# A PRACTICAL NATIVE AMERICAN GUIDE 

**FOR**

**PROFESSIONALS**

**WORKING WITH**

**CHILDREN,**

**ADOLESCENTS, AND ADULTS**

**WITH**

**FETAL ALCOHOL SYNDROME**

**AND**

**FETAL ALCOHOL SPECTRUM DISORDER**

**By**

# Robin A. LaDue, PhD

# A PRACTICAL NATIVE AMERICAN GUIDE 

**FOR**

**PROFESSIONALS**

**WORKING WITH**

**CHILDREN,**

**ADOLESCENTS, AND ADULTS**

**WITH**

**FETAL ALCOHOL SYNDROME**

**AND**

**FETAL ALCOHOL SPECTRUM DISORDER**

# By

**Text By**

**Robin** **A. LaDue, PhD**

**Illustrated by**

**Heath Fugate**

**Cover Illustration by**

**Katie Earll**

**IHS/PHS**

**NPAIHB, 2002**

**A PRACTICAL NATIVE AMERICAN GUIDE**

**FOR**

**PROFESSIONALS**

**WORKING WITH**

**CHILDREN,**

**ADOLESCENTS, AND ADULTS**

**WITH**

**FETAL ALCOHOL SYNDROME**

**AND**

**FETAL ALCOHOL SPECTRUM DISORDER**

# By

**Robin** **A. LaDue, PhD**

This work was supported by a grant from the Indian Health Service and
administered through the Northwest Portland Area Indian Health Board.

Dedication

In the past, I have dedicated my works to those patients with FAS and
FASD and their families who have taught me so much and have been guiding
forces in my life. This book, however, is dedicated with deep love and
gratitude to the one person who has stood beside me for the past twenty
years. It is trite, but in this case, very true: there are simply no
words of thanks that say enough to this person. So, in the best words I
can find, this manual is dedicated to my husband, Marshall Bruce Harmon,
who stuck to his vows of "Until death do us part" and back again.

# Acknowledgments

Over the course of the past five years, it has been my great pleasure to
work with Dr. Marlene Echohawk of the Indian Health Service. It is
through her dedication to Native children and their families that this
venture has been brought to fruition. No one person creates a work such
as this on their own. There are, literally, hundreds of people who have
contributed to this effort. While only a few can be named in these
pages, this does not lessen the appreciation I have for all who have
given so generously of their time and support.

Special thanks are owed to the hundreds of people that have shared their
lives with the author for nearly twenty-five years. Without their
courage, perseverance, and humor, none of this could be written. This is
also true of a group of very special people in my life: Dr.'s Sterling
and Sandy Clarren, Sharon Beck, and Julie Gelo. Love and thanks go to my
nieces, Traci, Sydney, Taylor, Shannon, Jensen, and, most of all, to my
beloved aunt, Lucile LaDue. A special thank you to Dr. Mary Butcher for
ensuring I survived long enough to write this book.

For the past three years, I have also had the pleasure of working with
one of the most competent, efficient, and talented production teams
ever: Kathy Ryor, Heath Fugate, Nancy Woo, and Katie Earll. Without
their exemplary efforts, this project could not have been completed.

I would also like to thank the reviewers of this manual who gave as
unselfishly to this manual as they have to the special children of this
world: Kathryn Alexander NPAIHB, Leslie Chernan, PhD, Lynn DeLorme
NPAIHB, Julie Gelo, Barry (BL) Levitt, Becke Macke, Kathy Masis, Terry
McAnally, Dee Robertson, Alan Willoughby J.D., and Georgianna Wilton.

And, of course, a special thank you to Creator and all the gifts he
bestows.

# Table of Contents

Prologue: Coyote and Raven 1

Introduction 14

a.  A Brief Historical Overview

b.  Fetal Alcohol Syndrome: A History and Diagnosis

c.  Formation of the Treatment Team

d.  Routes to Identification

e.  A Guide to this Manual

Section I: Developmental Milestones and Issues 27

a.  Normal Development by Age

b.  Developmental Concerns by Age

c.  Interventions by Age

Section II: Physical Health Issues and Needs 56

a.  Health Concerns

b.  Difficulties and Concerns from:

    a.  Ages Birth to Age Five Years

    b.  Ages Six to Eleven Years

    c.  Ages Twelve to Seventeen Years

    d.  Ages Eighteen Years and Up

c.  General Strategies for Health Care Professionals Working with
    Patients with FASD

d.  Integration of Traditional Native Beliefs, Values, and Practices

e.  Health Care Needs and Service Matrix

Section III: Psychosocial Issues and Needs 82

a.  Special Needs for Caregivers and Parents

b.  Challenging Behaviors Associated With FASD

    a.  Ages Birth to Age Five Years

    b.  Ages Six to Eleven Years

    c.  Ages Twelve to Seventeen Years

    d.  Ages Eighteen Years and Up

c.  Behavioral Interventions and Therapy Modalities for Working with
    Patients with FASD

d.  Speech and Language Services

e.  Mental Health and Substance Abuse Treatment Approaches

f.  Sexuality and Sexual Issues

g.  Transitions and Planning for the Future

h.  Integration of Traditional Native Beliefs, Values, and Practices

i.  Psychosocial Needs and Service Matrix

Section IV: Family Issues and Needs 135

> a\. Lack of Extended Family Support

b.  Financial Concerns

c.  Parental Emotional Instability

d.  Interventions

e.  The Role of the Professional

f.  Integration of Traditional Native Beliefs, Values, and Practices

g.  Family Concerns and Service Matrix

Section V: Educational/Vocational Issues and Needs 157

a.  Preschool and Early Elementary Years

b.  Later Elementary and Middle School Years

c.  Middle School Years

d.  High School Years and Beyond

e.  The Role of the Professional

a\. Educators

b.  Vocational Counselors

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f.  Integration of Traditional Native Beliefs, Values, and Practices

g.  Educational/Vocational Concerns and Service Matrix

Section VI: Legal Issues 179

a.  Criminal Issues Associated with FASD

    a.  Competency

    b.  Capacity

    c.  Diminished Capacity

    d.  Decline/Remand

    e.  Mitigation

b.  Civil Issues Associated with FASD

    a.  Adoption

    b.  Wrongful Adoption

    c.  Parenting/Custody Evaluations

    d.  Termination of Parental Rights

    e.  Guardianship

c.  The Role of the Professional

d.  Integration of Traditional Native Beliefs, Values, and Practices

e.  Legal Concerns and Service Matrix

Section VII: Avoiding Professional Burnout 195

Section VIII: Epilogue: Coyote and Raven 198

Section IX: References 208

Appendix 1: Developmental Matrices for Intervention Planning for
Individuals with Alcohol-Related Birth Defects 226

Appendix 2: Case Summation Form 228

Appendix 3: Diagnoses Commonly Associated with FASD 230

Appendix 4: Assessment and Screening Tools 243

Appendix 5: Commonly Used Medications 247

Appendix 6: IEP Forms 250

Appendix 7: Resource Guide 252

Appendix 8: Glossary 265