June 2006 - Volume 16 - Number 2

• Social Skill Development in Children with FASD: A Pilot Program to Enhance Friendship Building
• CJ’s Words
• David’s Words
• Ireland’s Trouble With Alcohol
• I Have FAS
• Our Lives with FASD
• Book Review: “Alcohol and Pregnancy – a Mother’s Responsible Disturbance”

Social Skill Development in Children with FASD: A Pilot Program to Enhance Friendship Building

by Jamie C. Byrne, Sarah L. McNulty and Melissa D. Nilsen

Friendships play an important role in children’s lives and in their social development. Children who have strong friendships are more likely to have high self-esteem and are less likely to become involved in high-risk behavior (Social skills of children and adolescents: Conceptualization, assessment, treatment. Merrell and Gimpell, 1998). Further, close friendships tend to make children more altruistic and help them develop a higher moral sensitivity (Children’s friendships: The beginnings of intimacy. Dunn, 2004). Information from parents and research studies indicates that children with FASD have difficulty making and maintaining friendships. Cognitive difficulties, lack of responsiveness to social cues, and failure to consider the consequences of an action are factors that may make social interactions challenging (Research in Developmental Disabilities. Merrell & Holland, 1997) for these children. Often, social skills must be specifically taught to children with FASD to help them interact successfully with peers.

Experience with peer friendships promotes development of several basic skills such as coordination of play behavior, imitation, turn-taking in social exchanges, the ability to respond appropriately to a partner’s characteristics and, perhaps most importantly, development of conflict resolution skills (The role of friendship in psychological adjustment. Bukowski, 2001). A pilot program designed by students from the Masters of Occupational Therapy (MOT) program at the University of Washington in Seattle sought to teach children with FASD the specific skills necessary for developing and maintaining friendships.

A focus group held in February 2005 identified a large number of children with FASD in Snohomish County, Washington, who were not receiving services to help them develop friendships and social skills (although there is a support group for teens with FASD in the area, no such group is available for preteens and children). The MOT students theorized that helping children develop friendship skills during elementary school might result in more favorable outcomes and progress the children to a more age-appropriate level. Based on parent input in the focus groups that their children did not “know how to make friends,” or even have an awareness of appropriate social boundaries, the need to focus on the sub-skills necessary for friendship building was identified (Administration project: Friends are super club. Haynish & Swafford, 2005; unpublished).

In response to these needs, the MOT student group developed the Kid’s Club to teach children with FASD how to understand important social cues, build foundational friendship skills and handle social participation. The group of 10 children, ages 6 through 11, met seven Saturday mornings to focus on the skills of complimenting others, taking turns, initiating play and maintaining self-control.

The group’s interactive process was designed to help children learn appropriate peer relationship skills within an activity-based curriculum. Program components included the following:

• The program utilized many sensory and movement-based activities to support the children’s awareness and development of self-control and self-regulatory behaviors.
• Activities for each week were based on the overall social goals for the group and included fine- and gross-motor activities; activities included friendship bowling, clay creations, puppet shows, relay races and parachute challenges.
• As the children had varying ability levels, activities were graded individually to allow each to feel successful.
• Activities varied between individual, paired, small group and whole group arrangements to give members the opportunity to develop positive social skills in a number of peer group settings.
• At each week’s conclusion the children received homework assignments to complete with parents or siblings to allow carryover of the concepts taught.

Evaluation of the group was based on facilitator observations, parental pre/post-questionnaires, and the children’s own comments about the group. As the Kid’s Club progressed, facilitators saw significant increases in several of the children’s abilities to successfully participate in the group. Parental reports indicated an overall increase in their children’s social skills. Parents commented that their children were, “more interested in playing with other kids,” “called friends on the phone to come over to play,” “showed increased self-confidence,” and “had better use of words when approaching someone new.” Most importantly, the children thoroughly enjoyed the group. Many frequently asked when the next Kid’s Club would be and looked forward to attending throughout the week.

The program was met with great enthusiasm by the parents and children. Parents expressed that they wanted the group to run for a longer time. The hope is that Kid’s Club will soon be led on a bi-weekly basis throughout the school year, and after “graduating” children will transition to the FASt Friends teen club.

Special thanks to Jean Deitz, PhD, OTR/L, FAOTA and Tracy Jirikowic, PhD, OTR/L for their guidance and advice in the development of this program. Their input was invaluable in successfully implementing the program.

Sarah McNulty, Melissa Nilsen, and Jamie Byrne are members of the 2006 graduating class of the University of Washington Masters of Occupational Therapy Program. Prior to beginning the Occupational Therapy program, Sarah spent five years working in the field of early and outdoor education. Melissa's background in health and fitness helped provide engaging activities for the children. Jamie has a degree in elementary education and she has worked with children of all ages in the school setting.

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CJ’s Words:

My name is CJ Lutke and I live in Surrey, B.C. I am 22 years old.

I was a diagnosed with FASD when I was a baby. I weighed 2 lbs and 9 ounces when I was born, and spent six months in the ICU for babies. I had many things wrong with me and needed lots of surgeries. I had seizures and breathing problems too.

I went to a foster home, and then I was adopted when I was 14 months old by Mom and Dad, who already had Sera and Michael, my biological sister and brother.

I have another birth sister, Ann, who I met a few weeks ago.

Our birth mother died when I was 11 years old from her alcoholism, which is a disease. She did not cause FASD on purpose. She had a disease and needed help that she did not get. I am pretty sure she had FASD herself.

Alcoholism is like FAS—you can’t switch it off with a button.

Growing up, school was very hard. I don’t remember a lot of it for which I am glad. I found a journal that I kept the other day, and it really reminded me of how bad school was. But I kept on trying and I finished school, even though I did not get a graduation certificate. At the time, it was a big accomplishment for me. If I had to do it again, I wouldn’t bother to finish. It was a waste of time for me. They set up this whole thing where you have anxiety attacks all the time because you are so worried about missing assignments and forgetting things and failing.

I love my family and they mean everything to me. If it wasn’t for them, I don’t think I would be as successful as I am. They are not just my family, they are my friends and helpers. I don’t have very many other friends. I hang out with family.

I have one friend, Nicole. I have had her since grade six. She just graduated from BCIT [British Columbia Institute of Technology] and wants to work with people with FASD, which is really cool. When we hang out, FASD does not really come up. I’ll have my troubles, like money, but I have always had that ever since we knew each other so it’s not embarrassing to me or her. It’s just normal. She helps when I need it and doesn’t when I don’t.

I still kind of avoid social situations because I don’t want to feel or look stupid. It takes A LOT of preparation to go out to a restaurant, for instance. Like we have to go before, and look at the menu and figure out what I will have, and I have to know exactly what to say.

After high school, I went to the Kwantlan College Program for people with disabilities, especially the FASD class. Marsha, my teacher, made school relevant. It made sense to me. It was useful stuff and stuff I could do and stuff that would help me in the future, like get a job.

Seriously, who needs to memorize a periodic table of elements or know when Buddha was born?? What am I going to do with that information when I still have trouble counting change or telling time?

Kwantlan helped me get a part-time job at Winners [a Canadian discount chain]. I LOVE IT SO MUCH!!!!! The people I work with are just SO wonderful!!!! I didn’t know that people could be like that. I look forward to going to work every day that I work. I love what I do there. They never expect me to do what I cannot do. I am always bragging about how wonderful Winners is. I feel safe to tell that I have FASD, and they are proud of me. It is SO different than school where people were mean.

Even change is easier there. If something changes, it’s OKAY there. They help make it work.

Some people in my life have really helped me.

My Mom and Dad and older brothers and sisters always help me. They never make me feel stupid. My Mom has all kinds of little tricks for me so I know what to do. They are all very patient with me.

Marsha, my teacher at Kwantlan helped me a lot. She made many extra copies of everything, she colour-coded things, she put schedules up, she explained things REALLY good so I could understand them, we got lots of breaks whenever we got stressed, she wrote in our planners, she didn’t talk and write at the same time, or expect us to write if she was talking (like taking notes is impossible), she did things SLOW, she went on job interviews with me, she came to the job sites all the time. She explained things REALLY WELL about work.

Nicole is a real friend and does not make me feel different. She is really smart, but she never dumped me because I wasn’t like the other smart kids.

Managers at work – I am sure I ask the same questions over and over, but it is okay to ask questions there. I get a list every day and it is very routine.

My life is going well.

I just wish I could take the bus, but I get lost so easily because I cannot do directions or tell where I am. I have problems with visual spatial things. I still can’t do left and right very well. (Like I still can’t tell which left to take because there are 2 different lefts and 2 different rights and they keep changing.) I get lost even in my own neighbourhood where I have lived for 10 years.

I also wish I didn’t get tired so easily from things like work. I find I can’t do social things very much if I work because it takes all my energy to concentrate and think and remember. I don’t think I could ever work full time. I need to come home and sleep. So, it’s a really good thing I like my job!!!!

I want you to know that I am honest, I love my family and the people I care about and I love my cat. I am not bad, or useless or stupid. I don’t know anyone with FASD who is. I have always tried my best, even when people thought I wasn’t. I work really hard to be the best person I can be.

I would also like everyone to know that no one causes FASD on purpose. Although I would rather not have FASD, it’s not the end of the world. A lot of blame is placed on people with FASD and on people with alcoholism that shouldn’t be. I think I know what it must feel like to have alcoholism.

I would like everyone to remember that FAS is what I have, it is NOT who I am. I am a person with FASD, NOT an FASD person.

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David’s Words:

My name is David. I have FASD. I am 17 years old and live in Vancouver, B.C. I was diagnosed with FASD when I was 9 years old. I understand a lot about it. I have a birth brother and a sister who also have FASD and partial FASD. I am the oldest. We live together in our family.

When I was little, I lived with my birth mother. She had a problem with alcohol and drugs. She did all her life. She did not do this on purpose.

I went to my first foster home when I was a baby. I was in lots of foster homes because my birth mother was not able to take care of us. I am pretty sure she had FASD too. Lots of things happened to us. My brother had three broken arms in one year and I got a big scar on my forehead. All of us were in different foster homes until the last one. Then we all got adopted together when I was 9. I used to see my birth mother once a month when we would take her out for brunch. She died two years ago from AIDS.

How FAS has affected me

I am very small for my age. I have always been the smallest kid in my class even though I am the oldest kid in the class. I had to have braces on my teeth because my jaw was too small for my adult teeth to come in properly and they were all crooked. I don’t feel pain. I am not sure what it is supposed to feel like when people ask me. You can stomp on my toes and it does not hurt. My fingers are not straight and they go skinny at the tip. My fingernails don’t grow hardly at all.

My face doesn’t look FASD anymore because when you get older and you have FASD, your face changes and you mostly look just like other people. But this does not mean I can grow out of it. I can’t. I have it for the rest of my life. My brain is smaller than a regular one, so I have a smaller head, too. I have really big problems with learning all kinds of things even though I am not mentally handicapped like my sister.

Math!!!! It feels like it is impossible for me to do. Money is hard for me to count, and I get mixed up with stuff like tax. I don’t understand how much things cost and get mixed up a lot of the time. I still can only sort of tell time on a round clock. I use a digital clock and watch which works better, but I still never know how long things take and how long I have been doing things.

I have a terrible memory!! I forget things all the time. I forget things pretty soon after I learn them. This is very frustrating because I have to learn it again. I forget all kinds of things, like what I just said and where I put something, or what happened a little while ago. Sometimes, I even forget I just ate dinner.

I have a really hard time paying attention and I get hyper when there is too much going on. It was very hard for me to stay in the classroom. The resource room worked better for me because the teacher would sit by me and go step-by-step and explain it my way, simply. It was quieter and had less distractions. But I don’t go to school any more because high school was just too hard and they would not let me go to the resource room any longer.

When people talk to me with big words, I don’t understand them. You have to use small words and slow down and it takes longer for me to figure out what you mean. Sometimes, I never do. I have to think over what I say, too, because sometimes it doesn’t make sense to me either.

It is hard for me to get friends and keep them. Kids used to pick on me, and be mean to me a lot. However, I do have some friends now.

Things I am good at

I am good at gym and sports. I am an excellent swimmer and I am good at diving. We have a pool so I can do this a lot and use up my energy. I am good at all outdoor activities. I am also very good at building things and putting things together. If you do the math and directions part, I can do the rest.

I was a good reading tutor to the Grade One student I helped my last year at elementary school. I was also a buddy to a Grade One and Two classes. That means I helped them with art, stuff on the computer, and I wrote out the rough copy for them of their journals. I had to set a good example for them of proper behaviour.

I have done excellent science fair reports on FASD. I know a lot about it and I can teach people about it. For the past 3 years, I have taught medical students in second year about FASD. I do that for 5 weeks, 2 afternoons a week. I get paid for this, and it is an important job. I think they learn a lot from me, and I get really good evaluations. I also have spoken at conferences and adoption programs.

I also take care of my sister’s dog when she is at work – which is another job I get paid for. I love animals and take really good care of him. I also have a nephew who is 6 who thinks I am the greatest. I help to look after him, too, sort of like with the Grade Ones and Twos.

What I want you to know

I need reminding about most things. I DO NOT forget on purpose!! I think I will always need help with how money works – like which one is better to buy. I need my Mom to help me so I don’t spend all my money, but I really don’t like that and get frustrated. Then I spend my money and get mad because I don’t have any. I don’t know the difference from 10 minutes to an hour so I need other people to help me so I am not late, too early or forget.

Whenever I get frustrated, I explode. It’s not because I am a bad person. I am a good person. I just get really frustrated because things don’t make sense no matter what I do sometimes. I have a hard time judging things. Lots of times I make mistakes because I don’t understand, no matter how hard I try. I also won’t ask questions, because I don’t want to look like an idiot, not because I am not listening. I actually listen really, really hard.

I need people to be patient with me.

I AM NOT LAZY!!!!!! NO MATTER WHAT!!!! I ALWAYS TRY MY BEST!!!

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Ireland’s Trouble With Alcohol

by Michele Savage

In recent decades all of Ireland has seen both a startling increase in the amount of alcohol consumed and a sea change for the worse in Irish drinking habits. Alcohol is declared to cost the Irish exchequer €2.65 billion annually, but this figure does not include any of the costs of either the primary or secondary effects of prenatal exposure to alcohol.

The public is well aware of the rising problem. Recent research shows that, “82 percent of people in Ireland believe that Irish alcohol consumption levels are a problem,” while, “51 percent of Irish people believe the government is not doing enough to address alcohol problems,” (Alcohol in Ireland – Time for Action: A Survey of Irish Attitudes. Alcohol Action Ireland, 2002).

In 2002, concerned organisations and individuals, reacting to the public outcry about the costs of alcohol-fuelled damage, created an umbrella group called Alcohol Action Ireland. In addition, as there has been very little awareness about the serious issue of prenatal exposure to alcohol, a group of professionals and foster caregivers founded Fetal Alcohol Support Ireland (FAS Ireland) that same year so that the rising tide of concern would also lift the FASD boat. These organisations, along with those affected by alcoholism and FASD, are operating in a difficult political and societal environment.

Alcohol ….officially

Alcohol issues come within the remit [authority] of the Minister for Health and Children, and that department published National Alcohol Policy Ireland (1996), the Strategic Task Force on Alcohol Interim Report (2002), and the Strategic Task Force on Alcohol Second Report (2004), having established both The Strategic Task Force on Alcohol, (STFA) and the post of national Alcohol Policy Advisor to the government. Interestingly, the National Alcohol Policy Ireland (1996) is not available anymore, either in hard copy or from the Web site of the Department of Health and Children. This may be reflective of other changes in the area of addressing alcohol’s impact on society.

Mary Harney, Ireland’s current Minister for Health and Children as well as Deputy Prime Minister, dispensed with the National Policy Advisor on Alcohol position in late 2005, stating that health promotion and the selection of a new advisor regarding alcohol would become the responsibility of the newly-formed Health Services Executive. So, although the ultimate responsibility for alcohol policy and legislation remains with her department, the Minister now has no such official policy advisor.

In addition, Minister Harney announced the establishment of a system whereby advertising of alcohol would be subject to a voluntary code, as opposed to one under-pinned by legislation. It would appear that this is very much according to the wishes of the alcohol industry.

Meanwhile, alcohol – a drug, a teratogen and a poison, and “no ordinary commodity” (No Ordinary Commodity. Babor, 2003) – is classified as a food by the European Community. Unfortunately, new Irish legislation, The Groceries Order, now allows retailers to sell alcohol “below cost,” furthering hampering consumption-reduction efforts. Alcohol products also are not required by law to warn about harmful side effects. Such is not the case with tobacco products.

Alcohol and pregnancy…. officially

Only two paragraphs of the Strategic Task Force on Alcohol Interim Report highlight some of the dangers of drinking and pregnancy, mentioning, “foetal alcohol syndrome.” The report’s first directive, which addressed at-risk groups, was that, “The Department of Health will encourage pregnant women and women who are planning to become pregnant to avoid alcohol consumption especially during the critical first few months of pregnancy.”

Minister Micheál Martin, launching the Strategic Task Force on Alcohol Second Report, announced on national television that his two particular areas of priority would be, “young people and alcohol,” and, “alcohol and pregnancy,” even though the report merely recommended that “alcohol related attitudes and behaviour surrounding pregnancy be evaluated.” Minister Martin was moved to another department within weeks.

However, President of Ireland Mary McAleese did warn young people attending the Youth Forum on Alcohol Consumption in Dublin last year about the dangers of Fetal Alcohol Syndrome, and the government’s most recent official publication on pregnancy states, “Do not take alcohol in pregnancy as it can harm your baby,” (Maternity and Infant Scheme: Information for Expectant Mothers. Department of Health and Children, 2005). This is encouraging, as previous official publications have given varying and sometimes conflicting messages.

Drinking and Pregnancy in Ireland

Two recent studies showed that 85 percent (Walsh, 2004) and 82 percent (Kearney, 2005) of women here drank in pregnancy. This rate of consumption is more than three and a half times the rate reported for U.S. women, where the occurrence of FASD is 1 percent of all live births.

Unfortunately, some gynecologists in Ireland still do not advise women that the placenta does not protect the fetus from alcohol, or even that abstention from alcohol is best for the baby. The doctors’ lack of advising patients is irrespective of the fact that fourteen years ago, Ellen O’Donovan and her son Malcolm were Ireland’s first international ambassadors to highlight the dangers of alcohol in pregnancy (National Geographic. Feb. 1992). Or that Dr. Desmond Corrigan’s warning about FAS in 1994 included reference to findings of a reduction in I.Q. at age 4, and both attention- and reaction-time deficits in children by age 7 (Facts About Drug Abuse in Ireland. Dept. of Health, 1994).

FAS Ireland steps in

Under-recognition and under-diagnosis are reflected in the dearth of FASD-specific services for those affected and their families, caregivers, schools and communities. Members of FAS Ireland give information talks, participate in radio discussions and media interviews, and provide articles for publications. We submit oral and written statements to inform policy-makers, service providers and legislators about how FASD affects their particular area of responsibility, highlighting how the needs of people with FASD can be understood and provided for in each relevant sector.

The past eighteen months have been particularly busy for FAS Ireland, as local and international experts have helped to research and advocate on behalf of Ireland’s youngest generation.

• Dr. Kieran O’Malley, Consultant in Adolescent Psychiatry at the Young People's Centre of South and East Belfast Trust in Belfast, gave three talks on FASD, two in Belfast along with Dr. Truman Coggins, and one in Dublin. Dr. O’Malley has been a source of inspiration and encouragement, and his concern and support are very much appreciated.
• Dr. Peter Hepper of Queen’s University, Belfast, has been producing important research in the field of fetal behaviour as a result of exposure to alcohol.
• Dr. Susan Ryan, Professor of Special Education at the University of Alaska, Anchorage, spent a year researching services in Ireland for students with FASD in her role as Fulbright Scholar at the National Institute for the Study of Learning Difficulties at Trinity College in Dublin.
• And Irish psychiatrist Dr. Siobhan Barry has been a tremendous advocate regarding issues of alcohol and pregnancy in Ireland.

In addition, FAS Ireland's Web site has proven to be a fantastic resource for exchanging information with interested parties.

Conclusion

Fortunately, Ireland is waking up to FASD and the far-reaching effects of prenatal exposure to alcohol. We are spreading vital details about prevention and treatment in order to change how we Irish view drinking while pregnant.

Michele Savage is one of the founding members of Fetal Alcohol Support Ireland (FAS Ireland), and with husband David has been fostering children for the last 14 years. Under the surname of NÌ Chionnaith, Michele has co-authored both an article and a booklet on FASD with Dr. Susan Ryan.

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Things I would like teachers to know

• I always try my best
• I am not lazy
• Telling me to try harder does not help
• Lighten the work load
• I need extra time to complete work (accept lates)
• Explain things simply
• I need things to be repeated many, many times
• I need minimum distractions (noise, people, other sounds and other visuals)
• I don’t get hyper on purpose – I can’t help it. I would like to, but I can’t
• There are some things I cannot learn no matter what!!! Or who teaches it!!
• I get frustrated easily, when I can’t do things I think I am supposed to
• I learn things slower than other people
• I don’t mean to forget my homework
• I am not trying to be annoying on purpose
• I move around in my desk a lot of times (fidgeting)
• I lose things a lot!!! (like textbooks)
• I can’t pay attention for a long time
• I forget many things (not on purpose – I get just as frustrated as the teacher!!!)
• I need to ask a lot of questions – sometimes the same one over and over
• I am not good at organization (I need lots of help)
• I have trouble telling time and I don’t know how long the classes are. I don’t understand how time works
• I don’t mean to be late for class
• I need to do things in the same order all the time. If I don’t, my whole day gets messed up!!!
• I need expectations I can meet – different from the other kids
• My handwriting and drawing skills suck!!!! I have trouble with hand-eye co-ordination. I can use a computer and it can check my spelling too
• I love gym but I have a hard time balancing
• Other kids are sometimes a little nasty to me (they don’t like anyone different or slower)
• Combination locks are impossible (you have to do many directions)
• I need people to talk to me in small words and to slow down when they talk to me so I can understand what they are talking about
• Do not give up on teaching me – I can learn lots of things – just different things

These are my own thoughts from experience
I wrote this myself
I think these things are true or similar for most kids with FAS

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Our Lives with FASD

Members of the Lutke family in British Columbia, Canada submitted the following writings and art. CJ, David and Thomas were all diagnosed with FASD as children, and were adopted by Jan and Lloyd Lutke. Their family includes 2 biological children and 21 adopted children; 13 of the children have been diagnosed with FASD.

A view of the British Columbia coast, created by Thomas Lutke, age 14. Thomas has FASD.

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Review of Elizabeth Russell’s “Alcohol and Pregnancy – a Mother’s Responsible Disturbance”

by Paul Connor

“Alcohol and Pregnancy – a Mother’s Responsible Disturbance,” was written by the birth mother of two children with FASD, and describes her experiences with alcohol dependence and its consequences for her family. Russell explains how she was initially mystified by her two sons’ health and behavior problems and describes the long process of discovery that enabled her to link the source of those problems with her alcoholism.

Russell gives a gripping account of her pain in realizing that her own behavior had harmed her children and so greatly impacted all of their lives. She talks about the fear and anxiety that many parents feel because their children with FASD have serious mental health problems, repeatedly fail in school and work and often have suicidal tendencies. Despite these fears, this book demonstrates Russell’s amazing skills as an advocate for her children, and details how she was able to obtain the appropriate services for her children.

Her account is appealing on several levels as she describes her personal experience with FASD, diagnosis, treatment, management, and advocacy. She explains the condition of FASD very clearly; enabling the book’s contents to serve as a series of “red flags” others can use to identify possible symptoms of FASD in their own children’s lives. She describes the treatment and intervention approaches that worked for her family, along with those that didn’t, which may be helpful to others. In addition, her grass-roots activism to improve the knowledge base and recognition of FASD in Australia is a "how to" manual for those who wish to follow that same path. Finally, the aspect that made this book most appealing to me was that Russell wrote not only of her own experiences, she also included the perspective of her husband, their pediatrician, her sons’ girlfriends and that of her sons themselves.

In “Alcohol and Pregnancy,” Russell hypothesizes that her delay in understanding her sons’ difficulties was partially due to the lack of recognition in Australia of the effects of prenatal alcohol exposure. She also felt that, if she had been living in America or Canada, she wouldn’t have had the same difficulties obtaining a diagnosis. While it is certainly true that knowledge of FASD has lagged behind in Australia, and there could be considerable resistance to focusing on the disorder because of the central nature of alcohol in the Australian culture, many people in America and Canada will agree that there are still many barriers to gaining a diagnosis and appropriate services right here in North America. Despite her difficulty in finding an appropriate diagnosis, Russell was very fortunate in being able to acquire services for her children that help them live as independently as possible.

This book tells a story that is all too familiar to anyone who works, lives or interacts with individuals with FASD; however, Russell details her story in such a compelling way that it is well worth reading. Russell blends her personal experiences with current scientific knowledge to create a very well written and well-researched book.

Paul Connor is an Assistant Professor and Clinical Director at the Fetal Alcohol & Drug Unit of the University of Washington’s Medical School in Seattle.