3. Some Things FASD is NOT!
• Only found among poverty and certain
races.
• Hereditary
• An indicator that an affected child’s
mother was a bad person
• A guarantee of disaster
4. One More Thing FASD is NOT
• Quote: “FASD is what I have, not
what I am.”
5. Prevalence
• FASD is now thought to affect between 2 and
5 percent of the school-age population of
North America and Europe
• It is more of an “equal opportunity” disability
than is generally acknowledged.
6. Fetal Alcohol Spectrum Disorder (FASD)
Partial Fetal
Fetal Alcohol Alcohol
Syndrome (FAS) Syndrome(PFAS)
Alcohol-related Birth Alcohol-related
Defects (ARBD) NeurodevelopmentalDis
order (ARND)
(Also called Static
Encephalopathy, Alcoho
l Exposed)
7. What is FASD?
1. Growth retardation in some of
affected population (FAS, pFAS)
2. Facial atypicalities in some of
population (FAS, pFAS)
3. Brain damage (FAS, pFAS, ARND)
4. Confirmed history of prenatal alcohol
exposure. (non-negotiable) (FAS,
pFAS, ARND, ARBD)
8. Four Domains
• Growth
– Height or weight (under 10th %ile)
• Face
• Brain
• Head circumference under 10th %ile
• Various areas of brain function
• Neurological signs: epilepsy and“Soft neurological
signs”
• Alcohol exposure
9. Diagnosis:
• Diagnosis is multidisciplinary
• Paediatrician
• Psychologist
• Optimally, also may include
– Speech-language therapist
– Occupational therapist
– Physiotherapist
– geneticist
10. Facial characteristics
Government of British Columbia, Ministry of Education, Special Programs Branch (1996)
Teaching Students with Fetal Alcohol Syndrome/Effects: A Resource Guide for Teachers
15. Brain Function
• When psychologists assess a person with
FASD, they look at a number of “functional
domains.”
• These overlap somewhat, but all contribute to
how we understand and identify brain damage
which is not visible.
16. Seven Domains
• Cognition
• Adaptation
• Executive function
• Memory
• Communication (Language and a bit more)
• Attention
• Achievement
17. Cognition
• Caution!!! IQ is a very unreliable
predictor of functional ability among
people with FASD
• Possible exception: very low IQs
• IQ can vary from severe intellectual
disability to high average.
18. Subdomains
• IQ is not a single entity--different
areas of intelligence are tested.
• Verbal abilities
• Nonverbal abilities
• Speed of processing
• Working memory
19. • In most people, subdomains are more
or less even
• Among people with FASD, there
tends to be a discrepancy among
subtest scores.
• Areas of strength don’t necessarily
predict other areas. This leads to
misunderstandings.
20. Adaptation: How Does the
Person Use Intelligence for Daily
Living?
• Among non-alcohol exposed population
IQ and adaptation are pretty much
comparable
• Among populations with
FASDs, adaptation is much lower than
would be predicted by IQ
• Can vary within itself as well.
21. Executive Function
• The ability to organise one’s skills.
Planning, working
memory, organisation, inhibition, initiati
on…
• The ability to evaluate one’s own
behaviour and change in response to
that evaluation. (self-regulation)
22. Executive functions
• Sequencing and planning—how to initiate a
task, what steps are involved in completion,
when to quit
• Flexibility-how to shift tasks smoothly,
accept change, deal with transitions
• Impulse control—
• The ability to keep one’s self and materials
organized, in order, predictable, etc.
23. Also related to EF
• Working memory. Holding information in mind
while performing action on it.
• Attention: Maintaining and switching
attention, distractibility.
• Motor control and sensorimotor processing
• Overly concrete language.
24. Memory
• Not a single factor
• Short-term/long-term/working memory
• Storage/retrieval
• Verbal/nonverbal
• Abstract/concrete
• Procedural memory
• “Norbert’s memory is just fine--he always
remembers when we’re going to the movies!”
25. • Memory can be intermittent—here
today, gone tomorrow
– Reteach, keep calm
– Look for multi-tasking—is the situation the
same as it was yesterday? In what
respects?
– Implications regarding generalisation
– Implications regarding use of consequences
to change behaviour
26. Communication
• Language impairments are very common
among alcohol-affected children and
adults.
• They are often very talkative.
• Expressive language is often apparently
more developed than receptive language.
• “Norbert is so controlling! Everything has
to be his way..conversation
topics, play, routine…”
27. Why is Norbert so controlling?
• What happens if you lack receptive
language?
28. Communication is a Biggie--
More
• Psychological testing may not be sensitive
enough to identify language problems
• SLP can identify subtle but treacherous
areas of weakness
• 110 km highway with huge potholes here
and there
• Understanding language important to
understand behaviour and learning in
addition to possibly indicating Speech-
language therapy.
29. Communication is More Than
Language
• Pragmatics--how language is used
• Nonverbal cues
• Language as social interaction--initiating
contact, ending contact, turn-taking.
• Problem solving--inference, “why”
questions, prediction
30. Attention/Activity Level
• Often a problem
• FASD and ADHD can coexist
• Or attentional difficulties can be a
part of the brain damage of FASD
• Sometimes but not always responsive
(but not entirely) to medication.
31. Achievement
• Academic achievement can be misleading
• Students can have limited ability to
generalise
• Not necessarily a predictor of skills
beyond the classroom
• Lots of challenges to achievement posed by
the issues we’ve covered
• Investment of time and energy to meeting
curriculum requirements may be
controversial.
32. Some Effects of Brain and
Central Nervous System
Damage
(mostly)
…and some hints about what to
do about them
36. What to do? Try:
• Provide a visually quiet space for
learning.
• Look from student’s eye level for
distractors
• Keep one thing on desk at a time
• Look for students’ own strategies
(hoodies, baseball hats)
37. Lighting
• Florescent lights can be a problem both
visually and auditorially.
• Try for natural light (good luck in
Vancouver!)
• Incandescent lighting tends to be
better.
38. Hearing impairments
• Can be either problems of acuity or
perception.
• Hypersensitive hearing (hyperacousis)
is common.
• Otitis media (glue ear).
39. Hearing impairments
• Can be either problems of acuity or
perception.
• Hypersensitive hearing (hyperacousis)
is common.
• Otitis media (glue ear).
40. Try:
• Listen for distracting noises-
– Gurgling fish tank
– Hallway noise
– Lights or screens buzzing
– Plumbing
• Warn before fire drills
• Find other way of getting class attention than:
“clap, clap, clap clap clap.”
• Watch for signs of auditory distress, in
gym, music, etc.
• Consider use of headphones or earbuds.
41. Hypersensitivity
(over-sensitivity)
• Children may be very uncomfortable with
being touched or held
• Toothbrushing can be a real battle
• Certain foods (temperature or texture) can
be very distressing
• Textures of fabric in clothing can be
distressing.
• Children can’t explain what’s troubling them.
42. Cautions:
• Don’t touch child without his/her knowing
you’re about to.
• Be aware of smells, including “coffee
breath,” perfume, scented felt tips, etc.
– ICK! You don’t smoke, do you?
• Exercise tolerance re: refusal to wear
socks, etc.
• Note that this can result in over-reactions
to slight touch in hallway—organise time
accordingly
43. Hyposensitivity
(Under-sensitivity)
• Dangerously high pain threshold
• Insensitivity to extremes of hot and cold
• May seek physical stimulation and feedback
by touching or banging on things
• May sniff things, people
• Find socially acceptable ways for student to
meet sensory needs
44. Cautions
• Hyper- and hypo- can coincide
• Interpret sensory seeking behaviour as
such rather than aggression or sexual
acting out
45. Students may mature at uneven
rates:
• Chronological age: 15
• Expressive language of a 17-year old
• Receptive language of a 7-year-old
• Social judgement of a 6-year old
• Gross motor abilities of a 15-year old
• Reading (decoding) of a 12-year old
• Reading comprehension matching
receptive language
46. Reading
• Essential skill
• Most kids with FASD can learn to read
• Comprehension can be an issue
• Reading as a support for memory
– Lists
– Labels
– ??
47. Math
• Best approached as applied skill
• Cooking
• Use of supermarket flyers for shopping
• Teach time very directly
52. Social Safety
• Minimal or no stranger awareness
• Optimally, keep student occupied and
observed
• Try social safety circles, but don’t rely
on them exclusively
• Uneven maturation can be a big issue
53.
54. It’s not easy…
• It’s less difficult than attempts at
reactive behavioural change.
• It’s more productive and cost-efficient in
the long run.
• It’s ethically the right thing to do.
• It’s worth it--students with FASD can
grow into contributing members of society.
• Education is all about hope.
Note that other areas of growth can be affected;CardiacGenitourinaryBone structureDentitionAnd recently, immune system
This is “full fas” It only represents about 10% of the affected population. Facial markers usually fade with age and are uncommon among adults. Not as easy to recognise as it would seem: Story re guy who was stealing airplanes last October…
Note that although response to stimulus may seem out of proportion, the distress is real.
2:12 on video Social implications
Caution re “whole language” –inferring meaning can be a problem, generally teaching decoding seems to work better
