Monique Michelle watches as Jesse George choses to sit in the "bunny hole" to read her book in a special FASD program at David Livingston Community School in Winnipeg, Tuesday, May 11, 2010.
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."