by tags in shirts or seams in

sockssocks• Bothered by certain textures of foodBothered by certain textures of food

Have problems sensing where their Have problems sensing where their body is in space (i.e., clumsy) body is in space (i.e., clumsy)


Executive Function DeficitsExecutive Function Deficits Go with strangersGo with strangers

Repeatedly break the rulesRepeatedly break the rules

Cannot entertain Cannot entertain themselvesthemselves

Have trouble changing Have trouble changing taskstasks

Do not accurately pick up Do not accurately pick up social cues social cues

Do not learn from mistakes or Do not learn from mistakes or natural consequences natural consequences

Frequently do not respond to Frequently do not respond to point, level, or sticker systemspoint, level, or sticker systems

Give in to peer pressureGive in to peer pressure

Have trouble with time and Have trouble with time and moneymoney

I’m late!

I’m late!

I’m late!


Information Processing Information Processing ProblemsProblems

Do not complete tasks or chores and may Do not complete tasks or chores and may appear to be oppositionalappear to be oppositional

Have trouble determining what to do in a Have trouble determining what to do in a given situationgiven situation

Do not ask questions because they want Do not ask questions because they want to fit into fit in


Primary Disabilities of Students Primary Disabilities of Students with a FASDwith a FASD

Lower IQLower IQ

Impaired ability in reading, Impaired ability in reading,

spelling, and arithmeticspelling, and arithmetic

Lower level of adaptive functioning; Lower level of adaptive functioning; more significantly impaired than IQ more significantly impaired than IQ

Streissguth, et al. (1996)

Permission to use photo on file.


Secondary Disabilities of Secondary Disabilities of Students with a FASDStudents with a FASD

Mental health Mental health issuesissues

Disrupted school Disrupted school experienceexperience

Trouble with the lawTrouble with the law

Inappropriate Inappropriate sexual behaviorsexual behavior

Confinement in jail Confinement in jail or treatment or treatment facilitiesfacilities

Alcohol and drug Alcohol and drug problemsproblems

Dependent livingDependent living

Employment Employment problemsproblems

Streissguth, et al. (1996)SAMHSA FASD Center for Excellence: SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov

Approximate Percent of Persons Approximate Percent of Persons with FASD Secondary Disabilitieswith FASD Secondary Disabilities

= Age 6+ = Age 12+ = Age 21+SAMHSA FASD Center for Excellence: SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov

Secondary Disabilities ReducedSecondary Disabilities Reduced

Stable homeStable home

Early diagnosis Early diagnosis

No violence against No violence against oneselfoneself

More than 2.8 years More than 2.8 years in each living in each living situationsituation

Recognized disabilitiesRecognized disabilities

Diagnosis of FASDDiagnosis of FASD

Good quality home Good quality home from ages 8 to 12from ages 8 to 12

Basic needs met for at Basic needs met for at

least 13 percent of lifeleast 13 percent of life

Streissguth, et al. (1996)SAMHSA FASD Center for Excellence: SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov

Overall Difficulties for Students Overall Difficulties for Students with a FASDwith a FASD

Taking in informationTaking in information Storing informationStoring information

Recalling information when necessaryRecalling information when necessary

Using information appropriately in a Using information appropriately in a specific situation specific situation

Information


Faces of FASDFaces of FASD

The different ‘faces’ of FASD. The different ‘faces’ of FASD. Sometimes the condition is not physically Sometimes the condition is not physically obvious and the brain damage of obvious and the brain damage of prenatal exposure to alcohol is not prenatal exposure to alcohol is not detected until much later in lifedetected until much later in life

“ “19 in 20 FASD afflicted children have 19 in 20 FASD afflicted children have no obvious physical characteristics of no obvious physical characteristics of FAS.” FAS.”

“ “The most vulnerable children are those The most vulnerable children are those withoutwithout physical characteristics of FAS” physical characteristics of FAS”

Class Notes - May 28, 2008Class Notes - May 28, 2008

Characteristic facial features in children of different ethnicities with fetal alcohol spectrum disorders. (A) Child of Northern European descent. (B) Native American child. (C) Black child. (D) Biracial child - Black/White.

Diagnosing Fetal Alcohol Diagnosing Fetal Alcohol SyndromeSyndrome

Prenatal maternal alcohol usePrenatal maternal alcohol use

Growth deficiencyGrowth deficiency

Central nervous systemCentral nervous systemabnormalitiesabnormalities

Dysmorphic featuresDysmorphic features• Short palpebral fissuresShort palpebral fissures• Indistinct philtrumIndistinct philtrum• Thin upper lipThin upper lip

Caucasian African American

Source: Astley, S.J. 2004. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code, Third Edition. Seattle: University of Washington Publication Services, p. 114.


FASD and Mental Health FASD and Mental Health DisordersDisorders

Prenatal alcohol exposure may lead Prenatal alcohol exposure may lead to severe behavioral, cognitive, and to severe behavioral, cognitive, and psychiatric problemspsychiatric problems

FASD is not a psychiatric disorderFASD is not a psychiatric disorder

FASD can co-occur with a mental FASD can co-occur with a mental health or substance abuse disorderhealth or substance abuse disorder

DSM-IV


Risks to a Child of Not Risks to a Child of Not Accurately Identifying and Accurately Identifying and

Treating FASDTreating FASD

Loss of familyLoss of family

Increased substance useIncreased substance use

Premature deathPremature death Photo courtesy of Microsoft.


Strategies To Improve Outcomes Strategies To Improve Outcomes for Students with a FASDfor Students with a FASD

Sensory Integration IssuesSensory Integration Issues Simplify the student’s Simplify the student’s

environment environment Provide a lot of one-to-one Provide a lot of one-to-one

physical presencephysical presence Take steps to avoid sensory triggersTake steps to avoid sensory triggers

SAMHSA FASD Center for Excellence: fasdcenter.samhsa.govSAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov


Strategies for Memory ProblemsStrategies for Memory Problems

Provide one direction or rule at a Provide one direction or rule at a time and review rules regularly.time and review rules regularly.

Use a lot of repetition.Use a lot of repetition.



Strategies for Information ProcessingStrategies for Information Processing

ProblemsProblems

Check for understandingCheck for understanding Use literal languageUse literal language Teach the use of calculators and Teach the use of calculators and

computers computers Look for misinterpretations of words or Look for misinterpretations of words or

actions actions and discuss them when they occurand discuss them when they occur

Tell me what you just heard me say.

SAMHSA FASD Center for Excellence: fasdcenter.samhsa.govSAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov


Strategies for Executive Function DeficitsStrategies for Executive Function Deficits

Establish achievable goalsEstablish achievable goals

Use short-term consequences Use short-term consequences specifically related to the behaviorspecifically related to the behavior

Provide skills training and use Provide skills training and use a lot of role playing. a lot of role playing.

Photo property of SAMHSA.


Strategies To Improve Outcomes Strategies To Improve Outcomes for Students with FASDfor Students with FASD

Self-Esteem and Personal IssuesSelf-Esteem and Personal Issues

Use person-first language (e.g., “child with FASD,” Use person-first language (e.g., “child with FASD,” not “FASD child”)not “FASD child”)

Do not isolate the studentDo not isolate the student

Do not blame students for what they Do not blame students for what they cannotcannot do do

Set the student up for successSet the student up for success Congratulations


Avoid AssumptionsAvoid Assumptions

The biggest mistake many professionals The biggest mistake many professionals make in working with students with FASD make in working with students with FASD is thinking that, because they said it, they is thinking that, because they said it, they are capable of doing it without ongoing are capable of doing it without ongoing assistance.assistance.

It takes them longer to process.It takes them longer to process. In a verbal-only instructional setting, In a verbal-only instructional setting,

students with FASD may understand only students with FASD may understand only every third word.every third word.

Please RememberPlease Remember Punishing a child with FASD for a behavior Punishing a child with FASD for a behavior

resulting from brain dysfunction is like punishing resulting from brain dysfunction is like punishing a blind child for bumping into the furniture.a blind child for bumping into the furniture.

Never, ever punish a child with FASD for Never, ever punish a child with FASD for forgetting.forgetting.

Students with FASD are developmentally Students with FASD are developmentally younger than their chronological age. When younger than their chronological age. When determining age appropriate behavior, their determining age appropriate behavior, their developmental age is roughly half their developmental age is roughly half their chronological age. chronological age.

Basic Classroom AccommodationsBasic Classroom Accommodations

Adequate levels of supervisionAdequate levels of supervision

Structure and routineStructure and routine

Language that is appropriate and individual to Language that is appropriate and individual to the studentthe student

More Strategies…More Strategies…

Role play, Social stories, Puppets, Sign Language, Modeling with pictures, Give a concrete list, Use repetition, Inform student if schedule will change, Peer tutor, Seating accommodations, Personalize rules with their names, Do not use “why” questions, Teacher or peer escorts, Visual or verbal reminder when end of recess is approaching, Use color coding, Use video instruction, Use rhythm, rhyme and rap, Computer based learning programs, Flashcards, Rephrasing, Physical guidance, Provide extra time, Create a safe place in each classroom

Always make concrete statements, not generalizationsAlways make concrete statements, not generalizations Consequences must be adaptableConsequences must be adaptable Consistency in schedules or routinesConsistency in schedules or routines Consistency reduces stressConsistency reduces stress Interpreter is needed to guide them through life due to naivetéInterpreter is needed to guide them through life due to naiveté Listen Listen Make personal relationships early on Make personal relationships early on Music and rhythm make a difference, use it whenever possibleMusic and rhythm make a difference, use it whenever possible Never punish a child with FASD for bad behaviorNever punish a child with FASD for bad behavior Patience and a sense of humor are crucialPatience and a sense of humor are crucial

Strategies for Working with Strategies for Working with Secondary StudentsSecondary Students

Strategies for Working with Secondary Strategies for Working with Secondary Students, continued…Students, continued…

Pay attention to bullying, many FASD children are being mistreatedPay attention to bullying, many FASD children are being mistreated Power struggles do not work, practice what to do, never what NOT to doPower struggles do not work, practice what to do, never what NOT to do Provide a safe place when student is in “overload” for relaxation and Provide a safe place when student is in “overload” for relaxation and de-escalation de-escalation Redefine success, help the child be successful todayRedefine success, help the child be successful today Slow the pace by using sign language, pictures, and peer helpersSlow the pace by using sign language, pictures, and peer helpers Success one day at a time, build habit patterns for the futureSuccess one day at a time, build habit patterns for the future Think of FASD as a disability of language rather than of behavior Think of FASD as a disability of language rather than of behavior Try alternative instructional modalities (if one way does not work, try Try alternative instructional modalities (if one way does not work, try another)another) Use multi-sensory modalities as much as possible Realize that Use multi-sensory modalities as much as possible Realize that developmental age is approximately one half of cognitive agedevelopmental age is approximately one half of cognitive age When reviewing rules, have the student write his/her own name in front of When reviewing rules, have the student write his/her own name in front of the rule so the rule will directly applythe rule so the rule will directly apply

SS - If a student with FASD is finding it frustrating or - If a student with FASD is finding it frustrating or difficult to do something, difficult to do something, SStop the activitytop the activity

OO - - OObserving a child’s actions in a busy classroom can bserving a child’s actions in a busy classroom can be difficult; it is essential, however, especially if the be difficult; it is essential, however, especially if the situation involves conflict with the child or you are feeling situation involves conflict with the child or you are feeling frustratedfrustrated

AA - - AAssess your observations of a child’s behavior in ssess your observations of a child’s behavior in terms of differences in his or her brain function. The terms of differences in his or her brain function. The child is not being bad; the brain is damagedchild is not being bad; the brain is damaged

PP - Successful - Successful PPlans are creative. Accommodating lans are creative. Accommodating children, rather than trying to change or “fix” them, children, rather than trying to change or “fix” them, means a greater likelihood of successmeans a greater likelihood of success

““SOAP” StrategySOAP” Strategy

TransitionsTransitions

Pay attention to all Transitions; Pay attention to all Transitions; Elementary to Middle School… Middle to Elementary to Middle School… Middle to High School…High School to Adult Life.High School…High School to Adult Life.

Planning should begin well before the Planning should begin well before the move to the new setting to give ample time move to the new setting to give ample time for placement choices and orientation.for placement choices and orientation.

Requires ongoing teaching of daily living Requires ongoing teaching of daily living skills.skills.

Eight “Magic Key” Strategies in Eight “Magic Key” Strategies in Responding to Students with Responding to Students with

FASDFASD

ConcreteConcrete ConsistencyConsistency RepetitionRepetition RoutineRoutine

SimplicitySimplicity SpecificSpecific StructureStructure SupervisionSupervision

“Making a Difference” 2006 Government of YukonMaking a Difference” 2006 Government of Yukon

Strengths of Students with a Strengths of Students with a FASDFASD

FriendlyFriendly

LikableLikable

Desire to be likedDesire to be liked

HelpfulHelpful

DeterminedDetermined

Have points of Have points of insightinsight

Not maliciousNot malicious

Dubovsky, Drexel University College of Medicine (1999)


More Strengths of Students with More Strengths of Students with a FASDa FASD

Cuddly and Cuddly and cheerful cheerful

Happy in an accepting Happy in an accepting and supportive and supportive environmentenvironment

Loving, caring, kind, Loving, caring, kind, sensitive, loyal, and sensitive, loyal, and ccompassionate ompassionate

Energetic and hard Energetic and hard working working

Fair and cooperative Fair and cooperative

Spontaneous, Spontaneous, curious, and curious, and involved involved

Permission to use photos on file.


Even More Strengths of Even More Strengths of Students with a FASDStudents with a FASD

Highly verbalHighly verbal

Highly moral—deep Highly moral—deep sense of fairnesssense of fairness

Kind with younger Kind with younger children children and and animals animals

Able to participate in Able to participate in problem solving with problem solving with appropriate supportappropriate support


Public Challenge and Public Challenge and ResponsibilityResponsibility

The statement that FASD students do not The statement that FASD students do not “grow up”, but just “get older” with the “grow up”, but just “get older” with the same behaviors and patterns and needs is same behaviors and patterns and needs is an important concept to understand.an important concept to understand.

As a community, it is imperative to As a community, it is imperative to recognize, strategize and plan for the recognize, strategize and plan for the future of these individuals in our society.future of these individuals in our society.

Children with a FASD grow up blaming themselves for a

disability that is…

100% Preventable

Our VISION for the future…

0% Disabilities

ASD ResourcesASD Resources

School NurseSchool Nurse School PsychologistSchool Psychologist FASD Tool Kit – usually held by Lead FASD Tool Kit – usually held by Lead

SpEd teacherSpEd teacher STEP Center 742-3867 STEP Center 742-3867

http://www.asdk12.org/depts/step/http://www.asdk12.org/depts/step/

Fetal Alcohol Syndrome Fetal Alcohol Syndrome ResourcesResources

http://fasstar.com/InternetGuide.htmhttp://fasstar.com/InternetGuide.htmOverall guide for Internet resources on FASDOverall guide for Internet resources on FASDhttp://fasstar.com/http://fasstar.com/Teresa Kellerman’s websiteTeresa Kellerman’s websitehttp://fetalalcoholsyndrome.org/http://fetalalcoholsyndrome.org/FAS family resourcesFAS family resourceshttp://www.nofas.org/resource/results.aspx?ST=2&Name=Alaskahttp://www.nofas.org/resource/results.aspx?ST=2&Name=AlaskaNational organizaion on Fetal Alcohol SyndromeNational organizaion on Fetal Alcohol Syndromehttp://faceproject.org/http://faceproject.org/Resource, training, and action on alcolol related issuesResource, training, and action on alcolol related issueshttp://fasdconnections.ca/http://fasdconnections.ca/Jan Lutke’s websiteJan Lutke’s websitehttp://fasday.com/http://fasday.com/Information on activities surrounding FAS Day (September 9)Information on activities surrounding FAS Day (September 9)http://fasalaska.com/linksresource.htmlhttp://fasalaska.com/linksresource.htmlLinks to FAS resourcesLinks to FAS resourceshttp://www.asdk12.org/depts/step/http://www.asdk12.org/depts/step/ASD Step Center. A resource center for students, educators, and parentsASD Step Center. A resource center for students, educators, and parentshttp://www.stonesoupgroup.org/http://www.stonesoupgroup.org/Statewide organization who provides support for families with special needsStatewide organization who provides support for families with special needshttp://www.providence.org/alaska/tchap/neuro/default.htmhttp://www.providence.org/alaska/tchap/neuro/default.htmDr. Ron BrennanDr. Ron Brennanhttp://www.fasworld.com/links.asphttp://www.fasworld.com/links.aspLinks to FAS resources on the webLinks to FAS resources on the webhttp://www.fasworld.com/links.asphttp://www.fasworld.com/links.asphttp://www.come-over.to/FAS/store/books.htmhttp://www.come-over.to/FAS/store/books.htmLink to books on FASDLink to books on FASD

ReferencesReferences

SAMHSA FASD Center for Excellence: SAMHSA FASD Center for Excellence: fasdcenter.samhsa.govfasdcenter.samhsa.gov

Centers for Disease Control and Prevention FAS Centers for Disease Control and Prevention FAS Prevention Team: Prevention Team: www.cdc.gov/ncbddd/faswww.cdc.gov/ncbddd/fas

National Institute on Alcohol Abuse and National Institute on Alcohol Abuse and Alcoholism (NIAAA): Alcoholism (NIAAA): www.niaaa.nih.gov/www.niaaa.nih.gov/

National Organization on Fetal Alcohol Syndrome National Organization on Fetal Alcohol Syndrome (NOFAS): (NOFAS): www.nofas.orgwww.nofas.org

National Clearinghouse for Alcohol and Drug National Clearinghouse for Alcohol and Drug Information: Information: ncadi.samhsa.govncadi.samhsa.gov

These sites link to many other Web sites.These sites link to many other Web sites.

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