FASD Elephant (TM) Podcast

Do Your Kids Make You Late? More times than you can count?
If you've struggled with constant lateness, this story is for you!

After sharing a little about Podfest 2018, you can hear a short but not-so-simple experience I had that gave me some surprising insights into being late. Feel free to learn from my mistakes for more of your own parenting peace.

Two mistakes to avoid are clearly labeled in the podcast, but the third is only alluded to. So, I'll state the third mistake clearly here in the show notes: "Stuff Your Own Feelings--MOMENTARILY!" Check out the podcast to learn more about handling chronic lateness.

Join my email list for a free gift and news about new podcast episodes, plus important information for any caregiver whose kids have difficult behaviors to understand and manage. Join here: Free Gift and Newsletter Sign-Up

Jody Allen Crowe - Healthy Brains for Children

Starting the Podcast Relaunch with Jody Allen Crowe

The 2013 FASD Matters Conference in November was a terrific experience! I met a lot of great new folks in the FASD community, and visited with old friends and acquaintances from over the years, too. One busy and interesting fellow I was finally able to meet and interview is Jody Allen Crowe, Executive Director of Healthy Brains for Children in Eagan, MN. This interview leads off the new year and the 2013 podcast relaunch. (You may have noticed there's more FASD blogs and resources on the website, and now the podcasts are starting up again.)

And What a Great Way to Start off the Podcast Relaunch!

Jody is an educator with innovative ideas and perspective. He first learned about FASD in late 1980s as an elementary school teacher in northern MN, and he started noticing the impact of the condition on students' learning. Since then, he worked in several educational systems and then founded Healthy Brains for Children in 2008. The mission of Healthy Brains is prevention, and Jody is especially interested in developing actionable FASD prevention activities for high school kids.

Finding few to no activities "out there," Jody came up with the idea of placing pregnancy tests in bars. They started with a bar in Mankato, MN, and since then the impact has been huge with the "Think Before You Drink" campaign. He also authored the book, The Fatal Link (2008), his journey of learning about prenatal alcohol exposure and its relation to potentially devastating effects when left untreated.

Listen in to the podcast to find out more about Jody Allen Crowe, and check out his website: HealthyBrainsforChildren.org

Help Me Figure out Books to Write

I'm finally getting my act together to finish up the books, chapters, and articles on FASD I've written or started over the years. For a limited time, I'm holding a survey with a chance to win US$5 Starbucks cards or an FASD Elephant™ coffee mug. More information at my recent blog posting or click and fill out my online survey to share your ideas and a chance to win (till January 28, 2014).

As always, contact me at Michael_at_FASDElephant_dot_com or message from the FASD Elephant Facebook Fanpage .

FASD and Suicidality

This podcast episode is an excerpt of my part speaking on a panel titled FASD and Suicidality at the 2011 IHS Action Summit for Suicide Prevention held in Scottsdale, AZ.

Podcast Notes

Here is the basic outline to my talk on the podcast:

Be Aware Of Suicide Signs in Self and Others
Be Connected to Self & Others
Be Settled to connect to Self and Others
Be Safe with Self and Others

There are also two articles on FASD and suicide:
Fetal alcohol spectrum disorders and suicidality in a healthcare setting , by M.R. Baldwin
Suicide attempts among adults with fetal alcohol spectrum disorders: clinical considerations , by J.E. Huggins, T. Grant, K. O'Malley, A.P. Streissguth

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~Michael Harris

Welcome to the FASD Elephant™ Podcast. Today we’re going to continue with the last half of my interview with Morgan Fawcett on May 25th, 2011. More details are in the previous podcast, number 13.

Here are some websites to find more about Morgan, his CDs, and FASD:

Morgan's website for FASD advocacy: One Heart Creations
Morgan's CDs can be purchased from CD Baby or iTunes
Morgan’s photography and music: www.morganfawcett.com
Morgan’s videos: www.youtube.com/user/MorganFawcett
Morgan on NOFAS: Tom and Linda Daschle FASD Hall of Fame

The FASD Wheel™ and FASD Elephant™ are now on Facebook, Twitter, and YouTube:

Facebook: FASD Wheel News & Tips
Twitter: @FASDElephant
YouTube: FASDElephant
Sign up for email: Receive a free FASD Wheel™ Mini Manual

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

Welcome to the FASD Elephant™ Podcast. After a hiatus for way too long, the podcast is back.

I’ve had a very exciting year so far in the world of FASD. A major highlight in February 2011 was four days worth of workshops and talks I gave in Saskatchewan—for The Saskatoon Tribal Council in Saskatoon, for the Prince Albert Parkland Health Region way up in Prince Albert (in February), and for the FASD Support Network of Saskatchewan which had their annual conference called Communities of Hope in Regina.

A second highlight this year is that I joined a speakers mentoring group led by Bill O’Hanlon (the psychologist who developed Solution-Focused Therapy, a writer extraordinaire, and prolific speaker in New Mexico), Fred Gleeck (a business speaker who really knows how to coach developing speakers on the business side of the art) and Avish Parashar (a very successful corporate trainer who coaches developing speakers and helps with targeting your topic). These guys and my fellow mentees have really been inspirational and I can just feel the jump start to my work in presenting more about FASD but also finally developing my worksheets, charts and books that people keep patiently asking me about.

The final highlight I want to speak of is the topic of this and the next podcast: a recent visit here to Minneapolis by Morgan Fawcett and his grandparents, Sue and Roy Hempel. Here is an excerpt of the press release we created for his visit:



Nineteen year old Morgan Fawcett is an accomplished Tlingit flute player with Fetal Alcohol Spectrum Disorder (FASD). With three albums released, a public speaking career, and a non-profit called One Heart Creations, it seems hard to believe Morgan has any disability. However, he names September 9th, 1991, as his first day of sobriety—the day a judge ordered his mother into alcohol treatment. “That is right,” he says, “My mother drank during her pregnancy, and this is why I raise awareness for FASD.”

“When I play the flute, it lowers my blood pressure and eases stress away,” says Fawcett. “With FASD, you could have ADHD; but instead of being on Ritalin, I play the flute.”

“Kids with FASD naturally seek their own ‘medicines’—usually rhythmic or sensory activities that help settle their damaged nervous systems so they can better cope with the ‘ordinary’ stressors of life,” according to Michael Harris, Indian Health Board psychologist who specializes in the disability. However, adults often mistake these medicines for willful misbehavior if odd or inappropriate—e.g., revolving in a swivel chair, pacing, leaving a room, or having a tantrum.

The trick, observes Harris, is for adults to first recognize that the child needs time to settle and regroup, and then to help the child find medicine that works both for the situation and for the child. For Fawcett, the flute is his medicine and his grandparents, Sue and Roy Hempel, perceived that and support it, so he can handle challenges that may be just minor hassles for those without FASD.

For teaching youth and professionals alike to use music and art as a medicine and enjoyable alterative to drugs, alcohol and video games, the National Organization on Fetal Alcohol Syndrome will induct Fawcett into the “Tom and Linda Daschle FASD Hall of Fame” in June 2011.

Morgan gave talks to each class at a local American Indian magnet school, gave a lecture and concert at my workplace for the public, and honored students in the Warriors Circle groups with an original song, “Legacy,” at the elders’ and family luncheon for students.

I listened to him present about a dozen times to classrooms ranging from High-Five pre-kindergarten to eighth graders in the middle school. It was simply inspirational, to the say the least, to hear him and his grandmother tailor his message to such a wide developmental range. It was just amazing to watch the younger kids settle and focus when he started his presentations with a flute song and then how the older kids asked him tough and thoughtful questions about his disability, his life, and his medicine. People stayed to listen and talk to him for an extra hour after the public lecture and concert at my workplace.

It was also terrific to meet his grandmother, Sue Hempel, who contributed so well during the presentations and supported Morgan as his “external brain,” keeping him on track and providing support and additional stories and information tailored to the different ages. His grandfather Roy was also a great support in the background and part of Morgan’s team of support.

Along the way, I was able to interview Morgan and record it for the podcast. The interview covers topics that have not been normally addressed in the articles about Morgan you may find on the internet, as I wanted to focus on his experiences of transitions, moments of insight and connections, and what medicines he found helpful along the way in order to give listeners insight into what might help others with FASD be and feel successful. This includes having a family and their support, asking the right questions, and becoming strong in his Tlingit culture.

Half the interview is on this podcast, and the remaining will be released in another week or so. The show notes on the website has information about Morgan, how to purchase his CDs, and the name of his websites and contact data. Let me just say though, if you need a speaker for your FASD event, call them up. You will be inspired and glad you did.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

This is a supplementary hand-out that outlines all the information provided in Podcast #012 (FASD School Intervention: Getting Back to Ready). You may download this from the website, rss feed, or through your podcast player (e.g., iTunes).

Please feel free to make and distribute copies, but please do not alter it in any way. If you have questions or comments, then contact me at Michael_at_FASDElephant_dot_com.

Students with FASD sometimes have “melt-downs” in school. These melt-downs can baffle and anger teachers, staff, and parents, but they are simply the student’s way of showing that they cannot cope with what is being asked of them or with what is going on at the moment.

When a melt-down begins, all goals should change to “getting back to ready,” rather than trying to force compliance (which usually worsens the melt-down). Try the steps suggested in this podcast, and a free PDF hand-out comes with it in episode #012a.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

People with FASD (including FAS) have both primary and secondary disabilities. Secondary disabilities are those disabilities that arise because of a mismatch between the brain damage and factors in the environment--they are not directly caused from the brain damage.

Streissguth, et al (1996) conducted a four year study on the secondary disabilities of 415 individuals with FASD and found six secondary disabilites:

Mental Health Problems - 90% of the 415 had mental health conditions of any type; 61% had ADHD and more than 50% had depression. Disrupted School Experiences - Over 60% had disruptions in school... from suspensions to drop-out. Trouble with the Law - 60% had trouble with the law, with shoplifting and theft the most common crime. Confinement - 50% had been confined, either incarcerated, inpatient mental health hospitalization, or inpatient chemical dependency treatment. Inappropriate Sexual Behavior - 49% had displayed inappropriate sexual behavior, most common was sexual advances, sexual touching, and promiscuity. Alcohol and Drug Problems - 35% had chemical abuse problems.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

Sorry folks, but I have laryngitis this week. Tune in next Wednesday for the next installment of the FASD Elephant Podcast.

In the meantime, I found an interesting website from Germany that has an animated FAS Facial Feature program, in which you can manipulate the various FAS Facial Features and visually compare them to an unaffected face. The program also allows for other facial features that are sometimes common to FASD, but not diagnostic.

The website link is: http://www.fasworld.de/index.htm, and the main website (mostly in German) is http://www.fasworld.de (look for the "Baby Face Animation" link toward the bottom of the page).

Also, I am sending though a PDF File of the FASD Evaluation Checklist discussed in last week's podcast #009 (September 19, 2007).

Thinking about obtaining an FASD Evaluation? Today's podcast talks about how to prepare for one. These evaluations often have long waiting lists and take just as long to complete. Here is a guide on how you can prepare for an evaluation, make it as thorough as possible, and hopefully speed the process up a bit. More details at www.FASDElephant.com Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

Today's podcast reviews the Ten Brain Domains of FAS and FASD in a little more depth; it is still an overview but gives more flesh to the domains in the context of completing an FASD Wheel.

This is the third of a multi-part series edited from a workshop on the FASD Wheel (TM) presented at the 2007 Brain Conference on the White Earth Indian Reservation in Mahnomen, MN... one of the largest annual conferences held in Minnesota.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

Today's podcast reviews brain functioning and how it can be affected by FASD.

This is the second of a multi-part series edited from a workshop on the FASD Wheel (TM) presented at the 2007 Brain Conference on the White Earth Indian Reservation in Mahnomen, MN... one of the largest annual conferences held in Minnesota.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

Today's podcast reviews useful metaphors and non-useful misattributions regarding FASD. This is the first of a multi-part series edited from a workshop on the FASD Wheel (TM) presented at the 2007 Brain Conference on the White Earth Indian Reservation in Mahnomen, MN... one of the largest annual conferences held in Minnesota. See www.FASDElephant.com for more details.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

The Fetal Alcohol Diagnostic Program (FADP), in Duluth, MN, spearheaded by the Executive Director, Jeanette Lang, and her crack team, has developed the Ten Brain Domains, which provides clear definitions of brain dysfunction, specifies empirical data needed for accurate diagnosis, and defines intervention considerations that address the complex nature of FASD. The Ten Brain Domains include functional skills in the following areas: Achievement, Adaptive behavior, Attention, Cognition, Executive functioning, Language, Memory, Motor skills, Sensory integration and soft neurological problems, and Social communication.

These domains are reviewed in the podcast and will be further expanded upon in future podcasts.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

Each key feature of FASD can vary widely across individuals exposed to prenatal alcohol. While consensus exists for the diagnosis of FAS across diagnostic systems (see last podcast), minor variations among the systems lead to differences in definitions and cut-off criteria for other diagnoses across the FASD continuum. The FASD conditions of Partial FAS (PFAS) and Alcohol-Related Neurodevelopmental Disorder (ARND) are reviewed today, as well as the University of Washington's 4-Digit Code designations of Static Encephalopathy and Neurobehavioral Disorder, which are essentially refinements of ARND. Partial FAS (PFAS) This diagnosis is easiest to explain and, in all practical purposes, the same as FAS. Central nervous system damage is present at the same level as FAS, and these individuals have the same functional disabilities but "look" less like FAS. Here are the criteria: Moderate to severe FAS facial features are present (small eyes, flattened philtrum, thinned upper lip), Central nervous system (CNS) damage is severe (either structural or neurological problems, or problems in three or more functional brain domains), and Prenatal alcohol exposure is confirmed.
Alcohol-Related Neurodevelopmental Disorder (ARND) This is where the diagnostics become muddy to the average layperson, so I want to keep it basic. For an ARND diagnosis, an individual must have confirmed prenatal alcohol exposure and evidence of clinically significant impairment in three or more of the following Ten Brain Domains: Achievement, Adaptive Behavior, Attention, Cognition/IQ, Communication/Language, Executive Functioning, Memory, Motor Skills, Sensory Integration/Soft Neurological Signs, and/or Social Communication. Growth deficiency and FAS facial features may be mild or nonexistent, and are irrelevant to the diagnosis. Static Encephalopathy and Neurobehavioral Disorder The 4-Digit Code separates ARND into "Static Encephalopathy," which literally means non-progressive brain damage, and "Neurobehavioral Disorder," which requires that only two Brain Domains are clinically impaired.Additional Notes
The problem with FASD conditions is not about the facial features or growth deficiency. It is about the CNS damage that then creates functional problems in an individual's life. That is why the assessment of the Ten Brain Domains is so important and the most germain aspect to an FASD Evaluation: to find out how to help an individual function better.

Don't worry about getting caught up in the specifics all the diagnoses. Just know that if an individual had moderate to severe prenatal alcohol exposure AND has functional problems, then an FASD condition (disability) may be present.

This leads to another question that someone asked last week at a workshop I gave: "I had a few drinks before I knew I was pregnant, but stopped in the second month. My kid has terrific grades, but has low attention skills and poor social skills [Adaptive Behavior problems, from the Ten Brain Domains perspective].

Does this mean he has FASD?" No. While there is no recommended safe level of drinking alcohol while pregnant, this situation does not result in an automatic FASD diagnosis. The attention skills and behavior problems would have to be severe, and the most important thing is missing: A diagnostic team would need to be convinced that the problems were related to the alcohol exposure. Attention and social skills can be affected by so many factors in life (e.g., genetics, peer group, parenting style, etc.) that this are not diagnostic.

I would like to caution everyone not to "over-diagnose" just as much as I want to caution everyone to be knowledgeable about the potential negative effects of prenatal alcohol exposure.

Links discussed in the Show Can be found at www.FASDElephant.com

Next week, we will review the Ten Brain Domains, which will start giving a better idea of what exactly CNS damage is. Until then....

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

Any Fetal Alcohol Spectrum Disorder (FASD) is diagnosed by assessing the four key features that were first identified in Fetal Alcohol Syndrome (FAS) in 1973.

FAS requires a positive and severe finding in all four key features, but other FASD conditions may vary across a continuum of severity. FAS is the only expression of FASD that has garnered consensus among experts to become an official ICD-9 and ICD-10 diagnosis.

The four key features of FASD that are assessed with any diagnostic system include:

Growth Deficiency (height and/or weight) FAS Facial Features (small eyes, flattened philtrum, thinned upper lip) Central Nervous System (CNS) damage (either physical damage or functional problems) Prenatal alcohol exposure level (confirmed, unknown, or no exposure)

The following criteria must be fully met for an FAS diagnosis:

Growth deficiency - Prenatal or postnatal height or weight (or both) at or below the 10th percentile at any point in life, FAS facial features - All three FAS facial features present, Central nervous system damage - Clinically significant structural, neurological, or functional impairment, and Prenatal alcohol exposure - Confirmed or Unknown prenatal alcohol exposure.

Is FAS worse than other FASD conditions? No.

The fact is that other FASD conditions have more secondary disabilities.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

History
The earliest known observation of possible links between maternal alcohol use and fetal damage may have been made in 1899 by Dr. William Sullivan, a Liverpool prison physician who noted higher rates of stillbirth for 120 alcoholic female prisoners than their sober female relatives and suggested the causal agent to be alcohol use (Sullivan, 1899).

This view contradicted the predominant theories of the day, which were that genetics caused mental retardation, poverty, and criminal behavior. A case study popular in the early 1900s by Henry H. Goddard involved the Kallikak family and shows the bias of the time period (Goddard, 1912), though later researchers conclude that the Kallikaks almost certainly had FAS (Karp, R.J., et al, 1995).

Fetal Alcohol Syndrome, or FAS, was named in 1973 by two dysmorphologists, Drs. Kenneth Lyons Jones and David W. Smith of the University of Washington Medical School in Seattle. They identified a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth deficiency and developmental delay" in eight unrelated children of three ethnic groups, all born to mothers who were alcoholics (Jones, K.L., et al, 1973).

While many syndromes are eponymous, or named after the physician first reporting the association of symptoms, Dr. Smith named FAS after alcohol, the causal agent of the symptoms. His reasoning for doing so was to promote prevention of FAS, believing that if people knew maternal alcohol consumption caused the syndrome, then abstinence during pregnancy would follow from patient education and public awareness. Nobody was aware of the full range of possible birth defects from FASD or its prevalence rate at that time, but admitting alcohol use during pregnancy can feel stigmatizing to birth mothers and complicate diagnostic efforts of a syndrome with its preventable cause in the name. Over time, the term FASD is coming to predominate.

Diagnostic Systems Since the original syndrome of Fetal Alcohol Syndrome (FAS) was reported in 1973, four FASD diagnostic systems that diagnose FAS and other FASD conditions have been developed in North America: The Institute of Medicine's guidelines for FAS, the first system to standardize diagnoses of individuals with prenatal alcohol exposure (Institute of Medicine (IOM), Stratton, K.R., Howe, C.J., & Battaglia, F.C. (1996). Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment . Washington, DC: National Academy Press.), The University of Washington's "The 4-Digit Diagnostic Code," which ranks the four key features of FASD on a Likert scale of one to four and yields 256 descriptive codes that can be categorized into 22 distinct clinical categories, ranging from FAS to no findings, The Centers for Disease Control's "Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis," which established general consensus on the diagnosis FAS in the U.S. but deferred addressing other FASD conditions, and Canadian guidelines for FASD diagnosis, which established criteria for diagnosing FASD in Canada and harmonized most differences between the IOM and University of Washington's systems.

Each diagnostic system requires that a complete FASD evaluation include assessment of the four key features of FASD--prenatal alcohol exposure, FAS facial features, growth deficiency, and central nervous system damage. A positive finding on all four features is required for a diagnosis of FAS, the first diagnosable condition of FASD that was discovered. However, prenatal alcohol exposure and central nervous system damage are the critical elements of the spectrum of FASD, and a positive finding in these two features is sufficient for an FASD diagnosis that is not "full-blown FAS."

Diagnoses and diagnostic criteria will be described in detail in the next podcast.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

My Podcast Alley feed! {pca-6ab64b0bda8df39635beb79ecf0e0585}

Today's episode covers the definiton of FASD and attempts to clear up the confusing terminology that has been used in the past.

Fetal Alcohol Spectrum Disorder (FASD) describes a continuum of permanent birth defects caused by maternal consumption of alcohol during pregnancy. Maternal alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damage neurons and brain structures, and/or cause other physical anomalies. While prenatal alcohol exposure does not automatically result in FASD, the U.S. Surgeon General advises pregnant women to abstain from alcohol use due to the risk of FASD.

The main effect of FASD is permanent central nervous system damage, in which developing brain cells and structures have been capriciously garbled, malformed, or underdeveloped by prenatal alcohol exposure. The risk of brain damage exists during each trimester, since the fetal brain develops throughout the entire pregnancy. Fetal alcohol exposure is regarded by researchers as the leading known cause of mental retardation in the Western world. In the United States alone, it is estimated that every year up to 40,000 infants are born with some form of FASD. The lifetime medical and social costs of each child are estimated to be as high as US$800,000 across the lifespan.

The term Fetal Alcohol Spectrum Disorder is not in itself a clinical diagnosis but describes the full range of disabilities that may result from prenatal alcohol exposure. Currently, Fetal Alcohol Syndrome (FAS) is the only expression of prenatal alcohol exposure that is defined by the International Statistical Classification of Diseases and Related Health Problems and assigned ICD-9 and ICD-10 diagnoses.

There are a number of other subtypes based on partial expressions of FAS, including Partial Fetal Alcohol Syndrome (PFAS), Alcohol-Related Neurodevelopmental Disorder (ARND), Alcohol-Related Birth Defects (ARBD), and Fetal Alcohol Effect (FAE). The latter two terms (ARBD and FAE) are not in general use today due to definitional vagueness.

There are four components to an FASD evaluation and diagnosis:

Growth deficiency (low height and/or weight, at birth or any point in lifetime) FAS facial features (small eyes, smooth philtrum [groove between the nose and upper lip], flattened upper lip) Central nervous system damage (there will be at least a couple podcasts just on this topic) Prenatal alcohol exposure (drinking while pregnant)

Diagnostics will be covered in the next podcast.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

This is a beginner's bonus track - the second half of an interview conducted on-air by KDWA on December 5, 2007, with myself and Alice Garceau, an adoptive mother of an FASD child. It was a good interview, and we continued with many FASD topics. If you haven't heard part one, go ahead and download it first. Next week, we will cover an overview of FASD, definitions, and the basics of terminology.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

This is an introductory bonus track - the first half of an interview conducted on-air by KDWA on December 5, 2007, with myself and Alice Garceau, an adoptive mother of an FASD child, and myself. Alice has been active in the FASD community for several years, runs a support group in the southern Twin Cities area, has been involved in several education videos and such about FASD (maybe we can post some at a later date), and has a lot of experience working with FASD. She was really a great person to meet.

It was a good interview, and we covered many topics concerning FASD. Next week, the second half will be released. Be sure to visit our friends at KDWA, at www.kdwa.com.

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

This is the introductory podcast about Fetal Alcohol Spectrum Disorders (frequently called by its acronym, FASD) and introduces the metaphor of the FASD Elephant(TM) , a new way to think about this complicated disability, which results in permanent brain damage to a fetus when drinking alcohol during pregnancy. In this episode, Michael Harris, (a licensed psychologist and now, a podcaster) introduces himself, gives a brief history of his clinical assessment and treatment experiences with FASD, and shares the story of the FASD ElephantTM .

Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com.

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