Angeline Lau’s 10-year-old son can lose his temper at the smallest
annoyance: his sister picking up his new toy, another student singing
and humming in line at school.
His brain was damaged by the
alcohol his birth mother drank when he was in the womb. But a 12-week
program at Toronto’s Hospital for Sick Children has helped him learn to
better understand and regulate his emotions.
“It has smoothed out some of the rough edges,” said Ms. Lau, his adoptive mother.
It
also may have rewired his brain. Joanne Rovet, a researcher at Sick
Kids, and her colleagues are using magnetic resonance imaging to study
the brains of 40 children with fetal alcohol spectrum disorder, or FASD,
before and after the 12 weeks of therapy. They are looking for changes
related to impulse control, hoping to find concrete evidence that the
therapy can create lasting changes in kids with FASD.
“We believe we may have the key to helping these children function in daily life,” said Dr. Rovet.
FASD
is an umbrella term to describe a number of conditions caused by
exposure to alcohol in the womb, the most severe being fetal alcohol
syndrome. Each child has a different constellation of symptoms that can
include learning disabilities, such as problems with attention and
memory, and behavioural difficulties. One in 100 children is born with
FASD and many of them develop a mental illness in adolescence or
adulthood, says Dr. Rovet.
The Alert program involves using games
and props to get children to think of their brains and bodies as engines
that at times can get too revved up. Each child finds “tools” to help
their engines gear down when they feel angry or hyperactive, like
putting in ear plugs, closing the blinds or sitting on a “wiggle seat,” a
half-inflated camping pillow. Tools include strategies for dealing with
situations that upset them. The children also learn how to fire up
their engines – perhaps with physical exercise – if they are feeling
tired or sad.
The principles of that program are used in three
special classrooms for children with FASD at David Livingstone public
school in Winnipeg. There is a steady stream of visitors from across
North America and Europe who come to see how the school helps kids with
FASD learn, says principal Debbie Lenhardt Mair.
Teacher Sharen
McDermit’s classroom has been configured to be as soothing as possible,
with the lights low and blue sheets covering the bookshelves and
bulletin boards when Ms. McDermit isn’t using them. When she talks, each
of the eight children holds a listening tool, like a textured ball, to
remind them to focus on what she is saying. When they go to their
individual “offices,” a cardboard screen makes it easier to concentrate
on their work rather than on what a neighbour is doing.
The
children, in Grades 2 and 3, have learned how their brains were damaged
by the alcohol their mothers drank during pregnancy, says Ms. McDermit,
who has been teaching children with FASD for 13 years. Two teaching
assistants also work with the children.
The youngsters know their
individual strengths, in art or language or music, and about the kinds
of things that are more challenging for them, like paying attention,
math, or keeping their tempers under control. As in the Toronto program,
the children try different tools to calm themselves down, like rocking
in a chair to do their work. Those who need physical activity can pull
themselves around on a coaster board.
Ms. Lau, whose son was
taught the Alert approach at Sick Kids in Toronto, has noticed a
difference at home since he finished the program in the fall. “He is
using his strategies, to walk away, ignore it, talk it out,” she said.
“Sometimes he can step on the brakes.”
Her son – she requested his name not be published – was diagnosed
when he was six years old. He is volatile and sensitive to things most
children don’t react to, which makes it hard for him to manage in the
classroom. He learned to read early, but struggles with math. Ms. Lau
says he was thrilled to be part of the research project at Sick Kids.
“He thinks it will help other kids,” she said.
Exposure to alcohol
in the womb can affect areas and structures critical for memory,
learning and abstract thinking. It also damages white matter, the
connections that allow parts of the brain to communicate and work
together.
Scientists are also starting to assess if there are ways
to improve brain function in these children, to capitalize on
neuroplasticity, or how experience changes the brain.
In Toronto,
the focus is on self-regulation, emotional processing, impulse control
and social understanding. In addition to the 40 children between the
ages of eight and 12 with FASD who are enrolled in the study, the
researchers are assessing 20 other children in a control group. They
hope to present their preliminary results in September, at conference in
Charlottetown.
Dr. Rovet is collaborating with Margot Taylor,
Jason Lerch and Gideon Koren, and the work is funded by the Canadian
Institutes of Health Research and Canadian Foundation on Fetal Alcohol
Research. The children get one-on-one therapy with graduate student
Kelly Nash, who asks parents to fill out a daily form to keep track of
their child’s behaviour at home.
To see if the therapy changes
their brains, she gets them to play an impulse control game inside a
functional magnetic resonance imager. It is similar to the popular game
whack a mole. Either a mole or a garden vegetable appears on the
computer screen. The kids are asked to press a button when they see the
mole, but not when they see a carrot or a head of lettuce.
Brain
circuitry that is involved in impulse control usually gets activated
when children without FASD play the game and stop themselves from
whacking the lettuce. But the same network doesn’t fire up in children
with FASD, although researchers suspect this will change after the
therapy.
That’s what happened with Ms. Lau’s son, one of the first to go through the program and the before-and-after brain imaging.
“After
therapy, we saw this network come on line,” said Ms. Nash. “It was
interesting to see these neuroplastic changes, along with the
improvements reported by the parent.”