5
Disorder Symptoms or Behaviors About the Disorder Educational Implications Instructional Strategies and Classroom
Accommodations
Fetal Alcohol Spectrum
Syndrome
(FASD)
Resources:
FAS Community Resource
Center
www.come-over.to/FASCRC
Fetal Alcohol Syndrome
Family Resource Institute
www.fetalalcoholsyndrome.org
National Organization on Fetal
Alcohol Syndrome (NOFAS)
www.nofas.org
Early Childhood (1-5 yrs.)
Speech or gross motor delays
Extreme tactile sensitivity or insensitivity
Erratic sleep and/or eating habits
Poor habituation
Lack of stranger anxiety
Rage
Poor or limited abstracting ability (action/
consequence connection, judgment and reasoning
skills, sequential learning)
Elementary Year
Normal, borderline, or high IQ, but immature
Blames others for problems
Volatile and impulsive, impaired reasoning
School becomes increasingly difficult
Socially isolated and emotionally disconnected
High need for stimulation
Vivid fantasies and perseveration problems
Possible fascination with knives and/or fire
Adolescent Years (13-18 yrs)
No personal or property boundaries
Naïve, suggestible, a follower, a victim, vulnerable
to peers
Poor judgment, reasoning, and memory
Isolated, sometimes depressed and/or suicidal
Poor social skills
Doesn’t learn from mistakes
Fetal Alcohol Spectrum Disorder refers to the brain damage and
physical birth defects caused by women drinking alcohol during
pregnancy. Fetal Alcohol Syndrome (FAS), can include growth
deficiencies, central nervous system dysfunction that may include low
IQ or mental retardation, and abnormal facial features (e.g. small eye
openings, small upturned nose, thin upper lip, small lower jaw, low set
of ears, and an overall small head circumference).
Children lacking the distinguishing facial features may be diagnosed
with Fetal Alcohol Effects (FAE). A diagnosis of FAE may make it
more difficult to meet the criteria for many services or accommodations.
The Institute of Medicine has recently coined a new term to describe the
condition in which only the central nervous system abnormalities are
present from prenatal alcohol exposure: Alcohol Related Neuro-
developmental Disabilities (ARND).
Because FAS/FAE are irreversible, lifelong conditions, children with
FASD have severe challenges that may include developmental
disabilities (e.g. speech and language delays) and learning disabilities.
They are often hyperactive, poorly coordinated, and impulsive. They
will most likely have difficulty with daily living skills, including eating
(as a result of missing tooth enamel, heightened oral sensitivity, or an
abnormal gag reflex).
Learning is not automatic for them. Due to organic brain damage,
memory retrieval is impaired, making learning difficult. Many of these
children have problems with communication, especially social
communication, even though they may have strong verbal skills. They
often have trouble interpreting actions and behaviors of others or
reading social cues. Abstract concepts are especially troublesome. They
often appear irresponsible, undisciplined, and immature as they lack
critical thinking skills such as judgment, reasoning, problem solving,
predicting, and generalizing. In general, any learning is from a concrete
perspective, but even then only through ongoing repetition.
Because FAS/FAE children don’t internalize morals, ethics, or values
(these are abstract concepts), they don’t understand how to do or say the
appropriate thing. They also do not learn from past experience;
punishment doesn’t seem to faze them, they often repeat the same
mistakes. Immediate wants or needs take precedence, and they don’t
understand the concept of cause and effect or that there are
consequences to their actions. These factors may result in serious
behavior problems, unless their environment is closely monitored,
structured, and consistent.
This fact sheet must not be used for the purpose of making a diagnosis.
It is to be used only as a reference for your own understanding and to
provide information about different kinds of behaviors and mental
health issues you may encounter in the classroom.
Children with FASD need more intense
supervision and structure than other
children. They often lack a sense of
boundaries for people and objects. For
instance, they don’t “steal” things, they
“find” the; an object “belongs” to a
person only if it is in that person’s hand.
They are impulsive, uninhibited, and
over-reactive. Social skills such as
sharing, taking turns, and cooperating in
general are usually not understood, and
these children tend to play alongside
others but not with them. In addition,
sensory integration problems are
common, and may lead to the tendency
to be high strung, sound-sensitive, and
easily over-stimulated.
Although they can focus their attention
on the task at hand, they have multiple
obstacles to learning. Since they don’t
understand ideas, concepts, or abstract
thought, they may have verbal ability
without actual understanding. Even
simple tasks require intense mental effort
because of their cognitive impairment.
This can result in mental exhaustion,
which adds to behavior problems. In
addition, since their threshold for
frustration is low, they may fly into rage
and tantrums.
A common impairment is with short-
term memory, and in an effort to please,
students often will make-up an answer
when they don’t remember one. This
practice can apply to anything, including
schoolwork or behaviors. These are not
intentional “lies,” they honestly don’t
remember the truth and want to have an
answer. Since they live in the moment
and don’t connect their actions with
consequences, they don’t learn from
experience that making up answers isn’t
appropriate.
Be consistent as possible. The way something in learned
from the first time will have the most lasting effect. Re-
learning is very difficult, therefore change is difficult.
Use a lot repetition. They need more time and more reps
than average to learn and retain information. Try using
mnemonics like silly rhymes and songs. Have them
repeatedly practice basic actions and social skills like
walking quietly down the hall or saying “thank you.” Be
positive, supportive, and sympathetic during crisis; these
are children who “can’t” rather than “won’t.”
Use multi-sensory instruction (visual, olfactory, kinesthetic,
tactile, and auditory). More senses used in learning means
more possible neurological connections to aid in memory
retrieval.
Be specific, yet brief. They have difficulty “filling in the
blanks.” Tell them step-by-step, but not all at once. Use
short sentences, simple words, and be concrete. Avoid
asking “why” questions. Instead, ask concrete who, what,
where, and when questions.
Increase supervision- it should be as constant as possible,
with an emphasis on positive reinforcement of appropriate
behavior so it becomes habit. Do not rely on the student’s
ability to ‘recite” the rules or steps.
Model appropriate behavior. Students with FASD often
copycat behavior, so always try to be respectful, patient,
and kind.
Avoid long periods of deskwork (these children must
move). To avoid the problem of a student becoming
overloaded from mental exhaustion and/or trying to sit still,
create a self-calming and respite plan.
Post all rules and schedules. Use pictures, drawings,
symbols, charts, or whatever seems to be effective at
conveying the message. Repeatedly go over the rules and
their meanings aloud at least once a day. Rules should be
the same for all students, but you may need to alter the
consequences for a child with FASD.
Use immediate discipline. They won’t understand why it’s
happening if it is delayed. Even if the student is told
immediately that a consequence will happen the next day,
he/she will not make the connection the next day. Never
take away recess as a consequence- children with FASD
need that break to move around. Denying them that will
only compound the problem.
Ensure the student’s attention. When talking directly to the
student, be sure to say his/her name and make eye contact.
Have them paraphrase directions to check for
understanding.
Encourage the use of self-talk. Recognize partially correct
responses and offer positive incentives for finishing work.
Try to set them up for success, and recognize successes
every day (or even every hour)!