Week Three

At 18 months of age, Terrance didn't meet many of the developmental milestones typically associated with children his age. He was able to talk, but the manner in which his mouth seemed to hang open a bit made articulation difficult. Terrance was a challenge overall and had been since birth. He simply could not sit still and had a very difficult time soothing in general. It was like he could never quite get comfortable in his mother's arms.  Terrance didn't walk until 17 months and was still very unsteady on his feet. He would meet his mother's gaze and was able to look at things she looked at, but his language was almost impossible to understand. He did seem to have many words that he was able to attempt to form, and his level of frustration when he couldn't speak in the way he wanted to was evident.

Vasha, for her part, continued to feel incredibly guilty, and she struggled with her depression. Going to AA was helpful for a time, and she was able to befriend Sarah, someone with whom she was able to share her joys and sorrows. Surely their friendship was a welcome bright spot in what otherwise was an ongoing struggle for Vasha. She often thought about giving up, but she really didn't know what that would mean. She loved Terrance, to be sure, but that sense of love was crowded with other feelings of helplessness, hopelessness, grief and sorrow.  

* Describe typical developmental milestones for an 18 month old child. Be sure to include physical, cognitive, social and emotional domains. 

* How does Vasha go about getting services through Part C of IDEA? Assume that Vasha does not have access to the Internet. What might a IFSP for Terrance include? Propose goals for Terrance. What are Vasha's responsibilities with regard to IDEA Part C?  

* Create an M-CHAT for Terrance that might exist at his 18 month pediatric visit. How will diagnosticians be able to distinguish between FASD and Autism Spectrum Disorder? 

* Given Terrance's significant challenges, what other services are available in the community for him? Check into PACE at the Community Services Board.  What other services are available for Vasha? Check into Medicaid-funded Mental Health Support.

DECISION POINT ::: Does Vasha obtain other services in addition to IDEA Part C? If so, which ones?

Week Two

Vasha was ready for her child to be born. She had picked a name – Terrance. It was a name she had always liked, and pre-natal ultrasounds had revealed that her child was a boy. Vasha went into the hospital for a relatively easy delivery.

It became apparent that Terrance was not like most babies. In fact, what Terrance’s birth revealed was that she had been wrong about her lack of alcohol consumption during the first weeks of pregnancy. First, Terrance’s delivery was relatively easy because his birth weight was low. Additionally, he presented with some facial abnormalities that were a clear indication of FASD.

Vasha was at once overjoyed at the birth of her son and also had a sense of incredible guilt with regard to Terrance’s challenges. Vasha could feel herself spiraling downward into a depression as the reality of the situation sunk in. She wasn’t sure she could do back to AA – it was too much a reminder of her past and of her responsibility for having done this to her child. She didn’t know what to do.

* What happens when a child is born with FASD? Is there anything unique about the postpartum process given the observable disabilities that were apparent with Terrance? Are further tests typically done to ensure that there are no other issues with internal organs, etc.?

* Outline the typical developmental milestones for newborns and infants in their first year. How are babies born with FASD likely to approach those milestones?

* What are the recommended immunizations for newborns? What immunizations are typically provided just after birth? Which ones in the first year? How frequently should the newborn visit the pediatrician in terms of what is recommended? What is the M-CHAT and when is it given to parents? Outline Terrance’s first year in terms of doctor visits. Provide rough information as to the fees associated with these visits. How does Terrance’s FASD affect these visits and the associated costs?

* What is postpartum depression? What is the prevalence of the disorder? How is it typically treated? What resources might be available to Vasha in terms of self-care? What is the effect of postpartum depression on parent-child attachment?

* With regard to FASD, what publically available services are there to support a newborn with FASD?

DECISION POINTS :::

Does Vasha return to AA? How does Vasha decide to manage her depression? 

Week One

Vasha Singh didn’t want a child at her age. In fact, her life was supposed to be completely different. If only she hadn’t listened to her “friends,” if only she hadn’t have been so impressionable. What was a 20 year old like her supposed to do? She hadn’t finished high school and had no prospects at all for employment or anything. She had no idea how she was going to raise a child. She worries about the drugs and alcohol that she was into before she knew about the pregnancy. Would any of that hurt the baby? She really had no idea. She thought that maybe she learned about the pregnancy in time…When was the last time she got really drunk? She couldn’t exactly remember, and that fogginess allowed her to pretend that the last several incidents were further in the past than another part of her knew that they were. Still, she would love this child no matter what.

Vasha had been talking to a pastor that she met during one of her bouts of despair – for some reason, the two struck up a conversation as she was buying cigarettes, and they wound up talking for over an hour. Vasha’s Hindu past was just that – well in the past, and she struggled to find meaning in her life. This person seemed to provide an open door when all other such doors were locked and dark. Vasha started going to a Christian church, and it seemed to help her just a little. The pastor talked with Vasha about AA, and she was really considering going, even while she was 8 months pregnant.        

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     1) What are the typical developmental milestones for the child in utero? Outline the stages of pregnancy and the threats to optimal development at each stage. When are teratogens most dangerous for the developing child?

·    2) Describe the various conditions that can result when someone uses alcohol at various stages of development. Is Terrance at-risk for any of these conditions given Vasha’s history of substance use and her “fogginess” with regard to knowing whether or not she “stopped in time?”

·    3) Given Vasha’s substance abuse and its possible effect on her child, what kinds of treatment options could she explore? Describe how Alcoholics Anonymous (AA) purports to work (and/or Narcotics Anonymous, Al-Anon, etc.).  

 
DECISION POINT ::: Does Vasha decide to attend AA? Why or why not?