Understanding Fetal Alcohol Spectrum Disorders with Christian Hancock

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Transcript of “Understanding Fetal Alcohol Spectrum Disorders ” – Bright Conversations Podcast

Hi, I am so excited for today's episode of Bright Ideas newest podcast, Bright Conversations. I'm Sarah, I'm your host for today. I am the co-founder of SLP Toolkit as well as Bright Ideas Media. And I am so excited to have this opportunity to have a conversation that is, I 'm going to feel like pretty new to me. So thank goodness we have Christian Hancock with us today and we are going to be talking about fetal alcohol spectrum disorders.

So what is it? The challenge is associated with it and how SLPs and professionals can provide strength base support. Which even that was kind of a new concept for me. So I am so excited to talk about all these things. Welcome Christian.

Thank you so much for having me. This is such a pleasure. I'm so excited. I got the ideas for the, or saw what the topic was going to be about. We were chatting a little bit before I hit record.

And I said, this might be more interview than conversation because I feel like so much of this is new for me. Yeah, and I agree. I think a lot of people, a lot of caregivers, a lot of educators, a lot of healthcare professionals are not educated about FASD. And so the opportunity to just share more about it, actually we'll talk about actually how prevalent it really is. I think will help change the way that we show up as practitioners to support these families and individuals.

Fantastic. At first, before we even dive into it, tell us a little bit about yourself and like how this became something that you got advanced training in. And I'd love to just hear more about what you're doing. Thank you. I am a speech language pathologist and community advocate.

I support families and individuals with neurodevelopmental disabilities and differences. So my private practice is called heart and soul speech. It's in the North Dallas area, but I offer services all across Texas. And I also work with a nonprofit organization called Texas FASD Network, which is the only organization in Texas supporting FASD, individuals and families with FASD. So through that work, I do a lot of education and training advocacy at the state and federal level for policy change and then supporting families who need support and connection.

I did not get a lot of FASD training in the university, like so many other allied health or educators. There's not many getting trained on FASD. But I had a neighbor turned dear friend who said, "I have a daughter with FASD and you need to know about it because we need more providers, more SLPs who know about FASD so that they can help within the systems of care." So I got involved and I haven't looked back. This is what I primarily do along with pediatric feeding disorders and bilingual language learners. Fantastic.

I love that, like how that works out, where you kind of, and I think we all do that. I always say like as a school based SLP myself, I feel like a jack of all trades. Like I'm not a master of any of them, but I have to know something about everything. And so, but then you find like the things where you like connect and you know, that make you feel more passionate. And so it's such a great way to be able to then specialize in something.

And so I think we'll have a mix of listeners probably for this podcast, but that's one of the things, you know, in the schools, again, being a jack of all trades, you know, we, this is something we need to be aware of. I have a feeling it happens, you know, we have students on our case all the time, we're missing some of those maybe signs or characteristics or what the challenges they're facing are. And so we're not doing the right treatment or I should say the right treatment, but you know what I mean. So this is fantastic. I love this.

Okay. So let's get into it. The basics. What is fetal alcohol spectrum disorder? So fetal alcohol spectrum disorders, FASD is the umbrella term.

It is not a diagnosis in the United States, but that is the umbrella term for a group of conditions resulting from the wide range of characteristics caused by alcohol exposure before birth. I think it's most important to know that it is a lifelong hidden, but very physical disability. It does not have a cure, but we know that earlier and appropriate supports can make positive impacts and in change outcomes. Prenatal alcohol exposure can result in these lifelong differences and disorders in physical, intellectual, emotional and behavioral development. So it really presents like a lot of other diagnoses or differences, neurodiver gence that SLPs allied health educators are more familiar with.

And we can talk more about those overlapping characteristics in a little bit, but the CDC estimates one in 20 talking about probably everybody does have somebody mis diagnosed or not diagnosed with FASD on their case loads. If you have one in 20, that's one child in every classroom, one or two in every workplace. So the prevalence does not match the awareness of FASD. It doesn't match the research. It doesn't match the federal funding.

That's allotted. So we are really trying to move the conversation forward to include FASD in those talks because we know it is not uncommon. Yeah. That is so interesting. I've got so many questions, but this is where I'm like, okay, let's break this down like step by step.

What do you, so even like when you were talking about how it presents to so many other things, what are some of those then misconceptions? Well, one, we're not even aware of it. So now we know what it is. Two, like what are the misconceptions about, I knew what that fetal alcohol syndrome was. Again, still not quite sure I understand how it's representing in maybe the students I work with.

Right. So fetal alcohol syndrome or FAS is one of the diagnoses that medical providers use under that FASD umbrella. We also have ARND, which is alcohol related neurodevelopmental disorder. And then we have a few other variations of that on the mental health side. We have something that we use NDPAE, which is neurodevelopmental disorder associated with prenatal alcohol exposure.

All of that to say under that umbrella, we don't have a standardized diagnostic label that all providers are able to use and that contributes to some barriers for diagnosis, for appropriate supports for conversations about what FASD looks like. So talking about the, you know, those overlapping characteristics, there's a really nice chart that kind of looks at the behavior characteristics. And a lot of times it looks like autism. It looks like ADHD. So every person presents with strengths and needs.

It is a spectrum, just like a lot of other neurodevelopmental disorders. So these characteristics like differences in learning, difficulties with memory , executive functioning challenges are abstract thinking, goal setting, planning, organizing, challenges with mood and behavioral regulation, impulsivity, attention, differences in sensory processing, social pragmatics, daily living skills. Everybody probably in the audience is thinking, that sounds like a lot of people on my case load and those primary characteristics overlap with what we know, especially behaviorally. Unfortunately, less than 1% of those with FASD will get the correct diagnosis because of those overlapping characteristics, because of the lack of public awareness and professional training and the shame and stigma attached to FASD. That's what I was just going to ask you because really the probably only way, like you said, because it's presenting like so many of these other things that we are familiar with, unless on that intake form, mom has said that, you know, there was alcohol at birth, you know, while she was in the baby was in utero.

Is there any other way for us to really confirm it? Right, there is no one test that determines prenatal alcohol exposure. So we have to be asking about it. How do we really know that it's autism if no one ever asked about prenatal alcohol use? Because it presents very similarly.

How do we know that individuals are misdiagnosed or never diagnosed because it 's not on our intake forms, or maybe we haven't created a safe environment where that careg iver can share that without being shamed. We do not routinely test for alcohol at birth, even though it is extremely easy and economical to do. The alcohol industry contributes to that shame and stigma and lack of testing available across the states. But prenatal alcohol exposure is the only essential biomarker that sets FASD apart from other neurodivergence or neurodevelopmental disorders. So if we're not asking about it, we will continue to misdiagnose it.

We will continue to not have the research and the funding available because that lack of awareness. So I think you're absolutely right. We need to be asking about prenatal alcohol exposure. Yes. And I think that going back to misconceptions, like you said, the guilt and shame.

I think immediate reaction is, well, how could a mother do that? And it doesn't have to be large quantities of alcohol. I didn't know I was pregnant with my second child until I was 20 weeks. That's a love story for a different day because nobody ever does like what? But so there could have been opportunity there where that might have happened.

And so what do you, I imagine you're meeting with lots of families and talking to different people. How do you kind of approach that question to make them feel like it's a safe opportunity and an important thing to understand? Right. I'm glad you asked that because I think sometimes as providers, we may not feel super confident in the way we counsel or the way that we haven't established rapport yet or maybe we're a little uncomfortable. And how do we start this difficult conversation knowing that it's in everyone's best interest to have this information, but we don't want it to be stigmatized.

We want the family, the individual to feel safe and sharing. And some states are criminalizing this. People are not sharing because they don't want their children taken away from them or they don't have a supportive environment or community. So we need to be really mindful of how we're approaching this with families. The American Academy of Pediatrics and the American Medical Association, AMA and AAP have both set forward a set of three questions that do you stigmatize is how to ask about this?

I put it on my intake forms. I encourage everyone to put it on your intake forms. It's simply asking about alcohol use prior to pregnancy. When did you know pregnancy was established? And then how much did you drink afterwards?

It's trying to take away the stigmatizing language that is used. But if you think about it, 50% of all pregnancies are unplanned, unintended, maybe didn't find out until much later in the pregnancy. And knowing that fact takes away some of the stigma or the stereotypes that we have about alcohol use. No person is drinking because they want to hurt their baby. So you will hear people say, "FASD is 100% preventable.

This should not be a problem. Just don't drink alcohol." And while it is true that FASD does not happen without the prenatal alcohol exposure, it's really a big issue to overlook the systemic inequities for women, how little support is available for maternal health care, family support. Another interesting thing is people say, "Well, it's just a women's health issue." But men are not off the hook as historically believed. In the past few years, Dr. Michael Golding and his team from Texas A&M have found that there is a correlation between the male contribution and alcohol present.

And so it does have an impact. This is a public health issue that we really need to change the conversation around. We've historically really stereotyped and even servalenced and removed children from child care and indigenous communities, black communities. That is not true. That is not what the research is showing.

It's really across the board, across all classes, all races, all cultures. Yes. I'm so glad that we are talking about all of this because I do. I think those negative stereotypes are causing the inability for us to then work with these children and we'll get into what that looks like later with the strength-based approach. I'm so excited to talk about that too.

And so I think that is super important. What about AFSD in the neurodiversity conversation? Is that where we should be thinking about, because you said it's very similar, it could be a look like ADHD, it could look like autism. So I'm guessing it's in that same category. Right.

So the neurodiversity movement is the hot topic. And I like to see the conversation happening around this, shedding awareness, but also exception and acceptance and inclusion. What I don't see as much conversation about is acquired neurodivergence, which is what FASD, what is like a TBI would be, what is a birth trauma-related neurodiver gence would be. So wanting to make sure that we include those in our conversation for supports, for disability justice, right? A lot of those neurodivergence do not share the same stigma as FASD.

FASD is the only one to my knowledge that has the etiology in its name. We say alcohol. We know what we are talking about. Everyone does not, and it's not a competition. It's not a competition.

But we do want to make sure that FASD is included in the movement. We don't have enough people aware of how it impacts the brain. It's really a hidden physical disorder. The only 10% of the population presents with the facial phenotype, the facial phenotype is for fetal alcohol syndrome, the FAS that we were talking about. So 90% of the FASD population is not really visible.

We know that the brain is impacted, but people don't always connect the behaviors that they see to the way the brain was changed, right? So there are lots of barriers to inclusion. I think like all disability, we really have that intersectionality between disability and the perception in society across races, the ableism, the misogyny, racism, all of these things really contribute across every setting that a person with FASD would be. It's in the schools. It's in the workplace.

It's in the criminal justice system. Every person or every community support that would be available really has barriers to it for FASD. And I'm glad that you had mentioned that with the neurodiversity piece and the challenges of it not being put into that category and the conversations that are happening that we're starting to finally talk about this idea of neurodiversity. But why does that matter? Why is that such an important thing right now that we're talking about?

That's more for treatment and just overall understanding, just in case anybody listening is like, I don't know what you mean by this neurodiversity thing and why that matters. Right. Well, I think it's important that people with living experiences and self advocates have the voice, have the platform to be able to share their daily experiences, their barriers to support. We have families who come through the nonprofit and they have seen 25 providers who dismissed them effectively. They said, this can't be due to alcohol or you said you didn't drink that much.

It's not that big of a deal, right? Like a glass of red wine and the third trimester is fine. It can't be due to alcohol. So there's really this misperception that FASD and the behaviors associated with the brain changes is due to poor parenting. It's due to a non-compliant child, right?

It's really... It's a behavior, right? And something that is undesirable in that child. And it needs to be fixed. And it needs to be fixed, right?

So I see that as a really interesting discussion happening in the neurod iversity movement because we have one side that is, neurodiversity is natural. It happens, but it is also true that FASD would not happen if there was not alcohol there. And so how do we bridge that gap to make sure that everyone is included? Everyone's voices are heard and accepted, even if society isn't quite ready to accept that, you know, it shouldn't happen piece. It's still a big conversation in the FASD world, unfortunately.

Yeah. Okay. It's like this is that moment too, where I can see why you just win like all in because it does. You just want to be like a part of this movement to get these things done quicker. And so, but this conversation is a perfect place to start.

So I'm hoping that those of you listening understand how, you know, this is something that we need to be having conversations about. Okay. So for our speech language pathologist listening, well, am parents too. So it signs that they might be saying, what are some of the common speech language and cognitive challenges we see in individuals with FASD? Right.

So early on, unless we know that there was prenatal alcohol exposure, which is very unlikely, we likely see the same sorts of characteristics or what we would expect, right? Probably a language delay, maybe some, you know, neurodivergent, place skills, social communication, feeding difficulties, sleeping problems, you know, and if we don 't know about alcohol, as we were probably thinking, you know, a different sort of, of label. As they get older, what we do start to see, which I think is really helpful for us to keep in mind as, as therapists is fluctuating skills. So sometimes we see the child be able to, to do something and the next time they cannot. And so we know that alcohol is a trattogen that kills brain cells.

It changes and reduces the way that the normal migration of those brain cells. So it's leading to these neurological holes and I'm using air quotes here in the brain when the neurons aren't firing and wiring consistently. So I tell families it's kind of like a light bulb in a, in a faulty wiring home . And I'm, I'm, I'm not the first person to use this example, but you flick the lights on and, and the lights turn on. Sometimes they flicker a little bit and sometimes they don't turn on at all.

And that's really how the brain is working with FASD. So those fluctuating skills is what starts to kind of set these kids apart from other neurodivergence in my mind. It can also get into a lot of trouble, right? Because you think, well, they did it yesterday. Now they're just being difficult, right?

And so when we really have the understanding of what FASD is, it can help our us support these children and families better. So we talked about, you know, social differences, sensory differences, learning difficulties, but really those fluctuating skills and the executive functioning challenges are what I am looking for. Another thing I tell families is if you've tried everything and it's not working, if your child has a lot of diagnoses and if they are probably on a lot of medications and it's not working, we know that some of the ADHD medications, which makes sense because of that overlap of characteristics, you're thinking ADHD, trying the medications, those, sometimes exacerbate or do not work for individuals with FASD. So I tell families if you've tried everything and it's not working, let's talk about FASD. Interesting.

Yeah, because I was just going to say, like, you know, we talked about the very beginning, there is no test. And so unless there's transparency, you know, from, or, you know, we even know the birth history of that individual, there, it's just like, I can see what's going on. And why they're probably getting diagnosed with the ADHD or the autism and then your treatment plan changes based on that. So that's so interesting. Now, could the ADHD medications, I know you said sometimes they won't help, but sometimes they could mask it, maybe a little bit of the executive functioning part.

Sometimes we do have some families that have success. You know, of course they're working with a psychiatrist, a mental health therapist who is prescribing the medication. Sometimes their physicians are also, but we find that it's mostly the mental health side prescribing the mental health medications. There is something called the Matthew's Protocol out of Canada, which is kind of like an algorithm to find out which medications might do better. But then you know, you think about the side effects, feeding issues are sometimes a problem, and that can exacerbate once you introduce medication sleep also is very important.

So it's really a personal choice for families and then it becomes a constant choice as the body changes, as the brain grows, what they're having to do to adjust. So medication is not always as helpful as we would hope. Yeah. No, and I was just thinking about, because I loved it when you were saying that what I will often tell people is if none of the other things are working. And so that's where things, if only there was just like a very clear like we thought ADD gave them the meds, didn't do anything, let's look at the next thing, but with the overlapping, I imagine some treatments will appear to be offering support of those difficulties.

I'm always curious because I think the prevalence of ADHD is maybe one in nine. I can't remember exactly, but with FASC it's one in twenty. Autism, I think the most latest is one in thirty six, one in thirty four. But I'm always curious how many of those individuals who are diagnosed with autism or ADHD actually have FASD as the primary diagnosis. And so the good news is when we start talking about the strengths based supports, the supports paradigm in a minute, most of these, I would argue all of these strategies work for everyone.

It's really about shifting the perspective of and the model of care for neurod ivergence across the board. Okay. I'm thrilled to hear that because there is. That part of my brain that's going, yeah, I'm going to try and I'm going to change my intake form and I'm going to show that I'm a safe trusted place and then I'm here to support this family. But then if that doesn't work and I'm trying all these things, it's not working .

So this like is that moment where I could, okay, let's talk about the strength based care and how those it's just good practices that will support all these children's needs regardless of maybe a diagnosis. Right. Right. I really do want people to walk away saying that there is hope, right? That's what we tell our families, our caregivers, our individuals who are starting their journey of, you know, do I have FASD?

There is hope and that we are here to listen to your story and to provide resources. So the most successful outcomes for FASD really do require a paradigm shift across the community from the medical model of disability to the social ecological model of disability. We call this the many names, but the supports paradigm or the neural behavioral approach. So we really need everyone that's interacting in the system of care to understand that this is now the lens through which all of our strategies must go. So it requires ongoing training, ongoing training, practice and education.

And sometimes I think there's a misconception like, oh, I'm trauma informed. You know, I have training on trauma and that is extremely helpful. But it's interesting to say that because we've, that's just some of the courses we've had recently, which again, eye opening and so a lot of things, I thought, okay, this is kind of similar to that where you need to be aware of this because it could be impacting other areas and okay, but it's not quite the same. Right. I think it's a nice compliment.

I almost feel like you have to have both because FASD is trauma. It comes with trauma. A lot of the FASD population is in the foster adopt community. We see it higher population and incarcerated individuals. We know that trauma and FASD really go together to me.

It's in the body. It's in the brain. So when thinking about how do we support, what are we doing in therapy? I kind of like to organize them in what I call the four E's. And this really just helps guide my plan of care.

But it also helps caregivers kind of understand what can I do in the moment that is so good challenging. So the first thing I like to talk about is explain by brain, which is not unique to FASD, the neurodiversity community uses it also. But this really helps determine the root cause of challenges and then isolate which skills needs some more support. So why is this child stealing? Right?

Maybe it's impulsivity. Maybe they lack knowledge of social rules. Maybe they don't understand consequences or that their behaviors are tied to a consequence. And they likely don't remember that consequence tomorrow. Right?

So when we link, when we use punishments, timeouts, yelling, consequences, that relies on a child's executive functioning skills, even positive reinforcements like a reward chart. That requires the child to remember to behave so they get a star and then they have to do it again 50 times and do it again tomorrow. And they have to link the behavior to the consequence. So those don't typically work with FASD. And that's why I think it's helpful to say have you tried everything because of all of those typical strategies do not work for FASD.

So that is the first step explained by brain. The second thing is modifying our expectations. So in order to explain by brain, we really have to accept that the brain is different, fundamentally different. Right? It's not that the child is being defiant or stubborn.

It's not poor parenting. It's that the child doesn't have the capability or the skill and the neurons aren't firing in that moment. Right? Sometimes it will. Sometimes it won't.

Really have to modify our expectations and accommodations. We don't punish people with a TBI. We don't discipline people with stroke. Right? It's the same brain damage as FASD.

It's not that they won't do it. It's that they can't do it. The third thing is adapting the environment. And I think tons, you know, SLPs, OTs, educators are actually really good at this. You know, we use structured and consistent routines.

We have visual cues. We do predictable transitions. We remove temptations. Sometimes I think we're not creative enough in how we do that. I've heard many different stories of children getting into things that they're not ready for, like taking a mom's wedding ring as a Valentine's Day gift.

Right? So we have to really be creative sometimes to get ahead of that temptation. But we want to set them up for success. And then finally, I think after we have that paradigm shift, after we're practicing that we've set up the environment for success, then we can start skill building and those executive functioning skills. The medical model wants us to skill build at first, right?

We haven't changed anything around that child. We just want to fix that child and they need to do something differently. This is the complete opposite in terms of the strengths-based approach. So we're using the strengths that the child has, usually enough, not usually, but often in FASD. We see lots of creative thinking, artistic ability.

They are pretty social. They love animals and children. There's lots of ways that we can build strengths, build skills through strengths that already exist. So we use repetition, modeling, one-step teaching, role play. These, again, are strategies that I think we do well as a field.

It's just ordering it in a way that's different than what we have typically done in the past. So again, these strategies, these four E's are not just great for FASD, but I think at anyone. But what makes these strategies really different for FASD is how long we are using them much, much longer into adulthood and how frequently they are used. So we can't just set up the environment and say, "Check, we did it." It's really constant adjustment. We have to anticipate the behavior that we may see when unregulated.

We have to co-regulate. We have to make sure the environment's set up. So much more longer in duration and also much more frequently dependent on these strategies than maybe some others. So that leads me to, I mean, it's critical to have the family involved because we're talking about school, the student while they're in school and what those environment, that environment looks like, but then also at home. And so everybody has to be involved in this plan.

Yeah. Because I'm thinking about that in the school system too, which is always a challenge. I had a difficult time because I do. I think these teachers are amazing. I love teachers so much.

But they're overwhelmed and often have huge class sizes. And so the behavior issues or what appear to be behavior issues, exacerbate everything. And so it'd be constant, you know, like, "We've got to get this kid out of this room." Like he's just out of control. And so it'd be really challenging to show that this is beyond the student. This is not like all those things you said.

This is not poor parenting. This is not a child who's just defiant and difficult for fun. And then the ways that we can support them in the school. And so is that something that like you're with the other, working with the Texas program that you're involved with? Is that are you guys doing more educating on what that should look like in the schools as well as home?

Yeah. Like I said, it's really the whole system of care. And so that intersectionality of every environment that they are in, it's really difficult to make a change at school and not have it reflected at home or vice versa. And although I kind of rattled off my four E's, I don't want to mislead anybody . This is not easy, right?

We're shifting a whole paradigm. Here's not one of the E's. The E's was not one of the E's. No, we're really making a huge shift in movement for how we are approaching this, you know, this neurodivergence. And so it's not easy.

And so yes, at Texas FASD Network, we offer training to anybody and everybody. We talked to police officers. We talked educators, the entire special education department as well as administrators. We talked to caregivers, families. We talked to healthcare professionals, of course.

So anybody and everybody I think can benefit from knowing more about FASD and knowing more about the strengths, the supports paradigm. Yes. And I do think it for those of the SLPs that are listening, you know, we all have similar characteristics and we're in this profession because we love to serve others and help others. And so then we hear things like this and we're like, that is going to take the entire village and all my time, especially in the schools. I don't have time for this and now I'm panicked and I don't know where to start .

This conversation is a start. You listening to this conversation is a start. But what are other resources where people can find more information if they suspect, you know, that this is impacting students on their caseload? So Texas FASD Network is a resource and I hope that we are used for that. Like I said, we offer support groups peer to peer support for families and individuals.

We are in Texas or do you say this is all Texas? Yes. Okay. Okay. We need all of Texas.

We are also an affiliate for FASD United, which is the national organization. So if you're in a different state and looking for resources, go to FASD United and find a state affiliate organization to get connected to resources. So another part of that nonprofit work is advocacy and excitingly we have a bill right now that was put forward by representative Ana Rodriguez. Well, of course I'm going to miss your name. It's Senate Bill 2219 and it involves adding FASD to the IEP criteria.

So right now it's just kind of lumped under OHI. People don't know about it. People really have to struggle to get it right now. 2219 bill would help so much. So advocacy is another part, but in terms of resources, there is an organization called FASD collaborative.

They have like over 35 free on demand webinars of about FASD from self advocates, people with living experience, researchers, caregivers. It's really great resource. There's also a new version of an older book that just came out. It's called Trying Differently Rather Than Harder, Rethinking Neurodiversity. It's by Lynn Alsup and Natalie Bressard.

That is like a very easy to read introduction about FASD. I wish everybody could have a copy of that. One more that's coming to mind is Nate Sheets. He has a great YouTube channel and he also has a book about executive support for FASD. Those are resources that are coming to mind.

I also want to let families know that therapists and educators know that you don't have to know about FASD to show up as a partner in this journey. I didn't know what I was doing 10 years ago and I felt like I was called to truly just show up as a listener. That was my first step is to show up, connect human to human and say, "I don't know what to do, but we're going to figure this out together." I mean, if anything that can be your action step takeaway is that I'm going to commit to learning more about this and that I'm going to show up as a present partner in this journey for this person. Well said. I love that.

It's about the connection more than anything. That's I think the other thing that we struggle with sometimes is that saying, "I don't know. I don't know anything about this." That's okay. It's okay. You don't know.

But again, it's that willingness to show up and be present. I love that. That's perfect. Yeah. How do we connect with you?

Where can we find you at? I have a website, heartandsolespeech.com. I answer all the emails at TexasFASDnetwork@gmail.com. We both are on Facebook and Instagram so you can find us by our names there as well. I would love to connect.

If anybody wants to learn more about it, please use us as a resource to get started. Yeah. Fantastic. I've already, while this podcast is going on, I'm like, "Well, that could be several different courses alone that I would be definitely interested in talking to you more about." Because even both the strength-based care in and of itself I think would be such a great topic too. Then again, I feel like this would just touch the surface.

There's so much more to dive in here. We've got access to all those resources. I will have those listed in the show notes for those of you that are listening. Then you will be able to follow up with you for those of you who have listened. Hopefully, we can hear more from Christian.

I am so grateful for you for your time and for sharing this. I'm grateful you. This is an area that you have found that's passionate. We need more of this. So, thank you so much.

Thank you so much for the opportunity. It's always such a pleasure and such a privilege to speak for those who have living experience. There are so many self-advocates that also have a voice to share. There is something called the ALC changemakers. They are all self-advocates that you can add to the show notes as well.

They really are the experts from whom I learn and grow. So, again, anytime I have the opportunity to share on their behalf of such a privilege. Thank you. Fantastic. Thank you.

Thank you guys for listening. If you want to find any more content like this, you can find us on bethebrightest.com.

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📌 Raising Awareness for CTE and Traumatic Brain Injury with Dr. Kelli Uitenham 
📌 Supporting Neurodivergent Kids Through Play & Connection 
📌 Intersections of Neurodiversity, Child Development, and Learning Theory