The main objective of this study is to construct a profile on the child with Fetal alcohol syndrome that can assist individuals working with these children. The focus of the study is the recognition of the emotional needs of the child with Fetal alcohol syndrome. Most studies done previously suggest that children with Fetal alcohol syndrome show behaviour similar to children with Attention Deficit Hyperactive Disorder. Although a child with Fetal alcohol syndrome shows the same characteristics as a child with Attention Deficit Hyperactive Disorder, the manifestation of their emotional needs differ. The Child with Attention Deficit Hyperactive Disorder does not necessarily show symptoms of cognitive developmental delay where the child with Fetal alcohol syndrome show symptoms of cognitive developmental delays. A Gestalt play therapy model has been used to show that through play therapy the child with Fetal alcohol syndrome can be guided to emotional awareness. These techniques are easy to use and applicable in class situations where the childcare worker, teachers or counselor work with the child with Fetal alcohol syndrome. The empirical research was done by means of quantitative research with was done by using the Conner symptom checklist to determine if the child with Fetal alcohol syndrome is hyperactive and impulsive and qualitative research with was done by means of participating observation Gestalt play therapy with the child with Fetal alcohol syndrome. The results show that the child with Fetal alcohol syndrome is hyperactive, impulsive and inattentional. These guidelines provided in the study will help the teacher and the child with Fetal alcohol syndrome cope better in the classroom environment and the child will learn how to cope with his emotional behaviours. / Social Work / M. Diac. (Play Therapy)

Thesis (M Social Work)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Fetal alcohol spectrum disorders (FASD) is caused by maternal drinking during pregnancy. Pre-natal drinking has a range of deleterious effects including physical, mental and behavioural consequences for the affected child. Although FASD is completely preventable, it is irreversible with consequences that last into adulthood. The range of effects of FASD forms a spectrum with fully developed FAS on the one end and no effects on the other end of the spectrum. The Western Cape has one of the highest recorded rates of FAS in the world. This seriously affects almost all systems in society and strains the already overburdened educational-, health-, social- and judicial systems. For this reason preventing FASD is of the utmost importance and requires a comprehensive approach on multiple levels. This study explores and describes FASD prevention services in the Bonnievale, Robertson, Ashton and Montagu-areas – a wine-producing area in the Western Cape. Available FASD prevention services on all levels of prevention, the focus-areas of the different prevention activities, collaboration and co-ordination between the role-players and obstacles in delivering prevention services, was examined. By adopting an ecological approach, FASD prevention services could be investigated on multiple levels. This study used a combination of quantitative and qualitative research. An exploratory design and a purposive sampling method were used. Participants were interviewed individually and with the help of a semi-structured questionnaire. The findings of the empirical investigation show that, although prevention efforts are applied on the universal, selective and indicated levels of prevention, a lack of formal prevention efforts that are actively pursued - especially on the level of indicated prevention - exists. This is aggravated by the absence of formal co-ordination of services and structured systems of referrals. NGO‟s and government departments are, as a result, not clear about their respective roles and responsibilities and women with the highest risk for having a child with FAS, therefore, fall through the cracks of the system. This happens partly because social workers are often perceived as the only agents for social change in the community. According to the ecological approach all levels (micro, meso and macro) of organizations in the social environment should work together for change by repeating prevention messages on the different levels and thereby reinforcing it. In the study area, however, most FAS prevention services were on the micro-level with few on the meso-level and virtually none on macro-level. Participants identified a lack of co-ordination, unplanned families, a lack of resources, a lack of training and training material and low levels of education as obstacles in service delivery. Recommendations resulting from the study indicate that FAS prevention will benefit from structured, formal programs on all levels of prevention. This will require non-government organizations and government departments to co-ordinate services and to develop a formal system of referral amongst the role-players. Training of personnel in clinics, NGO‟s, government departments and volunteers, as well as the development of training material targeted at people on different levels of education, should receive attention. It is, in conclusion, recommended that community organizations and structures such as churches, places of business, farmer‟s associations and liquor outlets are actively involved in the prevention of FASD. / AFRIKAANSE OPSOMMING: Fetale Alkohol Spektrum Afwykings (FASA) word veroorsaak deur alkoholgebruik tydens swangerskap. Alkoholgebruik tydens swangerskap het „n reeks skadelike effekte, insluitend fisiese, psigiese en gedragsafwykings in die geaffekteerde kind. Alhoewel FASA heeltemal voorkombaar is, is dit onomkeerbaar en duur die gevolge daarvan voort in volwassenheid. Die reeks effekte van FASA vorm „n spektrum met volledig ontwikkelde FAS aan die een kant en geen effekte nie aan die ander kant van die spektrum. Die Wes-Kaap het een van die hoogste aangetekende voorkomssyfers van FAS in die wêreld. Dit affekteer feitlik alle sisteme in die samelewing en plaas nog meer druk op die reeds oorlaaide opvoedkundige-, gesondheids-, maatskaplike- en regssisteme. Om hierdie rede is die voorkoming van FASA van uiterste belang en word „n omvattende benadering op veelvuldige vlakke vereis. Hierdie studie ondersoek en beskryf FASA voorkomingsdienste in die Bonnievale-, Robertson-, Ashton- en Montagu-area – „n wynproduserende streek in die Wes-Kaap. Die beskikbaarheid van FASA voorkomingsdienste op alle vlakke van voorkoming, die fokus-areas van die verskillende voorkomingsaktiwiteite, samewerking en koördinering van dienste tussen die rolspelers, sowel as struikelblokke in voorkomingsdienste, is ondersoek. Deur die ekologiese benadering aan te neem, kon FASA voorkomingsdienste op veelvuldige vlakke ondersoek word. Die studie kombineer kwantitatiewe en kwalitatiewe navorsing. Die ontwerp van die studie is verkennend en daar is „n doelbewuste steekproef gedoen. Indivuduele onderhoude met deelnemers is met behulp van semi-gestruktureeerde vraelyste gevoer. Die bevindinge van die empiriese ondersoek toon dat, alhoewel voorkomingspogings aangewend word op die universele, selektiewe en indikatiewe voorkomingsvlakke, daar 'n gebrek bestaan aan formele voorkomingspogings wat aktief nagestreef word, veral op die indikatiewe vlak. Dit word vererger deur die afwesigheid van formele koördinering van dienste en gestruktureerde verwysingsisteme. Nie-regeringsorganisasies en staatsdepartemente het gevolglik nie duidelikheid oor hul onderskeie rolle en verantwoordelikhede nie. Die gevolg hiervan is dat vroue met die hoogste risiko om geboorte te skenk aan kinders met FAS, deur die krake in die sisteem val. Dit geskied deels omdat maatskaplike werkers dikwels gesien word as die enigste agente vir maatskaplike verandering in die gemeenskap. Volgens die ekologiese benadering behoort alle vlakke (mikro, meso en makro) van organisasie in die sosiale omgewing saam te werk om verandering teweeg te bring deurdat voorkomingsboodskappe op die verskillende vlakke te herhaal en sodoende te versterk word. In die studie-area is die meeste voorkomingsdienste egter op mikro-vlak gelewer met min op meso-vlak en feilik geen op makro-vlak nie. Deelnemers aan die studie het „n gebrek aan koördinasie van dienste, onbeplande gesinne, „n gebrek aan hulpbronne, „n gebrek aan opleiding en opleidingsmateriaal en lae vlakke van geletterdheid geïdentifiseer as struikelblokke in dienslewering. Aanbevelings wat uit die studie voortvloei, dui aan dat FASA voorkomingsdienste sal baat vind by gestruktureerde, formele programme op alle vlakke van voorkoming. Dit sal vereis dat nie-regeringsorganisasies en staatdepartemente hul dienste koördineer en „n formele verwysingstelsel tussen die verskillende rolspelers ontwikkel. Opleiding van personeel in klinieke, NRO‟s, staatsdepartemente en vrywilligers, sowel as die ontwikkeling van opleidingsmateriaal wat persone op verskillende vlakke van opvoeding teiken, behoort aandag te geniet. Dit word laastens ook aanbeveel dat gemeenskapsorganisasies en strukture byvoorbeeld kerke, besighede, boere-verenigings en verkoopspunte vir alkohol, aktief betrek word by die voorkoming van FASA.

Background: Prenatal alcohol consumption is one of the leading preventable causes of birth defects, including fetal alcohol syndrome and learning disabilities. Although there is strong evidence of the benefits of screening and alcohol brief interventions (ABIs) in reducing hazardous and harmful drinking among the primary care population, evidence of its effectiveness with the antenatal care population is limited. Nevertheless, the Scottish Government is incorporating an alcohol screening and ABI programme as part of the routine antenatal care provided to women in a bid to protect the health and safety of the unborn child and improve subsequent health and developmental outcomes. This research therefore seeks to increase understanding of the factors that are likely to influence the effectiveness of this recently implemented programme. It also aims to explore the extent to which contemporary issues such as change in guidelines regarding alcohol consumption during pregnancy influences perceptions and attitudes, and the possible implications of these on the screening and ABI delivery. Methods: The study described in this thesis employed a realistic evaluation methodology. Realistic evaluation is a theory-driven approach to investigating social programmes. It is concerned with hypothesising, testing and refining programme theories by exploring the interaction of contexts, mechanisms and outcomes. To identify the relevant screening and ABI programme theories, two separate systematic reviews, a critical review and four face-to-face interviews were undertaken with health policy implementers. The findings were used to construct context, mechanism and outcomes propositions. The propositions were then tested by conducting individual interviews with seventeen pregnant women and fifteen midwives, a further six midwifery team leaders were involved in a focus group discussion. A thematic approach using a hybrid of inductive and deductive coding and theme development informed the qualitative analysis. Results: In the context of uncertainties regarding the threshold of drinking that causes fetal harm, pregnant women reported that screening assessment helped them to reflect on their drinking behaviour and facilitate behaviour change. For women who drank at hazardous and harmful levels before attending the booking appointment, screening and ABI may be helpful in terms of eliciting behaviour change. However, they may not be very beneficial in terms of reducing harm to the fetus as it has been found that drinking during the first trimester poses the most risk to the fetus. Training and resources provided to midwives as part of the screening and ABI programme were found to be facilitating mechanisms that midwives indicated improved their skills and confidence. However, most of the midwives had not subsequently employed the motivational interviewing skills required for the ABI delivery, as many of the pregnant women reported that they reduced or abstained from alcohol consumption once pregnancy was confirmed. The outcome noted was that midwives confidence decreased leading to missed opportunities to appropriately deliver the ABI to eligible women. The small numbers of women being identified for ABI meant midwives rarely delivered the ABI. This negatively influenced midwives attitudes as they then accorded ABI low priority in their workload. Other disenabling mechanisms noted to be hampering the implementation of the screening and ABI initiative included midwives contending with competing priorities at the booking appointments, and the lack of adequate rapport between midwives and pregnant women at the booking appointment to discuss alcohol issues appropriately, leading to women providing socially desirable responses to screening questions. Conclusions: The findings of this study has generated greater explanations of the working of the screening and ABI programme in antenatal care setting and has provided transferable lessons that can be used by others intending to implement similar programmes in other settings.

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Indiana University-Purdue University Indianapolis (IUPUI) / Despite warnings about the dangers of drinking during pregnancy, little progress has been made in reducing alcohol drinking among women of childbearing age. Even after the recognition of pregnancy, 15% of women continue to drink, 3% of which admit to binge drinking. Because we cannot stop women from drinking during pregnancy, and many children with fetal alcohol spectrum disorders (FASD) are adopted, there is a significant need to develop postnatal interventions that can improve the long-term outcome of children adversely affected by prenatal alcohol exposure. This thesis aims to evaluate one promising new treatment in the rehabilitation or rescue of specific learning deficits long after the damage has occurred. The treatment evaluated herein (40µg D-NAP + 40µg D-SAL) has long been used in the prevention of the detrimental effects of long-term and binge-like alcohol exposures in rodent models of fetal alcohol syndrome and FASD. Until recently this peptide treatment had only been shown to be effective in preventing some of the consequences of alcohol exposure when administered concurrently with the prenatal alcohol exposure. A recent report by Incerti and colleagues (2010c), however, reported that these peptides could completely reverse a profound spatial learning deficit induced by one episode of a heavy binge-like alcohol exposure (5.9g.kg in a single intraperitoneal injection) on gestational day 8 (G8) in C57BL/6 mice. In that report, the peptide treatment was administered starting in late adolescence, beginning three days prior to and throughout water maze training, and the profound deficits in their alcohol-placebo group were completely eliminated in the alcohol-peptide group. There are currently no FDA-approved treatments for FASD. An effective treatment for the cognitive and behavioral dysfunctions suffered by the 1% of people born today could potentially improve the lives of millions of children and adults. The first aim of this thesis was to determine whether the peptide treatment could reverse the significant spatial learning deficits we have demonstrated in adult C57BL/6 mice given high-dose binge-like alcohol exposure (2.5 g/kg in each of two intraperitoneal injections separated by two hours) on postnatal day (P)7. When administered three days prior to and throughout water maze testing (P67-76), the peptide treatment had no effect on spatial learning. The second aim sought to determine whether the same peptide treatment could reverse water maze spatial learning deficits in G8 binge-like exposure models, as reported by Incerti et al. (2010c). For this analysis, the first study used a different binge-like alcohol exposure model that is more commonly used than that employed by the Incerti et al. (2010c) study, namely administration of 2.8g/kg in each of two intraperitoneal injections separated by four hours (Sulik et al., 1981). This model has been shown to produce high peak blood alcohol concentrations and neuroanatomical aberrations in the hippocampal formation and septal regions (Parnell et al., 2009), which have been implicated in learning and memory. Surprisingly, this G8 binge-like alcohol exposure failed to produce a spatial learning deficit, undermining the usefulness of this model in evaluating the peptide effects. In direct contrast to the outcomes of Incerti et al. (2010c), the G8 Webster alcohol exposure was also unable to produce any deficits in acquisition of spatial learning in the Morris water maze. Surprisingly, neither of the heavy binge-like alcohol exposures on G8 were able to produce spatial learning deficits in the Morris water maze. The binge-like alcohol exposure on P7 did yield the expected spatial learning deficit, but the peptide treatment was unsuccessful in recovering water maze learning. These findings fail to support oral administration of 40µg D-NAP and 40 µg D-SAL as a potential therapy for postnatal alcohol-induced spatial learning deficits in adult mice.

La consommation d’alcool pendant la grossesse peut entraîner des conséquences néfastes sur le développement de l’enfant et mener aux troubles du spectre de l’alcoolisation fœtale (TSAF). Cependant on en connaît peu sur son effet durant la période de préimplantation. Cette période est reconnue comme étant sensible à l’environnement, majoritairement dû au fait qu’elle est caractérisée par la reprogrammation dynamique des profils de méthylation de l’ADN. L’alcool est reconnu pour altérer les mécanismes impliqués dans les processus de méthylation de l’ADN (e.g., cycle du folate, actions des DNMTs). Récemment, nous avons démontré qu’une exposition prénatale à l’alcool éthylique durant la préimplantation altère les futurs profils de méthylation de l’ADN du cerveau et augmente le nombre de défauts morphologiques à la mi-gestation. Il n’y a présentement aucun traitement pour les TSAF, mais certaines études suggèrent qu’une diète enrichie en donneurs de groupement méthyles (e.g., folate, choline), nécessaires aux réactions de méthylation, pourrait atténuer les effets d’une exposition prénatale à l’alcool. C’est pourquoi nous avons voulu déterminer si une diète enrichie en donneurs de groupements méthyles pouvait apporter une protection aux embryons ayant subi une exposition prénatale à l’alcool durant la préimplantation. Pour ce faire, une diète standard ou enrichie a été donné à des souris 4 semaines avant la gestation et pendant celle-ci. Les femelles gestantes ont reçu une dose d’alcool au jour E2.5, puis nous avons récolté les embryons à E10.5 et E18.5 pour évaluer les anomalies physiques et faire l’analyse de la méthylation des cerveaux antérieurs. Nos résultats démontrent que la diète enrichie prévient ou élimine un certain nombre de défauts morphologiques à E10.5 et E18.5. Nous avons aussi observé que la diète enrichie n’affectait pas la mise en place et le maintien de la méthylation et l’expression des gènes à empreintes durant le développement. La diète enrichie en donneurs de groupements méthyles aide donc à prévenir certains effets nuisibles de l’exposition prénatale à l’alcool survenant durant la préimplantation. / Alcohol consumption during pregnancy can have a significant impact on the development of the child and lead to fetal alcohol spectrum disorders (FASD). Nonetheless, little is known about its effect during the pre-implantation period. However, we know that this period is very sensitive to the environment, mainly because of major reprogramming of DNA methylation patterns. Moreover, alcohol can alter the mechanisms involved in DNA methylation processes (e.g., folate cycle, actions of DNMTs). Recently, we have shown that prenatal alcohol exposure (PAE) during preimplantation alters future DNA methylation patterns of the young embryo brain and increases the number of morphological defects. There is currently no treatment for FASD, but studies suggest that a diet enriched in methyl donors (e.g., folate, choline), which are necessary for methylation reactions, may mitigate the effects of PAE. Therefore, we wanted to determine if a diet enriched in methyl group donors could provide protection to embryos against a PAE during preimplantation. To do so, a standard or enriched diet was given to mice 4 weeks before and during gestation. Pregnant females were exposed to alcohol at day E2.5, then we harvested embryos (E10.5, E18.5) to assess physical abnormalities and analyse forebrain methylation. Our results demonstrate that the enriched diet reduces or eliminate defects at E10.5 and E18.5. We also observed that the fortified diet did not affect the establishment and maintenance of methylation and expression of imprinted genes during development. Thus, our results show that a methyl enriched diet can prevent some of the adverse effects of prenatal alcohol exposure occurring during preimplantation.