What Is Fetal Alcohol Disorder (FASD)?
Fetal Alcohol Spectrum Disorder (FASD) is the term used to describe the range of effects caused
by drinking alcohol during pregnancy. These effects may include physical, mental, behavioral
and/or learning disabilities with possible lifelong implications. Health Canada estimates that
approximately 9 in every 1,000 infants are born with FASD.
Some children with FASD have physical disabilities, but many of the effects are not visible and
may include problems with learning, memory, attention, problem solving, behavior, vision and
hearing. They may not understand social situations and their behavior is often interpreted as
problematic, rather than a symptom of an underlying condition.
Children with FASD do best when their individual strengths are recognized and built upon in a
supportive environment adapted to meet their needs.
Where to get help after diagnosis…
Key Workers:
Key workers assist families in understanding FASD by providing education and information
specific to the needs of the child and family. They are familiar with community resources, assist
families in accessing support, health and education services and are involved in the development
of local support services. They also provide emotional and practical support to families.
Key workers recognize that each family is unique and understand their role as one that builds on
a family’s strengths.
Children with FASD do best when their individual strengths are recognized and built upon in a
supportive environment adapted to meet their needs. A key worker works with parents, family
members, adoptive parents, caregivers and service providers in identifying ways to adapt the
child’s environment in response to the child’s needs. The key worker also strives to empower the
family to become their own best advocates for their child.
Parent Support:
Parent support includes local parent and grandparent FASD training, parent mentoring and
parent support groups. Key workers can provide parents with more information on supports that
may be available in or near their community.
Key Workers Key Workers assist families in understanding FASD by providing education and information specific to the needs of the child and family. They are familiar with community resources, assist families in accessing support, health, and education services and are involved in the development of local support services. They also provide emotional and practical support to families. Key Workers recognize that each family is unique and understand their roles as one that build on a family’s strength. Accessing a Key Worker A Key Worker can be accessed directly by families and guardians. Call the Key Worker in you region. Nanaimo/Ladysmith Key Workers: 201‐190 Wallace St. Nanaimo BC V9R 5B1 Ph: 250‐741‐5734, Toll Free: 1‐866‐722‐2235 Duncan Key Worker: Hiiye’yu Lelum‐ House of Friendship Society 205‐5462 TransCan Hwy Duncan, BC V9L 3Y2 Ph: 250‐748‐2242 Parksville / Qualicum Key Worker Family Resource Association 181 Sunningdale Road West Qualicum Beach, BC V9K 1K7 Ph: 250‐752‐6766 Port Alberni Coordinator and Key Worker Circles of Cedar Resource Centre 4260 B 10th Ave Port Alberni, BC V9Y 4X3 Ph: 250‐724‐FASD (3273) Courtenay Key Worker Wachiay Friendship Centre 1625B McPhee Ave. Courtenay BC V9N 5N4 Ph: 250‐338‐7793 Campbell River Key Worker Campbell River and District Association for Community Living 1153 Greenwood St. Campbell River, BC v9W 3C5 Ph: 250‐203‐0488 Port Hardy Key Worker North Island Crisis and Counselling Centre 7095 Thunderbird Rd. Port Hardy, BC V0N 2P0 Ph: 250‐949‐8333 Child and Youth Mental Health - (CYMH)
Nanaimo
202-488 Albert St. Nanaimo BC V9R 2V7
250-741-5444
Aboriginal CYMH (all FASD)
201-190 Wallace St. Nanaimo, BC V9R-5B1
250-741-5734
Duncan
161 4th Street Duncan, BC V9L-5J8
250-715-2725
Aboriginal CYMH
15 Craig St. Duncan, BC V9L 1V6
250-715-2737
Parksville
494 Bay Ave Parksville, BC V9P-2G6
250-954-4737
Port Alberni/Tofino/Ucluelet
4088 8th Ave Port Alberni, BC V9Y-4S4
250-720-2650
Courtenay/Comox
2455 Mansfield Drive Courtenay, BC V9N 2M2
250-334-5820
Campbell River
215-1180 Ironwood Rd. Campbell River, BC V9W 5P7
250-830-6500
Port Hardy
8755 Gray St. Port Hardy BC V0N 2P0
250-949-8011
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Tips for
Parents
¾There is no best time or way to tell children about FASD. As parents, you know your children best.
Some parents choose to tell their children early, even before the age of five. Children that young may
have limited understanding of what FASD means, but telling children early can make it easier to talk
about it as they grow older because the topic and words have been introduced.
¾School-aged children may understand simple explanations of the condition and want to know what is
different about their bodies. Children may be concerned about what caused their difficulties, and if
other children have FASD or if they are the only ones. They may find it helpful to know that others
have felt the way they do.
¾Emphasize the positive. Point out strengths, special talents and gifts your children bring to their
families and friends.
¾Explain that each person learns at his or her own speed, in his or her own way—some children learn
best by listening to material, and others by reading or looking at things. Emphasize that you will help
learn what works best.
¾Help children understand their experiences by comparing them to something familiar. For example:
“Your brain is like a radio with too much noise. We have to tune in the way you learn, just like we
tune in the music clearly.”
¾Be cautious using medical pictures of the brain meant for adults. They can be overwhelming and
confusing to children.
¾Many children and teenagers with FASD are relieved to find out the cause of their problems, but may
also be sad or angry. Help them talk about and deal with whatever feelings they are having.
¾If you have FASD yourself, talk about this as an example of how challenges can be overcome.
¾Explain that your children are not alone. Grandparents, siblings, teachers and parents are all there to
listen and help with problems.
¾Talk about the help your children will have—resource teachers, homework program, after-school
program. Be realistic, positive and specific.
¾Ask teachers for tips for coping, organization and time-management skills, such as homework books,
cue cards and study notes. Use the same strategies used in the classroom. Success will increase
children’s confidence in their own abilities.
93. Adapted with permission from Diane Knight, “Families of Students with Learning Disabilities,” in William N. Bender (ed.),
Professional Issues in Learning Disabilities: Practical Strategies and Relevant Research Findings (Austin, TX: Pro-Ed,
1999), p. 277; from Robin A. LaDue, A Practical Native American Guide for Caregivers of Children, Adolescents, and
Adults with Fetal Alcohol Syndrome and Alcohol-related Conditions (Juneau, AK: Office of FAS, Department of Health
and Social Services, State of Alaska, 1999), p. 85 (this document is in the public domain) AND from Antonia Rathbun,
“Talking About FAS/FAE With Children,” About FAS/E: A Publication of the FAS/E Support Network of B.C., February
2001, pp. 10, 15, 16.
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¾Be prepared to answer the question “Will it go away?” Be honest and encouraging. For example,
“Some things might change and some won’t. Your ears might always hear noises louder than mine.
You might always like reading better than math. But there are lots of things we can do to make
learning math easier.”
¾Repeated questions about why their birth mothers drank during pregnancy may indicate children are
struggling to accept that they were hurt by someone they depended on. It is less about why, and more
about how sad and frustrated they feel when things are hard for them. They need honest
encouragement and reassurance more than technical explanations. Answer simply, then ask what it’s
like for them. Also explain that no mother intentionally tries to hurt her baby. She may have been
unaware of the consequences of drinking alcohol to her unborn baby, or may have had an illness or
disability herself and could not control her drinking.
¾Talk about ways to handle teasing from peers. Practise responses through role-play.
¾Older children may want to know what to tell friends if they ask about FASD. Children will vary in
their choices about what they want others to know. Some children may want only certain people to
know. As one young man with FASD said, “I want helpers to know but I don’t want kids to, because
they would tease me.” Respect these choices.
¾Teenagers may benefit from talking with other teens and adults who are successfully dealing with the
same condition. They may feel less alone and can learn from role models. Peer support groups can
provide ongoing encouragement and a chance to learn about individual differences.
¾At all ages, children feel more powerful when they help create solutions for dealing with their
challenges. For example, children could turn the radio on between stations to create white noise for
sleeping or design posters with pictures of the items they need to pack in their backpacks each
morning before leaving for school.
¾Look for resources—organizations, books and videos that provide support and information. Help
children use these resources and become personal advocates for their education.
¾Encourage children to help plan their education programs by participating in IPP conferences and
setting realistic long-term goals as they progress in school. Remind children of all the options they
have for the futurehigh school diploma, post-secondary training, employment.
¾Be willing and able, time and again, to discuss the issue.
¾Give children the message that you care about them and love them as they are.
¾Children and teenagers can be sensitive about their physical appearance. As part of the assessment
process, they might have their eyes measured and other facial features evaluated. This may leave
them feeling uncomfortable and self-conscious. They may worry that others know they have FASD
just by looking at them. Emphasize they are attractive, and their friends and family members
typically will not know they have FASD just by looking at them.
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FASD TIP SHEET FOR PARENTS AND CAREGIVERS
EXPLAINING FASD TO
YOUR CHILD
WHAT YOUR CHILD SHOULD KNOW…



Cause of FASD: The brain damage
and resulting difficulties of FASD are
caused by a mother drinking alcohol
while pregnant. Often this happens
before a mother knows she is
pregnant, not because she wants to
hurt her baby.
FASD is a spectrum: Each child with
FASD is affected differently. Some
have more difficulties and
challenges, and some have less.
What helps: Using an external brain,
having others help them think
through decisions, remembering their
challenges are because of an organic
brain injury, it is not their fault!
STRATEGIES




When should you tell your child?
There is no ‘right age’ to tell a child
they have FASD, so take cues from
her – a good time to talk is when she
starts asking questions about why
things for her are different.
Have the conversation in an
understandable way: Use story
books, pictures, and other visuals to
help you explain what FASD is.
Use simple terms to explain the
facts: Remember your child’s
chronological and developmental
age. You may need to repeat several
times, and provide more information
as your child gets older.
Explain FASD to your child’s friends
and siblings: Explaining FASD to
other children can help them to
accept your child and understand
why he is sometimes treated
differently at home and school.
Lutherwood
1770 King St. East,
Kitchener ON, N2G 2P1
Phone – 519-749-8740
Fax – 519-749-2920
www.lutherwood.ca
Reinforce for your child that he
is unique. Remind him that
everyone is different, and
everyone learns differently.
Tell your child that even
though he has a disability
called FASD, he also has lots of
abilities, strengths, and skills.
FASD is just a part of who he
is, but it doesn’t define who he
is.
Make a list with your child of
all the qualities and skills he
has that other people admire
about him and all the things
that he likes about himself.
QUICK TIPS

HELPFUL BOOKS THAT CAN HELP
YOU TO EXPLAIN FASD:
o “Sam’s Bear” by Merryl
Hammond & Rob Collins
o “But Michael Makes Me Laugh”
by Lori Stetina
o “My Sibling has a Fetal Alcohol
Spectrum Disorder: Can I Catch
It?” By Substance Abuse and
Mental Health Services
Administration.
Parent Support Circles
What are Parent Support Circles?
Parent Support Circles are free, confidential, anonymous, weekly meetings of parents who wish to
learn new ways to nurture and protect their children.
Currently Parent Support Services operates about 40 Parent Support Circles in communities
throughout BC.
What will happen when I call about a Parent Support Circle?
When you call, you will speak with an employee of Parent Support Services, the group that
administers Parent Support Circles all over British Columbia or, if you call the local number provided
on this website, you may speak with a community-services or crisis agency.
Whomever you talk to will ask for your first name, how many children you have, their ages, your
home phone number, and a convenient time for a group facilitator to call back.
A Circle facilitator will call and tell you more about the program and ask more about you. The two of
you may arrange to meet and talk further before the next meeting, or you may simply be invited to
the next meeting.
But the most important thing you need to know is that the person on the other end of the phone will
appreciate the courage it has taken for you to pick up the phone and say, "I think I need help."
What will happen when I attend a Parent Support Circle?
All Parent Support Circles follow a similar plan but the details for each meeting vary from one Circle
to another.
Many Circles open with each parent saying how they are and how their week with their children has
been. Participants discuss parenting concerns in the supportive setting provided.
One of the most important things about Parent Support Circles is that they respond to the needs
expressed by the parents who attend them.
What else do I need to know about Parent Support Circles?
In some communities circles operate in Spanish, English Cantonese, Mandarin and Filipino. There
are also support groups for Grandparents Raising Grandchildren. Parent Support Services Society
of BC ensures that anyone parenting children and teens will be comfortable joining a Parent Support
Circle.
Parent Support Services is able to provide a small subsidy to pay for chid care and transportation, if
needed. Our objective is to remove the financial obstacles that might prevent a parent from attending
a Support Circle.
Central Island:
P.O. Box 86
Nanoose Bay, BC V9P 9J9
Toll-free1.877.345.9PSS (9777) Phone: 250.468.9658
Fax: 250.468.9668
Email: [email protected]
Program Manager: Sandi Halvorson
F
F
What to Expect From
amily physicians can play an important role
in getting help needed when a child is
exhibiting behaviours that are unusual and
may be symptoms of a mental health problem.
Your Family Physician
in Children’s Mental Health
The family physician is usually:
The medical professional that families are most
familiar with.
The starting point when families suspect there
may be a problem with their child.
The professional who can refer you to other
specialized services such as a paediatrician
or psychiatrist.
Able to provide you, the parent, with resources
and support.
A professional who has the knowledge and
resources to help rule out other medical
conditions that sometimes can cause certain
behaviours or symptoms.
One person of many who will probably be
needed to fully assist and support your child
and your family.
Your family physician will probably ask you about:
Changes you have observed in your child
(i.e., What are the changes or behaviours that
concern you? When do these behaviors occur,
how long do they last? What are the conditions
in which the behaviors most often occur?).
Settings or activities that are most challenging
for your child.
What you have done to try and help resolve
the problem.
Family physical and mental health history.
Whether there have been any recent changes
in your family situation (e.g., death in the
family, divorce).
Whether your child is having any problems
at school.
Whether your child has sexual
knowledge or body-talk that is
unusual for a child his or her age.
When To See Your Family Physician
A parent will often see their family doctor when they suspect
something doesn’t seem right like:
The child is exhibiting behaviours that are unusual,
disruptive, or that prevent them from participating in
situations that are typical for their age.
The child no longer seems to enjoy or participate in
things they once did.
The child’s school has noticed
increased difficulties that they
can’t explain.
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to expect
What to Expect From
Your Family Physician
in Children’s Mental Health
Your family physician may:
Want to perform a physical examination and
order some diagnostic tests (e.g., blood tests).
He or she may invite you to stay with the child
for physical exam, if your child would be
more comfortable.
Ask you to keep a log of the behaviours
and schedule another visit if they feel there
isn’t enough time in one visit to diagnose
the problem.
Feel that additional evaluation is necessary to
accurately diagnose and make appropriate
recommendations for treatment.
Refer you to Child and Youth Mental Health
Services, who may be able to offer additional
help for your child.
Continue to act as a resource for you and
your child.
Also work with other professionals who are
involved in your child’s care and, in some
cases, prescribe and monitor the ongoing use
of medication.
Recommend that you get immediate help
(i.e., take your child to emergency), or through
the urgent assessment clinic at BC Children’s
Hospital, if he or she believes your child is a
danger to himself/herself or others.
It may assist your family physician if you can provide:
Some samples of your child’s school report cards.
Information on possible sources of help that you
have already researched.
Permission to speak with your child’s teacher,
school counsellor or other
agencies and supports that
are involved in your child’s
How You Can Help Prepare Your Child
life (NOTE: You can ask to
You can meet the needs of your child by encouraging them to participate
be present when informaand provide input at the appointment with your family physician. Let
tion is shared and to limit
your child know:
what can be shared with
other professionals).
You will be discussing your concerns with the doctor.
Results from any assessments
That he/she can correct you if you are saying something that
or psychological testing
doesn’t match how they feel.
your child has received.
They can add their own impressions of how they are feeling.
The doctor may want to speak to them alone, just to ask a few
other questions, and that it’s safe and okay to tell the doctor about
absolutely anything.
It may also be necessary for the parent to speak to the doctor alone.
The F.O.R.C.E.
Families Organized for Recognition and Care Equality
Society for Kids’ Mental Health
Developed by the FORCE Society for Kids’ Mental Health. For more information please visit our website at www.forcesociety.com.
Funding for this resource was made possible by the Ministry of Children and Family Development and BC Mental Health and Addiction Services, an agency of the Provincial Health Services Authority.
M
m
ental health conditions can interfere with
a child’s learning. The role of the school
is to ensure that all students, including children
with mental health issues have equitable access
to learning opportunities, and to help them succeed educationally to the best of their abilities.
Parents can play a vital role in the education of
their children by working in partnership with the
professionals to develop a plan that maximizes
their child’s abilities to succeed at school.
What to Expect From
Your Child’s School
in Children’s Mental Health
What Parents Can Do
Try to establish regular ongoing contact and
not just when a crisis arises. Expect you will
have regular contact. Be proactive and let the
school know your preferences for how you will
communicate with them.
When you meet with the school to review
your child’s progress, begin the meeting with
things that are going well, as well as the concerns. It is important to look at what has been
working. Put together some notes (positive
feedback first, then concerns) and bring to the
meeting. This will relieve some anxiety and
help you be prepared going into the meeting.
If you have noticed something in your child’s
behaviour that is troubling, it is a good idea
to contact the school to find out whether their
school work or social interaction with the
other children is also being affected.
Be aware of everything that is in your child’s
file. If there is anything you do not have a copy
of and which you would like, do ask the school
if they could please provide one. Offer to pick
up the copy at a later date, so it can be copied
during a quiet part of the day. This is especially
important if you would like copies of more than
one report or if the reports are long.
Get to know and understand your rights and all
the terms and conditions that apply to the services
your child and family use. Read everything carefully. Be sure you understand and fully agree to
everything before you commit to, or sign anything.
Once a child has involvement with a service provider outside of the school, an integrated case
management (ICM) meeting is often required and
parents, as well as schools, can request an ICM
meeting. These meetings bring together everyone
involved in assisting your child.
It is best if you can start by contacting your
child’s teacher as they are the one who knows
It is advisable to bring a third party with you to
your child the best. The school counsellor is
the meeting, to be an extra set of ears for you,
also a good contact and parents can request to
and to take notes. It is recommended that you
meet with them. The school principal is a good
inform the school ahead of time that you will be
resource and may be able to pull together
bringing an additional person.
appropriate staff members
to talk with you about your
child, but is usually not the
What Parents Need From Schools
person who knows your
child the best.
To be treated with courtesy, consideration and respect for the
job they are attempting to do. Appreciation for the expertise
that parents have gained from bringing up their child and living
with them.
To be fully involved in the assessment and planning; the goal
being to develop a plan for the day-to-day management of the
child and to prevent situations from
reaching a crisis point.
Information that is explained in plain
language that doesn’t cause parents more
stress by needing to ask what things mean.
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What to Expect From
Your Child’s School
in Children’s Mental Health
What Schools Can Do
Because of different stressors and expectations at
school, the child will often behave differently at
school. The school may contact the parents because
they are seeing a problem that may not be evident
at home. This is an opportunity for both school and
parents to work together on the child’s behalf.
A recommendation for psycho-educational testing
may be made to help identify any learning problems.
It could be a learning disability that’s making it
very difficult for them to understand expectations
or read the social cues and that can create a lot of
anxiety, a lot of stress on the child.
When teachers first notice a problem, they will often
consult with the parents and attempt strategies to
manage the behaviour or support the student in the
classroom. If these prove unsuccessful, the teacher
may seek assistance from other school-based services.
If your child is given a special education designation,
the school will work with you to develop an individualized education plan (IEP) that will provide
accommodations and interventions designed specifically around your child’s needs. All schools have
access to a Support Services (or Special Education)
teacher who can help with the case management
for the IEP.
If a classroom teacher finds effective ways to help a
student, it may not be necessary to investigate further.
However, if your child continues to experience
significant academic, social, or emotional difficulties
that interfere with learning, it is usually a good idea
for the family and school to meet to discuss next steps.
A behavioural assessment may be administered
which will provide a better understanding of the
function and the patterns of your child’s behaviour.
You may be asked to contribute information about
your child’s behaviour at home. This provides
important information needed for developing
an appropriate plan of support.
If there is a meeting required with the school, it may
include the teacher, principal, school counsellor, and
possibly other school personnel such as the special
education assistant, etc. to discuss the difficulties
they are experiencing with the child. These meetings sometimes result in recommendations being
made for the child to be referred to a specialist and/
or the local Child and Youth Mental Health (CYMH)
Center for assessment. It may also be appropriate at
this stage to have families involve their physician or
pediatrician to rule out any other health problems.
The teachers at your child’s school can provide you
with valuable information about how your child
behaves at school and about his or her academic performance. With this information, families are able to
develop a more complete understanding of their child.
What Schools Need From Parents
To be treated with courtesy, consideration, and
respect for the job they are attempting to do.
A description of the child’s personality, strengths,
likes, dislikes, struggles etc. Information on what
the child is saying about school, their friends,
things they are struggling with, things they
are happy with and enjoying. Strategies used
at home for setting limits, for encouraging the
child, for giving the child safe time. A common
message and approach at home and school are
very important for the child.
To ensure privacy when talking about a child’s
difficulties, teachers can be more helpful if parents
make an appointment or give the teacher a note.
This helps to prevent other children or parents
from overhearing any conversations you need to
have with the teacher.
A team effort where everyone is respectful and
mindful of the need to agree on a plan of action
and agree to adjust the plan if necessary.
Access to other reports, assessments, information
that parents have that may help the school in
understanding and managing the child.
The F.O.R.C.E.
Families Organized for Recognition and Care Equality
Society for Kids’ Mental Health
Developed by the FORCE Society for Kids’ Mental Health. For more information please visit our website at www.forcesociety.com.
Funding for this resource was made possible by the Ministry of Children and Family Development and BC Mental Health and Addiction Services, an agency of the Provincial Health Services Authority.
Queen Alexandra Centre for Children’s Health
Autism Early Intervention Program
®
SCHOOL & HOME STRATEGIES FOR CHILDREN WITH FASD The key to working successfully with children with Fetal Alcohol Spectrum Disorder is to apply Structure/Routines, Consistency, Repetition, and be Brief/Specific. ENVIRONMENTAL Limit number of objects or displays out at one time. May need a carrel or divider to limit distractions. Organize their world. May need well‐defined areas such as a mat or cushion during floor time at the library etc. Use visual schedules or picture cards as often as possible. TRANSITIONAL PERIODS Ritualize transition times. Use a warning system. Use Visual timers to prepare student that the activity is soon over. Change classroom decorations gradually. INCREASING ATTENTION Dress in the morning in the bathroom. No TV on during meals. Vary the loudness and inflection of your voice. Direct their attention to your face. Touch them when you call their name. Connect new learning to old learning. Novelty is an excellent attention getter. Ask child to paraphrase directions back at you. ENHANCE LEARNING Use kinesthetic learning. Show child and then have them show you. Focus on landmarks in the environment. Repeat and restructure. Maximize sensory stimulation and respect sensory defensiveness. Queen Alexandra Centre for Children’s Health
2400 Arbutus Road, Victoria. BC V8N 1V7, Telephone: (250) 477-1826 Facsimile: (250) 721-6837
SAFETY Chair safety‐rules about rocking and climbing. De‐tox the environment. Have arrival and leaving rituals. Safeguard doors with locks/bells to alert if child slips out. Detail the difference between strangers and familiar people. (Circles program for 5 years and above.) Remember that children with FASD bring naiveté to daily life situations. LANGUAGE You swear, they swear. Be brief, concrete and clear. Be Specific – avoid using idioms, words with double meaning or abstractions. Speak expressively, they hear with their eyes. Use visuals as much as possible and repeat verbal information. DISCIPLINE Set limits and consistently follow them. Limit time child expected to sit quietly. Talk about cause and effect relationships. Be brief, firm, but supportive. Change rewards often to keep interest high. Tell Children exactly what you want them to do and expect of them before new situations. Review and repeat consequences of behavior. Avoid statements that place a value on behavior. AVOID THE SAME TIRED PHRASES ( TRY THESE: ) Now you have it! Outstanding That’s just Super Sensational Marvelous Work Exceptional Impressive Dynamite work Stupendous That’s the best ever Your personal best You’ve mastered it GENERAL STRATEGIES Know strengths as well as weaknesses. Everyone needs to be good at something for self ‐
esteem development. Be as master salesperson. Get them into yes mode. References: FAS Alaska: 8 Magic Keys by Deb Evensen and Jan Lutke. www.fasalaska.com/8keys.html Ed. Methods‐FAS/FAE Child by Patricia Tanner Halverson, Ph.D. ‘Avoiding the same tired phrases and reinforcements.’ From Bob Algozzine. Last updated January 26, 2007 Adelle Rama- OT
FAS
Parenting Children Affected
by Fetal Alcohol Syndrome
A Guide for Daily Living
Ministry for Children
and Families Edition
Ministry for Children and Families
Children
with FAS
Common Manifestations
I wish I could repair myself;
I wish people didn’t throw me on the shelf.
I wish people wouldn’t use me soooo much,
I wish people would take advantage of how precious I am.
And...I wish they wouldn’t use too much touch.
—Nigel, age 16: “This refers to FAS/E people
as well as to electrical appliances.”
No two children with FAS are affected in exactly the same way. However, as a group, children
with FAS display more developmental and behavioural problems than other children. The
child with FAS may exhibit a number of the characteristics described here, but likely not all of
them. The clustering of these characteristics and behaviour patterns coupled with the history
of pre-natal exposure to alcohol are strong cues for identification.
Parents who identify reasons for their children’s problems are best equipped to plan effective
treatment and education strategies. The following is not an exhaustive list of FAS characteristics, but rather a place to start. However, an accurate diagnosis is important. There are
other disorders that have similar characteristics. Parents are advised to consult with a physician, pediatrician, pediatric neurologist, dysmorphologist or geneticist who has experience with
FAS—or a willingness to learn. For more information about diagnosis, please see the section on
Assessment and Referral Information on page 48 of this manual.
This list has been compiled from a number of sources and represents items common to several
reference sources. Please refer to the bibliography and resource list at the back of this manual
for further reading.
Infancy
When dealing with infants, you might also encounter the term, “Neonatal Abstinence Syndrome
(NAS), which refers to infants suffering through drug withdrawal after birth. We recognize that
many women are multiple drug users, and that the mother of a baby with NAS has likely been
using alcohol as well. Affected infants may exhibit a combination of lasting NAS symptoms and
emerging FAS symptoms.
n often tremulous and irritable; may cry a lot
n weak sucking reflex and muscle tone
n highly susceptible to illness
n feeding difficulties: often disinterested in food, feeding can take hours
n erratic sleep patterns; no predictable sleep-awake cycle
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Parenting Children Affected by FAS
n sensitive to sights, sounds, and touch
n failure to thrive
n slow to master developmental milestones (e.g. walking, talking, imitating sounds)
n problems with bonding
Preschool
n disinterest in food and disrupted sleep continue
n poor motor coordination
n flits from one thing to another with “butterfly-like” movements
n more interested in people than objects
n overly friendly, highly social; indiscriminate with relationships
n expressive speech may be delayed; may have less in depth language than peers or may be
excessively talkative and intrusive, giving the superficial appearance that speech is not
impaired
n unable to comprehend danger; does not respond well to verbal warnings
n prone to temper tantrums and non-compliance
n short attention span
n easily distractible or hyperactive
n does not respond well to changes; prefers routines
Early School
n reading and writing skills during the first two years may not be noticeably delayed
n arithmetic may be more of a problem than spelling and reading
n attention deficits and poor impulse control become more apparent as the demands for class-
room attention increase
n inability to transfer learning from one situation to another—to learn from experience—
without more repetition than normal
n requires constant reminder for basic activities at home and school
n “Flow through” phenomena—information is learned, retained for a while and then lost; poor
performance of “learned” tasks may appear deliberate
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A Guide for Daily Living
n gross motor control problems (e.g. clumsy)
n fine motor problems (e.g. trouble with handwriting, buttons, zippers, shoe laces, etc.)
n difficulties with social skills and interpersonal relationships: may be unable to share, to
wait for turn, to follow the rules or to cooperate; may be inappropriately intrusive
n poor peer relations and social isolation may be noted; may prefer to play with younger
children or adults rather than with peer group
n memory deficits
n exists in the “here and now,” seems to lack an internal time clock
n unable to monitor his/her own work or pace him/herself
n sleep disturbances continue
Middle School
n delayed physical and cognitive development
n reading and spelling skills usually reach peak
n increased difficulty maintaining attention, completing assignments and mastering new aca-
demic skills
n usually a very concrete thinker, may have trouble working with ideas—tends to fall farther
behind peers as the world becomes increasingly abstract and concept based
n continuing fine motor problems may make volume work production impossible
n good verbal skills, superficially friendly social manner and good intentions often mask the
seriousness of the problem
n psychological evaluation and remedial placement may be necessary
n a pattern of school suspensions may start
Adolescence
n increased truancy, school refusals and school dropouts
n increased behavioural disruption in school
n reading comprehension is poorer than word recognition
n math tends to be the most difficult task, suggesting poor memory, poor abstract thinking,
and difficulty with basic problem solving
9
Parenting Children Affected by FAS
n may be able to “talk the talk” while unable to “walk the walk”—for example, they may tell
you they understand your instructions, but are unable to carry them out. They may have
learned to act as though they understand, but cannot follow through on their own.
n often misjudged as being lazy, stubborn and unwilling to learn
n faulty logic; lacks basic types of critical thinking and judgement skills
n increased problems with abstract thinking and the ability to link cause and effect
n impulsive, total lack of inhibition and easily influenced, subject to peer manipulation and
exploitation
n difficulty showing remorse or taking responsibility for actions
n frequently behaves in ways that place him/herself or others at risk
n high risk for problems with the law and involvement in the criminal justice system
n problems managing time and money
n difficulty identifying and labelling feelings
n low motivation
n low self-esteem
n clinical depression may become evident
Adulthood (18+)
n perseverates with ideas or activities, may appear compulsive and rigid
n difficulty holding down jobs
n may be unable to live independently or parent children
n problems managing money
n poor social skills
n lack of reciprocal relationships
n unpredictable behaviour
n depression/suicidal ideation
n withdrawal and isolation
n drug or alcohol abuse; susceptible to chemical dependency
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A Guide for Daily Living
Additional Behavioural Characteristics
and Secondary Disabilities
The frequently disabling characteristics of FAS often cause secondary disabilities—problems
that arise after birth as a result of the neurological deficits. These secondary conditions come at
a high cost to the individual, their family, and society, but may be reduced by early diagnosis,
appropriate intervention, better understanding, and a stable, nurturing home environment.
Additional behavioural characteristics and secondary disabilities that may be associated with
FAS include the following:
n behavioural deficits reported in many areas, including interpersonal relationships, commu-
nication, daily living skills, sexuality and adaptive skills
n communication deficits, including the inability to listen to a story for five minutes or longer,
to relate to an experience, to use a table of contents or to address an envelope
n problems with social skills include:
• talking too much and too quickly, but having little to say
• liking to be the centre of attention
• outgoing and friendly manner, often seen as positive in early childhood, often becomes
•
•
•
•
•
•
problematic as the child grows older because they are indiscriminate and/or overly intrusive;
impulsiveness, lack of inhibition, and naiveté regardless of age and gender
difficulty telling time, knowing the value of money, and interpreting social cues
problems sequencing tasks or instructions
low tolerance for frustration
difficulty distinguishing fantasy from real life
tending to gravitate to young children or adults rather than people their own age
n depression
n anger and aggression
n low self-esteem
n other mental health problems
n school problems and/or disrupted school experience
n running away
n substance abuse
n inappropriate sexual behaviour
n trouble with the law
n dependent living
11
Parenting Children Affected by FAS
n problems with employment
n violent or threatening behaviour
Overlapping Diagnoses
Disabling characteristics of FAS may also be compounded by “overlapping diagnoses,” meaning
that the child has been diagnosed with other conditions as well as FAS. Accurate identification
is important for developing an appropriate intervention and treatment plan.
Common overlapping psychiatric diagnoses include:
n Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)
n Attachment Disorder
n Autism
n Oppositional Defiant Disorder
n Conduct Disorder
Positive Characteristics
Characteristic features or behaviours associated with FAS may also serve as strengths. It is
important to recognize and reinforce these strengths so that they don’t wane. Some positives
may include the following:
n creative intelligence (e.g. artistic, musical)
n perseverance (determined, persistent, willing, committed hard workers, involved, energetic)
n highly moral, deep sense of fairness, rigid belief systems
n strong sense of self
n friendly, trusting
n loyal, loving
n affectionate, compassionate, gentle
n tactile, cuddly
n concerned, sensitive
n love children, animals, nurturing—devoted partners and parents
n highly verbal
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A Guide for Daily Living
n exceptionally good long term visual memory
n spontaneous, have lots of energy
n curious and questioning, have sense of wonder
n rich fantasy life (poets, writers, wonderful story tellers)
n great sense of humour
13
Myths
Myths
Common Misconceptions
Our lives would have been
So much less complicated
If all those born with A.R.B.D.
(Alcohol Related Birth Defects,)
Were also born with F.B.H.
(Flourescent Blue Hair.)
—Leon’s Mom
Dr. Ann Streissguth (1997) identifies seven common myths surrounding FAS—based on more
than twenty years of work in the field—which she shares with us here:
There are several widespread misconceptions that can be detrimental to understanding the
complicated life circumstances of individuals with FAS/FAE and responding appropriately to
their needs. Before people can effectively help these individuals, they must understand the
true nature of their disability. The following seven statements that are frequently assumed to
be true are, in fact, common misconceptions:
1. Myth: People with FAS/FAE always have mental retardation.
Although it is true that FAS/FAE is caused by prenatal brain damage and every person
with FAS/FAE has specific, individualized cognitive strengths and weaknesses, not all people with FAS/FAE have mental retardation. For example, as one study (Streissguth, Barr,
Kogan, & Bookstein, 1996) found, only 25% of 178 individuals with the full FAS were classified as having mental retardation by an IQ score below 70. In fact, it is possible for an
individual with FAS/FAE to have an IQ score within the normal range. FAS/FAE diagnostic
centers such as the one at the University of Washington Medical School, see individuals
with broad spectrum of IQ scores. Only the most severely affected children—those with
clear microcephaly and other physical malformations—are easily detected at birth.
2. MYTH: The behavior problems associated with FAS/FAE are the
result of poor parenting or a bad environment.
Because people with FAS/FAE are born with some brain damage, they do not process information in the same way as most people and do not always behave in a manner that others
expect them to. This brain damage, in fact, can permeate even the best environments to
cause behaviour problems and present parenting challenges. Parents and caregivers need
help and support, not criticism. Of course, a loving and understanding environment helps a
child with FAS/FAE. But its absence isn’t the primary cause of the disability.
3. MYTH: Admitting that children with FAS/FAE have brain damage
means that society has given up on them.
Some people believe that acknowledging the brain damage that accompanies FAS/FAE will
depict these individuals as hopeless and devoid of treatment options. Yet, society spends
millions of dollars developing treatment procedures for children born with more obvious
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A Guide for Daily Living
birth defects and for people sustaining brain damage in more noticeable ways (e.g. auto
accidents). As of 1997, the research to understand and ameliorate the specific neuropsychological and cognitive impairments associated with FAS/FAE has not yet been conducted.
These individuals are in no way hopeless, but their needs have been sadly overlooked in the
allocation of societal resources.
4. MYTH: Children eventually outgrow FAS/FAE.
FAS/FAE lasts a lifetime, although its manifestations and associated complications vary
with age. Children with brain damage (including those with FAS/FAE) usually require a
longer period of sheltered living, and many need a stronger than usual support system to
achieve their best level of adaptive living. Understanding this can help families plan effectively for structured transitions between school and work and can help them spare their
children with FAS/FAE the expectation that they should be or must be independent at age
18 or that it is shameful to ask for help.
5. MYTH: Diagnosing children with FAS/FAE will thwart their
development.
Diagnosing is the art or act of recognizing a disease from its symptoms. At a practical level,
it is a method of grouping people with some common characteristics together so others like
them can be identified, the cause can be identified, and treatments can be provided. The
problem is not the diagnosis, but the current lack of scientific knowledge about how to treat
the disease. An accurate diagnosis does not thwart development in any way whatsoever; it
simply alters unrealistic expectations. Most individuals who are diagnosed, and their families, actually feel a sense of relief.
6. MYTH: It is useless to diagnose FAS/FAE because there is no “real”
treatment approach.
This attitude isn’t taken toward any other incurable diseases (e.g., childhood autism). Why
should it be invoked for FAS/FAE? Any family is in a better position to raise a child once
members know the child’s diagnosis. Once an individual is diagnosed with FAS/FAE, family members and social services workers can customize developmental approaches and goals
to ensure that the individual reaches his or her personal potential. A diagnosis helps everyone to understand behaviors that would otherwise be incomprehensible and helps families
explain these behaviors to others and to respond more appropriately themselves. A diagnosis helps families build networks of support with others experienced with FAS/FAE. Parents and the individuals themselves need diagnostic information in order to behave rationally and respond realistically. In addition, when no treatment is known, then the acknowledgment of people with this diagnosis motivates the development of appropriate treatments
and remediations. Diagnosis provides visibility, and visibility prompts solutions.
7. MYTH: People with FAS/FAE are unmotivated and uncaring,
always missing appointments or acting in ways that society
considers irresponsible or inappropriate.
People with FAS/FAE usually care tremendously about pleasing others and want desperately to be accepted, but their basic organic problems with memory, distractibility, processing information and being overwhelmed by stimulation all work against their desires. They
simply have difficulty understanding the meaning and interrelationships of a complex world
15
Parenting Children Affected by FAS
that complicate their daily lives. In addition, the repeated experience of failing to meet
expectations can generate a general reluctance to meet challenges, even in someone with
the best intentions. Some people with FAS/FAE are now learning strategies and techniques
for working around these problems.
16
Brain
wiring
Information Processing
I am a brain cramp, never thinking of the right subject at the right time.
It seems like my brain goes on screen saver
or my input device has put a virus in my brain
to clear my memory of my train of thought
and needs a jolt to snap out of it.
But my brain is always chugging away.
—Ken, age 17
FAS significantly impairs information processing. This is one of the most devastating characteristics of FAS, since our ability to process information impacts so many areas of our day-today lives.
FAS affects at least four important components of information processing (adapted from Morse,
1993):
1. Cause and effect
the ability to translate information into appropriate action, or judge
the link between action and consequence
2. Generalization
the ability to take information learned from one situation and apply
it to another
3. Sorting, classification, inference and abstraction
the ability to perceive and understand similarities and differences
in people, places, things and events.
4. Prioritization, prediction, production and sequencing
the ability to assess a situation, request direction, or identify similar circumstances and take appropriate step-by-step action.
The Effect
FAS involves a serious information processing deficit.
The brain link between understanding the information supplied (request) and performing the
action required (response) is defective.
An individual with FAS has difficulty translating knowledge learned from one situation into
another. For the FAS child, a similar situation is new and may bear no resemblance to anything which s/he may have previously experienced. Previous rules do not necessarily apply in
the new situation.
17
Parenting Children Affected by FAS
Asking a child with FAS to repeat instructions does not ensure compliance or understanding,
but asking them to demonstrate or to explain in their own words will help to ensure understanding.
Developmental delays become more obvious with age, as the gap widens between the alcoholaffected child and their age-peers.
The problems are neurologically-based, caused by damage to the developing brain. Affected
children often have behavioural and emotional problems—secondary disabilities. A good environment may reduce the impact of the neurological damage.
18
4 S’s
Plus C
Structure, Supervision,
Simplicity, Steps
and Context
The FAS/FAE child is not a hopeless case, he/she is simply a nowhere child,
never quite fitting into any setting.... There needs to be radical changes in our
classroom structures and attitudes if we are to give these children a chance to
develop and maximize their unique potential.
—Maureen Murphy
Taking these information processing deficits into account, clinicians and educators who have
worked with children affected by FAS stress the importance of the following factors, “The 4 S’s
+ C,” as described by Maureen Murphy (1991):
Structure
Create a structured environment for children with FAS which includes choices within clear
and predictable routines.
Supervision
Carefully supervise children with FAS so that they do not get into trouble or place themselves
in dangerous situations.
Simplicity
Offer simple directions and orders, stated briefly in simple language that you know the child
understands, rather than the elaborate verbal justifications and explanations often given by
parents and teachers.
Steps
Break down tasks into small steps and teach each step through repetition and reward.
Context
Teach skills in the context in which the skills are to be used, rather than assuming children
will generalize from one context to another or understand in which situations the behaviour is
appropriate and when it is not.
19
A place
to start
Parenting Suggestions
If you’ve told a child a thousand times and he still does not understand,
then it is not the child who is a slow learner.
—Walter Barbee
It is important to remember that all children, alcohol affected or not, are first and foremost
individuals with distinct personalities, preferences, and temperaments. Parenting tips which
may work wonders with one child may prove inappropriate and ineffective for another.
The following section offers suggestions for parenting a child with FAS which have been effective for some children. Based on the input of many parents and professionals, these strategies
focus on effective communication and positive parenting.
Please note that this is not a definitive list which will always lead to good communication and
daily living skills. Remember that you are the expert on your own child. You likely know which
parenting techniques may or may not work with your child. Keeping individual differences in
mind, we invite you to adapt the ideas to suit your children.
Effective Communication
Offer simple directions. Break down tasks into small steps and teach each through repetition
and concrete reward.
n Begin all conversations with the child’s name and make eye contact.
n Be specific when telling the child what to do, such as “sit on that chair” rather than “get out
of the kitchen,” and “hang your coat on the hanger in the closet” rather than “put your coat
away,” etc.
n Realize that many words or expressions have more than one meaning and teach these
meanings. Children with FAS may be very literal in their understanding.
n Use the same words to express directions for daily routines, such as “brush your teeth”
rather than “clean your teeth” or “get your teeth done.”
n Be brief and keep directions short. The child may have a short attention span, even though
they may appear to be listening. Multi-step directions should be given gradually and only
as the child exhibits the ability to follow more complex directions. There is no definite
time-line as to when this may occur. For some children, understanding multiple directions
may remain a problem throughout their life.
n Give the FAS child separate instructions using their name. The child may not realize that
s/he is to follow group-directed instructions.
20
A Guide for Daily Living
n Speak slowly and pause between sentences to allow for processing. Auditory processing
may lag behind rate of speech. Repeat and restructure information as needed.
n When the child needs to focus on a task or listen to you, you may need to keep the environ-
ment as free from the distractions as possible (i.e. TV, radios, video games, other people, etc.)
An F/M transmitter/receiver (known as a body pack hearing aid) is very useful for screening
out distracting noise at school.
n Lists for older children that give step-by-step simple instructions on how to do things can be
a useful lifeskill for both common and unexpected situations. Teach the child how to use a
list and practice with role-play and simulation games.
n If the child does not know what to do next, jog their memory. Tell, demonstrate, show and
then find a visual way to tap into their memory. If the child cannot remember, remind them
and move on.
n Gentle reminders help produce a positive attitude.
n Link one task with another to help establish sequences (e.g. dinner comes after homework;
the bus comes after breakfast; story time comes after the bath.)
n Use expressive gestures when talking. Try varying loudness, inflection, tone, coupled with
hand signals.
n Use as many visual cues as possible to trigger memory and to aid comprehension. Be spe-
cific when labelling inappropriate behaviour (e.g. “John doesn’t kick” with an exaggerated
shaking of the head) and include visual cues to emphasize the desired action.
n Touch can be useful for teaching appropriate social distance from others. (e.g. place your
hand straight on the child’s shoulder and say “This is where we stand when we stand to
talk.”)
n Teach the child a visual or verbal cue to help them understand it is time to begin the task.
For example, you might end instructions with the word “now.” Use exaggerated facial and
body language. Use hand signals for behaviour cues with language.
n Help the child interpret social and behavioural cues of others. (e.g. “That person looks happy
because...”) Encourage the child to self monitor and to recognize context, social cues (i.e.
facial expressions, tone of voice, posture, etc.) and their own feeling state. Model these skills
(e.g. “How do you think you are (I am) doing right now? Things are getting wild. You (I) need
to slow down and take ten deep breaths while doing nothing.”)
n Help the child to express their emotions in acceptable ways.
n Encourage the use of positive self talk: “I can do this!” “I need to pay attention.” “I’m smart!”
“ I can figure this out!”
n Help the child develop skills for safe expression of feelings through use of metaphor, art,
play, and anger management strategies to provide a bridge to verbalizing issues.
21
Parenting Children Affected by FAS
Consequences and Positive Feedback
Processing deficits may make it difficult for the child to connect consequences and feedback to
their behaviour. Creating structure in expectations and consequences will aid the child in predicting outcomes and feeling secure in their environment. FAS children may disobey instructions due to lack of comprehension, memory impairment, or—like any child—wilful disobedience. Ask yourself if the child’s misbehaviour is due to lack of comprehension or wilful lack of
compliance. Recognize your child’s unique strengths and weaknesses, build on their abilities
and interests, and set realistic goals for performance. (for more on structure, see pages 19 and
24)
n Often children with language disabilities have difficulty with“why”-type questions. Help
them learn this format by using alternate forms such as “what is the reason?” or “what
caused this to happen?”, or restating as who, what, where, how and show me to invite input.
n Spend time discussing cause and effect relationships. Be patient with their delayed ability
to learn this relationship.
n Tell the child what to do, not just what not to do. Letting children know what to do gives
them a direction to take the behaviour and focuses on the positives while defusing the
negatives (e.g. “Chris, put your feet on the floor, not on the table.”)
n Encourage the child to “help” as a valued member of the family.
n Give immediate rewards or consequences and remind the child what the consequence is for.
Parents of children with FAS often notice that rewards lose their effectiveness, and are
constantly searching for new ways to motivate behaviour. For some children, stars and
stickers on a chart work well, while for others time on the computer or videos are effective.
Older children often accept the “cost” for the behaviour (e.g. no telephone privileges or being
grounded for breaking curfew) as worth it. The goal may simply become keeping the child
out of harm’s way.
n Be firm. Set clear, consistent limits. Don’t debate or argue over rules. Post family rules in
simple words and/or with pictures.
n Separate the child from the behaviour. The action may be “bad,” but the child must never
feel that s/he is a “bad” person.
n When removing a child from a situation to diffuse and calm down, once again separate the
child (not a bad child) from the inappropriate behaviour (e.g. “Your behaviour tells me you
need a time-out.”) Always return to the child when calm and reinforce that s/he is a good
person.
n Do not make threats that you cannot carry out. These children may take you literally. Also,
the child learns that there is no consequence when the threat is not carried out.
n Be very specific with praise and criticism. (e.g. “Joey, good sitting” or “Susie, good listening”
with a smile and a touch rather than simply “Good boy/girl.”)
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A Guide for Daily Living
n Intervene before inappropriate behaviour escalates (this is a difficult thing to do—the
caregiver must be tuned into the child’s feeling state and behavioural cues all the time.)
n Designate a place for “quiet time” when the child feels overwhelmed. Encourage the child to
choose a place where s/he will feel comfortable and secure.
n Give the child positive acknowledgement and regard for just being themselves—as well as
for desirable behaviour.
Transitions... Things Change
Changes in a child’s life, such as moving or starting school, can be traumatic. Children with
FAS may also experience difficulty in the simple changes that occur every day, such as moving
from one activity to another. This may even be the case when the child is being asked to change
their focus from a less pleasant task to a more pleasant one.
For the major changes:
n Develop “hello” and “farewell” rituals between you and your child.
n Use photographs of actual people, places, and important things to prepare a child for such
events as moving to a new home, going to the dentist/doctor, going to the hospital or going to
a new school.
n The absence of a family member can be upsetting to the child. Use photographs of the
person and the place where they will be to explain their absence.
n If a child must move to a new foster or adoptive home, or is even attending a sleep-over, try
to keep the child’s daily routines as normal as possible. Consistency and routine will minimize negative impact.
n Acknowledge the child’s fears about abandonment and other separation issues. Be as reas-
suring as you can while still being realistic. Help them work through separation issues in
advance of an impending move.
For more minor changes:
n Establish routines so that your child can predict coming events.
n Offer structured, limited choices and encourage decision making. Help the child shape
their environment.
n Teach the child a visual or verbal cue to help them understand it is time to begin the task.
n Egg timers are a useful way to clearly define the length of an activity.
n Give the child advance warning that an activity will be over soon.
n Prepare the child for school the night before and allow the child to direct as much of this
activity as possible. For example, in planning what to wear, offer some limited and structured choices.
23
Parenting Children Affected by FAS
Structure and Routines
Build security into the child’s day by maintaining consistency. Create a structured environment
for children with FAS which includes choices within clear and predictable routines.
n Write down or diagram what needs to be done for the completion of a task. For example,
you might post photographs of the child engaged in each step of an activity such as brushing
teeth.
n Break down daily activities into specific steps—plan mini-routines within the larger rou-
tine. Do everything in the same way and in the same order every day (e.g. wake the child in
the same predictable way each morning.) This may help the child become more comfortable
moving between activities, and able to operate more independently.
n Encourage imitation of daily activities through representational play.
n Avoid situations where the child will be overstimulated by people, sound, light or move-
ment.
n Have a place for everything and everything in its place. Allow only one item out at one time
if the child is overwhelmed by excessive stimulation. Storing things together by a system
(e.g. by type, size, colour, etc.) may assist the child in developing independence within their
own environment. For example, if all the blocks are stored together, the child may learn
where to go get them without your assistance.
n Place labels on the outside of drawers, cupboards, shelves, and so on. Use single words or
pictures to indicate contents.
n If the child has difficulty understanding boundaries and private spaces, such as shared
bedrooms, marking off areas with masking tape may be helpful.
n Create a homework corner in a quiet place. Have the minimal but necessary “tools of the
trade” there at all times. Use creative language to name this separate, personal space (e.g.
the child’s “office,” “workshop,” “private library,” etc.)
n Alternate active times with relaxation.
n Help your child to meet children who will be positive role models.
Supervision
Alcohol-affected children may need careful supervision so that they do not get into trouble or
place themselves in dangerous situations.
n Remember that it is impossible to be everywhere all the time and that structures in the
environment can help support supervision.
n Because children with FAS have trouble understanding the link between behaviour and
consequences, they are typically the child in the group who gets caught, even though they
may not have been the child who initiated or carried out the action.
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A Guide for Daily Living
n Given that you too must sleep, keeping the child’s bedroom fairly sparse can minimize the
potential for disaster! For the child who wanders at night, an alarm on the bedroom door
may be necessary.
n If the child approaches strangers, deal with it immediately in front of the stranger (e.g.
“This is a stranger, this is someone we do not know. We do not talk to people we do not know.”)
This may be difficult and embarrassing, but essential for reinforcing the concept.
Advocacy
The ability to work effectively with schools, doctors and support workers may be challenging but
is critical. As a parent, you are likely the best advocate for your own child. Expand your advocacy skills. Look for advocacy resources and workshops in your own community, and check your
local library for books on self-advocacy.
n Continue learning about FAS. Search out magazines, books, newsletters, movies and tapes
for information and support. Attend workshops and conferences. Share your information
with professionals involved in your child’s life. (see the Resource List on page 55 of this
manual for some ideas and a place to start.)
n Work beyond the label. Remind yourself and others that a diagnosis of FAS should not be
used to label limitations. Each child has different potential. The goal is to facilitate their
development so that their fullest potential is realized.
n Recognize that FAS is a relatively new area, and that it will take time for a formal “system”
to develop to help affected individuals and their families. Find people who share an interest
in the area to work with you and help you through the existing system.
n Join a support group and share your information. Parents in some communities have started
FAS-focused self-help groups. Other parents have found much comfort and support in groups
for parents/adopted parents of special needs or high risk children. Check your local community resource directory or self-help resource association for listings of groups in your area.
n Find a child advocate if necessary, someone who will champion your cause within a sys-
tem—be it the school system, the legal system, the medical system or social services. There
are formal child advocates within the system, such as the Child, Youth and Family Advocate
for the Province of British Columbia, as well as outside help, such as community advocacy
groups. You can also tap into the support of an “informal” advocate—such as the friend who
walks into the principal’s office at your side when you lobby for better supports for your
child at school.
n Become active in efforts to shape legislation and support research endeavours.
n Make sure you get support for yourself! (see section on Parents Needs, page 45)
25
Day to
day basics
Guidelines for Daily Living
We’re the mothers who are “different;”
Special Needs Adoptive Parents.
—And the uninformed will find us
As peculiar as our children
Who are daily being challenged
With birth defects they can’t manage....
—Leon’s Mom
Expanding on the parenting suggestions outlined in the previous section, here are some strategies for dealing with specific situations that make up daily living.
Please keep in mind that these are loose guidelines only, a place to start. Once again, these
suggestions have been effective with some children, but do not necessarily work for everybody.
Remember that each child is unique. It is important to analyse your child’s problem areas as
well as their strengths and adapt the environment accordingly.
Routines
Daily routines are essential. They help maintain consistency, and build structure and security
into the child’s day. Without them, little gets done.
n Break down daily activities into specific steps. Plan mini-routines within the larger rou-
tine. Do everything in the same way and in the same order every day. For example, wake
the child up at the same time and in the same predictable way every morning. This could
look something like this:
• enter room and say “Chris, time to get up.”
• open drapes
• turn on light
• gently nudge, stroke child
• pull covers back to ease transition from sleep to awake
• aid child in sitting up; make sure their feet are on the floor
• tell them what comes next
n Use calendars in the kitchen and bedrooms to list events. Write down or diagram what
needs to be done. For example, morning needs before school might be listed like this:
• get up
• get dressed
• eat breakfast
• personal hygiene (wash face, brush teeth, comb hair)
• get school things together (books, backpack)
• prepare a lunch
• put on coat and shoes
26
A Guide for Daily Living
n Post key family rules in simple words:
• no hitting
• gentle hugs
• sit when eating
n Alternate active times with relaxation. Limit the time the child is expected to work quietly
at a desk. Take “action” breaks.
n Prepare the child for school the night before:
• choose clothes
• make lunch
• put homework in a designated spot
Dressing
Again, dressing is a task that needs to be handled in a routine, concrete manner to help the child
learn and retain the skill.
n If a child can’t choose clothing, put entire outfits together on individual hangers in the order
they go on. Teach the child to put on clothes in the same order.
n Teach children how to sort clothing by a system, to help them learn to coordinate what they
wear.
n Teach buttons from bottom to top to help the child “see” the match better. Try velcro instead
of buttons.
n Teach how to tie shoe laces, but if this is difficult for the child, use velcro instead, elastic coil
laces that do not require tying, or slip-on shoes.
n Keep outer clothes in the same place (e.g. only the front hall closet or only the mud-room.)
Have a hook, at the child’s level, with the child’s name on it for their coat. Label a place for
their boots.
n For winter climates, pin a hand drawn thermometer beside the door (inside) with a red line
drawn on it at the temperature where heavy clothing must be worn. On the outside of the
door hang a real thermometer. If the outside thermometer reads the same as or lower than
the hand drawn line, winter clothing is put on.
n Have an extra supply of mitts, hats, lunch bags, shoes and any other items likely to get lost.
n If your child wears eyeglasses, have two pairs and keep one at school.
The Bathroom
Structure and routine are also helpful in the bathroom.
n Keep all personal grooming aids together in a container. Assign a colour to the child to
indicate their toothbrush, comb, and so on.
27
Parenting Children Affected by FAS
n If overly long showers are a problem, put a timer on the shower that shuts it off. If overfill-
ing the tub is a problem, use indelible ink to draw a line on the bathtub to prevent the child
from overfilling the bath.
n Post bathroom routines on the mirror. Use simple words with pictures. Use a colour code
system for hot and cold taps (e.g. red and blue) or pictures (e.g. a sun and a snowman).
n Keep the hot water tank temperature down or invest in a scald-guard faucet. This is essen-
tial for children who do not have a normal sense of pain and temperature!
Mealtime
Eating problems are common for alcohol-affected children. Some children over-eat, some undereat, some eat very slowly, while others never seem to feel hungry. Many children use food as a
comfort. Also, since children with FAS have poor impulse control, mealtime itself can be a
problem because the dinner table is full of impulsive things—play things like silverware, napkins, glasses and food. Anticipate that meals could be a problem and be flexible in your expectations.
n Children with FAS are often slow to gain weight, despite good nutrition. However, if the
child starts to lose weight for no obvious reason, or has persistent vomiting or diarrhea, a
medical check-up is needed.
n Allow ample time to eat.
n Establish a firm routine for meals at the table (e.g. we all choose what we eat from what is
prepared; the child must ask to be excused; etc.)
n Avoid spicy foods for young children if they react to strong flavours. Some children do not
have a distinct taste sense and prefer strong flavours, like lemon.
n Require that the child take at least one bite of everything. Have reasonable expectations of
portion size.
n If “eating all night long” or late night eating is a problem, establish rules about eating at the
table only and one light snack just before bed. You may find that sugar and food additives
are a problem.
n Use plastic tags on frozen food and use non-metallic wrap on left-leftovers or convenience
foods so that children do not inadvertently damage the microwave. Get rid of plates, mugs
and other dishes with metallic rims.
n A child with FAS may eat slowly because of poor muscle control or poor swallowing reflex.
Accept that FAS children may be sloppy eaters and have sensitive gag reflexes.
n Carefully control the temperature and texture of foods. The child may have hypersensitiv-
ity toward certain food textures. Food without some sort of texture may be rejected. Try
mixing in something a little rough. Conversely, a rough texture may be rejected.
28
A Guide for Daily Living
n Some infants seem not to “feel” nipples or spoons in their mouth. Some have a high palate
which hampers the use of a nipple.
n Manipulating forks and knives may be a problem. Allow use of fingers or a spoon, even for
older children.
n If the child is agitated or confused at meal time, you may need to keep routines the same
every meal:
• Use the same dishes for the child at every meal.
• Serve meals at the same time daily.
• Give the child a specific seat at the table. If possible, seat the child at the end of the table
away from others’ elbows. Seat the child beside a high tolerance child and avoid the
one(s) with whom the FAS child fights.
• Consider having the same meals on the same days. This helps children with sequencing
difficulties to “know” the day of the week. You can try this for school lunches, as well.
n Serve the FAS child first if they have trouble waiting for others to be served first. You may
want to try having the child serve: this lets them get up and do something physical several
times during the meal and gives them an important role to play during dinner time.
n Avoid putting dessert on the table until after dinner.
n If the child cannot reach the floor when seated and finds this uncomfortable, allow the child
to stand instead or place a step-stool under the child’s feet.
n Work on one kind of table manner at a time. Integrate a new “manner” only when the
previous one has been successfully used for a time.
n Avoid fast food restaurants at peak times when eating out. Look for quiet eateries with low
light and minimal noise.
n Reduce distractions at mealtimes. Avoid TV, radio and too much conversation. Save dis-
tracting socializing for after the meal—although this may be difficult to do as meals are
often a key socializing time for families.
Bedtime
Children with FAS often have difficulties with transitional periods and activities where there is
little or no structure. Bedtime contains elements of both, and can pose problems for children
with FAS from a very early age. Again, the key is to establish a firm and calm routine, as in the
following examples.
n Establish a definite bedtime and stick to it, even during summer holidays.
n Have a calming routine that starts an hour before bedtime (the child picks up their toys, has
a bath, brushes their teeth, gets into their pj’s, gets their hugs, goes to their room for story
time/quiet time, etc.)
n If the child wishes, have one light in the room, by the bed—all lights out except that light.
29
Parenting Children Affected by FAS
n The child may have one toy or book in bed with them—only the one they choose for that
night.
n If they wish, the child can have the radio on very low with reasonable relaxing music. “White”
noise in the bedroom (such as a fan or humidifier, very low music, or anything that makes a
low hum) can be calming. This helps relax them so they can go to sleep.
n Every time the child gets out of bed repeat the same identical words like a broken record.
(e.g. “This is your bed. This is where you are supposed to be.” If another light is turned on,
“This is the only light left on.”) Accept that the child might be in bed but not sleeping.
Sleep
Sleeping problems are also common, particularly for younger children. Patterns vary from
child to child. Many children with FAS need extra hours of sleep each night, while others seem
to require little sleep.
n A warm bath before bed may help the child fall asleep. A warm bath after a stressful day of
school can also be calming.
n Snug bedclothes are also helpful.
n A rocking crib can be useful.
n Establish bedtime rituals for saying goodnight which visually allow a transition from the
“getting ready for bed” routine to the bed itself.
n Keep furnishings in the child’s bedroom to a minimum.
n For children who wake up at night, have a list of acceptable things for the child to do in an
acceptable place.
n Safety-proof the house for night time wandering. Lock doors. Place locks near the top of the
doors so the child cannot reach the lock. Consider installing a single alarm system that lets
you know when the child has passed a certain point. Before that point, let the child wander.
Make sure that this area is entirely child-proofed. A gate across the bedroom door may be
useful.
n Encourage the habit of having the child sleep in their own bed.
n Many parents have found that it does get easier as the child gets older!!
Laundry
Laundry is an example of a complex life skill that may present difficulties for a child with FAS.
Laundry can be challenging as it involves following an elaborate sequence of steps, making
judgment calls (e.g. sorting clothes appropriately) and generalizing (e.g. dealing with different
combinations of clothing each time). Again, it is helpful to teach this skill step by step, with
demonstration and simple language.
n
30
Teach the child/teen to do laundry sorting by colour of clothing.
A Guide for Daily Living
n Break down laundry into specific steps. [i.e. open door, put in clothes, add 1 soap (only have
1 measuring cup available), shut lid, turn dial to dot, push in knob, etc.] Provide visual cues
with drawings.
n Buy an iron with an automatic shut-off.
Supervision
Children with FAS can easily get themselves into trouble due to poor impulse control and difficulties understanding cause and effect. They also tend to be overly friendly and trusting, even
towards strangers. It is important to supervise children with FAS so that they do not get into
trouble or place themselves in dangerous situations.
n Small children and most pre-teens should be in direct line of vision at all times. One-to-one
supervision is mandatory in strange places, on field trips, in stores, and so on. Do the best
you possibly can, but keep in mind that even supervision is bound to occasionally fail to
prevent problems.
n Some parents use a bungee cord to keep a small child close to them in public.
n If hyperactivity for the FAS child tends to increase with the day, shop with them first thing
in the morning. Shop at small stores where there is low noise, fewer people and good service.
n Teach your child how to protect themselves from danger. For example, meeting a new per-
son on the street does not mean that the person is no longer a stranger.
n Help the child to be aware of their environment. Walk in your neighbourhood together and
point out the landmarks. Make trial runs of new trips on foot or on the bus. It is helpful to
do this repeatedly from pre-school to adulthood.
n Make a telephone book for the child with addresses and phone numbers. This should be
small enough for the child to keep in their pocket. Keep a copy for yourself.
n Safety-proof the home. Place locks on outer doors. Lock up all medication, household clean-
ers, other potential poisons and power tools. Safely store knives, scissors, matches and
lighters. Cover electrical outlets. Erect high fences and keep gates locked. Give away any
poisonous plants. Never leave a lit cigarette unattended and dispose of used cigarette butts.
n Fire extinguishers are advisable in the kitchen.
n Always be on hand if a child/teen is cooking.
n Never leave a child with someone you do not know well.
n Assess whether the child can be left alone. Even some teenagers need supervision.
n Escort children to and from all activities.
31
Parenting Children Affected by FAS
n Arrange for recess and noon hour supervision at school.
n Try not to let the child know that you are supervising all the time. The child needs to feel as
independent as other children. Plan concurrent activities that legitimately keep you in the
child’s proximity.
Managing Hyperactivity
Hyperactivity is a common problem for children with FAS. Parents can help control the problem by carefully structuring the child’s activities and by reducing the amount of external stimulation.
n Limit TV-watching and avoid video games if this causes the child to become overstimulated.
Keep in mind that highly-charged social activities such as birthday parties may be overwhelming for a child with FAS.
n Alternate activities requiring attention (e.g. studying, washing dishes, etc.) with physical
exercise (e.g. running, tumbling, dancing, trampoline, etc.). Give your child opportunities to
be physically active. Sports such as soccer and gymnastics—and skiing/snowboarding for
older children—are excellent ways to use all that energy. These activities also promote
healthy self-esteem. Swimming is also a good physical outlet for many hyperactive children. However, group swimming lessons may be counter-productive. Private lessons may
be preferable.
n Avoid cluttered space. Clutter may increase hyperactivity.
n Make the home a calm place.
n Calming music is preferable to loud, frenetic music.
n Fluorescent lights may be bothersome. Children with FAS may be more sensitive to flicker
that others don’t notice. Use low or recessed lighting.
n Avoid situations where the child may be overstimulated by light, movement, sound, toys,
noise, colour, activities or crowds.
n Designate a calm, cosy, comfortable place for “quiet time” where the child can go when they
are overwhelmed. Make it clear that “quiet time” is not a punishment. It is best that an
adult be present while the child calms down.
n Avoid trying to have a child concentrate for long periods of time. Concentration is hard
work and physically tiring.
n Limit the number of visitors if this is overwhelming for the child. Try to have people over
when the child is asleep or not at home. Many parents have found a substantial increase in
energy levels when extra people are around, especially people the child doesn’t know.
n If anger is a problem, have a safe place for the child to express it in some physical manner
(i.e. screaming, kicking a ball.)
32
A Guide for Daily Living
n Avoid activities such as pillow fighting or wrestling which can cause over-stimulation. Make
sure extracurricular activities do not cause over-stimulation. At the same time, do not
deprive your child of extracurricular opportunities. Sports or Boy Scouts/Girl Guides may
provide an excellent channel for the child’s energy, while boosting self-esteem and encouraging personal interests. The child needs the outlet, and you probably need the break!
n Ask yourself, “Does it really matter?” Don’t sweat the small stuff.
Managing Impulsivity
Children with FAS and Attention Deficit Hyperactivity Disorder (ADHD) tend to have poor
impulse control. They often have difficulties understanding cause and effect relationships, or
foreseeing long-term consequences for their actions.
n Teach the concept of “your turn” by using a physical object such as a “talking stick” which
could be a pebble or any small, portable object that is easily passed around—“if the object is
in your hand, it’s your turn.”
n Teach “walk, don’t run” by counting numbers between steps.
n Verbally label and redirect unacceptable impulsive behaviour as early as possible in the
child’s life (i.e. toddlerhood) and on each occasion. Do so in a calm, consistent manner with
visual cues.
n Learn to recognize the signs that the child is going to have a “negative event” and step in as
soon as the signs begin. Avoid, anticipate, act!
n If time out is needed, consistently use the same designated place. Avoid places used for
other important or fun activities (e.g. bedroom, play table, book corner, etc.). If possible,
choose a calm, uncluttered space that is used for no other purpose.
n Don’t hook into tantrums!! Allow each one to run its course. Help the child to calm. Make
sure the child is in a safe place where they cannot hurt themselves. If necessary, move the
child to a safer place (i.e. a carpeted floor.)
n In order to “look before they leap” (reflection), a child must have the language (words) for the
situation. Try to teach in simple terms with visual cues.
n FAS children have “good” days and “bad” days. Do not expect compliance today because
they had it yesterday. Always have a fall-back plan.
n Limit choices. Inability to choose from a variety of options causes intense frustration and
impulse control problems.
Sensory Considerations
Many children with FAS are hypersensitive to noises, touch, bright lights, hot and cold, sudden
movements, and pain. They may also be sensitive to small amounts of various stimuli (e.g.
people, noise and movement) all at once. This problem of overstimulation is noted in newborns,
33
Parenting Children Affected by FAS
especially those with NAS, and apparently some alcohol-affected individuals remain hypersensitive to sensory stimulation most of their lives. On the other hand, some individuals with FAS
are hyposensitive, meaning they have extremely high tolerance to sensory input and may even
seem impervious to pain.
n If the child is hypersensitive, avoid itchy clothing. Soft, loose material is more easily toler-
ated. Elastic, sock seams, ties under the chin, labels in the neck, tags, jeans seams, appliqués
with a scratchy backside, hair bands, barrettes and stiff shoes may cause problems. Solutions include:
• Remove tags from clothing.
• Wash all clothes 2 or 3 times before wearing.
• Turn socks and gloves with seams inside out.
n Avoid bright lights (particularly fluorescent) and sunlight reflecting from water, snow or
vehicles.
n Use sunglasses and tinted glasses (prescription and non-prescription) to reduce glare.
n Loud noises may be quite painful for the child’s ears, but use earplugs only under supervi-
sion.
n Loud music is often distractive because it seems to “switch off” what is being seen visually.
It is as though the child can have either visual stimulus or auditory stimulus, but not both
at once.
n Avoid crowded situations. Place child at the beginning or end of a line, not in the middle.
n Learn which foods seem to be too smooth or too rough. (see section on mealtime, page 28)
n Use soft play-dough or other smooth surfaces with which the child can feel and play.
n Use routine calming techniques when the child is overstimulated (e.g. sitting in a bean bag
chair, rocker, or hammock; taking a warm bath or shower; listening to quiet music through
headphones; etc.)
Social Skills
Individuals with FAS have difficulty relating cause and effect, generalizing, and learning from
non-verbal cues. As a result, a child with FAS may have trouble picking up social cues and may
not realize when they are acting inappropriately. Other children and adults tend to reject peers
who are not skilled socially or who act differently. Teaching social competence and how to
communicate with others serves to bolster their self-esteem and enhance their social well-being.
n Teach social skills carefully, consistently, and repetitively through modelling, role play and/
or practice.
n Teach appropriate social skills, such as:
• how to share and take turns
• how to ask for help
34
A Guide for Daily Living
•
•
•
•
•
•
how to interpret facial expressions, tone of voice, posture, etc.
how to deal with rebellious behaviour in peers
how to react when there is a disagreement with a supervisor
how to make choices
how to ask others if they can join in an activity
how to say “no”
and so on. Talk about each situation in some detail. Try to seize “teachable moments.”
Keep the tone light and natural, and the “lesson” brief.
n Teach what is inappropriate, such as:
•
•
•
•
standing too close
interrupting and talking non-stop
throwing things
not asking for help
n For a child who requires excessive body contact, structure the physical contact so that the
child learns what is acceptable and what is not. Gradually replace the excessive amount of
physical contact with visual and verbal assurances (i.e. a key word, phrase or sign).
Telephone
Telephone manners and taking messages pose problems for children with FAS because these
skills require memory work as well as understanding abstract concepts and appropriate social
skills. Teach by role-play:
n Have a large, erasable message board next to the telephone.
n Have an answering machine with a “record” function so that messages do not get lost or
numbers mixed up. Some parents have found the voice mail service through their local
telephone company very effective.
n You may consider having two phone lines, one for the children and a second which only the
adults answer.
Handling Time
Children with FAS have great difficulty telling time and understanding how much time has
passed. Dealing with time involves abstract concepts, and understanding abstract concepts is a
common difficulty for people with FAS. A 12 year-old child with FAS may still be unable to tell
time on an analog watch.
n Make time visual with paper chains, time-lines or other concrete objects to represent peri-
ods of time (e.g. 5 minutes). The adult takes responsibility for removing one object/link
every 5 minutes so the child can “see” time pass. Sand-timers and egg timers also work
well.
n Teach time using an analog watch or a clock face with hands that the child can manipulate.
Digital watches seem to work only if the child is looking at the watch when the specific time
rolls around.
35
Parenting Children Affected by FAS
n Even when a child has started to master telling time, they may still have difficulty under-
standing the concept that 9:45 is the same thing as quarter to ten, or that 10:30 and 10:40
are roughly the same time.
n The child may also have a poor sense of time. The idea of when time occurs has no meaning.
“Dinner is at 5 o’clock” means nothing, while “Dinner comes after...” may be easier for the
child to comprehend. Always relate events to other events to create a sense of the day and
the usual order of things. The words “after” and “before” are helpful when referring to time.
n FAS children who are in an established routine will follow that routine regardless of the
time. The fact that dinner may be delayed due to a late lunch is complicated information for
the child with FAS to process.
n Do not have high expectations about handling time. It may not be reasonable to expect a
child to be able to complete a certain amount of work in a specific amount of time. It is also
best to send a child from point A to B with an escort if you need them to be there at a specific
time. Give the child lots of time to get ready for an event and supervise closely.
n The responsibility for making sure FAS children/teens are where they are supposed to be
on time rests with the adult. Even some adults with FAS may require help in this area,
although many find this skill improves with age.
Teaching Ownership
Similarly, ownership and personal belongings are abstract concepts that are difficult for many
alcohol-affected children to understand. A child with FAS will often pick up something that
catches their eye and then drop it whenever they lose interest. Or, the child may take something
they recognize as having been left by someone else with the good intention of returning it. Unfortunately, short term memory dysfunction, distractions and other problems may cause them to
forget, leaving them open to charges of stealing. Work on teaching the child to ask before they
touch anything that is not theirs.
n Teach the child what belongs to them by placing a colour code or an initial on all their
possessions. The child then knows what to take (e.g. the item with the purple “J”) and what
not to take (everything without the purple “J”).
n Connect ownership to visual cues. The child may understand that a specific person owns a
specific item as long as the person and object are together, but not if the two are apart (e.g.
the child finds an object that’s been left somewhere.)
n If the child takes something that is not theirs, do not get caught up in an argument. Simply
state, “This .... belongs to ....” and return the object. Stealing should be dealt with firmly
with appropriate consequences.
n Objects of value should not be left around where a child may come across them.
n Keep in mind that malls are neither recreation centres, nor suitable places to hang out. It
is best not to allow unsupervised trips to stores. You cannot expect store managers to
understand FAS.
36
A Guide for Daily Living
Handling Money
Money, and the value associated to it, are also abstract concepts. Not surprisingly, FAS-affected
children do not typically handle money well. The ability to handle money has a significant
impact on the potential for independent living.
n Children with FAS do not associate value to items and have difficulties making judgements
about the sum of money asked for an item. For example, $10 for a candy bar or for a bicycle
may both appear acceptable to a child with FAS.
n FAS children are at risk for being victimized by others. Children and teens should have a
very limited access to money without direct supervision. Money should be given in small
amounts. Pay for lunches at school ahead of time, or be at the store when expensive items
are being purchased. Use an account book to record every cent the child spends with the
child present.
n Monitor the child’s money. Where did it come from? The child may have sold a personal or
household item just because they were asked.
n Teach the child about money whenever you go to the store or in other real life situations.
n Be very cautious about the use of cheques, credit cards or banking machines. Set up a bank
account where cheques are not allowed and withdrawal amounts are limited. Many parents suggest that bank cards and cheques should not be used because they are open to
misuse.
37
Good decision making is very hard for children with FASD. Everyday decisions are difficult for them to make. Because their brains
work differently, children with FASD may not be able to clearly
understand the outcome of their actions. They may also have trouble
sorting out the facts when they make decisions.
FASD
Tip #1
Most parents help their children to learn how to make good decisions
and wise choices. Parents and caregivers of youngsters with FASD
soon discover that their children need extra help learning how to
make decisions. They might need this help for a longer time than
other children do. This sheet offers you some tips on how to teach
your child about how to make good decisions and wise choices.
First, some ‘real life’ examples…
Example #1
It’s a cold winter day and your child doesn’t want to put on her coat,
hat or mitts.
How you can help
Your child may not understand that she is cold because she
doesn’t have enough clothes on. In the cool fall weather, start
teaching her to wear her mitts and hat. Let her hands get a little
chilly and then have her put on her mitts and hat. Say to her,
“When my hands are cold I always put mitts on. When my
body and head feel cold I always wear a hat. Don’t your hands
and head feel warmer with your mitts and hat on?” Do this over
and over again. You can help her stay safe in cold weather.
Example #2
You’re in a grocery store and your child opens a bulk candy bin full
of bright coloured candy. He reaches for some candy to eat. You tell
him that you’ll first need to pay for the candy - it’s not free. A few
minutes later, he picks up an apple and takes a bite.
How you can help
This little boy didn’t understand that you have to pay for ALL
the food you take in the store. He needs a very clear and simple
direction. “We don’t put things in our pockets until we’ve paid
for them. We need to pay for everything we take from every
store. After we pay for our food at the check out you can eat
something.”
Fetal Alcohol Spectrum Disorder
How You can help Children with FASD
Make Decisions
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
1.
A child with FASD takes longer to learn some things. Routine is important. Try to do
things the same way every day. For example, your child needs to put his dirty clothes in
the laundry hamper every time he gets into his pyjamas. Repeat, repeat, repeat- it will
help your child develop a good life skill.
2.
Try to keep your explanations short. Use the same words each time. A rhyme or rap
may help your child remember the order of things to be done. For example, “Feed the
cat, outside there’s snow, wear your hat, off to school you go.”
3.
Use visual cues or hints whenever you can. For example, put a picture of a coat over
the coat hook where your child should put her coat.
4.
Offer only 2 choices at a time. For example, “Do you want to wear your blue sweater
or your red sweater today?”
5.
Try to cut down on things that distract the child with FASD. It’s hard for them to think
straight when a lot is going on. For example, if a few children are getting ready to go
outside, it will be easier for you and the child with FASD to get ready before or after the
other children.
6.
It is important to leave enough time for a child with FASD to move from one activity to
another. It may help to set a timer for 3 minutes and let your child know that when it
rings it’s time to stop playing and get ready for school.
7.
Point out good decisions and good choices made by your child. For example, “That was
great that you didn’t run into the street after your ball! You made a good decision. I’m
proud of you.”
8.
Try to stay calm and cool. If you get angry or lose it your child may become excited or
confused and lose control of his or her behaviour.
Fetal Alcohol Spectrum Disorder
Some Tips to Improve Decision-Making:
It can be hard for children with FASD to get along with others their own age.
Children with FASD tend to have the social skills of a child much younger
than their peers. To cope with daily life, children with FASD need to use a
lot of energy focusing on themselves. And sometimes this leads them to miss
the subtle messages and habits of friendship. For example, they may not wait
their turn. Or they may stand too close to others and get into their ‘personal
space’.
FASD
Tip #2
It can be very lonely and frustrating when other children don’t want to play
with them. This makes them in danger of being taken advantage of or bullied
by others. For a parent it is hard seeing your child not ‘fit in’. Here are some
tips on how you can help your child become more aware of how friends act
with each other.
First, some ‘real life’ examples…
Example #1
A child with FASD is on the schoolyard all alone. The children ignore him.
What is happening
This child doesn’t know how to ask to be part of the other groups. He
finds it hard to just join in. The other children don’t make the effort to
include him. He needs help knowing and practicing what to say to
join a group.
Example #2
When your 10 year-old with FASD comes home from school he wants to
play with the 6 year-old down the street and not with his 10 year-old
neighbour. He feels more comfortable playing with someone younger. He
likes the games played by the 6 year-old more.
What to do
Your child just may not be able to play well with children his own
age. Avoid situations where his lower maturity level makes it hard for
him, such as in competitive sports.
Example #3
Your 7 year-old son is at the pool and he’s trying to join a group of teenage
boys who are jumping off the diving board.
What to do
He doesn’t understand that the teens don’t want him. Help your child
become sensitive to body language and facial expressions. Look at
pictures of people in books and magazines together and ask them what
they think the people are thinking or feeling. Explain how humans
‘talk’ in many ways not just by using words. Play act together and see
if your child can figure out what emotions you are expressing.
Fetal Alcohol Spectrum Disorder
How You can help your Child with FASD
Make and Keep Friends
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
1.
Find games and activities that help your child build social skills. Safe and supervised
groups such as Scouts, Girl Guides, Air Cadets or swimming or skating lessons are great.
2.
Don’t expect that your child will have a large group of friends. One or two close friends
who have known her for many years will not only be good friends but, care enough about
her to help her stay safe.
3.
Keep an eye on your child when he plays with others. This way you can explain why
things may have gone wrong and, how he might want to act the next time to get along
better with his friends. You could also protect a child from children who are too rough or
cruel.
4.
Children with FASD usually feel best in a place they know and in situations they can
predict. Avoid large sleepovers and parties because they can be too confusing and over
whelming to a child with FASD. A sleepover with one friend in her own home would be
best. A birthday party with 2 friends over for a short time would be more successful than
a large party with many children and a lot of chaos for a long time!
5.
Over and over again teach them the social skills of listening, taking turns, not talking
when others are and taking an interest in other people by asking them questions. Your
child will need help and lessons on all these subtle ways of friendship.
6.
Talk to your child’s teachers and ask them to make efforts to include your child in
activities and groups. And, thank them for their efforts. Your child’s teacher will be more
likely to help if she sees you notice her extra care.
7.
Sometimes children don’t notice that they are different. Even though we know they are
less mature than their peers, if they are happy the way they are then that’s where they are
at and that’s great.
8.
If you see that some children are being cruel to your child, you may need to step in and
stop them. Try to do this gently, so that your child is not embarrassed. Then, when
there’s a chance, talk to the children about how great it is that we’re all different, how
boring it would be if we were all the same. Ask the other children how they might feel if
they were left out or teased.
9.
From a very young age, children learn a lot from their friends. All parents need to keep an
eye on the friend their children make. Like other parents, you may need to forbid your
child from being with certain kids and be happy they are with others.
10.
Supervise, supervise and supervise. Keeping a close eye on your child and their play
mates so you can step in and help them sort things out at the first sign of overexcitement,
stress, exhaustion, misunderstanding or trouble.
Fetal Alcohol Spectrum Disorder
Some Tips for Friendship:
All children tell stories. Children see the world differently than adults do. But,
children with FASD have a hard time knowing the difference between reality
and fantasy.
Your child may lie, over and over again, about many things. But, they probably
aren’t doing it because they are a ‘bad kid’. They may be having trouble with
their short-term memory, so they are filling in the blanks. They may be trying
to please you by telling you what they think you want to hear. Or, they may be
having trouble thinking in a logical way. Because of the way their brain works,
they might really believe the lies that they are telling you.
FASD
Tip #6
This can be very frustrating and confusing for parents and others. Sometimes
it’s hard to feel close to someone whom you can’t trust or believe. This tip
sheet offers you some ideas on how to cope and teach your child about reality
and fantasy.
Example #1
You ask your son if he has brushed his teeth. He says he has. But, you see that
his toothbrush is still dry. You feel mad because he seems to be willfully lying.
What is happening
He is telling the truth as he sees it. He HAS brushed, many times in the
last month. Because of the way his brain works, his sense of time is
different from yours. He doesn’t connect your question with something
that has happened in the last half hour. His answer shows that he
processes information differently.
Example #2
One member of the family has lost $20 while doing laundry. The rest of the
family has been told that the money is missing. The next day your child with
FASD finds the money. She insists that this $20 was not the one that had been
lost, even though she found it in the laundry room.
What is happening:
The child with FASD may believe she is telling the truth. She can’t
connect the money she has found with the lost cash. After all, in her
mind that money is lost - the money she found isn’t lost!
Even when something seems clear and obvious to you, it might not be to
your child. You’ll need to make an effort, over and over again, to fill in
the gaps of what your child can’t understand. For example, when talking
to your child, ask questions like, “Do you think it might be that
_______’s money fell out onto the floor when she was loading her
clothes into the washer? Could this be her money? Could you have
found ______’s lost money”?
Fetal Alcohol Spectrum Disorder
How You can help Your Child with FASD
Figure out Reality and Fantasy
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
1.
Can your child tell you when she has made a mistake or lied? There are times when
you will need to help a child sort out the truth from a lie. It helps to have an open and
honest relationship with each other.
2.
Learn to give very clear instruction like, “Go brush your teeth please.” A clear order is
less confusing than asking questions.
3.
Encourage your child to tell you what is true, not what they think you want to hear.
4.
Practice story telling with your child. Have your child tell you stories and praise them
for having a good imagination. Tell them that there are good times to make things up
and bad times. Offer real life examples.
5.
Read stories with your child every day. Many books are based on make believe. Have
your child tell you when he thinks the story might be true or when it is made up. If you
go to the library, the librarian can help you pick some good books that work for kids
your child’s age.
6.
Be very careful about what you allow your child to see, read and hear. Your child may
have a lot of trouble separating reality from fiction in the things they see.
Be aware that a child may believe that what they see on TV shows, movies and video
games are “real”. Music and pictures can be very suggestive and confusing to a child
with FASD. Some video games are very violent and /or sexually inappropriate for
children. Take the time to sit and watch the TV or a movie with your child. You will be
able to help them sort out fact from fiction.
7.
Be careful about what games you allow your children to play.
8.
Be your child’s ‘external brain’. Know what they have been doing and need to do next.
This way you will know what really happened and be able to guide your child to
remember the facts.
9.
Help family members and school staff understand that your child may not remember
things as they really happened. Be positive about it if you can and suggest some of the
ideas mentioned here. Do this before there’s a problem, if you can.
10.
If you catch your child lying, try to remain calm. If you yell they will get distracted and
find it harder to understand what they have done wrong.
11.
Every child needs love and responds to love. If you speak with compassion they may be
more open to listening to you.
Fetal Alcohol Spectrum Disorder
Some Tips to Help with Telling the Truth:
Some children with FASD are very sensitive to touch, movement,
light or sound. Because of the way their brains work, children with
FASD may be so focused on what they hear, see or feel on their skin
that they can’t focus on other things. When children have oversensitive senses, they may need to shut down. Or they might act out
and act badly as they try to stop the thing that is bothering them. This
can be very hard for parents to cope with, especially when you are out
in public.
FASD
Tip #7
It is important to remember that some children with FASD have
senses that don’t work well or that are numb. They really can’t tell
when they are hot or cold. And some may not feel pain as much as
other children can. Try to help these children dress in the right way for
the weather and to check them for illness or injury.
Here are some ’real-life’ examples and strategies...
Example #1
A parent takes her child to a puppet show at the library. All week
they’ve wanted to go! But, when they get there the room is noisy and
crowded and the child gets nervous. He plugs his ears and as he gets
more frustrated he starts to yell, “shut up” at the kids around him.
What you can learn
This child is over-sensitive to sound. The noise in a crowded
room is too much for him. He tries to cope by covering his ears.
His sensitivity to noise makes him frustrated and overstimulated.
Example #2
A 7-year old child takes off her socks as soon as she gets home from
school. Sometimes she takes her socks off at school. When the girl is
asked why she takes off her socks she says, “I can’t stand to wear
them”.
What you can learn
She is over-sensitive to the clothing she’s wearing. She can feel
even the small seam in a sock and can’t ‘tune out’ that feeling.
This means she can only focus on the clothes that bother her and
nothing else. She needs to wear clothes that are comfortable for
her.
Fetal Alcohol Spectrum Disorder
How You can help Children with FASD
Learn to Cope with their Senses
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
Try to find out what your child is reacting to so that you can avoid what’s causing them trouble. Try not to go to places where your child may be over-stimulated by noise, light etc.. You
may also want to be pro-active and have sunglasses or headphones ready. If a child is showing
signs of over-sensitivity to something, and heading to a ‘meltdown’ try to leave before the
meltdown happens. As the child gets older, he or she can be taught why they are feeling oversensitive, and how they can avoid these situations. An Occupational Therapist may be able to
suggest some exercises or ways to reduce the child’s sensitivities.
Sensitivities to Noise:
1.
If you want or need to go to public places like malls or fast food restaurants try to go at
quiet times of the day. Fewer people go mid-afternoon or early in the day.
2.
Holding the child’s hand will help them feel calmer and less confused by the hustle and
bustle around them. Plan to stay for a short time only.
3.
Turn down the TV, radio, telephone etc. Do not have the TV and video games on in the
same room. It is too much for the child with FASD to hear at one time.
4.
Speak to your child in a quiet voice .
Sensitivities to Light:
1.
If a child seems sensitive to light offer sunglasses, tinted goggles or a big sunhat.
2.
Use dim lighting when you can.
3.
Avoid flickering or blinking lights like the ones on Christmas tree decorations.
4.
Avoid TV shows, movies and video games that use flashing lights and flashing things to
make you notice the screen.
Sensitivities to Touch:
1.
Wash all clothing a couple of times before wearing.
2.
Turn socks and gloves inside out so the seams won’t bother them.
3.
Comfort is the most important thing for your child. Buy soft feeling clothes and avoid
stiff and scratchy clothes. Remove all tags. Bedding needs to feel comfortable for the
child. Some children like heavy blankets on their beds (even in summer) and, some like
light blankets on their bed (even in winter).
4.
To some children firm touch feels better than light touch. Some children like their hair
stroked while some children like a firm backrub. Find out what kind of touch your child
likes.
Fetal Alcohol Spectrum Disorder
Tips on How to Adapt to Sensitivities:
Children and teens with FASD often have trouble understanding what
‘ownership’ means. There are many reasons for this. First, because they
might be ‘living in the moment’, if they see something they want and it’s
available they take it. Or, because of problems with short-term memory, they
might not remember taking it. Or, they might have thought that it was theirs
or that someone had given it to them. They also might lie and deny stealing
because they are afraid of being in trouble. Finally, because each day is new
and different to someone with FASD, the child or teen may not remember
that they had stolen before and that this was the wrong thing to do.
FASD
Tip #8
It is hard to know what to do when a child or teen with FASD steals something. Are they stealing because they are behaving badly? Or, because they
really didn’t understand that it is wrong to take things that belong to other
people? You will need to use your judgment in each case. And, you’ll need to
teach them over and over again about what ownership means.
Here are some tips on how you can do this and some ‘real life’ examples…
Example #1
A child sees a blue jacket he likes at school. So, he takes it and wears it.
What happened
The jacket doesn’t seem to belong to anybody. He doesn’t consider
who owns it. It looks at that moment that no one does and, his
thinking is based ‘in the moment’. Because of the way his brain
works, he doesn’t think ahead to what would happen when the owner
of the jacket sees him wearing it.
Example #2
A teen with FASD asks her older sister if she can wear her sweater. The sister
says, “Yes”, but she assumes that she is loaning it and not giving it to the little sister. She may not give it back. She argues that it’s now hers and that her
big sister ‘gave’ it to her.
How to help
People in this teen’s life need to be very clear when they lend her
things. “Yes, you can borrow my sweater for the dance. But, I’ll need
it back tomorrow. This is not a gift to keep.”
Example #3
Some children are on the playground. One child has a skipping rope. Another
child with FASD takes the skipping rope.
How to help
The child with FASD wants the skipping rope and even though she
knows it belongs to someone else she picks it up and puts it in her
backpack. This is something we might expect from a 2 year-old child.
This may be the age this child functions at. Talk, over and over again,
about how ownership works. Describe things as your jacket, my
wallet, Jane’s skipping rope.
Fetal Alcohol Spectrum Disorder
How You can help Children and Teens with
FASD Learn about Ownership
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
1.
Most children will take something that is not theirs at least once while they are young. It
is up to the parent or caregiver to teach a child about ownership and right from wrong.
Be patient. Ownership is a hard thing to learn from children and teens with FASD.
2.
If your child takes something that is not theirs, ask her how she would feel if her
favourite toy or shoes were stolen. Help them to understand that no one likes to have
their things stolen.
3.
If your child takes something which doesn’t belong to her, make sure she returns it with
an apology. Practice how she will say sorry. Go with her for support.
4.
Mark the things your child owns with a sticker. For example, everything with blue
stickers are his. If they don’t have his sticker on them, he should not take or use them.
5.
If your child takes something that is not theirs, do not get caught up in an argument. Sim
ply say, “This … belongs to …” Have them return the item. Stealing needs to be dealt
with quickly, firmly and with appropriate consequences.
6.
Valuables should not be left around where a child may come across them. Lock up
things like coin or stamp collections, cameras, money and jewelry.
7.
Stores and malls are not good places for children and teens to “hang out”. A good rule
is that a parent must always go with the child or teen to the store or mall. Shoplifting
can be a big problem with children and teens with FASD.
8.
Supervise, supervise, supervise. Children and teens with FASD need supervision at
home, at school, during free time, and all the time.
Fetal Alcohol Spectrum Disorder
Tips to Teach about Ownership:
Life is full of change. For children and teens, adults control many of the
changes. Moving to a new home, starting school, changing classrooms
or teachers, changes in the family or moving to the next grade are
changes children often face. But for children and youth with FASD,
change can be very difficult to cope with. Along with the big changes,
they may really struggle with simple every day changes such as, stopping play to go eat. There are many ways you can help your child or
teen learn to cope with change.
FASD
Tip #9
Here we offer some ‘real life’ examples and tips...
Example #1
At school a child with FASD is working on his math. The teacher tells
all her students to stop and get ready to go to gym class. The girl with
FASD starts shouting that she’s not done with her math!
What is happening
It is hard for this child to get into her math work and then have to
leave. Changing from one activity to another is harder for her
than for most children. It would help if the teacher would give
her advance notice before a change in class needs to be made.
Example #2
A teenaged girl with FASD is being given a ride to a friend’s home. On
the way she asks, over and over again, which streets they will be going
down and at which corners they will turn.
What is happening
She wants to make sure she’ll get home. She’s nervous about not
having control of getting there and she believes there is one
‘right’ way to get to her house.
Example #3
Fetal Alcohol Spectrum Disorder
Making Changes with Children and Youth
with FASD
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
One day a child with FASD gets to school late. She is really upset about 1-866-673-3276
In Saskatoon call: 975-0884
being late. But instead of going into her classroom, she stands just inE-mail:
side the door and she can’t move.
[email protected]
Website:
What is happening
Being late has changed her routine. She doesn’t know what to do www.skfasnetwork.ca
so she does nothing. She is a concrete thinker. It is hard for her
Please feel free to photocopy
to problem solve about what she should do next. If she usually
hangs her coat up at 8:50, and it is now 9:05, what should she do? and use these sheets.
1.
Create routines so your child knows what comes next in the day. Try hard to stick to the
same routines. This way no matter how much change is in their life, their home life will
be secure. Structure helps ease stress.
2.
For young children, it is helpful to have a board with pictures that show the daily
routine. (Many preschools and daycares have picture boards.)
3.
Tell your child ahead of time if the routine has to change. Some children may need a
full day’s notice of change, and others may do best with just a few minutes warning.
4.
Sometimes plans change. Talk with your child or teen about what might happen if the
plan doesn’t go the way you hope. For example, “What will we do if our car isn’t fixed
by tomorrow?”
5.
Sometimes it makes sense to plan for problems. Talking about a plan B or C can teach
your child or teen about how decisions need to be flexible. For example, “Since our car
is always breaking down, do you think we should look into getting a bus pass?” Have a
‘plan B’ and maybe a ‘plan C’ too.
6.
Break changes into small steps. For example, “First you need to put away your toys.”
“Okay, now let’s go brush our teeth.” “Good, here are your pajamas.” A long list of
things to do is very confusing for children and teens with FASD
7.
Instructions need to be simple and clear. It helps to look each other in the eye.
8.
A countdown may be helpful for younger children. For example, “Play for five more
minutes and then it’s time for your bath. …three more minutes… Time to put the toys
away your bath is ready.”
9.
Using an egg timer may help your child or teen ‘see’ how much time is left for a certain
activity. For example, if you ask them to do homework for 15 minutes, they will hear
the bell when the time is up.
10.
When you can, let your child finish the thing they are working on. Some children really
like and need to take their time to finish things. They enjoy working on things at their
own pace and like to finish a project.
11.
Organize yourself for the morning. Have school clothes out and ready to wear. Have
backpacks packed and ready to go.
12.
Use photos of real people and places to help prepare a child for moves from one grade to
another or to a different school or home. For example, a ‘transition book’ can help get a
child ready for a move to the next grade. This book can have pictures of the child with
this year’s teacher and pictures of the child with next year’s teacher. The book can hold
pictures of the child’s new classroom, where he should put his boots, what door to come
in etc. This may make it easier for him to adapt to a big change in his life.
Fetal Alcohol Spectrum Disorder
Some Tips to help Your Child Deal with Change:
Many children love sports and want to join team sports and group activities.
But, for some children with FASD the demands of teamwork, following
instructions, improving skills quickly and competition leads to more stress
than fun. Here are some tips that can guide you in helping a child who is
really keen to take part in sports and activities.
FASD
Tip #10
First, some ‘real life’ examples...
Example #1
A child really wants to take swimming lessons. She’s like a fish in water and
loves swimming. But, the swimming teacher says that she can’t move to the
next level because she didn’t master all the skills she was supposed to. She is
really upset by this.
What is happening
This child is gaining some new skills in the class. Regular lessons
are quite rigid about what needs to be learned in a set amount of time.
This can be frustrating for the child because she wants to do well and
move up to the next level.
What to do
As a child moves up the levels in swimming, the skill level becomes
more difficult. Many children need to repeat levels. If this child d
doesn’t want to repeat a level until she gains the needed skills, many
communities offer one-on-one lessons for children with special needs.
The YMCA or YWCA would be able to help you find out more about
lessons in your area. Some small towns will offer one class just for
children with special needs.
Fetal Alcohol Spectrum Disorder
Tips to help your Child or Teen with FASD
Take part in Sports and Activities
Developed by:
Example #2
A 12 year-old boy wants to join a school soccer team because his best friend
is on the team. You are nervous because the last time he tried a team sport
the coach complained that he didn’t follow directions well and he wasn’t
focused enough.
What to do
Should he get another chance, but what if he fails again? This boy is
coping in the best way he can and he just wants to do what other kids
can.
His coach needs to watch him carefully and get to know his strengths.
A parent or caregiver can talk to the coach to explain how FASD
limits what he can do but also talk about what strengths he has that
could help a team. The parent may want to explain how important
emotionally is to this boy to play on the team. The coach wouldn’t
know this without some background information.
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
1.
Don’t be shy to talk to your child’s coaches or teachers about the things that are hard for
your child. Coaches and teachers care about children and want your child to have a
good season on the team. If you share information about your child with the coach or
teacher, they will know more about how to help your child succeed.
2.
Share some information about FASD with the group leader or coach. They need to
understand why your child needs longer to do things or has some trouble following
directions.
3.
If your child has a close friend, try to have them join a group together. It will help your
child to go with someone she or he knows.
4.
Your child’s friends and team mates can be a support to your child and can help him
make good choices.
5.
Help your child to choose activities that she enjoys and has fun doing. This gives her a
chance to be successful.
6.
Supervise, supervise, supervise. Go to your child’s team practices and games.
7.
Be there and help her by explaining things. Watch for inappropriate behaviour and help
her if she misunderstands something.
8.
Practice with your child to help him learn the new skills.
9.
Ask your child to tell you all about his or her activities. Ask many questions about the
coach and the other players. Listen for things that are challenging for him and also things
that he is doing well.
10.
Cheer her on because she’s an awesome child.
Fetal Alcohol Spectrum Disorder
Tips on how to have Fun with Sports and Activities:
Being a parent or caregiver can be a great experience, but it is also
tiring and challenging. Families with children with FASD are often
under a great deal of stress. Others don’t always understand the issues
they face everyday. This can make one feel alone and overwhelmed.
You and your family need you to take care of yourself. If you are
stressed and tired you won’t be able to see clearly or give your kids all
that they need. And, stressful times seem even worse when you are
exhausted. Here are some tips on how you can take time to care for
yourself.
FASD
Tip #11
First, some ‘real life’ examples...
Example #1
Your son’s teacher tells you that he’s doing fine, but you know that he
has a ‘meltdown’ most days when he gets home from school. You
dread the time between school and supper.
What is happening
Your son is probably trying really hard at school. He’s putting so
much effort into his work that he’s exhausted. He knows that
home is safe place and he can relax. He does this by letting his
feelings loose and letting go of feelings that have been building
up all day.
What to do
You can help your son develop some good relaxation habits.
Listening to his favorite music with the headphones on or quietly
watching a favorite movie can help him unwind. Maybe some
quiet time in his room is what he needs to help him calm down
or a bike ride will help him relax after school. Find out what
works for your son and encourage him to relax in a positive way.
Example #2
Your family has been invited to spend Christmas Day with your partner’s parents. You know your children will be uncomfortable there and
out of their routine. But, you don’t want to upset your in-laws. You lie
awake at night worrying about how you can keep everyone happy.
What to do
You know from experience that your children need structure and
routine but your in-laws don’t understand this. Share information
about FASD and how it relates to your child. Ask them to come
to your home for Christmas. Or go to their home for a short visitmaybe for breakfast and then spend the rest of your day at home.
Fetal Alcohol Spectrum Disorder
How to Care for the Caregiver of Children
and Youth with FASD
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
1.
All parents have dreams for their kids. It may be hard for parents of children with
FASD to deal with disappointment or guilt. A counselor, religious leader or Elder may
be able to help you.
2.
Think about what helps you to relax and make a real effort to do it every day or at least
every week. Have coffee with a friend, take a long bath with the bathroom door locked,
call a parent you like, go out with your partner, go to a support group, hire a babysitter
or share and swap childcare.
3.
Find someone to talk to who understand what it’s like living with children with FASD.
This could be a family member who is close to you, or another parent of a child with
FASD. If you don’t know any other parents, call the FASD Support Network of SK
(our number is 1-866-673-3276 or 975-0884). We’ll connect you with another parent.
It is amazing how many experiences parents share.
4.
Sometimes, the only place your children can truly ‘shine’ is in your own home. Let
them be at home a lot and don’t feel badly about celebrating holidays and birthdays at
home where your children feel safe and comfortable.
5.
Many children with FASD become very stressed when a family leaves home to go on
holidays. It can be hard for them to leave a familiar area and routine or stay in a strange
hotel room. It will be good for everyone if your children can stay in their
routine.
6.
Give your relatives some information to read about FASD. Or, have them call us at
the FASD Support Network Saskatchewan .
7.
Arrange for a break for you and /or your partner. Hire a mature babysitter who under
stands your child and train them about FASD and the importance of routine.
8.
Take time to laugh. Rent a funny movie. Think about the funny side of some of the
things your kids do.
9.
Rest, relax, exercise, walk and try to look at the big picture. You are doing the very
best job you can.
10.
Think about all the things that you love about your children and all the things you
admire.
11.
Phone the FASD Network and get involved. Other parents need support and you may
be the perfect person to support them. Another parent may be able to help you too.
12.
Educate yourself. Knowledge is empowering.
Fetal Alcohol Spectrum Disorder
Some Tips on How to Care for Yourself:
This FASD Tip was written for parents to give to a group leader, coach or
community member. The tips will help those in the community understand
the behaviours and needs of a child or teen with an FASD.
Being a part of a community group is good for children and teens. Children
and teens with FASD may have trouble joining in community activities like
Brownies, Cubs, 4-H and community sports teams. It is important for group
leaders and their helpers to understand and support a child with FASD. This
will help the child or teen be successful, make friends, and enjoy the activities
in their community.
FASD
Tip #12
Here are some ‘real life’ examples of what might happen...
Example #1
The group meets in the school gym at 7pm. The children can play with the
skipping ropes and basketballs until the meeting is ready to start. One child
cannot settle down when the leader asks that the balls and ropes be put away.
She runs out of control and hits the other children with the rope. This upsets
everyone in the group.
What is happening
This child is over-excited. The noise, bright lights and the confusion
of all the children playing are hard for her to cope with.
What you can do
Understand what is happening and help the child before there is a problem. Organize a quiet activity for all the children as they arrive. This
will help the child with FASD to keep from getting over-excited. Or,
arrange for the child to arrive right at 7pm or a few minutes late so the
pre-meeting activity will not get her over-excited.
Example #2
You are Ryan’s soccer coach. For the past 3 weeks, the teens have been learning a new skill. Ryan learns it well each week, but at the next practice, he has
forgotten what he learned. Ryan doesn’t want his team to know that he’s
forgotten, so he fools around and it looks like he’s not trying. The other teens
are annoyed at him and don’t want him on the team anymore.
What’s happening
Many children with FASD need to be taught a new skill many times before it is mastered. Ryan wants to be part of the team and do well. But,
FASD causes poor memory and he really has forgotten what he knew
last week. Ryan wants to be liked so he acts silly to hide his poor
memory.
What you can do
Be patient and give Ryan lots of time to learn a new skill. Maybe he can
practice the new skill at home or before the other children arrive for
practice. Maybe Ryan could have success if he is allowed to be a supporting player rather than a key player. Community groups help all
children learn teamwork and gain confidence.
Fetal Alcohol Spectrum Disorder
How to Help Children and Teens Succeed in
Community Groups
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK
S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
My child has Fetal Alcohol Spectrum Disorder (FASD) and I would like you to know some
things about this disability. FASD is a permanent, lifelong brain injury. However, with
support, encouragement, and understanding, people with FASD can have many successes.
People with FASD:





Usually have an average IQ, are friendly and outgoing, and want to do what everyone
else is doing.
Have some special skills – some are very athletic, some artistic, some have a great sense
of humour.
May have developmental delays, behavioural problems, or learning difficulties. These
are often invisible and misunderstood.
Can experience failure and miss the opportunity to enjoy activities with their peers due
to their disability.
Friendship and community support is important to all children and youth.
Here are some things that might help:
When __________________________feels stressed, you may see him/her____________
(child’s name)
_______________________________________________________________________.
What I do when this happens is ___________________________________________
_______________________________________________________________________.
Sometimes___________________________ will________________________________
This is because __________________________________________________________.
What I find works best is ___________________________________________________
_______________________________________________________________________.
If you have any questions or concerns please call me at ___________________________
______________________________________________________________________.
For more information about FASD call the FASD Support Network of Saskatchewan at
1-866-673 –3276 or visit the website at www.skfasnetwork.ca.
Fetal Alcohol Spectrum Disorder
Things I would like You to know about FASD
Understanding time is hard for people with Fetal Alcohol Spectrum Disorder.
Time is an abstract idea. There is the telling of time, like reading a watch or a
clock on the wall and the passage of time, such as playing for 30 minutes
while waiting for supper. There is also being on time, being early or late!
Time involves numbers and numbers can be very confusing. People with
FASD learn best when they can touch and see things – time cannot be
touched or seen.
FASD
Tip #13
Here are some ‘real life’ examples and tips...
Example #1
A parent tells a child that he may go bike riding after lunch. The child really
wants to ride his bike, so he makes a peanut butter sandwich, eats it for lunch,
and is out riding his bike by 9:30am.
What is happening
The parent gave clear and simple directions for when the child could
ride his bike. The child knew he could not go riding until after lunch.
He made lunch, ate it and left. The parent used the word ‘lunchtime’ to
mean the child could ride his bike in the afternoon, after 12. The child
understood he needed to eat his lunch before he could ride his bike!
What you can do
If your child can tell time, say “You can ride your bike at 1 o’clock”
instead of after lunch. Many watches have simple alarms that can be
set to ring to notify a child when they can do an activity.
Fetal Alcohol Spectrum Disorder
How to Help a Child or Teen Understand
Time
Example #2
Your child asks you over and over again when an event is going to happen.
“When is Barney on?” “When is it supper time?” “When is Daddy coming
home?” are just some examples. You are going crazy because he asks the
same questions twenty times a day!
What is happening
A child with FASD has no internal clock. Passing time, 10 minutes or
1 hour both feel the same to him. He looks at the clock on the microwave and it says 8:00. He does not know if it means 8:00 in the morning or 8:00 in the evening. He needs help keeping his day organized.
Many children with FASD get thoughts stuck in their heads, (this is
called perseveration). This causes them to ask the same question over
and over again.
What you can do
A digital clock is much easier for a child to understand than a clock
with hands. Be very consistent with how you say the time to your
child. We understand that 2:45, fifteen minutes to one and quarter to
one all means the same time. A child with FASD may think you are
giving him 3 different times.
Developed by:
FASD Support Network
Of Saskatchewan
510 Cynthia Street
Saskatoon, SK S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy and
use these sheets.
1.
Establish routines that will help to develop habits. The habits will serve in place of the
inner clock.
2.
Use an egg timer for activities like showering and brushing teeth. Teach your child
how to set the timer.
3.
Use an egg timer or the timer on the oven to remind the child when it is time to pick
up toys or go to bed.
4.
Write down what time the child is to leave for school. Tape this paper under the
digital clock on the microwave. Tell your child, “When the numbers match it’s time
to leave for school.”
5.
Compare the passing of time to something the child might understand. “We will be at
Grandma’s house in the time it takes to watch Rugrats.”
6.
Use the radio or TV to help the child understand when it’s time to do something. “It’s
time to go when The Magic School Bus is over.” “We will clean up for one more
song.”
7.
Link the time of day to an activity such as brushing teeth before bed or washing the
dishes after breakfast. This will help the child develop good lifelong habits.
8.
FASD causes faulty memory. Teach your child to write down appointments and
events in an agenda or day timer and to refer to it often during the day.
9.
Be your child’s ‘external brain’. They need your help to understand what they need to
do and when they need to do it.
Fetal Alcohol Spectrum Disorder
Some Tips to Help your Child Understand Time:
Children with Fetal Alcohol Spectrum Disorder often have a hard time
without structure in their lives. When we structure our day, we arrange our
busy lives into an order that makes sense to us. Some people get up early and
go to bed early. Some people get up late and go to bed late at night. We like
to do what works well and helps us in our day-to-day tasks.
FASD
Tip #14
A child with FASD needs structure to help with all their daily activities. The
use of reminders is helpful in giving structure to our daily lives. These
reminders can be like having an ‘external brain’. An external brain can be
very helpful. Things like day planners, wall charts, timers, verbal reminders
and school agendas all help us to make sense of our day.
Here are some ‘real life’ examples of how to use structure in your home...
Example #1
A child with FASD is playing in the yard. Her father calls out that it is time
to go to the doctor. The child has been told many times that they will visit
the doctor today. The child becomes upset and does not want to go. She refuses to leave the back yard.
What is happening
The child has trouble remembering she has an appointment and gets
upset because she does not want to leave the fun she is having in the
yard. She may not have understood the words that were used to tell her
of the appointment. The child with FASD often does not understand
the days of the week or the structure of the day without external reminders. She does not understand that most appointments need to be
booked ahead for a set time during the day.
Fetal Alcohol Spectrum Disorder
How You can use Structure to Help
Children with FASD
Developed by:
How you can help
When your child gets up in the morning, use both a verbal and visual
cue to remind her about the appointment. Help her understand what
time the appointment is. Use words she understands such as after
breakfast, before morning recess, or after her favourite TV show. Remind her several times. Write it in her school agenda or on the back of
her hand. If you use a visual calendar, write it down so she can see
when the appointment will be in her day.
Example #2
A child with FASD always wants to eat and asks over and over again when
the next meal is. Mom has said that lunch in not for another hour, yet the
child keeps asking for food.
How you can help
Use visual reminders for meal times. If a meal has just ended, show the
child on a chart when the next meal is. Teach your child that we eat
meals at set times. You may have to watch how much food your child
eats.
FASD Support Network
Of Saskatchewan
510 Cynthia Street
Saskatoon, SK S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
1.
Meals can be a simple way of having some structure in daily life. Plan meals for the
same time everyday. For example mealtimes could be 7 a.m. breakfast, 10 a.m.
snack, 12 p.m. lunch.
Having this structure can cut down on the child’s stress about eating. The child could
also learn to see structure in their day by using meal times as markers. You can
explain that an activity is happening “before lunch” or “after supper”.
2.
A weekly calendar that has pictures can help children with FASD understand the
days of the week. It is helpful to split the day into 3 parts: morning, afternoon, and
evening. You can place a picture of an event on the day it will happen.
For example a picture of a church on Sunday morning or a picture of a child in their
Brownie uniform on Monday evening. This will help the child remember activities.
3.
Keep the same activity patterns every day. Children with FASD thrive on routine and
structure. School gives structure to the day. Staying up really late on weekends or
holidays can make your child feel out of sorts. This can lead to poor choices and
behaviours that are upsetting for the whole family.
4.
When your child keeps asking about an activity, have him check the calendar and
then tell you what activity is on the calendar. Every time he asks have him check the
calendar. It can be his job to check the calendar and let you know what his schedule
is. This teaches him to use the calendar as an “external brain”.
5.
Family activities can be colour coded. All activities for Jamie are blue and all
activities for Anna are in red. Mom’s activities in green and Dad’s in orange.
6.
When changing from one activity to another, children with FASD need time to
adjust. Warn your child about a change in plans.
7.
Helping your child use structure in her day will lead to a better understanding of the
passage of time, the days of the week, the weeks in the year and even the seasons of
the year.
Fetal Alcohol Spectrum Disorder
Tips on How to use Structure in Your Home:
Summer camp, whether it is a day camp, or a sleep away camp, can be fun
and exciting. Camp can be a great way for children to explore the world.
However, children with FASD have trouble in the less structured setting of
camp. Children may find it hard to get used to not being in their own home
with routines they are used to. Meeting so many new children and adults is
stressful to a child with FASD. All these stresses may cause the child to
behave in ways we find difficult to understand. Some children act aggressively. Some may be in your face, invading your space. Some children ask
questions and talk non-stop. Other children may shut down because they feel
so overwhelmed by everything.
FASD
Tip #16
Unsupervised free time may be a problem. The excitement and high energy
of the activities can also be difficult. This does not mean that children with
FASD can’t enjoy camp. It means that they need extra support and
understanding to have a good time at camp.
Here are some ‘real life’ examples and some tips about camp...
Example #1
A camper wants to be helpful. She gets up very early and vacuums the cabin
while others are sleeping and the counselor is at a staff meeting.
What is happening
The child wants to be liked and believes that by doing extra chores
the kids in her group will like her more. She knows it makes her mom
happy when she vacuums at home. She does not grasp that waking up
her cabin mates very early will annoy them.
Fetal Alcohol Spectrum Disorder
How You can Help Create Success at Camp
How you can help
An unsupervised child usually means trouble! Make sure there is
always someone in charge in the cabin. FASD causes a child to be
impulsive and make poor choices. A child with FASD tends to ‘live
in the moment’ and not see how her actions can upset others.
Example #2
A camper is sitting alone on a bench while other campers are having fun
making tie dyed t-shirts. He is just sitting there and it looks like he doesn’t
want to be with the other campers. Some of the other children think he is mad
at them or doesn’t like them anymore.
What is happening
The child with FASD often misses all or part of the instructions. He
may not know where he is supposed to be or what he is supposed to be
doing. The more he sees the others having fun, the more frustrated he
gets with himself. He really wants to join in but is too confused to
know what to do.
How you can help
Ask staff to be clear in their words and use actions to show how to
complete the steps of an activity.
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy and
use these sheets.
1.
Pick a camp with as much structure as possible. Call the camps in your area to ask
questions about their programs. Ask about what kinds of structures and routines they
have.
2.
Tell the Camp Director that your child has FASD and explain what this means to your
child. Offer to answer all their questions and send them more information about
FASD. Let them know they can contact the FASD Support Network of SK so the camp
staff learn about FASD and can make plans and be prepared.
3.
Supervision, supervision, supervision. Supervision at all times even ‘free’ time. Rules
and supervision keep everyone safe. Supervision will help the child to follow the rules.
4.
Camp staff or counselors should meet the child and have plans ready to put into place
as soon as the child arrives at camp.
5.
A ‘buddy’ system with an older camper or a junior counselor could be set up to give the
child with FASD some extra help and a feeling of security.
6.
Verbal instructions must be short and simple. Be precise and concrete. Clearly tell the
child what to do, rather than what not to do.
7.
Be consistent and clear with rules. Rules should be as few as possible, but safety for
everyone is important so there will need to be some rules.
8.
Be ready to repeat and demonstrate instructions as many times as needed. Instructions
may be needed each time an activity is presented as learning can take longer for
children with FASD.
9.
Consequences for poor choices need to be immediate and short-term. Children with
FASD have a poor understanding of cause and effect.
10.
Enjoy the creativity of children with FASD. They may excel in some areas such as
crafts and drama.
11.
An excellent booklet for parents and camp staff is Your Victory: A Happy Child
Supportive Strategies for the Staff of Children’s Summer Camps. For information on
how to purchase, call the Network office.
Fetal Alcohol Spectrum Disorder
Some Tips for Success at Camp:
Fetal Alcohol Spectrum Disorder (FASD) is a term used to describe the range
of disabilities that can occur in a person whose mother drank alcohol while
pregnant. Some women do not know that alcohol can injure their unborn
baby; others may not be able to stop using alcohol. Other women stop drinking when they find out they are pregnant but some injury may already have
happened. There is no safe amount or safe time to use alcohol during pregnancy. In Saskatchewan, one in 100 people may be affected by prenatal alcohol use. (SK Prevention Institute 2005). Women need to be supported and
encouraged to avoid alcohol use during pregnancy and breastfeeding.
Individuals affected by alcohol exposure before they were born are unique
and will have different amounts of brain injury and disability. The disabilities
caused by alcohol exposure are present from birth and can include
physical, learning and behavioural difficulties. Possible diagnoses for those
affected by FASD are: Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol
Syndrome (pFAS), or Alcohol Related Neurodevelopmental Disorder
(ARND).
FASD is often called an invisible disability. The signs and symptoms of
FASD may go unnoticed or be masked by other things in the individual’s life.
Most people with FASD look just the same as everyone else, but they have
some differences in how their brain works and that makes life difficult for
them. Most individuals with invisible disabilities do not get the support they
need to succeed in life. Many people with FASD are very smart. Even though
FASD is a lifelong disability, with the right changes to the
environment, individuals can be productive and successful members of our
communities. They can make friends, get jobs and reach the goals they set.
FASD
Tip #20
Fetal Alcohol Spectrum Disorder
Understanding Fetal Alcohol Spectrum
Disorder (FASD)
Signs and Symptoms of FASD
A child or adult with a Fetal Alcohol Spectrum Disorder may:












Have memory problems (especially short term memory)
Have difficulty with math, telling time and managing money
Be very impulsive
Act younger than her or his age
Have poor judgement and poor decision making skills
Be depressed
Be hyperactive
Have sensory problems like how they react to temperature, sounds,
bright lights or busy places
Be slow processing information and need more time to learn things
Have trouble with social skills, knowing/using boundaries and
maintaining friendships
Be a concrete thinker; learns best by doing
THERE IS HOPE AND
THERE IS HELP.
CONTACT THE NETWORK FOR INFORMATION AND SUPPORT.
Developed by:
FASD Support Network
of Saskatchewan
510 Cynthia Street
Saskatoon, SK S7L 7K7
Phone for free:
1-866-673-3276
In Saskatoon call: 975-0884
E-mail:
[email protected]
Website:
www.skfasnetwork.ca
Please feel free to photocopy
and use these sheets.
8 Magic Keys
1. Concrete – Individuals with FASD do well when people talk in concrete terms; do not use
words with double meanings, or idioms. Because their social-emotional understanding is far
below their chronological age, it helps to “think younger” when providing assistance and
giving instructions.
2. Consistency – Because of the difficulty individuals with FASD experience trying to
generalize learning from one situation to another, they do best in an environment with few
changes. This includes language. For example, teachers and parents can coordinate with each
other to use the same words for key phrases and oral directions.
3. Repetition – Individuals with FASD have chronic short-term memory problems; they forget
things they want to remember as well as information that has been learned and retained for a
period of time. In order for something to make it to long-term memory, it may simply need to
be re-taught and re-taught.
4. Routine – Stable routines that don’t change from day to day will make it easier for individuals with FASD to know what to expect next and decrease their anxiety, enabling them to learn.
5. Simplicity – Remember to Keep It Short and Sweet (KISS method). Individuals with FASD
are easily over-stimulated, leading to “shutdown” at which point no more information can be
assimilated. Therefore, a simple environment is the foundation for an effective school program.
6. Specific – Say exactly what you mean. Remember that individuals with FASD have difficulty
with abstractions, generalization, and not being able to “fill in the blanks” when given a
direction. Tell them step by step what to do, developing appropriate habit patterns.
7. Structure – Structure is the “glue” that makes the world make sense for an individual with
FASD. If this glue is taken away, the walls fall down! An individual with an FASD achieves
and is successful because their world provides the appropriate structure as permanent
foundation.
8. Supervision – Because of their cognitive challenges, individuals with FASD bring a naiveté
to daily life situations. They need constant supervision, as with much younger children, to
develop habit patterns of appropriate behaviour.
Not Working?
When a situation with an individual with FASD is confusing and the intervention is not working, then:
Stop Action!
Observe.
Listen carefully to find out where he or she is stuck.
Ask: What is hard? What would help?
Reprinted with Permission. Evensen, D. & Lutke, J. (1997). 8 Magic Keys. Adapted version, (2005)
Minnesota Organization on Fetal Alcohol Syndrome.
Fetal Alcohol Spectrum Disorder
While there is no recommended “cookbook approach” to working with individuals with FASD there
are strategies that work, based on the following guidelines:
Action 1
8
Chronological age-appropriate
expectations
Developmental age-appropriate
expectations
Age 5
Be in school all day
Follow three instructions
Sit still for 20 minutes
Participate in interactive and
cooperative play
Take turns and share
Age 5 going on 2 developmentally
Take naps during day
Follow one instruction
Active, sit still for 5–10 minutes
Parallel play
“My way or no way” attitude
Age 6
Listen, pay attention for 30–60 minutes
Read and write
Line up on their own
Wait their turn
Remember events and requests
Age 6 going on 3 developmentally
Pay attention for about 10 minutes
Scribble
Need to be shown and reminded
Don’t wait gracefully, act impulsively
Require reminders about tasks
Age 10
Read books without pictures
Learn from worksheets
Answer abstract questions
Structure their own play at recess
Get along and solve problems
Learn inferentially
Know right from wrong
Have physical stamina
Age 10 going on 6 developmentally
Beginning to read, with pictures
Learn experientially
Mirror and echo words, behaviours
Require supervised play, structured play
Learn from modelled problem solving
Learn by doing, experiential
Developing sense of fairness
Easily fatigued by mental work
Age 13
Act responsibly
Organize themselves, plan ahead, follow
through
Meet deadlines after being told once
Initiate, follow through
Have appropriate social boundaries
Understand body space
Establish and maintain friendships
Age 13 going on 8 developmentally
Need reminding
Need visual cues, modelling
Comply with simple expectations
Need prompting
Kinesthetic, tactile, lots of touching
In your space
Forming early friendships
Age 18
On the verge of independence
Maintain a job and graduate from school
Have a plan for their lives
Form relationships, safe sexual behaviour
Budget their money
Organize, accomplish tasks at home,
school, job
Age 18 going on 10 developmentally
Need structure and guidance
Limited choices of activities
Live in the “now,” little projection into the
future
Easily led, impulsive and sometimes
inappropriate sexual behaviour
Need an allowance
Need to be organized by adults, limited
self-management
re: defining success
Is it that the child won't?
or
Is it that the child can't?
by Diane Malbin
Beliefs dictate behaviors. The belief that many primary learning and behavioral characteristics which may
reflect the underlying neuropathology associated with FAS/FAE are the result of willful, volitional or
intentional behaviors often leads to punishment of these symptoms. Inadvertently, this may in turn result in
the development of an array of secondary defensive behaviors. The chronic lack of a good 'fit' between the
needs of those with FAS/FAE and their environments may lead to tertiary characteristics of school failure,
mental health problems, running away, or trouble with the law. These are all believed to be preventable.
The key to prevention is linking the idea of brain dysfunction with presenting behaviors, reframing
perceptions, and moving from punishment to support. The shift is from seeing a child as one who "won't"
do something to one who possibly "can't".
Primary Characteristics:
Neuropathology
Standard Interpretation:
May Lead to Punishment
Secondary Defenses
or Characteristics
Memory problems
Could remember if they he/she
tried
Fear, self protection
Inconsistent performance
Not trying on "off" days
Anxiety
Forgetful
Willful
Frustration
Poor short term (auditory)
memory
Not listening, paying attention
Anger, avoidance
Remembers some things, not
others
Seen as lazy
Confusion, depression
"Gaps": Talks the talk, doesn't
Walk the walk: disconnections
Willfully disobedient
More defensiveness
Can't link words with feelings
Seen as uncaring
Shut down, confusion
Forgets words, ideas
Doesn't try, could do it
FRUSTRATION!!!!
Decodes, doesn't comprehend
Manipulative
Inferiority, fear, masking
Difficulty forming associations
Does it 'on purpose'
Internalizes negatives
Doesn't see similarities
differences
"Should" know better!
Isolated, fearful
May not generalize or apply
rules in new settings
"Trying to make me mad"
Masks mistakes, lies
Difficulty with abstractions:
money, math, time
Has to know times tables!
Avoids homework
Poor planning, sequencing
initiating, following through
Punished for not doing tasks
Feels blindsided, may not
understand
Difficulty understanding danger
Psychopathology
May shut down
Impulsive, suggestible
Daredevil, sociopath
Behaves accordingly
Can't see consequences
No conscience, punished
Blames others
Fatigue
Passive resistive
Irritability to rage
Long response time
Trying to be controlling
Gives up or acts out
Acts young for age
Too dependent, irresponsible
Overwhelmed
Socially "inappropriate"
Poor values, insensitive
Gravitates to "comfort" friends
Perseverative
Controlling, wants own way
Rigid, resistive
Oversensitive
Hypochondriac
Discomfort, distress, whiny
No response, flat affect
Doesn't care
Lacks language to communicate
clearly
Prenatal Alcohol Exposure and the Brain
© 2000-2010 Teresa Kellerman
Alcohol is a "teratogen" - an environmental substance that can
harm the developing baby. Damage can occur in various
regions of the brain. The areas that might be affected by alcohol
exposure depend on which areas are developing at the time the
alcohol is consumed. Since the brain and the central nervous
system are developing throughout the entire pregnancy, the baby's
brain is always vulnerable to damage from alcohol exposure.
Not all damage from alcohol exposure is seen on brain scans, as
lesions are sometimes too small to be detected with current
technology, yet large enough to cause significant disabilities.
The brain is the organ most sensitive to prenatal alcohol
damage. [Dr. Edward P. Riley lecture, September 25, 2002]
Brain of baby with
no alcohol exposure
Brain of baby with heavy
prenatal alcohol exposure
(Photo courtesy of Sterling Clarren, MD)
Alcohol Exposure During Stages of Pregnancy:
1.
During the first trimester, as shown by the research of Drs. Clarren and Streissguth, alcohol interferes with the migration
and organization of brain cells. [Journal of Pediatrics, 92(1):64-67]
2.
Heavy drinking during the second trimester, particularly from the 10th to 20th week after conception, seems to cause more
clinical features of FAS than at other times during pregnancy, according to a study in England. [Early-HumanDevelopment; 1983 Jul Vol. 8(2) 99-111]
3.
During the third trimester, according to Dr. Claire D. Coles, the hippocampus is greatly affected, which leads to problems
with encoding visual and auditory information (reading and math). [Neurotoxicology And Teratology, 13:357-367, 1991]
The regions of the brain affected by prenatal alcohol exposure include:
Frontal Lobes – this area controls impulses and judgment. The most
noteworthy damage to the brain probably occurs in the prefrontal cortex, which
controls what are called the Executive Functions.
Corpus Callosum - passes information from the left brain (rules, logic) to the
right brain (impulses, feelings) and vice versa; related to attention deficits,
psychosocial function, and verbal learning.
Basal Ganglia – involved in cognitive function; affects spatial memory and
behaviors like perseveration and the inability to switch modes, work toward
goals, and predict behavioral outcomes, and the perception of time.
Hypothalamus - controls appetite, emotions, temperature, and pain sensation
Amygdala – central part of emotional circuitry, senses danger, fear and anxiety; plays major role in recognizing faces and
facial expressions, social behavior, aggression, and emotional memory; critical for stimulus-reinforcement association learning.
Hippocampus - plays a fundamental role in spatial and verbal memory retrieval; damage can cause chronic stress, anxiety, and
depression; dysfunction is related to symptoms of schizophrenia.
Cerebellum – controls balance, coordination and movement; impacts learning and cognitive skills.
The hypothalamus, amygdala, and hippocampus are part of the limbic system, which regulates emotions, social and sexual
behavior, the “fight or flight” response, and empathy, all areas of concern for individuals with prenatal alcohol exposure.
The term Fetal Alcohol Spectrum Disorders (FASD) includes Fetal Alcohol Syndrome (FAS) and Alcohol Related
Neurodevelopmental Disorder (ARND). Individuals with FASD often have symptoms or behavior issues that are a direct result
of damage to the prefrontal cortex, which is the part of the brain that controls “executive functions.”
Executive Functions
Executive functions of
the prefrontal cortex:
•
•
•
•
•
•
•
•
•
•
•
•
•
inhibition
problem solving
sexual urges
planning
time perception
internal ordering
working memory
self-monitoring
verbal self-regulation
empathy
regulation of emotion
motivation
judgment
Effects of alcohol exposure on behaviors
related to executive functions:
•
•
•
•
•
•
•
•
•
•
•
•
•
socially inappropriate behavior, as if inebriated
inability to figure out solutions spontaneously
inability to control sexual impulse, esp. in social situations
inability to apply consequences from past actions
difficulty with abstract concepts of time and money
like files out of order, difficulty processing information
problems with storing and retrieving information
needs frequent cues, requires “policing” by others
needs to talk to self out loud, needs feedback
diminished sense of remorse, inability to understand others
moody “roller coaster” emotions, may withdraw or lash out
needs external motivators to carry out menial tasks
inability to weigh pros and cons when making decisions
Children do not need to have full Fetal Alcohol Syndrome (FAS) to have significant difficulties due to prenatal exposure
to alcohol. According to research done by Drs. Joanne L. Gusella and P.A. Fried, even light drinking (average one-quarter
ounce of absolute alcohol daily) can have adverse affects on the child's verbal language and comprehension skills.
[Neurobehavioral Toxicology and Teratology, Vol. 6:13-17, 1984] Drs. Mattson and Riley in San Diego have conducted
research on the neurology of prenatal exposure to alcohol. Their studies show that children of mothers who drank but who do
not have a diagnosis of FAS have many of the same neurological abnormalities as children who have been diagnosed with full
FAS. [Neurotoxicology and Teratology, Vol. 16(3):283-289, 1994]
Damage to the brain from alcohol exposure can have an adverse affect on behavior. Alcohol exposure appears to damage
some parts of the brain, while leaving other parts unaffected. Some children exposed to alcohol will have neurological
problems in just a few brain areas. Other exposed children may have problems in several brain areas. The brain dysfunction is
expressed in the form of inappropriate behaviors. Their behavior problems should be viewed with respect to neurological
dysfunction. Although psychological factors such as abuse and neglect can exacerbate behavior problems in FASD, we are
looking primarily at behavior that is organic in origin. To better understand FASD behavior issues, shift perspective from
thinking the child "won't" to "can't." (Diane Malbin, MSW, Trying Differently Rather Than Harder.)
Sometimes the person's behavior is misinterpreted as willful misconduct (Debra Evensen, www.fasalaska.com), but for the
most part, maintaining good behavior is outside of the child's control, especially in stressful or stimulating situations. Behavior
problems in children with FAS are often blamed on poor parenting skills. While good parenting skills are required, even
alcohol exposed children raised in stable, healthy homes can exhibit unruly behavior. The most difficult behaviors are seen in
children who were prenatally exposed to alcohol and who also suffer from Reactive Attachment Disorder.
Most children with FASD have some attachment issues, may display inappropriate sexual behaviors, show poor judgment,
have difficulty controlling their impulses, are emotionally immature, and need frequent reminders of rules. As a result, many
will require the protection of close supervision for the rest of their lives.
For more information on Fetal Alcohol Spectrum Disorders visit www.fascrc.com
For information on training and workshops on FASD issues visit www.fasstar.com
NOTES ON THE ORGANICITY OF FAS/FAE
AND SECONDARY SYMPTOMS WHICH MAY DEVELOP OVER TIME:
Sources: Morse, Rathbun, Malbin
"The one thing we can say about FAS/FAE is that no two are the same." (Randels) Because of the
wide variability of the nature of the impairment, degree of effect, their manifestation and presence
of confounding variables (secondary symptoms) there is no "cookbook" approach to working with
individuals who are effected. The following are a few general indicators of organicity and how they
may present themselves. They are organized loosely around the theoretical construct presented by
Dr. Barbara Morse.
MEMORY DEFICITS:
•
Difficulty translating from one modality to another (hearing into action, talking into action,
words onto emotions)
•
Slow cognitive pace: Time lag from input to understanding to action (trouble with seeing a
movie, taking notes)
•
Random reinforcement: Spotty learning, retention (need constant reminders, reteaching)
•
Inconsistent memory: Their own memory is unreliable for them.
•
("Aware that they're not doing something right, but can't figure out what it is" (Morse))
Learn on Monday, forget on Wednesday
•
Auditory processing, vision processing problems
ABSTRACTIONS IN GENERAL ARE DIFFICULT:
•
Math, arithmetic
•
Money
•
Time
•
Learn facts as isolated entities, may have difficulty mastering new skills and integrating
these with earlier learning
EXPRESSIVE LANGUAGE IS BETTER THAN RECEPTIVE LANGUAGE:
•
May have trouble retrieving accurate words from memory, rely on 'off the wall' comments
to attempt to communicate.
Recommend: Observe patterns, re-frame perception of problem. Depersonalize. Provide structure
rather than control, invite individual to participate in developing goals and structure. Articulate
goals, expectations and timelines; modify as appropriate. Provide simple, one step cues, check to
assure comprehension. Introduce information in as many modalities as possible. Modify the
environment as appropriate, either increasing or reducing stimuli.
DIFFICULTY GENERALIZING:
•
Have difficulty forming links, ie., between behaviour and consequence, cause and effect.
•
Poor predictive skills: Prediction is based on ability to reflect, integrate, relate events,
synthesize, compare and contrast, and project abstractly into the future.
•
Impulsivity: Impulse control is based on prediction.
•
Poor social skills; may miss nuances, meaning of social cues.
•
Limited in traditional problem solving skills, planning
•
May not make associations, ie between clothing and weather, etc.
•
May not generalize behaviours from day to day, ie, "Don't hit" then hits the next day, 'Don't
ride in the street', rides in other street.
Recommend: Observe. Depersonalize. Teach links. Walk through process of deduction and
prediction. Specifically teach social skills. Model appropriate behaviours, conflict resolution,
identification of feelings, concerns. Provide structure rather than control. Understand learning
curve, issues of organicity in planning teaching strategies.
DIFFICULTY SEEING SIMILARITIES AND DIFFERENCES:
•
Have difficulty filtering and prioritizing external stimuli
•
May be distractible
•
Hyperactivity/increased motion may reflect overstimulation
•
Have difficulty seeing patterns, sequencing and tracking
•
May have difficulty distinguishing fantasy from real life (especially where protective
mechanisms are in place.)
Recommend: Observe. Provide visual, multimodality cues. Simply articulate/demonstrate similarities
and differences. Provide concrete, life-skills related opportunities to explore similarities and
differences. Assure 90%, check for retention periodically.
PERSEVERATION:
•
May be related to slow cognitive pace, need for time and closure
•
May relate to resistance to change (to the relative unknown)
•
May relate to rigidity which reflects attempt to control and make sense of their environment
(If one can't anticipate, predict, change may be frightening.)
•
"Keep on keeping on", have difficulty initiating stopping of a behaviour, whether a project,
teasing, interrupting.
Recommend: Observe. Identify need, modify timelines as appropriate. Prepare for transitions:
Forewarn, anticipate, state, act.
SHUT DOWN:
•
Secondary characteristics
•
Cumulative effect of chronic frustration, global defense mechanism.
•
May have difficulty accessing, processing and relieving stress and frustration. Accurate
association of words and internal state may not be readily available; internal discomfort may
not be alleviated.
•
Affect may be flat, responses to painful stimuli may be blunted
•
Shut down may alternate with explosive episodes with little provocation
•
May appear as withdrawn, passive, resistant, lying, aggressive, otherwise defensive.
•
May resist school, act out among peers.
•
"Peer driven"; many behaviours at home may reflect rigidity and perseveration around
affilliative needs and behaviours intended to create or preserve peer relationships
•
Shut down, defiance/non-compliance appears common for adolescents where there is a
perceived threat to peer relationships; not uncommon for adolescents in general - the
degree to which behaviours occur and their resolution are reflective of organicity
Recommend: Observe. Reframe. Identify shut down cues, areas of chronic frustration. Identify
strengths, integrate into environment. Modify expectations to be congruent with actual level of
ability. Refer as appropriate for specific support for psycho- social issues related to FAS/FAE. ** Note
** Resolving secondary symptoms may pose a challenge. Since the organicity often impacts
individuals' ability to effectively use words to communicate distress, traditional psychotherapy may
be ineffective. Perseveration, rigidity, and learned behaviours which are developed as a function of
living in an alcoholic/dysfunctional home further dictate the need for realistic expectations for
timelines for resolution of these issues.
http://www.acbr.com/fas/i.htm
External Brain
©2003 Teresa Kellerman
Where did this term originate?
The idea of the alcohol affected person's need for an external forebrain was first voiced by Dr. Sterling
Clarren, one of the pioneers in the field of FASD research in Seattle, Washington. The term "external
brain" has been paraphrased and used by many presenters. The first time I heard it was during a
conference on FAS in 2000 by Susan Doctor (now Dr. Doctor, from Reno, Nevada). Susan Doctor shared
the wisdom she had gleaned from having Dr. Clarren as a mentor while pursuing her doctorate. Notes
from her presentation on Modifying the Environment can be found here and notes on her presentation
on Intervention can be found here. The Susan Doctor/Sterling Clarren quote I use often is "The person
with FAS will always need an external brain - key words are 'always' and 'external'."
What is the rationale behind the claim that the person with FAS or FAE will always need an external
brain?
The person who has impaired vision is given a seeing eye dog. The person with impaired hearing is given
an interpreter or a hearing aid. The person who has cerebral palsy or muscular dystrophy is given braces
or a wheelchair. These external devices are necessary for the person with physical impairments to be
able to function to maximum potential in life. The person with FAS or FAE - collectively called FASD or
Fetal Alcohol Spectrum Disorders - has a physical impairment in the area of the brain, especially the
forebrain or frontal lobes, which regulate the executive functions. Read about the forebrain here. See
the article about FASD and the Brain here.
We would never blame a person who is sight impaired if he were to bump into a table and knock over a
vase. We would never blame a person who is hearing impaired if she didn't follow instructions she could
not hear. We would never judge a person who could not walk for choosing not to participate in a foot
race. Instead we would advocate for these persons to receive the assistive devices needed for them to
participate in life in as normal a capacity as reasonably possible.
FAS and FAE are physical disabilities, brain damage from prenatal alcohol exposure.
The person with FAS or FAE has a physical disability (static encephalopathy) that precludes normal
function of an important part of their body, the brain. As the above linked article explains, there are
several parts of the brain that are affected, but the crucial area that causes the most significant
impairment is the front of the cerebral cortex, the frontal lobes. Sometimes the lesions in the brain are
large enough to be detected by a brain scan, as is the case in about 20% of individuals with full FAS. But
in 95% of cases of FAE, the damage to the brain is tiny and scattered and does not show up on brain
scans performed at this time. Perhaps in the future, technology will be refined enough to detect the
more subtle yet serious damage done by prenatal exposure to alcohol. Regardless of the inefficiency of
brain scans, there are ways to assess the degree of brain damage. According to Dr. Ed Riley, leading
researcher on FASD and the brain, the best way to determine which areas of the brain are affected and
to what degree is by having a good psychological evaluation done on the person.
Assessing the degree of disability is not difficult.
A good Psych eval would include an IQ test and an assessment of functional ability and adaptive
behaviors by an instrument like the Vineland Adaptive Behavior Scales. Read one parent's rationale for
requesting the school perform a Vineland for her son here. Read Dr. Robin LaDue's recommendations
for assessments for adults with FASD here. For affected infants from age of birth to 4, the recommended
assessment is the Bayley Scales of Infant Development. The IQ test that seems to give the most detailed
results in different areas of information processing is the Woodcock-Johnson. Because children and
adults with FASD typically have an IQ in the "normal" range, the brain dysfunction and developmental
deficits may not be apparent to professionals. But a detailed assessment (Woodcock-Johnson and
Vineland for example) will show specific areas where the child succeeds and where the child has
difficulties. The results can be charted to look like this Array of Abilities of a typical young man with FAS.
Interpreting test results may require professional guidance.
When the assessments have been done, the testing professional will share a written report and will
explain the results. It is most helpful to have the scores interpreted as age levels. We will often see an
individual with a "normal" IQ who has good expressive language skills and adequate information, but
who does not have the ability to communicate effectively, to use the information appropriately, or to
interpret his or her world in a manner that promotes safety and well being.
External brains come in many models.
Because the individual may appear to be bright and normal, the disability that is brain damage may only
be apparent in the test results, and of course in actions that place the person at serious risk. It is the risk
of danger to the person and to others that justifies the need for the "external brain." If you have not
figured it out yet, that external brain refers to the presence of another responsible person (parent,
teacher, job coach, sibling) who can mentor, assist, guide, supervise, and/or support the affected person
to maximize success (which may need to be redefined as the avoidance of addiction, arrest, unwanted
pregnancy, homelessness, or accidental death).
The risk to pursue independence without an external brain is not alway apparent, but is always
present.
There are many neurological effects caused by the alcohol induced brain damage: learning disabilities,
attention deficits, memory deficits, behavior problems, hyperactivity, lack of impulse control, and poor
judgment. It is my opinion, based on consultation with hundreds of families, that the most serious
difficulties in adulthood are based on these three effects:
•
Memory deficits
•
Lack of impulse control
•
Poor judgment
It is my further opinion that of these three, it is the poor judgment that gets the person in the most
serious trouble. For example, my son John may forget the rules and the consequences of breaking the
rules when he is interacting with others in a social situation. He just is plain not thinking. If he breaks a
social rule, such as hugging to close and too long, he will be able to remember the rule and explain the
consequences later, but will not always think of it at the moment. If he remembers the rule to not hug
women he doesn't know very well, he may just do it anyway, without much thought, as an act of
impulse, without really considering the seriousness of the possible consequences. Or he may remember
the rule, and stop and think about the consequences, and then do it anyway. I have seen this happen
several times. Usually when I was present and observing but he was not aware that I was observing, or
when I was not present as his external brain. Sometimes his memory works and sometimes it doesn't.
Sometimes he can control his impulses and sometimes he can't. His judgment is sometimes good and
sometimes not. Neither he nor I can predict when his memory, his impulse control, or his judgment will
be working adequately.
Because of the seriousness of the consequences of acting with poor judgment on sexual impulses, some
individuals with FASD will require close supervision at all times. Even "innocent" hugs can be interpreted
as sexual assault - I have letters from many parents of teens who have been incarcerated for such
impulsive acts. Some teens and adults will only require guidance and monitoring on a daily basis. But
experience tells us that the greater the freedom, the greater the risk of serious consequences. The risk
of arrest for inappropriate sexual behavior is so great, that to most parents it is not worth the risk of
giving "normal" freedom to teens and adults who cannot handle independence as society urges us to
give our growing children.
Other factors increase the risk of failure.
If we have a bright individual who appears to others to be normal, the risk of failure in an independent
setting is intensified because of unreasonable expectations of others that this normal, bright person
should be able to control his or her behavior and society wants to hold them accountable for their
actions, even if they cannot - CANNOT - control their social behaviors. If we have teens who have adult
hormones surging through their bodies and these adult-looking persons have the social skills of a child
and the impulse control of a first grader and the judgment of a toddler, then we can see more clearly
the risk and vulnerability. Even those who have learned to act like an adult may revert to a child when
making decisions that could affect their future, their safety, their life.
Choice of friends, sexual activity, use of alcohol and other drugs, potentially criminal behavior - these
are all risks inherent in the lives of individuals with FASD. With close guidance, they can be assisted in
thinking through a situation and might arrive at a wise decision. Without close guidance, they are likely
to end up in jail, an institution, on the streets, or in the morgue. No freedom there! Being realistic in
assessing their ability to handle pressures from peers, from society, from their own impulses, and being
realistic about the risks of erratic problem solving skills and poor judgment helps us accept their need
for that external brain. Our challenge is now to help THEM accept the need for an external brain.
Not all teens and adults with FASD need an external brain all the time for all decisions. And not all FASD
experts are comfortable with the term "external brain." One expert with extensive experience in the
clinical setting said that this term sounds like a reference to a brain on the outside of the head.
Ewwwwww! But that is just what a person with FASD might need. My son John's brain does not always
function properly, so he needs my brain to be working for him. And he needs more than one external
brain. We have several on hand: myself, his brother, a mentor volunteer, his job coach, his music group
leader, his respite provider. There has to be one available at all times for John to succeed (not get
arrested, in trouble, or killed), because his brain may function at any given time at any age level from 4
to 24.
Building a Circle of Support can ensure success.
Bonnie Buxton, co-founder of FASworld, has stated the need for a Circle of Support for the adult with
FASD, to be developed and stabilized during the early adult years so that it is functioning well enough to
be sustained later when the parents are no longer able to function as primary external brains. The Circle
of Support is a crucial component of success for even mildly affected individuals. The affected person
needs to be within that Circle of Support at all times.
Assess the level of need by making an inventory.
Some teens only need an external time-keeper or external change-maker. Others might need an
external friend-chooser. Some adults will need an external alarm clock or external budget manager.
Many will need a hygiene monitor. Most will need an external decision-maker. Whatever kind of
external brain is needed, it should be one that is working properly, that can be vigilant to foresee
potential problems to prevent difficult situations in the first place. The external brain definitely needs to
be trained in the area of FASD issues, and should have a good understanding of the individual's specific
talents and deficits.
The level of support or supervision will depend on the individual's specific abilities and disabilities. A
family can determine the level needed for their child by assessing the risk factors in the child's teen
years and recent history of events in the person's life. Making a list of situations that have resulted in
serious problems or presented high risk to the individual or others can help to demonstrate the level of
guidance that is needed. It would be helpful to note in this inventory the instances when guidance or
supervision was provided and whether it was adequate. For instance, problems can occur when the
individual is with a family group, if there is not consistent vigilance by a family member who
understands the risks and vulnerabilities and the areas of neurological dysfunction in the individual.
Again, that external brain needs to be in good working order.
Acceptance is the key to successful support.
This idea may take some getting used to, especially if the person has had significant levels of freedom in
the past. Acceptance by the affected individual is as important as acceptance by the responsible external
decision-maker (parent or care provider). It is important to be frank and honest with the individuals
about their impairments. Discussions should be based on fact, on the reality of the individual's situation
and the results of their behavior in the past. Set some realistic goals (maintaining a healthy relationship
with significant other, keeping a stable job, pursuing a fun and healthy life style) and outline some steps
to achieve these goals (avoiding addiction, staying healthy, avoiding pregnancy, pleasing the employer,
keeping a budget). The objectives should be reasonable and should take into account the neurological
dysfunction and risk inherent in FASD.
The reason we pursue getting assistive devices for person with physical impairments is because we care
about them and want to maximize their ability to function. The reason we want to provide an external
brain for the teen or adult with FASD is not because we want to restrict their freedom, but because we
want to maximize their ability to be as independent as possible.
http://www.come-over.to/FAS/externalbrain.htm
Impulse Control
FAS/E and Impulse Control
(Teresa Kellerman's reply to a parent's question)
Page 1 of 1
The "do's and don'ts" are sitting there in the left brain,
but when that impulse hits the right brain, a child with
FAS acts first, and processes the information later,
information that is there but cannot be accessed in
time to prevent disaster.
This is very similar to what happens when a "normal"
person drinks alcohol. After a few drinks, alcohol
shuts down the left brain, which kind of falls asleep
and no longer functions the way it should. So the
person is now acting on the right brain only, feeling,
acting on impulse, disregarding consequences.
A person with FAS is kind of like an inebriated
person. You all know how a person who has had one
too many might try to drive home, even if he knows
he shouldn't, or a person might say things impulsively
that she wouldn't dare say when she's sober. A man
and woman are more likely to have unprotected sex
when they have been drinking.
"Why can't they control their impulses? That is the
part I don't understand. If they can understand, why
can't they control it? I don't understand."
You all know what I'm talking about. I have heard this
behavior described for FAS and alcoholics as "F--k it"
syndrome, because a person does something anyway,
even when they know it is likely to cause trouble.
Fact: John understands the rules
Fact: John understands the consequences.
Fact: John goes ahead and does it anyway (AGAIN).
Fact: John can later relate the exact rules and
consequences.
Fact: Mom emits a long sigh.
Fact: John still cannot control his behaviors most of
the time.
Why?
Remember hearing about how the prenatal exposure to
alcohol affects the corpus callosum? That's the
membrane between the left brain and the right brain
that passes information between the two hemispheres
of the brain. The corpus callosum of kids with
FAS/FAE is damaged, and in some cases it is absent.
The left brain is the one that handles facts, rules,
order, thoughts, language and logic. The right brain is
the one that handles music, feelings, intuition,
creativity, and impulses. Is it beginning to become
clear yet?
Impulse control has NOTHING to do with knowing
the rules or understanding the consequences when
rules are broken. Impulse control is a neurological
function of the frontal lobe, which is damaged by
prenatal exposure to alcohol. The frontal lobe, when it
functions properly, controls inhibitions and judgment.
When the frontal lobe has connections that are not
wired properly or when it has holes in it, well, it just is
not going to function well. It is NOT a matter of will
power.
Giving John cues and reminders helps him to control
his impulses because it interrupts the process between
impulse and action long enough for the information to
get where it needs to go.
Medication seems to sober John up... really! And
when his meds wear off, its just like watching him get
drunk. He turns into Mr. Silly, immature, center of
attention, pain in the butt. With meds, he's almost
human! :-)
I have explained this to John enough times that I
actually think he understands the concept pretty well.
As a matter of fact, when John does something really
stupid, I never ask him "Why did you do that?"
because he just might explain it to me.
http://www.come-over.to/FASCRC
file://aplsrvr11/Data/Programming/Staff/CDBC/CDBC%20Resources/Binder%20materia... 25/07/2013
FAS/E and Conscience Development
© 2000-2002 Teresa Kellerman
Normal conscience development is part a neurological program that progresses by
levels to maturity as a child grows into adulthood.
Toddler level: Do what makes Mommy happy. Motivated by desire to please Mommy
(or Daddy or Grandma) and to get affection. At this age they have a hard time
understanding just what is right and what is wrong, but they begin to get it in concrete
simple ways.
School age level: Do the "right" thing to avoid punishment. Desire to be a “good girl”
or “good boy.” With poor impulse control, this might more frequently translate to: Do
"whatever" I need to do to avoid punishment, even if it means lying to cover my cute
little butt. They know what is right, but they still can't always make the right decision,
poor judgment being affected by neural dysfunction in the frontal lobes.
Adulthood: Do the right thing because it's the right thing to do, because it feels right.
Altruism is more obvious in the late teen and early adult years, making a commitment
to a program, or adopting a cause. Kids with FAS/ARND usually never make it to this
level. They usually stay stuck in the "avoid consequences whatever way possible"
mode.
It is my humble opinion (and that of several professionals) that conscience
development with our kids who are FAS or FAE is connected to the ability to link
cause and effect. They have the knowledge in their heads, they know what is right and
wrong, they know it is upsetting to us when they repeatedly fail to “do the right thing,”
and sometimes it might appear to some people that they don't care But when you talk
to them heart-to-heart, it is very clear that they do care, just at a very immature level.
When John has broken rules at school or displayed less than appropriate behavior and
was confronted with his actions, he can seem flippant and uncaring, and might even
say, "Who cares!" or "So what!" It has been reported to me that he has shown no
remorse for wrong-doing. But I know John, and when he is mentally in a space where
he can be honest about his actions and feelings, he is quite remorseful and expresses
concern about how his actions affect himself and how they affect others, especially
family who love him.
Some parents say, "My child has no conscience." Of course our kids have a
conscience! It is just the conscience of a 6 or 7-year-old. Remember, moral
development is a neurological process, a program that unfolds progressively in
"normal" kids and is only fractionally complete at age 6, and this is where a lot of our
kids stop developing emotionally and functionally, even if they continue to learn facts
as they grow older, even if they have IQs in the normal range.
John as reached chronological adulthood, but is still maturing emotionally, and
although sometimes he is capable of thinking like a 12-year-old, many times he is
stuck at that 6-year-old level. I have to remember this when he acts as though he
doesn't care or covers up what he has done wrong or denies responsibility or expresses
other immature thoughts and ideas and feelings.
One mother reported that after the confession of stealing, her son thinks the solution is
to give him a larger allowance so he won't have to steal. Makes sense to me! :-) Kid
sense, anyway. You have to give him credit for trying.
"A clear conscience is usually the sign of bad memory." - Steven Wright
Human behavior is complex and difficult to understand, even by neurobehavioral
scientists. There are many factors that affect a person’s development of conscience.
We can’t overlook the implications of damage to the brain from drinking during
pregnancy.
Animal research also shows that the frontal lobes of the brain, which are vulnerable to
damage from prenatal exposure to alcohol, are involved in fear conditioning, which is
the subconscious association between antisocial behavior and subsequent punishment.
In humans this is believed to be a key factor in developing a healthy conscience.
According to researchers, the mature conscience is the result of learning set of
conditioned responses through the process of reward and punishment.
The function of a healthy human conscience depends on one’s ability to think
rationally and analyze information, to process feelings and make judgments, and to
control one’s responsive behavior accordingly. All these neurological functions are
disrupted by damage from alcohol exposure in the womb.
The kids who don't have any conscience are the kids who give the impression that they
don't really care (at all, ever) if what they do causes others to feel hurt. Our kids may
have difficulty connecting their actions with the consequences, and they might not
always understand the abstract reasoning behind the concept, but most of them do
have a conscience, just at an immature level. The child who truly acts without a
conscience is likely to be suffering from RAD - Reactive Attachment Disorder. (Not
all children with FAS/ARND have attachment issues, and the cause of RAD in alcohol
exposed children can involve many factors. This will be covered in a separate article.)
John has a conscience, sometimes he is aiming to please me or somebody else, and
sometimes he just tries his best to avoid the consequence, including lies to cover up
his screw-ups. I can usually get him to confess, but that can backfire too, as I can get
him to admit to something he didn't do. Now that's scary. I'd say that John has a
working conscience, it just doesn't work right.
Lying, stealing, noncompliance, inappropriate behavior, and an inability to integrate
socially are all symptoms that are seen in children with FAS and FAE, and are all
reflections of the underlying neurological dysfunction.
John saw some loose change on the table by the front door (at age 18, “old enough to
know better” but obviously he didn’t) and picked it up and put it in his pocket. When I
asked who took the money, he readily confessed, not realizing he had done something
“wrong.” I asked him if the thought had crossed his mind that it might belong to
someone else. His reply was that he liked the feel of change in his pocket, he liked
making it jingle. In this household there is frequent discussion about moral and ethical
issues, about respect and ownership. Sometimes he just doesn’t get it.
http://www.come-over.to/FAS/conscience.htm
Behavior Environmental Adaptation Model
The 15 BEAM Rules of FASD Behavior Management
Also known as the Fasstar Trek Model
© 2004 Teresa Kellerman
1. Brain Damage
5. Meals and diet
7. Understanding
9. Supervision
2. Environment
6. Expectations
8. Punishment
10. Consequences
3. Attitude
11. One-a-days
4. Medications
12. Time out
13. Tough love
14. Individualize
15. Education
1. Think Brain Damage. Understand and remember that the basis for most of the challenging behaviors
is neurological dysfunction. The medical term is “static encephalopathy” which means brain damage
that is permanent and unchanging. The frontal lobes were damaged by the alcohol exposure. This is the
part of the brain that controls behavior and judgment.
2. Think “Environment.” Instead of trying to change the child, change the child’s environment. That
includes the physical surroundings (minimize chaos), and people that interact with the child. When
family members, teachers, and care providers all understand the nature of FASD, they can change their
behavior and as a result the child’s behavior will improve.
3. Adjust Your Attitude. Be positive rather than punitive. Remember that most of the time the child
cannot control his/her behavior. Even when actions seem deliberate or manipulative, this is really the
nature of FASD, a process of brain dysfunction. Be supportive and respectful. Remember that your role
is not to watch for misbehaviour to punish, but to encourage healthy, respectful behaviors. Watch what
behavior you model.
4. Medications Work. Consider the risks of not medicating (out-of-control behavior) with possible side
effects (usually minor with classic FAS/FAE and no co-occurring serious mental health disorders like
Bipolar). If there happen to be side effects, doctors might suggest alternate meds until one is found that
works and does not cause discomfort. Most parents of children with classic FAS/FAE report that a
combination of stimulant and SSRI work best. (See article about medications for FASD.) Parents of
children who are too young for meds report that Mountain Dew helps. This seems to have a calming
effect on most children with classic FAS or FAE. This information is based on data gathered from parents
and doctors and is not to be construed as medical advice. Consult your doctor.
5. Meals and Diet. Maintaining a healthy diet goes a long way to helping the child control behavior.
Avoid additives, read labels, minimize fast food and stick to restaurants that don’t use preservatives.
Teachers will tell you that the worst days for behaviors are the day after Halloween, Christmas time, and
Valentine’s Day. It’s not necessarily the sugar, which in reasonable amounts should not cause problems.
It’s the food coloring, and red coloring agents seem to cause the most problems. Other likely culprits are
Nutrisweet (aspartame) and preservatives. Try an additive-free diet for about a week, then try adding
one potentially troublesome food at a time to see what affects the child and what does not.
6. Adjust Your Expectations. The child will most likely not be able to consistently function at age level.
Divide the child’s chronological age by 2 and assume that the child’s ability to function will be around
that level. A 4-year-old will act like a 2-year-old most of the time, and a 10-year-old will act like a 5-yearold. A 16-year-old may act like a 4-year-old sometimes, like a 10-year-old sometimes, and like an adult
sometimes. The older the child is, the better he/she will be at acting his/her age, but it is often just an
act, and the teen’s ability to function socially and emotionally is often around the 6-year-old level.
7. Understand the Nature of FASD. Having an awareness of what FASD is – brain damage – will help you
focus on effective intervention. This message, that FASD behaviors are primarily a matter of neurological
dysfunction, is repeated because it is important to remember.
8. Avoid Physical Punishment. Never hit or slap the child. Even spanking should be avoided. The child
learns by imitating others and if others are physically aggressive with the child, he/she will most likely
become physically aggressive with others. If physical aggression is learned at a young age, it will be very
difficult for the child to unlearn this behavior later. There are ways to apply non-punitive means of
discipline. They take time to learn and effort to apply, but it is worth it to prevent behavior in the child
that could lead to violence, abuse, injury, and/or incarceration.
9. Supervision. Most children with FASD require close monitoring. Most adults with FASD require at
least daily monitoring, and some need 24/7 supervision. Because of lack of impulse control and poor
judgment, the decisions they make are not always wise and may put them at serious risk. Depending on
the recent history of the child’s behavior, provide the close level of supervision that will allow them
maximum freedom without putting them or others at risk. This is very tricky to determine. When in
doubt, make your decision based on what is safest for the child. Once freedom is given to the child, it is
more difficult to take that freedom away later. Take very small steps toward independence only when
the child demonstrates a stable long-term ability to handle time alone at home or in social situations.
Don’t take unnecessary chances, and don’t give in to pressure from others if it goes against your
intuition. If you give the child too much freedom and something traumatic happens, the child will not
likely learn from the incident, and the guilt you will experience will be heavy and painful, and the child’s
freedoms could be even more restrictive with hospitalization or incarceration. Most parents whose
older children ended up in serious trouble wish they could turn back time and provide closer supervision
to their children starting at an early age.
10. Use Consequences With Care. Don’t expect consequences to work effectively. Consequences must
be concrete and simple and must be applied immediately and consistently. Even then, the child may not
learn, or may forget or make the same mistake again. Adapt consequences to the child’s functional age
rather than actual age.
11. Give One-A-Day Vitamins. The child with FAS or FAE may have nutritional deficiencies in spite of a
seemingly healthy diet. A one-a-day vitamin with minerals is sufficient, preferably one that does not
have artificially coloring added. A vitamin that includes B-6 and B-12 is best. Extra C and E will help as
well.
12. Rethink Time Out. Don’t use time out as a punishment. If the child is out of control it is most likely
due to feeing frustrated or overwhelmed or by sensory overload. Quiet time can be used as a coping
strategy to help regains control.
13. Don’t Use “Tough Love.” It almost never works. This method assumes that the child has the ability
to make wise choices if the consequences are severe enough. The child with FASD has impaired
judgment and makes the same mistakes over and over, even when strict consequences are applied
consistently. The child’s ability to make a wise choice depends on how well his/her brain is functioning
at the moment.
14. Individualize the Behavior Plan. Don’t apply one model or method to all children with FASD. Each
child is affected differently and therefore each child needs a plan that is based on individual needs. Not
all these rules will apply to all children with FASD.
15. Educate. Do your homework. Read the information on the Internet (FAS Community Resource
Center). Print out the brochures and articles. Teach others what you learn. Share this information with
your spouse, other family members, your neighbors, the teachers and principal, the therapists, care
providers, medical staff, everyone. The most important person to educate is the child. The more they
know about their disability, the better they will be able to cope with their own challenges. If they
understand the nature of FASD, they will be able to accept the restrictions needed to keep them safe
and healthy.
Note that these are not typical behavior management strategies, but are ideas on how to adapt the
environment to meet the child’s needs, and how to modify your own behavior to facilitate a positive
outcome.
Now that you have rules to guide you, take some time to learn about Positive Behavior Supports and
adapt them when necessary using the above guidelines. Read more about how alcohol exposure affects
the developing brain, how that brain damage impacts behavior, and specific behavior issues that are
common in children with FASD. Understanding the nature of FASD is crucial. Apply the SCREAMS
intervention strategies, and remember that most children with FASD require more intense supervision
than non-affected children, and that some will require round-the-clock monitoring.
Disclaimer: This information is not intended to be medical or therapeutic advice. Share this information
with care and treatment providers, but in all situations requiring medical care or therapy, please consult
your physician and therapists.
More information is available at the FAS Community Resource Center: www.fasstar.com
Resource Websites and Book List for FASD
http://www.come-over.to/FAS/
Http://www.asantecentre.org/
http://www.ades.bc.ca/resources/fasd.html (FASD resources in BC)
http://www.faslink.org/
http://www.fasdoutreach.ca/
http://www.fasdconnections.ca/
Books:
Adopting a Child Living with Fetal Alcohol Spectrum Disorder
Lawryk, L. (2011) OBD Triage Institute
The Broken Cord
Dorris, M. (1989) Harper Collins & Row
Finding Perspective: Raising Successful Children Affected by FASD
Lawryk, L. (2005) OBD Triage Institute
Living With FASD: A Guide for Parents
Graefe, S. (2003) Society for Special Needs Adoptive Parents
Let's Talk FASD: Parent Driven Strategies in Caring for Children with FASD
Victorian Order of Nurses (VON) (2005)
Ministry of Public Safety
and Solicitor General
Provincial Emergency Program
PERSONAL PREPAREDNESS TIPS FOR
PEOPLE WITH DISABILITIES
This fact sheet is designed to provide a checklist for activities for people
with disabilities to improve your emergency preparedness in a disaster
or emergency. Preparation may seem like a lot of work. It is. Preparing
does take time and effort. So do a little at a time, as your energy and
budget permit. The important thing is to start preparing. The more you
do, the more confident you will be that you can protect yourself and
your family.
Establish a Personal Support Network
A personal support network is made up of individuals who will check with you
in an emergency to ensure you are O.K. and to give assistance if needed.
This network can consist of friends, roommates, family members, relatives,
personal attendants, co-workers and neighbours.
Some people rely on personal attendants. This type of assistance may not be
available after a disaster. Therefore it is vital that your personal support
network consist of different people than those who are your personal
attendants. If you employ a personal attendant or use the services of a home
health agency or other type of in home service, discuss with these people a
plan for what you will do in case of an emergency. How will you get along after
an emergency or disaster strikes? A critical element to consider in your
emergency planning is the establishment of an additional support network.
Even if you do not use a personal attendant, it is important to consider
creating a personal support network to assist you in coping with an
emergency. Do not depend on any one person. Work out support
relationships with several individuals. Try to identify a minimum of three
people at each location where you regularly spend a significant part of your
week: job, home, school, volunteer site, etc.
1
In spite of your best planning, sometimes a personal support network must be
created on the spot. For example you may find yourself in an (evacuation)
reception centre and needing to assemble help for immediate assistance.
Think about what you will need, how you want it done and what kind of person
you would select.
Seven Important Items to Discuss, Give to and Practice with Your
Personal Support Network:
• Make arrangements, prior to an emergency, for your support network to
immediately check on you after a disaster and, if needed, offer assistance.
• Exchange important keys.
• Show where you keep emergency supplies.
• Share copies of your relevant emergency documents, evacuation plans
and emergency health information card.
• Agree and practice a communications system regarding how to contact
each other in an emergency. Do not count on the telephones working.
• You and your personal support network should always notify each other
when you are going out of town and when you will return.
• The relationship should be mutual. Learn about each other’s needs and
how to help each other in an emergency. You could be responsible for food
supplies and preparation, organizing neighbourhood watch meetings,
interpreting, etc.
Travelling
When staying in hotels/motels identify yourself to registration desk staff as a
person who will need assistance in an emergency and state the type of
assistance you may need.
Health Card
• An emergency health information card communicates to rescuers what
they need to know about you if they find you unconscious or incoherent, or
if they need to quickly help evacuate you.
2
• An emergency health information card should contain information about
medications, equipment you use, allergies and sensitivities, communication
difficulties you may have, preferred treatment, treatment- medical
providers, and important contact people.
• Make multiple copies of this card to keep in emergency supply kits, car,
work, wallet (behind driver’s license or primary identification card),
wheelchair pack, etc.
Emergency Contact List
• Ask several relatives or friends who live outside your immediate area
(approximately 100 miles away) to act as a clearing house for information
about you and your family after a disaster. It is often easier to place an out
of province long distance call from a disaster area, than to call within the
area. All family members should know to call the contact person to report
their location and condition. Once contact is made, have the contact person
relay messages to your other friends and relatives outside the disaster
area. This will help to reduce calling into and out of the affected area once
the phones are working.
• Besides emergency out-of-town contacts, the list should include your
personal support network, equipment vendors, doctors, utility companies,
employers, schools, day care centers, for other family or household
members.
Emergency Documents
(includes important information typically needed after a disaster).
• Store emergency documents in your home emergency supply kits. Copies
of life saving information (i.e., specifications for adaptive equipment or
medical devices should be in all of your emergency kits and medication
lists should be on your health card) should be stored in all of your
emergency kits. Other emergency documents should be kept together with
your home emergency pack - family records, wills, deeds, bank accounts,
etc., for access in an emergency. These should be stored in sealed freezer
bags with copy sent to out-of-province contacts.
3
Conduct an “Ability Self -Assessment”
Evaluate your capabilities, limitations and needs, as well as your surroundings
to determine what type of help you will need in an emergency.
1.
Will you be able to independently shut off the necessary utilities (gas,
water, electricity)?
• Do you know where shut-off valves are? Can you get to them?
• Can you find and use the right wrench to turn those handles?
2.
Can you operate a fire extinguisher?
• Have you practiced?
• Will extended handles make these items usable for you?
3.
Will you be able to carry your evacuation kit?
• What do you need to do, in order to carry it; how much can you carry
regularly; do you have duplicates at other locations?
4.
Have you moved or secured large objects that might block your escape
path?
5.
Write instructions for the following (keep a copy with you and share a
copy with your personal support network):
a. How to turn off utilities; color-code or label these for quick
identification:
• Main gas valve, located next to the meter - blue; electrical power
circuit breaker box - red; and Main water valve - green.
• If you have a reduced or limited sense of smell, alert your personal
support network to check gas leaks.
b. How to operate and safely move your essential equipment. Consider
attaching simple to read and understand instructions to your
equipment.
c. How to safely transport you if you need to be carried, and include any
areas of vulnerability.
4
d. How to provide personal assistance services.
• Remind anyone who assists you to practice strict cleanliness and
keep fingers out of mouth. With limited water and increased health
hazards, the possibility of infection increases. Keep a supply of
latex gloves in your emergency supply kit and ask people assisting
you with personal hygiene to use them.
• List all personal care assistance needs (dressing, bathing, etc.) with
instructions on how best to assist you.
• Make a map of where to find medications, aids and supplies. Share
with your personal support network.
e. How will you evacuate?
• Be aware of barriers and possible hazards to a clear path of exit.
Change what you are able to change (clear obstacles from aisles;
secure large, heavy items such as bookcases that may fall to block
your path). Plan alternate exit paths. Know who can help you.
Communication: Practice Assertiveness Skills
Take charge and practice how to quickly explain to people how to move your
mobility aids or how to move you safely and rapidly. Be prepared to give clear,
specific and concise instructions and directions to rescue personnel, i.e., “take
my oxygen tank,” “take my wheelchair,” “take my gamma globulin from the
freezer,” “take my insulin from the refrigerator,” “take my communication
device from under the bed.” Practice giving these instructions with the least
amount of words in the least amount of time. For example: the traditional “fire
fighter’s carry” may be hazardous for some people with some respiratory
weakness. You need to be able to give brief instructions regarding how to
move you.
Be prepared to request an accommodation from disaster personnel. For
example, if you are unable to wait in long lines for extended periods of time,
for such items as water, food, and disaster relief applications, practice clearly
and concisely explaining why you cannot wait in the line.
5
Carry-On/Carry-With-You Supplies/Supplies to Keep
with You at All Times
Packing/Container suggestions: a fanny pack, back pack or drawstring bag
which can be hung from a wheelchair, scooter or other assistive device.
1.
Emergency Health Information Card.
2.
Instructions on personal assistance needs and how best to provide them.
3.
Copy of Emergency Documents.
4.
Essential medications/copies of prescriptions (at least a week’s supply).
5.
Flashlight on key ring.
6.
Signalling device (whistle, beeper, bell, screecher).
7.
Small battery-operated radio and extra batteries
Disability-Related Supplies to Add to Regular
Emergency Kits
Store supplies in areas you anticipate will be easy to reach after a disaster.
Others may be able to share traditional emergency supplies, but you need
these so store on top and in separate labelled bag! If you have to leave
something behind, make sure you get these.
Plan for enough disability-related supplies for up to two weeks (medication,
syringes, colostomy, respiratory, catheter, padding, distilled water, etc.). If you
have a respiratory, cardiac or multiple chemical sensitivities condition, store
towels, masks, industrial respirators or other supplies you can use to filter
your air supply. Do not expect recreation centres, group lodging facilities or
first aid stations to be able to meet your surly needs. In an emergency
supplies may be limited.
If you are unable to afford extra supplies consider contacting one of the many
disability-specific organizations such as the Multiple Sclerosis Society,
Arthritis Foundation, United Cerebral Palsy Association, etc. These
organizations may be able to assist you in gathering extra low cost or no cost
emergency supplies or medications.
6
Medication
It is best if you are able to maintain at least a 7 to 14 day supply of essential
medications (heart, blood pressure, birth control, diabetic, psychiatric orphan
drugs, etc.) and keep this supply with you at all times. If this is not possible,
even maintaining a three day supply would be extremely helpful.
Work with your doctor(s) to obtain an extra supply of medications, as well as
extra copies of prescriptions. Ask if it would be safe to go without one dosage
periodically, until an adequate supply has been accumulated? Make several
copies of your prescriptions and put one copy in each of your survival kits, car
kit, wallet, with your Emergency Documents and your evacuation plan.
Ask your provider or pharmacist about the shelf life and storage temperature
sensitivities of your medication. Ask how often you should rotate stored
medication to ensure that the effectiveness of the medication does not
weaken due to excess storage time. If you are on medications which are
administered to you by a clinic or hospital (such as methadone, or chemo or
radiation therapy) ask your provider how you should plan for a 3- 14 day
disruption.
If you are a smoker, be aware that smoking will not be allowed in Reception
Centres or Group Lodging facilities. If getting to an outside smoking area may
be difficult for you, consider stocking your evacuation kit with nicotine gum or
patches available by prescriptions.
Equipment and Assistive Devices
Keep important equipment and assistive devices in a consistent, convenient
and secured place, so you can quickly and easily locate them after the
shaking. Make sure these items such as teeth, hearing aids, prosthesis,
mobility aid, cane, crutches, walker, respirator, service animal harness,
augmentative communication device or electronic communicator, artificial
larynx, wheelchair, sanitary aids, batteries, eye glasses, contacts including
cleaning solutions, etc., are secured. For example: keep hearing aid, eye
glasses, etc., in a container by bedside which is attached to night stand or bed
post using string or velcro, oxygen tank attached to the wall, wheelchair
locked and close to bed. This helps prevent them from falling, flying or rolling
away during a disaster.
7
If you use a laptop computer as a means of communication, consider
purchasing a power converter. A power converter allows most laptops (12
volts or less) to run from a cigarette lighter on the dashboard of a vehicle.
PERSONAL EMERGENCY PREPAREDNESS
CHECKLIST FOR PEOPLE WITH DISABILITIES
DATE COMPLETED ACTIVITIES
‰
Establish a personal support network.
‰
Customize an emergency health information card.
‰
Keep copies in wallet, purse and emergency supply kits.
‰
Complete an emergency contact list.
‰
Collect important documents
‰
Store emergency documents in emergency supply kits, wallet, safe
deposit box and give copies to personal support network and out of area
contact (see Tips for Collecting Emergency Documents).
‰
Conduct an ability self-assessment.
‰
Collect Grab and Go supplies to keep with you at all times.
‰
Collect disability-related supplies for emergency kits.
‰
Maintain a seven day supply of essential medications.
‰
Keep important equipment and assistive devices in consistent, convenient
and secured place.
‰
Write out Instructions for items you will need help with in an emergency.
‰
If you use a service animal (see Tips for Service Animal and Pet Owners).
(Important documents may include: Health Cards, Medical Documents for
People with Visual Disabilities, Deaf or Hard of Hearing, Communication and
Speech Related Disabilities, Psychiatric Disabilities, Developmental or
Cognitive Disabilities, Mobility Disabilities, Multiple Chemical Sensitivities,
People Who Use Life Support Systems, and Service Animals.)
February 2006
8
Ministry of Public Safety
and Solicitor General
Provincial Emergency Program
PERSONAL PREPAREDNESS TIPS FOR PEOPLE WITH
COMMUNICATION & SPEECH RELATED DISABILITIES
This fact sheet is designed to provide a check list for activities for People with
Communication and Speech Related Disabilities to improve your emergency
preparedness in an earthquake. Preparation may seem like a lot of work. It is.
Preparing does take time and effort. So do a little at a time, as your energy
and budget permit. The important thing is to start preparing. The more you do,
the more confident you will be that you can protect your self and your family.
DATE COMPLETED! ACTIVITIES
__________ How will you communicate?
__________ Store communication aids in all emergency kits.
__________ Complete emergency health information card with
communication information.
__________ Batteries or chargers for communication equipment.
Communication
Determine how you will communicate with emergency personnel if you do not
have your communication devices (augmentative communication device, word
board, artificial larynx).
Communication Aids
Store copies of a word or letter board, paper and writing materials, preprinted
messages and key phrases specific to an anticipated emergency, in all your
emergency kits, your wallet, purse, etc.
1
Emergency Health Information Card
Make sure emergency health information card explains the best method to
communicate with you, i.e., written notes, pointing to letters/words/pictures,
finding a quiet place.
Alternate Power Source
Obtain an alternative power source (i.e., power converter, batteries) if you use
a computer or laptop computer as a means of frequent communication.
Created in partnership with the BC Coalition of People with Disabilities
March 2006
2
Ministry of Public Safety
and Solicitor General
Provincial Emergency Program
PERSONAL PREPAREDNESS TIPS FOR
PEOPLE WITH COGNITIVE DISABILITIES
(developmental disabilities, brain injury, stroke and other conditions that
may reduce the ability to process information.)
This fact sheet is designed to provide a checklist for activities for People with
Developmental or Cognitive Disabilities to improve your emergency
preparedness in an earthquake. Preparation may seem like a lot of work. It is.
Preparing does take time and effort. So do a little at a time, as your energy
and budget permit. The important thing is to start preparing. The more you do,
the more confident you will be that you can protect yourself, your family, and
your belongings.
DATE COMPLETED I ACTIVITIES
__________ Practice what to do during and after a disaster.
__________ Keep a written emergency plan with you.
__________ Provide copies of your emergency family and/or friends.
__________ Ways and tools to help remember.
__________ Practice how to tell someone about what you need.
Before, During and After an Emergency or Disaster
• Practice what to do during and after an emergency or disaster.
• Practice leaving places where you spend time (job, home, school,
volunteer assignment, etc.) until you feel comfortable and feel confident
that you will know what to do during and after a disaster.
1
Emergency Plan
• Keep a written emergency plan with you and in several locations.
• Make sure your emergency plan is easy to read and understand.
• After a disaster, information often comes at you quickly. Think through
ways to do things you will need to do after a disaster. Small tape recorder,
calendar with room for notes, to do list, etc., will help you remember things.
• Give copies of your written emergency plan to your family and/or friends.
Communication
Think through what a rescuer might need to know about you and be prepared
to say it briefly, or keep a written copy with you:
• “I cannot read. I communicate using an augmentative communication
device. I can point to simple pictures or key words which you will find in my
wallet or emergency supply kit.”
• “I may have difficulty understanding what you are telling me, please speak
slowly and use simple language.”
• “I forget easily. Please write down information for me.”
Created in partnership with the BC Coalition of People with Disabilities
August 2006
2
The Registered Disability Savings Plan
BC EDITION
our son has been PLAN’s advice
that we need to think about both
Josh’s social and financial wellbeing if we want to secure a good
life for him.
Saving for a Good Life
When my son Joshua became disabled at five months of age I was
not ready for this change to my son’s life, nor to my own. Like many
I grew up in a community where individuals with a disability were
segregated. I had no first hand experience of how to support a child
with a disability. What I did know is that I had a responsibility to
care for my son, now and in the future.—Ted Kuntz
Cathy and I knew that our
son would not grow up to be
independent. Josh would require
care and support for the rest of
his life. We recognized that our
responsibility to Josh didn’t end
when we died, rather it ends
when Josh dies. Our greatest
challenge was to find a way to
care for our son after we died or
became unable to care for him.
The most valuable lesson that we
have learned in our journey with
www.rdsp.com | 1 | www.plan.ca
A Registered Disability Savings
Plan (RDSP) will be an important
part in securing Josh’s financial
future. An RDSP will help
to ensure that Josh will have
resources to access services and
opportunities that will provide
him with a good life.
An RDSP will enable Josh to
access the latest medical advances
that are often not covered by our
medical system and whatever
supports or services might exist
in the future to ensure his health
and happiness.
In the meantime, his RDSP
provides us with peace of mind
knowing that we have planned
for our son’s future.
What is a
Registered
Disability
Savings Plan?
The RDSP will help you or your
family member save money for
the future. If you put a bit of
money into an RDSP each year,
it will grow into a lot of money.
The federal government will
also put money into the RDSP.
Sometimes you can get money
from the federal government for
your RDSP even if you don’t put
any money in!
Your BC Disability Assistance
will not be reduced. The money
in an RDSP can grow to whatever
amount and you can still receive
your BC Disability Assistance.
You can also use the money in
the RDSP for anything you want.
What is the Canada Disability
Savings Bond?
The Canada Disability Savings Bond is money that the federal
government will put into an RDSP. If family income is less than $24,183*
per year then the federal government will put in $1,000 per year. If family
income is between $24,183* and $41,544* they will put in some but less
than $1,000.
Before December 31st of the year the person with a disability turns
18, it is the family income that counts. After that it is the person’s
income that counts.
You don’t even have to put anything into the RDSP to get the Bond!
The maximum amount of Bond the federal government will put into
an RDSP is $20,000 over the person’s lifetime.
*Income amounts shown are for 2010, amounts are updated each year based on the rate of inflation.
What is the Canada Disability
Savings Grant?
The Canada Disability Savings Bond is money that the federal
government will put into an RDSP when a person with a disability
or family members or friends put money in. In some cases the federal
government will put in $3 for every $1 that other puts in.
Usually, the most that the federal government will put into an RDSP
in an year is $3,500. The most that the federal government will
contribute in the life of the person is $70,000. Like the Bond, the
amount the federal government puts in depends on the family income
until December 31st of the year that the person turns 18. After that
date, it is the person’s income that counts. To get either the Bond
or the Grant the person has to be 49 or younger.
www.rdsp.com | 2 | www.plan.ca
Q U I C K FAC T S
Key Terms
Registered Disability Savings
Plan = The new plan to help
you or your relative with a
disability save for the future.
Bond = money the federal
government puts into an RDSP
even when you or your relative
don’t put money in.
RDSP = Short form for
Registered Disability Savings Plan.
Grant = money the federal
government puts into an RDSP
when you or your family or
friends put money in.
Account holder = The person
who manages the RDSP and
makes the decisions on how
to invest.
Registered
Disability
Savings Plan

Helps you or your family
member save for the future.

You don’t have to pay taxes
on money in the RDSP, and
payments will only be
partially taxed.

You can put up to $200,000
dollars into the RDSP.
Where to get more
information about the RDSP

The federal government will
put in up to $90,000.

Visit www.rdsp.com or www.disabilitysavings.gc.ca

For Questions—Call 1 800 O-Canada (1-800-622-6232)

For Questions by TTY—Call 1-800-926-9105

Take a free Telephone Seminar on the RDSP by calling PLAN
at 604-439-9566 www.plan.ca

Pick up a free copy of our book Safe and Secure: RDSP Edition
at any London Drugs pharmacy
www.rdsp.com 
Anyone can contribute to the
RDSP. You, your family, friends,
neighbours, or anyone else.
| 3 | www.plan.ca

You can open a plan at most
major financial institutions in
Canada—check www.rdsp.com
for the full list.

You do not need to visit a
lawyer or accountant to set
up a plan.
How does the RDSP work?
With the RDSP they can set aside
small amounts of money and
the federal government would
contribute alongside their savings.
With the income it could earn
when they invest, it could grow
into a large amount of money.
Kathy and Rob set up an RDSP for their daughter.
Kathy and Rob live in New Westminster British Columbia. The
Bromley’s have two children, Michael and Shannon. Shannon is 15
and has a severe disability called Angelmann’s Syndrome. Shannon
loves playing baseball, skiing, and swimming with dolphins.
Kathy and Rob are in good health, but they are worried about what
will happen to Shannon when they pass away. An RDSP would be
one way of preparing for the future and could really help Shannon
to plan for a good life. Saving on their own has been difficult.
Shannon could use it to pay for a
home when she’s older, to cover
additional supports, or just use it
for things that she might not be
able to afford otherwise.
Rob and Kathy went to
www.rdsp.com and looked at
the RDSP calculator. They used
the calculator to figure out how
much the plan would grow if they
put $200 a month into an RDSP
for Shannon.
Here’s how it works:
From age 45 to death, the RDSP
will make monthly payments to Shannon
www.rdsp.com | 4 | www.plan.ca
MONEY IN SHANNON’S RDSP
FROM AGE 15 TO 34
$600,000
Kathy and Rob open an RDSP
for Shannon at their local bank
and deposit $2,000.
They put $200 per month
in the RDSP for 20 years.
(that’s a total of $48,000)
$500,000
$400,000
$300,000
$200,000
$100,000
The federal government
puts in $79,500.
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
$0
AGE
FROM AGE 35 TO 45
Shannon waits ten years to
withdraw money because she
doesn’t want to return any Grant or
Bond to the federal government.
AT AGE 45
This graph shows how Shannon’s RDSP could grow. You
can see that it starts at zero at age 15 (on the bottom) and
grows to more than $500,000 when she is 65. Remember
that this is a prediction and that it could grow faster or
slower depending how well her investments do. We have
estimated Shannon’s return on her investments of 5.5%.
MONTHLY PAYMENTS FROM SHANNON’S RDSP
Shannon’s RDSP is worth
more than $377,237.
$9,000
$8,000
$7,000
$6,000
FROM AGE 45 TO DEATH
$5,000
The RDSP will make monthly
payments to Shannon
$4,000
$3,000
$2,000
$1,000
87
84
81
78
75
72
69
66
63
60
57
54
51
45
48
$0
AGE 45 $850/MONTH
AGE
AGE 55 $1500/MONTH
AGE 65 $2500/MONTH
AGE 75 $4200/MONTH
At Shannon’s death, whatever is left
in her RDSP will be part of her estate
and distributed through her Will.
This graph shows how much Shannon would receive each
year from her RDSP. At age 45, she would get $10,000. At age
60, she would get about $22,000 per year. The payments in
this scenario are determined by a set formula. The payments
could be different if Shannon and her family put in more than
the federal government or if she purchases an annuity.
Keep in mind that Shannon could keep her RDSP payments
and also her British Columbia Disability Benefits.
www.rdsp.com | 5 | www.plan.ca
Questions and Answers
1
WHO QUALIFIES FOR THE RDSP?
People who live in Canada.
People who get the Disability Tax Credit.
People who are 59 or younger can put money in an RDSP.
People who are 49 or younger can get the federal government money.
WHAT IS THE DISABILITY TAX CREDIT?
A tax credit is something you claim when you do your Income Tax Return
so you don’t have to pay so much tax.
2
3
4
The Disability Tax Credit is a credit that a person gets if they are disabled.
Parents that are caring for a child with a disability can also claim it to
save taxes.
You or your family member must apply for the Disability Tax Credit
to be able to claim it or to be able to open an RDSP.
HOW DO WE APPLY FOR THE DISABILITY TAX CREDIT?
To apply for the Disability Tax Credit you need to get your doctor or other qualified
health professional to fill out a special form and send it to Canada Revenue Agency.
The form that needs to be filled out is called Form T-2201. After looking at
the form, they will let you know whether you have been approved. If you have
questions or want to get the form, call the CRA at 1-800-959-2221.
WILL I OR MY FAMILY MEMBER LOSE DISABILITY ASSISTANCE?
No. A person can have as much as they want in an RDSP and can also
receive and use the money from the RDSP without affecting their BC
Disability Benefits.
www.rdsp.com | 6 | www.plan.ca
What if I set
up an RDSP?
Can I still
get my BC
Disability
Assistance?
BC Disability Assistance
& the RDSP
What is BC Disability Assistance?
If you live in British Columbia, are 18
years or older, have a low income and
a disability, you could get BC Disability
Assistance. These benefits assist with
housing, food, shelter, clothing and
disability related items. You can also
receive support for employment and
other medical benefits.
BC Income Limits
Any money from a trust, employment, self employment or pension
must be reported. BC Disability Assistance allows you to earn an
additional $500 without it impacting your benefits.
Yes. If you set up an RDSP, you
will still receive all your BC
Disability Assistance from the
province. Even if your RDSP
grows to be a large amount of
money and you take the money
out, you will not lose your BC
Disability Assistance.
Any money coming out of an RDSP is not counted as income,
and will not be deducted from your BC Disability Assistance cheque!
BC Asset Limits
You are allowed to have a certain amount of valuable items without
having any money deducted from your cheque. These items are
called assets and include things like cash, property, clothing and
other possessions. Some assets, like your house or car, are completely
exempt and you do not have any money deducted from your BC
Disability Assistance cheque for their value.
Other assets, like cash and bank accounts, are exempt up to a certain
amount of value. For example, as a single person, the asset exemption
is $3,000. You can have assets worth $3,000 without having any
deduction to your cheque.
An RDSP is in addition to these assets
and is not limited to $3000 in value!
www.rdsp.com | 7 | www.plan.ca
How do I get
BC Disability
Assistance?
For information on how to apply,
contact the Ministry of Housing
and Social Development,
toll free at 1-800-663-7867,
TTY 1-800-661-8773.
Things you must do to set up an RDSP!
Get your social insurance number
Apply for the Disability Tax Credit
File your income tax returns (for the past two years)
Choose your financial institution
Choose your holder
Open your account
Once open, you will need to invest and manage your money!
NEED
HELP?
The Step-by-Step guide will assist you, friends or family to become
eligible, open and manage your RDSP. Download your copy at
www.rdsp.com or www.getsmarteraboutmoney.ca
Subscribe to get regular information from PLAN
Subscribe to receive:

Monthly information with news, stories and planning tips

Connect with families across the country

Strengthen a national family voice
An independent voice for families
of people with disabilities.

Updates on advocacy and policy initiatives
Information and resources to secure
a good life for your loved one.

Web-based resources

25% discount on seminars

Abilities or Exceptional Family Magazine
Visit www.plan.ca to join!
This edition funded by the Government of Canada.
www.rdsp.com Printed on 100% post consumer recycled paper with soy base inks.
| 8 | www.plan.ca
Fetal Alcohol
Spectrum Disorders
Education Strategies
Fetal Alcohol Spectrum Disorders Education Strategies 1
Working with Students with a Fetal Alcohol Spectrum
Disorder in the Education System
Fetal Alcohol Spectrum Disorders Education Strategies
Working with Students with a Fetal Alcohol Spectrum Disorder in the Education System
Prepared by:
National Organization on Fetal Alcohol Syndrome - South Dakota (NOFAS-SD)
Fetal Alcohol Spectrum Disorders Institute
Center for Disabilities
Department of Pediatrics
Sanford School of Medicine of The University of South Dakota
1400 W. 22nd Street
Sioux Falls, SD 57105
(605) 357-1439 or (800) 658-3080 (V/TTY)
www.usd.edu/cd
Developed by:
Kristen Blaschke, M.A.
Marcia Maltaverne, M.A.
Judy Struck, M.A.
Layout and Design by:
Eric Dalseide
The printing of this handbook is made possible through funding provided by the
South Dakota Department of Education, Office of Educational Services and Supports.
Contract No. 2009-L-158
The development of these materials was supported in part by IDEA Part B Grant
#HO27A080091A from the U.S. Department of Education, Office of Special Education Programs
through the South Dakota Department of Education, Special Education Programs. The views
expressed herein do not necessarily reflect the views of the U.S. Department of Education or
any other Federal agency and should not be regarded as such. Special Education Programs
receives funding from the Office of Special Education Programs, Office of Special Education
and Rehabilitative Services, U.S. Department of Education. This information is copyright free.
Readers are encouraged to copy and share it, but please credit the Special Education Programs,
South Dakota Department of Education.
This handbook is available in alternative format upon request from the Center for Disabilities.
© 2009 Center for Disabilities, Sanford School of Medicine of The University of South Dakota
2
Fetal Alcohol Spectrum Disorders Education Strategies
Section 4:
Communication
Fetal Alcohol Spectrum Disorders Education Strategies
37
38
Fetal Alcohol Spectrum Disorders Education Strategies
Section 4:
Communication
Description:
The act of communicating in the classroom is the exchange of thoughts, messages or
information, as by speech, signals, writing or behavior.
What to look for:
Some students with an FASD are very chatty and love to socialize while others are
quiet and tend to keep to themselves. Students with an FASD may learn fewer words
and may have difficulty expressing their thoughts and feelings in a logical manner.
The student may experience difficulty with distinguishing between talking and
effectively communicating, understanding sequential verbal instruction, retrieving
words, drawing conclusions, going beyond stereotypic utterance and/or going “offtopic” in conversation and classroom discussion. In addition to the student’s struggles
with communicating, he/she can also have difficulty understanding others.
Communication
Students with an FASD may frequently miss important information, have difficulty
understanding vocabulary used and fail to follow verbal directions. They may take
information very literally and not understand jokes, sarcasm or idioms. Students
with an FASD can have difficulty putting thoughts and ideas into a written format.
They may struggle to transform verbal information into writing, such as taking notes
during a lecture. Students may be able to complete written work when asked for
specific information on a worksheet while having trouble writing a story, paragraph or
report. Students might have difficulty in inferring meaning. He/she may read a story
but not be able to generalize from it. The student may confuse meanings of the same
word used in different ways. The student will have difficulty in understanding the
consequences of his/her actions.
Students with an FASD will be eligible for speech and language services at a very early
age, while communication difficulties may not be apparent until well into the school
years for others. Social aspects of communication may be very difficult as considering
another’s perspective is often a higher-level language skill. Often, students with an
FASD may display presumably normal vocabulary, grammar and sentence structure.
A student with an FASD may also have Hyperlexia Syndrome. Students with Hyperlexia
have the following characteristics:
• A precocious ability to read words, far above what would be expected at their
Fetal Alcohol Spectrum Disorders Education Strategies
39
chronological age or an intense fascination with letters or numbers.
• Significant difficulty in understanding verbal language.
• Abnormal social skills, difficulty in socializing and interacting appropriately with
people.
Strategies
Receptive Language
• Gain the student’s full attention before communicating. Speak face-to-face with
him/her and use the student’s name.
- One way to gain the student’s attention is to use rhythm techniques such as
slow rhythmic clapping to focus attention.
- Use an established cue, such as a hand signal or sign, to get the student’s
attention when giving directions to the class. This cue will also help to cut
down on the competing noise in the classroom.
- Use eye contact with the student and touch his/her arm when giving
directions.
Communication
• Once you have his/her attention, you should talk at the student’s level and avoid
using long sentences or poor articulation. Be concrete in your communication
with the student and avoid using figures of speech, euphemisms or sarcasm.
• All adults in that student’s life should attempt to use consistent language for
targeted behavioral prompts across environments. Examples of this would be
the use of “listen to me” when you want to gain the student’s attention. “Stop and
think” could be used when you see the student’s behavior as a concern.
• Monitor the rate of speech when talking to a student with an FASD. Use clear,
brief statements so students can attend to the relevant details. Student may “shut
down” with too much talking.
• Teach students to notice the changes in intonation (louder tone may indicate
important information) and body language.
E
- Teach students to interpret non-verbal cues such as facial expressions, yawning
or looking at the clock. Use graphics of the different facial expressions and talk
about what they mean.
Giving Directions
• When providing instructions to the student, give him/her one step at a time and
check for understanding often. Have the student repeat information and reinforce
the learning as needed. The student may need to be reminded of the steps
frequently.
40
E
- Younger students may need to have a picture flow chart to follow. Allow the
Fetal Alcohol Spectrum Disorders Education Strategies
M
M
H
student to color the pictures on the chart so there is some ownership to the
directions given to him/her. This will make the task more personal.
- Students who are a bit older may be able to have the steps written down.
Give the student a small flip chart with each step on a separate page. Include
pictures and words if the student needs to have that visual reminder. Once the
student finishes a step, he/she can flip the page to go on to the next step.
- For activities that will be replicated often, have the student create a binder for
the directions. When the student begins to work on a particular type of a math
problem, have him/her pull out the binder and turn to the correct page for the
instructions. This binder should be kept in the classroom so it is not misplaced.
- Older students could use electronics to help them remember the steps. These
students may benefit from the use of a computer to keep track of different
steps or they can also utilize a Personal Digital Assistant (PDA) if available.
Once the student completes the step, he/she can mark the step off on the
electronic device.
• Use demonstration, pictures or visual cues whenever possible. Show a sample of
a completed worksheet or project a blank worksheet on the overhead or white
board, read the directions together and do one problem from each section before
independent work.
Be Specific when Teaching New Concepts
• Preview new concepts and vocabulary at the beginning of learning activities and
highlight important concepts again at the end.
M
Communication
- Pre-teach vocabulary before giving a lecture of having a discussion on a topic.
Provide the student with a list of the words with the definitions so he/she can
use this to refer to during discussion.
• Use concrete learning examples. Students with an FASD have a difficult time
understanding theoretical ideas and language. Be very clear in your wording and
in the idea that you are teaching.
• Provide tactile examples of what you are teaching. Allowing the student with an
FASD to touch, see and/or feel something will help him/her to succeed in learning
what you are teaching.
• Take pictures or videotape the student performing a correct task or behavior. Use
these images to remind the student of what is expected of him/her.
• Use the student’s own life when teaching new ideas. This will give the student a
reference point for his/her learning.
E
M
- For younger students, use a popular cartoon character when teaching about
responsibility. There are many excellent resources available with these
characters. Or, have the student help create a book by drawing the pictures to
go along with the idea you are trying to teach.
- If the student shows a strong interest in sports, use this interest when teaching
a new math concept. Draw the concept out using basketballs instead of
Fetal Alcohol Spectrum Disorders Education Strategies
41
H
numbers.
- This is the time to start using daily living skills when teaching new concepts.
Use cooking as a focus in all classes. At the end of certain time period, have
the student assist you with making something from the cookbook. The
student will be allowed to practice their reading, math and comprehension
skills.
M
H
• Use art projects to make abstract concepts more concrete.
- Use colored sand to teach the student about volume. Give the student a
clear plastic cup or a clean glass jar and allow him/her to fill in the item with
different colors of sand.
- Have the student paint or draw a picture representing how a poem made him/
her feel after reading it.
• Stress concept development through concrete examples encouraging the student
to demonstrate understanding. For example, when teaching the student about
temperature, use a blanket as an example of cold and hot. The student will
understand that he/she will put on a blanket when they are cold and will take the
blanket off when warm.
• Allow the student time to process after asking a question. It will help to count to
10 before prompting again for an answer. The student may also need the question
presented in a different format before being able to respond.
• Sign language may be helpful to teach students with an FASD even when they do
not have a hearing loss. Sign language is concrete and visible and can be used
along with verbal language.
Communication
Expressive Language
• Students with an FASD can have problems with finding the appropriate vocabulary
and articulation errors are common. Accept communications without correcting
the student. Instead of correcting the mistake, model the correct articulation to
the student when communicating with them.
E
42
E
• Recognize and honor the student’s communicative attempts. Without effective
verbal language, students will find other ways to communicate their needs.
Facial expressions and body language are recognized means of expression, but
behaviors, even challenging ones, also can be attempts to communicate.
• For younger students who are not talking, there are different strategies that can be
used to help him/her understand the communication process.
- Begin with simple story books with pictures. Find books that are interesting to
that particular student.
- Use real objects (e.g., trees, cars, dogs) and name the object for the student.
Ask the student to repeat the word and to point or touch the object.
- Add written labels to objects in the classroom and refer to them often.
• For students who are using single words to communicate, you can help to slowly
Fetal Alcohol Spectrum Disorders Education Strategies
expand on his/her use of vocabulary. If the student says “drink,” say to the student,
“more drink” to stimulate more words into the student’s vocabulary.
E
• Students with an FASD often use a large quantity of speech. Be aware that
quantity does not indicate quality. Many times the student does not know the
definition of words they use, which may give the listener an inaccurate indication
of their communication ability. Listen for the number of words per sentence and
the number of new words that the student uses.
• Music activities can help students with an FASD learn vocabulary. The following
are some effective songs that can be used throughout the day with all of the
students: good morning song, song before students eat, name songs, circle game
songs - sit down, stand up, name games.
E
M
• Once the student begins to learn more words, have him/her start a file of the
words so it can be reviewed frequently.
- Use a picture chart of the learned words. Have the student find pictures in
magazines that he/she can paste into the chart or have him/her draw pictures.
This will help the student to have concrete examples of the new words.
- Older students can develop a file of the new vocabulary. This file can be
created on index cards or in a computer format. Have the student review them
often to assist with their memory.
• Develop a peer tutor to work with the student to assist with expanding his/her
vocabulary. The peer tutor can assist with reading practice, reviewing lessons,
studying for tests, editing procedures and proofreading. Through this process, the
student with an FASD will have the potential to learn new words, to expand their
communication skills and to socialize with a peer.
Communication
• Allow the student to write or talk about his/her own experiences to facilitate
organization of thought and to improve vocabulary. Students often enjoy talking
about themselves and their families, and this will assist in building up their
communication skills.
E
- Start using a memory wall or hall of fame display for students. Each week, a
different student will be responsible for bringing in pictures of themselves,
families, friends, etc. to put on the wall. Have the students write or dictate to
you information regarding the pictures and post these on the wall for display
throughout the week.
M
- Have the student use a journaling notebook to record the day’s activities.
Activities to be noted could include special events, what they had for lunch or
what they have going on at home that evening. Schedule a timeslot each day
for the students to journal. This journal can be taken home each evening to
encourage sequential verbal expression and structure.
H
- Older students can work on a memory book throughout the semester. Let
the student identify different areas of their year or their life that they would
like to highlight and have them record this through drawings, pictures and
journaling. Ask them to discuss their memory journal frequently, practicing
telling about events in logical sequence.
• Today at School and Last Night at Home are communication tools that the student
Fetal Alcohol Spectrum Disorders Education Strategies
43
prepares in one environment to help him/her communicate more effectively
in another environment. Use pictures, written language or other visual forms
the student understands. Help the student prepare a visual tool that provides
information about something that happened in his/her life. Think about the types
of information students like to share in conversation such as “This is what I did.
. .”, “This is where I went. . .”, or “This is what I bought at the store”. This process of
putting the information in a visual form helps students understand the types of
information they can share with others. Then, when the student goes to the other
environment, it will be a visual tool for the student to use to communicate that
information to someone else.
• Practice visualization paired with verbalization. Have the students picture
something then describe it using “wh” statements (What is it? Who is it? Where
is it? When is it? What color, shape, size is it?). Start by describing pictures and
single words then expand on them. Using the “wh” questions, develop sentences,
paragraphs and compositions.
• Encourage an open forum in the classroom by allowing students to ask for help
when needed.
Communication
44
Fetal Alcohol Spectrum Disorders Education Strategies
Section 5:
Executive Functions
Fetal Alcohol Spectrum Disorders Education Strategies
51
52
Fetal Alcohol Spectrum Disorders Education Strategies
Section 5:
Executive Functions
Description:
Executive functions are described as the directive capacities of the mind routed
through the frontal lobe that act in a coordinated way to direct perception, emotion,
cognition and motor functions. They work together and can be thought of as
co-conductors or a coaching staff and give commands to engage in purposeful,
organized, self-regulated, goal-directed behavior. They cue the use of other cognitive
abilities such as reasoning, language, visual perception and memory processes. They
are involved in the direction of shifting strategies and adapting, inhibition, abstract
reasoning, metacognitive capacities and sequencing and organizing processes.
What to look for:
Individual students can have strengths or weaknesses in one or more of the
executive functions at any given time. Students with an FASD may have a well
developed executive ability while also having one or more underdeveloped abilities.
Underdeveloped executive functions may become apparent through the following
ways:
• The student may demonstrate a failure to perceive new information. The student
may not appear to hear what is being said, see what is occurring around him/her,
know where things are located, or may not realize when physical contact is made
or sensations are present. The student or the parents may report the student has
difficulty getting out of bed despite adequate sleep.
Executive
Functions
• The student may be slow to initiate or engage in an activity. You may observe a
lack of initiation of social contact by the student. The student may be unable to
modulate his/her behavior which may be misconstrued as being lazy, careless,
unmotivated or irresponsible. You may observe that the student does not monitor
or regulate his/her social behavior and emotional control through self observation
and self analysis.
• The student is unaware of her/his emotional states, thoughts or actions. You
might observe that the student is acting without thinking, interrupts or blurts out
responses, acts wild or out of control or gives excessive responses or reactions in
typically normal situations. The student is often out of his/her seat, immediately
attempts to get what he/she wants without considering consequences and does
Fetal Alcohol Spectrum Disorders Education Strategies
53
or says things that might embarrass others of the same age.
• There could be an apparent failure to judge or size up tasks or the student
approaches tasks in a haphazard way lacking in forethought. The student may
seem unaware of what is required to get a task done or completes tasks in unusual,
inefficient or ineffective ways. The student may immediately start working before
hearing all directions and then frequently has to change the strategy because of
mistakes. The student does not think about the future or the end product while
completing a task as he/she is absorbed in the immediate moment. The student
does not display problem solving efforts or does not realize when problem solving
skills are required.
• The student could be slow to flexibly shift from one activity to another or may try
the same plan or strategy even when the results are inaccurate. You may observe
perseveration or the tendency to repeat the same actions over and over. There
might be difficulty in stopping or interrupting an activity or mental process. He/
she might maintain a rigid adherence to the routine even when circumstances
have changed and it is necessary to develop a new plan. The student may be
organizing information and materials so that it is out of sequence, fragmented or
incoherent.
• The student may show a lack of focused and selective attention to or inability to
consider the information being presented or the task at hand. You might observe
that the student’s attention may be briefly focused but not maintained for the
period of time necessary or the student has a good initial performance followed by
a steady decrease in consistency. The student may frequently request repetition of
directions, fail to complete all the steps in a multi-step direction or assignment or
give vague responses about information that is being held.
Executive
Functions
54
• The student may demonstrate difficulties with processing the information
presented. Some common concerns can include the lack of focus on a concept
when the details are important. The student may be slow in processing the details
and producing responses and reactions that are appropriate. The student may
not realize when specific routines are required or may not effectively complete
routines.
• You may observe that the student has trouble monitoring the passage of time
and estimating how long something will take to complete. The student may
accomplish little work during a specified period of time, consistently hand in
assignments late, show up late for activities or events, need to be reminded to
hurry up and require significantly more time to complete work. The student may
either work too quickly or too slowly even when aware of time constraints. You
may notice careless errors in assignments and tests or that the student does not
check his/her work.
Fetal Alcohol Spectrum Disorders Education Strategies
The following table provides specific executive skills, descriptions and possible signs or
symptoms of deficits.
Executive
Skill
Planning and
Sequencing
The ability to…
Possible Signs or Symptoms of
Dysfunction
• Develop steps to
reach a goal or
complete a task,
identify materials
needed and set a
completion date.
• May start project without necessary
materials
• Arrange steps in
proper order.
• May skip steps in multi-step task
• May not leave enough time to complete
• May not make plans for the weekend
with peers
• May have difficulty relating story
chronologically
• May “jump the gun” socially
Organization
Time
Management
and
Prioritization
• Obtain and maintain
necessary materials
to completing
a sequence and
achieving goal.
• May lose important papers or
possessions
• May fail to turn in completed work
• May create unrealistic schedule
• Estimate how much • May waste time doing small project and
time one has, how
fail to do big project
to allocate it, how to • May have difficulty identifying what
stay within timelines
material to record in note-taking
and deadlines.
• Set and make
appointments.
• Establish ranking
of needs or tasks,
deciding what is
most important and
should be done first.
Working
Memory
• Hold information
• May not follow directions
in mind while
• May not write down, complete or hand
performing complex
in assignments or bring appropriate
tasks.
materials
• Draw on past
• May forget the process for assignments
learning or
(long division, proper headings)
experience to apply
• Remember to perform responsibilities
to the situation at
hand.
• Lose things
Executive
Functions
• Project problem
solving strategies
into the future.
Fetal Alcohol Spectrum Disorders Education Strategies
55
Executive
Skill
Metacognition
The ability to…
Possible Signs or Symptoms of
Dysfunction
• Understand the big
picture of oneself in
a situation.
• Make careless mistakes, fail to check
work
• Observe or think
about how they
solve a problem.
• May fail to check assignment to make
sure rules were followed
• Fail to recognize there is problem and
fail to ask for help
• Self monitor and use • Fail to evaluate their own performance
self evaluation skills.
• Fail to see how their behavior affects
the group, an individual or situation
Inhibition
Executive
Functions
• May appear distractible and/or
• Stop one from
responding to
impulsive
distracters and think • May take others’ items, lie or verbally or
before they act.
physically lash out without warning
• Resist the urge to say • May pick smaller, immediate reward
or do something.
over larger, delayed reward
• Delay gratification
in service of more
important, longterm goal.
• Personal safety may be compromised
due to inability to consider
consequences before acting
Self Regulation
• Manage emotions
to achieve goals or
control and direct
behavior.
• May exhibit inappropriate or overreactive response to situations
Initiation
• Begin a task
without undue
procrastination in a
timely fashion.
• Difficulty getting started on tasks may
appear as oppositional behavior
Flexibility and
Ability to Shift
Between Tasks
• Revise plans in view
of mistakes and
the adaptability
to changing
conditions.
• May get stuck on one approach
• May not know how to access
appropriate resources
• May become easily frustrated and throw
temper tantrums
• May be slow to stop one activity and
move on to the next
• Tend to continue trying one plan or
strategy even when the results are
negative
• Rigid adherence to the routine
regardless of the circumstances
• The need to do only one task at a time
and unable to shift between different
tasks when necessary
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Fetal Alcohol Spectrum Disorders Education Strategies
Executive
Skill
The ability to…
Focusing
Attention
• Focus attention to
the most relevant
information in
the environment
or situation while
ignoring less
relevant events.
Sustaining
Attention
Possible Signs or Symptoms of
Dysfunction
• May lose important information needed
to complete assignments accurately
• May not realize they need to change
their behavior based on the setting
• Maintain attention
• Attention may be briefly attained or
and effort for a
focused but not maintained for the
prolonged period of
period of time needed to complete a
time.
task
• May have good initial performance
followed by a decrease in consistency
as time goes on
Storing
Information
Retrieving
Information
• Move information
to the present into
storage for retrieval
at a later time
• Fail tests due to lost information
• Find and retrieve
previously stored
information
• Inconsistent performance; some
days the student can access stored
information and some days they
cannot
• May struggle to remember day to day
events
• May be unable to recall information
after a delay
• Talks around topics or subjects. Describes the concept instead of just
saying the word
• May raise hand to answer a question
and have forgotten the answer by the
time they are called on
Executive
Functions
Assessing Executive Skills:
In order to teach and promote executive skills, it is important to determine which skills
are underdeveloped. Assessing executive skills can include:
• A case history through interviews with parents, teachers and student
• Observation of the student in typical settings
• Review of work samples
• Formal assessments when indicated Examples and ready to use forms of interview questions, intervention planning and a
list of formal assessments can be found in Appendix 5.
Fetal Alcohol Spectrum Disorders Education Strategies
57
Intervention Planning:
After the assessment is complete and the student’s difficulties are known, it is possible
to teach students with an FASD to develop and use their executive functioning skills
within the classroom and at home. Follow these steps in designing a plan to address
executive skills excesses or deficits (See the intervention planning worksheet in
Appendix 5 to structure the plan):
1. Describe the problem behavior.
Example: Student forgets to bring necessary materials home, do homework or
hand in completed homework, resulting in failing grades (working memory
deficit).
2. Set a goal.
Example: Student will write assignments and follow the steps on the form each
day, as seen by handing in 90% of assignments on time.
3. Create an intervention plan including skills that will be taught, supports and
materials to be provided, and how the skill will be taught. Make sure to include
incentives.
Example:
• Student and teacher will meet to determine the steps that work best to meet
the goal and list them.
• Teacher will provide and explain the planning form to student.
• Teacher will walk the student through the steps.
• Teacher will post assignments in the same place in the classroom for each class
period. Teacher will prompt student to use the planning form at the end of
each class period and will monitor student while he/she completes the form.
Executive
Functions
• Teacher will prompt and monitor student in packing all necessary materials in
the designated homework bin at the end of each class.
• Teacher will prompt student to pack up all materials from the homework bin at
the end of each day.
• Parents will review the planning form with student at home and prompt
student to complete the steps on the form, check each homework item off the
form as it is completed and re-pack all materials each evening.
4. Discuss incentives with the student and parents, ensuring the incentives are
motivating for the student and realistic for the parents and teachers. Write the
incentives decided upon into the plan.
Example: Each class period that the student follows the steps of the plan, he/she
will earn a point. Student can use points toward free homework passes, time
to do a preferred activity and/or extra TV time at home. Points may also be
accumulated to earn larger incentives such as purchasing a new movie, video
game or sports equipment. Student can earn bonus points at the discretion of
his/her teacher and parents for following the plan without being prompted.
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Fetal Alcohol Spectrum Disorders Education Strategies
5. Supervise the student following the steps, prompting as needed.
6. Evaluate and make changes if necessary. Teacher and student will decide when
they will meet to review the goal and plan, starting with a daily meeting and less
frequently as appropriate. At this time the teacher will gain a verbal commitment
from the student to work toward his/her goal throughout the day. Examples of
questions to be asked during the meeting may include:
• Did you follow the steps of your plan yesterday?
• What homework do you have today?
• When are you going to do the homework on your list? Think about other
activities you may need to work around.
• Are there any projects or tests coming up?
• Thinking about how your plan is going, do you believe you will reach your
goal?
7. Reward students for using the plan and fade supervision and prompts until
only minimal or no prompts are needed for the student to engage in the steps
independently. Students with an FASD may eventually be able to internalize the
routine, but some may require continued prompting.
Strategies
Planning and Sequencing
• Model, teach and practice the use of planning prior to beginning the task. Prompt
verbally by asking what would be the best way to get the task done and what the
student thinks will happen if he/she does it that way.
• Start with tasks that require planning only few steps then gradually increase the
complexity of the kinds of plans required.
• Prompt the student to think about the task and develop a plan of action rather
than starting impulsively without a plan.
Executive
Functions
• Use scoring rubrics when giving assignments.
• Work with the student to break long term projects into subtasks, sequence the
tasks based on priority and attach deadlines to each task.
• Use a template for long-term project planning. See Appendix 5 for a sample
planning template.
Organization
Take time in the daily schedule to teach organizational skills. It is important to start
early on in the year and remind often. If a particular organizational strategy is being
utilized in the classroom, make sure to spend extra time going over the concept.
Model the organizational skill daily. For example, if the math worksheet is to go in the
Fetal Alcohol Spectrum Disorders Education Strategies
59
red folder, announce this at the end of the lesson and demonstrate it to the entire
class. Give the student extra credit when you observe them using the organizational
strategy independently.
Classroom Structure
• It is important to intentionally teach organizational skills to a student with an
FASD. One way to do this is to have the student use electronics to provide him/
her with reminders or to track assignments and instructions.
E
M
- Use an electronic alarm clock to help the student recognize important times
throughout the day. Set the alarm for when it is time to clean up or when it
is time to get ready for lunch.
- Have the student use a desktop computer with access to a calendar program.
The student, along with assistance from the teacher or a peer, can schedule
due dates for assignments, the time to take his/her medicine or other
important events. Have the student check the calendar often throughout
the day or set the calendar up to remind the student when events are to
occur.
H
- Provide a Personal Digital Assistant (PDA) for the student and have the
parents or school mentor assist in entering information. The student can use
the PDA to track important activities and due dates along with instructions
for upcoming assignments.
• Schedule adequate time between activities so the student has time to organize
his/her materials and to complete any outstanding tasks. If the student feels
scattered because materials are in disarray, he/she will have a difficult time
focusing on any new activities.
Executive
Functions
• Schedule the classroom activities for a week at a time. Post the schedule in the
classroom and give the student a copy of the schedule to be kept at the desk
or in a notebook. Students should also be allowed to take a schedule home or
emailed to their parents.
E
M
H
- Younger students do well in a very structured environment. If there are
any deviations to the normal daily routine, spend some extra time with the
student preparing him/her for the change. When the routine is back into
play, the student may need a little extra time to adjust to the daily schedule.
- Class schedules can be confusing to students, especially if they have a
number of teachers or leave class for school programs such as music lessons
or speech therapy. Try to schedule activities at the same time every week.
For example, give science assignments every Tuesday or spelling tests every
Friday.
• Provide structure to the daily routine. - Utilize daily assignment sheets and fill them in as a group at consistent
times.
- Place the daily schedule on the board. Make sure to use words and pictures
for each activity. Review this schedule orally and repeat throughout the day.
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Fetal Alcohol Spectrum Disorders Education Strategies
Have the student cross off each activity as it is completed.
- Use a small flip chart to provide order to the day for the student. Make sure
to use words and pictures for each activity and color code the morning and
the afternoon.
• Have a class discussion in which students share their ideas about keeping
organized. Students can be creative in coming up with ways of staying on top
of school responsibilities. You may find that the student with an FASD is more
likely to use strategies that he/she knows other students are using. Record the
students’ suggestions and post or distribute them to the class.
• If the student has multiple teachers, work with the other teachers to set up a
similar class schedule and organizational routines. If the student only has to
remember one format instead of five, he/she has a greater potential to succeed.
• Make sure the student practices connecting the time on the clock to the time
of activities. This concept can be difficult for students with an FASD; however,
knowing how to tell time can assist him/her with organizing daily routines and
keeping on schedule.
Individualized Space
• Assignment Notebooks
- Have the student use an assignment book and require him/her to keep
the book with them at all times. At the beginning of each period, give the
student time to copy the daily assignments from the board into his/her
assignment book and remind him/her to check it off if the assignment is
completed before the end of the class period.
- Some students will do better using a 3-ring binder for their assignment
book. Instead of copying down the assignment, have the assignment typed
up and hand it to the student at the beginning of the period so he/she can
put it into a binder.
Executive
Functions
• Create a personal space on a shelf or the wall for the student in each classroom. Once the student enters the classroom, have the student place his/her finished
papers in a box or on a giant paper clip on the wall. Helping the student get into
this routine will assist him/her with remembering to hand in papers.
• Use color-coded folders with the same color book cover and notebook for
different subjects.
• Use color-coded bags that contain everything needed for each subject and have
the student hang these in the locker in the order of his/her classes.
E
• Students should be required to organize their materials and schoolwork within
the classroom.
- Younger students should put his/her name on their materials. Each student
should have personal space to keep these materials. If an item is left out
at the end of the day, it will be easier to identify and return the item to the
rightful owner.
Fetal Alcohol Spectrum Disorders Education Strategies
61
M
H
- Consider requiring students to organize their materials and schoolwork in a
three-ring binder with subject dividers, blank notebook paper and a plastic
pouch for pens, pencils and erasers. Each section should have a folder
for items to bring home (assignments to be completed, notes to parents,
papers to bring home and leave home) and another folder for items to bring
back to school (completed assignments, notes from parents, signed parent
permission slips).
• Pre-punch holes in handouts so students can easily put the papers into their
binders.
• Color code papers that are required to go to the student’s parents/guardians. The student will have an easier time in finding the color-coded papers in the
binder.
• Make sure your students have a container for pencils, pens, erasers and scissors. The container might be a plastic zippered pouch kept in the binder or a box or
re-sealable plastic bag kept in the desk.
• Have students use self-stick notes to mark very important papers in their binder.
• Require disorganized students to check with you before going home to make
sure they have the proper materials and have correctly recorded assignments.
Homework
• Prompt the student to determine whether organization is required and what
kind of organizational strategy might be the most effective for the situation.
Model, teach and practice routines that encourage the student to determine
when organization is required.
Executive
Functions
• If at all possible, avoid sending excess amounts of schoolwork home to be
completed outside of the classroom. If the student needs help to understand an
assignment, he/she will have a difficult time completing it on time.
• The rule of thumb for students with an FASD is to stick to the 10 minute
per grade rule. For example, fourth graders should have no more than 40
minutes of homework per night. Send home only work you know they can do
independently.
• Pay attention to how you communicate assignments to your students to ensure
that they get the correct information. Be clear about the due date, the page
numbers, the format, the expected length and the required materials.
• Instead of making written homework lists, some students may need to have
visual cues. For example, when asking a student to read a range of pages in his/
her textbook, scan a copy of that page and put the picture on the assignment
sheet.
• Give the student the option to come in a few minutes before school starts to
finish homework which has not been completed. This allows the student a quiet,
distraction-free setting where the teacher can provide structure, encouragement
and answers to questions.
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Fetal Alcohol Spectrum Disorders Education Strategies
• When handing out papers to be completed, include the due date on the
papers. Emphasize that you expect assignments to be handed in on time. If the
assignment is not handed in on time, let students know they must still complete
that assignment, even if it is for a lower grade.
• Have the student start difficult assignments before he/she leaves class in
case there are questions. Ask students if they have any questions about the
assignment and give the students time to write it down.
• Record your daily assignments on a telephone message system for students to
call. Talk with your principal about looking into a program that allows you and
other teachers to do this. Once it is implemented, students will not have the
excuse that they did not copy down the assignment. In addition, it will allow
students who are absent to keep up with schoolwork.
• Many students and parents/guardians now have email accounts. At the
beginning of the school year, have each parent/guardian fill out a permission slip
to email homework assignments or class news on a daily or weekly basis. Set up
a distribution list on your email account and take time each day to send a short
email to the list updating everyone on the daily activities.
• It may be just as easy to set up a website for everyone to access. Make sure
to include your contact information on the website along with some basic
information about yourself and your expectations for the students.
- Set up a link to other sites that include appropriate information about the
subject, along with age-appropriate games to play to give the students extra
help.
- Create a section on the website where you are able to post daily assignments
and activities.
- If possible, upload any worksheets or handouts onto the website. This way, if
the student is at home and realizes that he/she forgot or lost a critical piece
of the homework assignment, it will be possible for him/her to download the
information and print it out.
- Include a section that highlights organizational expectations and tips.
Executive
Functions
• It will be important for the use of any technology for communication be
available in multiple formats. Understand that your student population comes
from varying backgrounds, so they may not have access to a phone, computer
and/or email.
Organizing at Home
• Suggest organizational strategies for parents to use with their student. Parents
play a key role in helping to organize their student. Send a letter home early in
the school year to describe your classroom and homework policies, as well as
the materials required by students. Include in the letter some of the following
suggestions or steps parents can take to help their student stay on track:
- Encourage your student to put his/her school materials in the same place
every day.
Fetal Alcohol Spectrum Disorders Education Strategies
63
- Ask your student daily for notes from school, or look in the part of his/her
binder or backpack reserved for parent information. It is imperative to have
close communication with the school in order to be kept up to date on
assignments, tests and out of the ordinary events at school. Ask to have one
contact person at the school for when there are questions.
- Establish a “homework-comes-first” policy.
- Set limits on your student’s television watching and/or computer use.
- Tell your student that you expect him/her to write down all assignments.
- Have your student do the more difficult assignments earlier in the evening
when he/she is most alert.
- Put up a checklist in a prominent place to remind your student of materials
to be brought to school daily.
- Mark on the family calendar tests, projects and important school activities.
- Have your student put all school materials inside his/her backpack before
going to bed.
Prioritization and Pacing
Some students with an FASD may rush through work and make careless mistakes
which have a negative impact on their grade. Other students with an FASD will
procrastinate or spend too much time on inconsequential details to the point that they
do not have enough time to finish. Teaching students to recognize how much time
they have, what they should work on first, and how fast they should work is helpful not
only on school assignments but as a lifelong skill.
• Teach Time Concepts
Executive
Functions
- Students with an FASD often need to have visual clues when learning new
concepts. Use items like a kitchen timer, paper chains, an hourglass or a
growing plant to show change related to time passage.
- Use calendars in the classroom to help students recognize that there is a
predictable pattern to the week and year.
- When teaching about a topic that takes place over a length of time, create a
large timeline to post in the classroom. This will help the student visualize the
event and the activities that lead up to it.
- Create a visual of a clock and put the student’s scheduled activity in the block
of time when it occurs. If the events change throughout the week, create
separate blocks of time with the labeled event. Different events can be
interchanged when needed.
- Provide and encourage the use of timing devices such as wrist watches, alarm
clocks, stop watches and visual timers to show the student how much time is
left for an activity.
• Model and prompt prioritizing tasks to be completed. Prompt students to number
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Fetal Alcohol Spectrum Disorders Education Strategies
tasks in order of importance.
• Prompt the student to estimate time requirements for various activities, and then
time him/her to determine how long the activity actually took. After noting the
difference in time, ask the student what he/she learned about estimation skills and
how it applies to homework. See Appendix 5 for a sample time estimation form.
• Prompt the student to ask himself time related questions such as, “Do I have
enough time to get that done?” “How long will this take?”
• Model, teach and practice the use of mental routines that help the student
develop a sense of when pacing is required and how to use cues to maintain a
good pace. For instance, tell the students how much time they have to work and
ask them what that means about their work pace. Model mental routines such as,
“I have 15 minutes to work. If I work steadily without stopping, I should be able to
get this assignment done.” Or, “I have plenty of time to finish this assignment so I
can check it over before I hand it in.”
• For students who rush through their work and lose points for careless mistakes
frequently, teach a routine of checking everything before handing it in. Give
bonus points for having zero careless mistakes that could have been caught if the
work had been checked.
• If you have a student who rushes through work, do not encourage working fast
or competing to see who can get done first. Instead, prompt to slow down and
check the quality of work and spontaneously give bonus points or school bucks to
students you see working carefully.
• Review timelines ahead of time for an activity by pointing out the time which each
step or action will take and prompt students to check the time in order to adjust
their pace as needed. For example, say, “Since the first step will take a bit longer
than the rest, you can plan on spending about ten minutes on the first step and
five minutes on each remaining step. Let’s set the timer for five minutes and check
to see if you are on track.”
• Teach the student to think adaptively by having him/her use the following steps
when completing a task. These steps can be used with any task or activity and will
help him/her with applying similar processes to different projects.
Executive
Functions
- Identify the goal to be accomplished (completing the worksheet by class time
tomorrow).
- Identify how long the assignment should take (the teacher said this
assignment should take us about 20 minutes).
- Identify options to accomplish the goal (I could work on it for 10 minutes now
and finish it in study hall or at home; or since I do not have enough time to
finish it all now, I could do it during study hall or at home).
- Select the best action plan (starts it now and finish in study hall).
- Develop a series of steps to accomplish this plan (1. Bring the assignment and
other materials to study hall; 2. Finish the assignment in the first 10 minutes of
study hall; 3. Put the assignment in my finished folder; 4. Hand assignment in
when I get to class tomorrow).
Fetal Alcohol Spectrum Disorders Education Strategies
65
Working Memory and Holding Information
Working memory is the ability to temporarily hold information in your head while
manipulating that information toward the end goal. For example, think about
multiplying two digit numbers in your head; you have to remember the process, keep
track of where you are in the process and the results as they accumulate in order to
add the final numbers to get the answer. A common complaint is the person’s inability
to remember what he/she was supposed to do if given too many tasks or steps at one
time. This is an executive level thought process that many individuals with an FASD
have difficulty with and needs to be recognized and coached and/or adapted for.
• Students with an FASD can have difficulty with remembering assignments or
directions. Try shortening directions or providing directions one step at a time.
Make sure to write the directions on the board or project them using an overhead
or PowerPoint slide as this can be helpful for all students.
• Use storage or cuing mechanisms to help the student store information in memory
or to cue the student to retrieve the information at a set time. Storage devices or
cuing mechanisms can include:
- Agenda books or calendars for writing down assignments or appointments
- A notebook to record tasks to be done
- Allow the use of calculators for math operations
- Allow the use of formulas and problem solving steps while completing tasks
- Electronic devices, such as a PDA
- Tape recorders with the directions recorded into them
- Pre-arranged verbal reminders or watch alarms
Executive
Functions
- Recurring phrases or behaviors the teacher uses to cue (tap on the desk to
signal specific behaviors for particular activities)
• Cue the student that longer statements or multistep directions are going to be
given and to listen carefully and hold the information until all directions have been
given.
• Teach the student to think about what needs to happen when longer directions
are given, such as jotting down one or two words that will remind them in
sequential order.
Metacognition
Metacognition is often simply defined as thinking about thinking. It is traditionally
defined as the knowledge and experiences we have about our own cognitive
processes (Flavell 1979). Activities such as planning how to approach a given learning
task, monitoring comprehension and evaluating progress toward the completion of
a task are metacognitive in nature. It is important for students with an FASD to know
what they know and when to apply it.
• Ask the student for feedback about helpful learning behaviors and not-so-helpful
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Fetal Alcohol Spectrum Disorders Education Strategies
learning behaviors. For example, “What can we do to make this work?” and “If this
was not helpful, what would be?”
• Practice and allow students to think aloud while performing a task. Make graphic
representations (e.g. concept maps, flow charts, semantic webs) of their thoughts
and knowledge. See Appendix 2 for examples.
• Embed questions into daily classroom instruction that are designed to have the
student reflect back on how he/she made a decision or remembered to do a
particular task:
- How did you solve that problem?
- Can you think of another way of doing that?
- What can you do to help yourself remember that information?
• Have the students grade themselves on a particular assignment and explain why
they feel they deserve that grade.
• Develop error monitoring checklists and prompt the student to use: - What is the problem?
- What is my plan?
- Am I following my plan?
- How did I do?
Inhibition and Stopping or Interrupting Behavior
Students with an FASD may put themselves into dangerous situations even though
they may have been told the rules repeatedly. For example, the student may run out
into a street without looking or try to open a car door when the car is in motion. In
the classroom, the student may be restless and have a tendency to give up when
a situation or environment becomes too frustrating. Common complaints include
stealing, lying and displaying inappropriate social interactions.
Executive
Functions
• Just as important as the transition between activities is teaching students with
an FASD how to successfully stop or interrupt a task. Try using environmental
prompts, such as turning off the lights or music, to guide the students’ attention
toward the end of the activity.
• Cue the student ahead of time when inhibition will be required in a certain
situation. Rehearse through role play the desired behavior during the upcoming
situation or activity. For example, before the student goes out for recess, stop
him/her and ask, “What behaviors are we working on?” “What are you going to do
when (a common problem situation) happens?” “Let’s practice before you go” to
remind the student to exhibit self control.
E
- Create a picture chart and work through these questions with the student on a
regular basis to illustrate the importance of problem solving. Model, teach and
practice self-talk that encourage students to stop and think before acting.
Fetal Alcohol Spectrum Disorders Education Strategies
67
M
H
-Teach and practice the “FAST” strategy. This strategy helps teach students
to consider problems carefully before responding, consider alternatives to a
problem and can be used to role play using real life situations.
Freeze and think! Have the student identify the problem he/she is
encountering.
Alternatives? Have the student identify what possible solutions there
are to the problem at hand.
Solution. Decide which solution would work and would be safe and
fair.
M
Try it. Try the solution you chose and decide if it worked. If not,
discuss what they could have done instead.
- This age group will begin to encounter a number of new social situations, so
problem solving instruction can be beneficial for everyone in the classroom.
Identify stories or books that highlight the importance of this and incorporate
these into the curriculum. For students with an FASD, make sure to identify
alternatives with appropriate reading level if necessary.
H
- High school students have a strong desire to become more independent,
and the same is for students with an FASD at this age. Allow for the student
to journal his/her thoughts on a particular event. Video journaling can be
effective if the technology is available.
Classroom Rules
• Establish a few simple rules for the student to follow. Make sure to use concrete
language with the rules and all people use consistent language. For example:
“You hit, you sit.”
Executive
Functions
• Make posters of the school rules and the consequences. Remember that
students with an FASD can be overwhelmed by the information presented, so
make your poster clear and without too much decoration. Prominently display
the rules in the classroom or place them inside the student’s binder and/or desk.
Positive Reinforcement
• Although it may or may not result in long term behavior change, students with
an FASD benefit from positive reinforcement in order to establish habits of
behavior and increase self esteem.
• Work with the student and parents to decide on agreeable incentives. If the
incentives do not mean anything to the student, the student will not have the
motivation to regulate his/her behavior. Examples include: for the student who
likes to read, use free reading time as the incentive or if the student is good
with younger children, add an incentive to help in the kindergarten or early
childhood classroom (with the appropriate level of supervision).
• Connect incentives to home. The student could earn a later bed time or extra TV
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Fetal Alcohol Spectrum Disorders Education Strategies
or video time at home if he/she reaches the goal.
• Come up with a creative and lengthy list of incentives. Some students with an
FASD lose interest in the agreed upon incentives resulting in loss of motivation
to work toward it. Make two or three different incentive lists and rotate as
needed.
• Be immediate in your rewards. The student will need to receive positive
recognition right after he/she successfully completes the task or follows the rule
in daily situations. See Appendix 4 for examples of free or inexpensive rewards.
• Place a chart at the student’s desk to track the rewards and to give him/her
positive visual feedback.
E
M
H
- Have the student assist you in creating a sticker chart. When the student is
observed following a rule correctly, have him/her apply the sticker that was
earned to the chart.
- Allow students to build up their rewards to earn certain privileges. Students
may be allowed to choose from a number of privileges including free time
at the library, computer time or reading a magazine during quiet time
depending on what incentives you and the student have determined.
- For older students who have email accounts within the school system,
you could send them an email of recognition, free homework passes or
certificates to trade in for rewards for following the rules.
Consequences
• Remember that consequences may not affect future behavior in students with
alcohol related disorders. Brief, immediate, consistent consequences work
best. Lecturing and asking the student why he/she misbehaved are typically
ineffective for behavior change.
• When the student breaks the rule, make sure to enforce it by using consistent
consequences. Implement the consequence immediately following the rule
breaking and remind the student what the consequences are for.
Executive
Functions
• Remember that peer acceptance is difficult for students with an FASD to obtain. Do not single the student out in front others. Take him/her apart from others
when you administer any consequence.
• Remind students of the rules and consequences daily to reinforce their learning.
• Do not debate with the student over the classroom rules or the consequences of
breaking those rules.
• Students with an FASD may need individualized consequences. Have the
consequence fit the issue and make sure to have variations in levels of
consequences based upon what the area of concern is. For example, if a student
breaks one of the rules consistently he always gets the same consequence for
breaking that rule but may have a different consequence for breaking a different
rule.
Fetal Alcohol Spectrum Disorders Education Strategies
69
• Work on teaching empathy by having the student take another person’s point
of view. When the student is impulsive in a way that affects another student or
individual, talk with him/her about how the other person may have felt when the
incident happened.
E
M
- Younger students can have a difficult time with this process, but there are
many picture books available to show how empathy works.
- A peer may be effective in teaching empathy to students of this age. Identify
a student in the classroom who is someone the student with an FASD may
be comfortable with and pair these students up in activities whenever
possible. When the student with an FASD has impulsive moments, meet
with both of the students and have the peer briefly talk about how his/her
actions impacted everyone. It is important to use real-life experiences when
reviewing behavior.
H
- Use role playing to illustrate specific examples of when impulsive behavior
can have an impact on those around the student. Other students can also
model the appropriate behavior.
• Be pro-active! Plan to increase supervision and external control when incentives
or consequences do not work.
- For example if the student may take others’ belongings, he/she should not
be allowed to be in the classroom without adult supervision and may need
to have his/her pockets or book bag checked at the beginning and end of
each day.
- Supervision is important for safety reasons. Do not assume the student
with an FASD will remember or generalize lessons or reminders about safety
issues. Some students will require supervision well into their teenage or
even young adult years.
Executive
Functions
• Use clear, concrete and direct prompts when it is necessary to stop or interrupt
a student’s attention on a task. Say, “stop now”, or place a hand on the student’s
hand to stop writing.
• Allow the student to make mistakes. Help the student to see his/her value in
terms of what can be learned from these mistakes. Understand that students
with an FASD have difficulties with impulsivity and the opportunities for
mistakes have the potential to be increased.
Self Regulation of Emotions
Some students with an FASD may be observed to be overemotional, anxious, dramatic,
easily frustrated or hyperactive. They have difficulty monitoring others’ emotions;
realizing when their emotions are inappropriate for the situation compared to their
peer’s emotions; and then regulating their emotions to fit the situation. When
students’ behavior is obviously different than others in the environment, peers
and others tend to notice and label them as odd or not somebody they want to be
associated with. It is important to attempt to help students regulate their emotions so
that they fit in with peers more easily and learn to handle frustrating situations more
calmly.
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Fetal Alcohol Spectrum Disorders Education Strategies
Hyperactivity
• For students who display hyperactivity, remember this is a physiological
response that is, for the most part, out of their control. Research has shown that
a combination of medication, learned strategies and accommodations is most
effective for managing hyperactivity.
E
M
H
• Make sure to facilitate movement and creativity between seat work assignments.
- Have the student move about the classroom to find items of a certain color
or shape. Ask students to run errands for you, such as taking an envelope to
the secretary or returning a book to the library.
- Allow the student to get up to speak with classmates when working on some
assignments. Make it necessary for the student to collaborate with peers to
complete an assignment.
- Allow the student to go to the library to research a topic or set up a time
during the class for the student to interview another teacher, student or staff
person at the school in order to obtain information regarding an assignment.
• Utilize a quiet-active approach. Split up by periods of quiet activity with periods
of activity where the student has an opportunity to work out some energy.
Make these changes every 20-30 minutes or more often if necessary.
• Allow the student to have reading time in a rocking chair or to stand by his/her
desk when working independently.
• Some students always have something in their hands signaling the need for
appropriate tactile stimulation that can help them refocus. Provide the student
with textured items to use as needed. Some examples include velvet fabric,
sandpaper taped to the bottom of the desk or squishy balls.
• Hyperactive students should sit on a chair rather than the floor. The chair keeps
the students from leaning backward, forward and sideways, and it helps keep
the student in a specific space.
• Pre-set a timer for the student to complete an assignment. Tell the student he/
she has the same amount of time as everyone else but can stop the timer when
needed to take a brief break to stand up, walk to the water fountain or use the
bathroom. The student will then start the timer again when back to work.
Executive
Functions
Frustration and Anxiety
• Some students may have outbursts of behavior due to an inability to effectively
communicate. Teach the student how to communicate his/her needs through
social stories, role playing and practice in real situations.
• Students with an FASD often experience test anxiety which can greatly affect
their grades.
- Provide students with the questions on the test before hand or tell them
generally what will be on the test. Alternate types of assessments such as
oral presentations, projects and providing word banks can also be helpful.
Fetal Alcohol Spectrum Disorders Education Strategies
71
- Take the time to teach coping strategies, such as relaxation techniques, for
these students and cue them to use these techniques during assessment
times in the classroom.
• Work hard at teaching the student to recognize his/her emotions. Give examples
to help put the feelings into words. For example, a picture of the color red could
mean that the student feels a burning in his/her stomach or head. A picture of a
tornado could mean the student is feeling confused with too many thoughts.
• Help the student recognize the most common situations that cause him/her
to become frustrated. Once students can recognize their emotions, work with
them to develop scripts that can be used before behavior escalates. For example:
- “I’m getting confused. I need to calm down, take three deep breaths, and try
again or ask nicely for help. I don’t have to figure this out on my own.”
- “I know this might be hard for me but I’m going to keep trying.”
- “If I get stuck after I have tried hard, I can ask for help.”
• Teach the student a signal he/she can give to you when feeling frustrated or
overwhelmed. Develop a plan for when this signal is used. The student may
need to go to a quiet part of the room or sit in the rocking chair for a bit to calm
down. You may use the same signal to let the student know you think he/she
should use their planned strategy.
• Break tasks into smaller, manageable steps to avoid frustration.
E
M
• Adapt the classroom environment as a way to avoid problem situations. - If a student becomes anxious that someone will play with the toy he/she
wants, limit the number of students in that play area or coordinate with
students who do not typically play with that particular toy.
Executive
Functions
- Pay close attention to how the students interact with each other when
seated at their desks. Some students with an FASD have difficulty with
personal relationships which may be illustrated in their behavior with others
around them. Have the students sit next to others that they get along with
in order to avoid some emotional outbursts.
H
- Moving from one classroom to the next in high school can be very
overwhelming for a student with an FASD. This experience can be
emotionally charged if the student encounters other students who may try
to pick on him/her. If possible, have a teacher or peer walk with the student
to avoid these types of encounters.
• Use books and characters from literature to help the students understand how
their feelings affect them. See children’s literature list in the resource section for
appropriate books.
• Let the student know there is a protocol for loss of control. Taking the student’s
hand and holding it a short time will give the student a signal that the teacher
thinks the student is losing control.
• It will be important to know the student well before implementing any external
control over their behavior. Some strategies that ‘sound good’ or work for other
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Fetal Alcohol Spectrum Disorders Education Strategies
students may actually escalate the behavior instead. It is always better to be
pro-active and prevent behavior rather than be forced to implement external
control once it is escalated.
- Talk to the student, telling him/her that you are helping to control the
behavior.
- “I am going to hold onto you until you are calm.”
- “Are you feeling better?”
- “Let me know when you are ready for me to let go.”
Meeting Physical Needs and Avoiding Over-stimulation:
• Remember that students with an FASD may become over- or under-stimulated
due to sensory integration dysfunction. In combination with teaching students
to regulate for themselves, teachers can observe to determine environmental
or physical needs and set up opportunities to meet those needs. It is important
for teachers and parents to be aware that negative behavior may be a symptom
of unmet needs. Some students may be tired or hungry while others may have
medical concerns that will need to be addressed.
• If the teacher or parents believe their student is having difficulty modulating
or processing his/her environment, they can request an evaluation for sensory
integration dysfunction so that a professional occupational therapist can provide
appropriate strategies.
• Students may need several rest breaks throughout the day and some students
may need to take a nap. When you know this is the case, schedule these breaks
into the student’s day so he/she is aware of when the break will take place.
• Students may need snacks during the day. Have healthy food available for the
student when he/she is hungry during a break time.
• Observe the student for any health problems, including physical and mental
health.
Executive
Functions
- The student may have an ear infection if you see him/her pulling at his/her
ears. Ask the student to “Show me where you hurt.”
- Observe the student’s interactions with other students to see if they are
positive. Some behavior problems may come from the student being
depressed or being bullied by his/her peers.
- Older students with an FASD may have problems with drug and/or alcohol
abuse. Watch for the signs or symptoms of such abuse.
- Look for behaviors which may signify visual problems such as abnormal
head posturing, squinting, holding paper close to face or obvious errors
made when working from the board.
• Keep the noise level to a minimum when possible. When the student’s behavior
escalates, keep a normal or softer voice at a slower pace.
Fetal Alcohol Spectrum Disorders Education Strategies
73
• Some students are calmed by background music or the sound of a fan. If
this is disturbing to other students in the classroom, allow the student to use
headphones with the volume turned down very low when he/she is reading or
doing individual work.
• Create borders around the student with an FASD. Try using arm rests, foot rests
and beanbag chairs. This helps the student feel more secure and will have a
calming effect.
• Have pets and plants in the classroom to help the student to relax.
Initiate, Execute and then Modulate
Some students with an FASD have difficulty starting tasks and understanding the
amount of effort and energy required to engage in a task. Many times this is because
the task seems overwhelming because there is too much print or it looks too long.
Sometimes it is because they do not understand what they are supposed to do and
cannot form questions to ask for help. It is important for teachers to observe and take
note of the times or tasks involved when the student fails to start or engage effort.
This will help determine what strategies to try.
• Use daily routines that help to form habits of initiation. Try writing the date on
the student’s paper when doing an assignment. Another example is to scan the
section in the book for the main ideas in bold. Cue the habits verbally for the
student. For example, “Just like always when we start a math assignment…”
E
M
- When students enter the classroom after recess, set a routine that the students
will take off their outside gear and return to their seats right away for a couple
minutes of quiet time.
Executive
Functions
- As students start to move from one classroom to another in middle school,
there can be difficulty with establishing daily routines. For students with an
FASD, work together with all of the teachers to ensure that the same routine is
used when the student enters the classroom. A routine could include putting
his/her books on the desk, sharpening pencil and sitting in seat before bell
rings to start the period.
H
-Routines continue to be important as the students get older. Start to work in
life skill routines that can be used throughout the student’s day. For example,
at the end of the day they write a to-do list for tomorrow’s tasks.
• Allow alternative response modes. Try allowing the student to type up his/her
work on the computer. Some students may benefit from giving oral responses in
person or through a tape recorder. Other students could benefit from a hands on
approach such as creating a map, a collage or a science demonstration. Students
may find that the option for different output styles is more interesting than always
writing their answers and they may be more willing to complete the work.
• Alter assignment difficulty level. Give advanced level assignments for an ‘A’ or
lower the level of difficulty for a ‘B’ and so on. Allow the student to choose the
level of difficulty to be attempted.
• Use the One Minute Drill to get the student started on the task. Give points to
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Fetal Alcohol Spectrum Disorders Education Strategies
the class when everyone has started work within one minute. Once the class has
cumulatively earned a predetermined number of points for getting started, they
earn a reward:
- Put paper on desk
- Open book to assignment
- Write name on paper
- Begin work
• Break tasks down into segments if needed. Give only directions for those specific
segments so the student is not overwhelmed by the steps. Provide a reward for
completion of certain steps in a task and not only at the end of the entire task. See
Appendix 4 for other examples of free or inexpensive rewards.
• Change the task, the environment in which the task is done, or the reinforcement
for task initiation instead of punishing a refusal to work on a task. Remember that
the student’s non-compliance might be triggered by incomprehension of the
instructions or the difficulty of the assignment. By changing the way that the task
is presented, the student may be able to complete the work.
• Together with the student, make a list of steps for starting an assignment and cue
the student to follow it.
• Make steps more explicit for the student. Provide the student with a cheat sheet,
mnemonic or template of the steps for solving word problems.
• Make tasks closed-ended. Use fill-in-the-blank or true-false tests rather than
essays. Allow the student to practice spelling words using cut out letters instead
of writing them in a sentence.
• Provide external prompts such as additional explanation, a visual cue or light
physical touch to let the student know it is time to start an activity.
• Guide students through the first step of an assignment or routine by telling the
whole class to do the first few problems then wait, check to make sure everyone is
on track and do the next group of problems.
Executive
Functions
• Group students in pairs or small groups. Make sure the student with an FASD is
paired with a student who displays good initiation skills.
• Allow additional time for engagement to occur. Have the student specify when
he/she will begin the task and cue him/her when the scheduled time arrives. The
student should decide on the cue to be used.
Flexibility and Shifting Tasks or Attention
• Offer the student options for alternative activities as a form of built in flexibility
throughout the day.
• Announce schedule changes in advance so students have more time to adjust. Make sure to change the written schedule or highlight the change visually.
Fetal Alcohol Spectrum Disorders Education Strategies
75
• Flexible problem solving can be difficult to learn. Spend time with the student
modeling, teaching and encouraging the use of flexibility. For example, when a
task does not go as planned, tell the student, “Well that strategy didn’t work out;
we’ll have to change something.”
• Provide close contact at transition times.
• Reduce the demands for flexibility by avoiding the use of novelty within the
curriculum. Familiarize the student in advance with places, schedules or activities
using rehearsal of the activity. Pre-teach or give the student the opportunity to
review the material before it is presented.
• Teach students that people are allowed to make mistakes and offer examples
through stories, movies and real life situations.
• It is important to reduce the speed, volume or complexity of information that is
being presented to a student with an FASD. One way to do this is to adapt open
ended tasks to make them close ended. Show the student how a problem can be
solved.
• Offer a high frequency of reassurance for students with an FASD. This can be
provided by step by step assistance, physical proximity and cuing the student
to use coping skills such as scripts when needed. Provide advance warning of
transitions and review what needs to be done when the shift occurs.
• The student with an FASD may need to be taught how to divide or shift his/her
attention between activities. The following activity can assist with this learning
process: Have the student begin by playing a game which has both a timing
and attention component (Simon, Bop-It or Perfection). As the student starts
the game, ask him/her for other information (teacher names an animal and the
student has to make the animal sound, give two numbers and the student has to
give the sum, ask the student to describe the classroom). Although this may seem
overwhelming at first, setting small goals will help the student strengthen his/her
ability to shift attention from one task to another.
Executive
Functions
• Set up practice of shifting attention by deliberately interrupting a task. When the
student is engaged in a task, ask him/her to put a finger on the problem he/she is
working and listen to a new direction, a reminder, or a tip for finding an answer,
then go back to the problem they were working on.
• Try this activity: Provide the student with a task or assignment and add small
distractions while prompting the student to stay on task. Set a goal with the
student to determine an appropriate period of time he/she will be able to handle
this. As the student is able to handle small distractions, increase the distractions.
Provide a reward or privilege when the student meets his/her goal.
Focus Attention
Students with an FASD may have difficulty attending to what is important within the
classroom, a lesson or directions. Focused attention is the ability to attend to one
thing to the exclusion of everything else and requires a high degree of mental energy.
Students with attention difficulties avoid it when they can and may require assistance
to focus attention when needed.
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Fetal Alcohol Spectrum Disorders Education Strategies
• It is important to eliminate as many distractions as possible so the student can
more easily focus her/his attention where needed. Provide study carrels or a folder
to set on the desk to reduce distractions and help student understand where his/
her attention should be.
• Minimize the clutter on handouts. Students can be distracted not only by
the clutter in their desks and around the classroom but also by the clutter on
their papers. For some students, even a pencil smudge on the paper can be a
distraction when they are trying to do their work.
• Simplify the visual presentation of the papers you hand out by limiting the amount
of information you put on a page, or by having the student fold the paper to allow
him/her to concentrate on one part or problem at a time.
• Create a tool by cutting windows the size of one line of text or one problem on a
worksheet out of heavy paper and lay it over the page or worksheet to help the
student focus only on the line he/she is reading or the problem being worked on
and blocking out all extraneous information.
• When giving a test of more than one page, consider giving the student one page
at a time. Direct his/her attention to key information through highlighting or
underlining on the exam.
• Use red or pink highlighters, not yellow. These colors will help to draw the
students’ attention to the important information.
• When giving an oral presentation or a lecture, have the student sit close to
the speaker. The student will be able to focus his/her attention on the person
presenting instead of the surroundings. Make sure that the area behind the
presenter is clear of distractions including any doors or windows.
• As frequently as possible, work one-on-one or in small groups with students who
have difficulty focusing attention to allow for more immediate feedback, increase
engaged learning time and decrease teacher frustration.
• Use focus words to gain attention. For example, “Listen to me.”, “Do it now.” Do not
muddy up your language by using a lot of adjectives or adverbs. The student may
get lost in your words and not understand the true meaning of your request.
Executive
Functions
• When presenting information orally, vary your speech tempo by talking faster and
slower at different intervals. Also try and vary the loudness, inflection and the
quality of your voice to keep the student tuned in to what you are saying.
• Utilize frequent prompting during a task to help maintain a consistent level of
focused attention.
- Point to the portion of the material being discussed, telling students the
information is important.
- Instruct the student to be ready for a question from you in the near future.
• Students with an FASD need to have a structured and predictable classroom
routine. This routine can allow the student to anticipate where their attention is
likely to be needed.
• The use of verbal rehearsal to support repetitious activities can be helpful for
Fetal Alcohol Spectrum Disorders Education Strategies
77
students with an FASD. Have the student verbally repeat the steps of the routine
when working on a project to keep him/her focused on the sequence and each
step.
• Be alert to the time of day and have students do difficult tasks when they are most
alert.
• Introduce a lecture or laboratory with a short outline or summary. Have students
fill in one or two details under each main idea as the class progresses to help them
stay focused throughout the lesson.
• Increase curiosity by starting with a controversy, challenge, case or example (the
“hook” or “lead”).
- Use an image or video to capture attention.
- Start with a personal story or struggle to personalize and capture attention.
- Use humor. The concept to be understood should be the focus of the joke.
- Ask for predictions or “guessing” prior to introducing information.
• Use pre-surveys or pre-tests and instruct students to check their answers as you
deliver information.
• Focus specific attention on important concepts. Strategies to accomplish this
include underlining important ideas, writing them on the chalkboard, flashing
them on the computer screen, saying them more slowly or loudly.
Sustain Attention
Executive
Functions
Sustained attention is the ability to direct attention to a task or lesson through to
completion. Some students with an FASD have difficulty persisting with a task until it
is done and may give up halfway through. Research has shown that the longer their
attention is required, the less attentive they become. It is also thought that visual
attention is stronger than auditory attention for students with an FASD.
• Teach students to self-monitor their attention. Audio cues are typically tape
recorded tones at predetermined intervals and are used to remind students to
self monitor their attention, behavior or amount of work accomplished. When
the tone sounds, the students should ask themselves if they are exhibiting the
target behavior, i.e. “Have I been paying attention?” Other audio cues can include
messages to the student such as, “work carefully,” “work slowly” or “check work.”
See self monitoring form in Appendix 5.
• Provide frequent prompting and external motivators during a task to help
maintain a consistent level of attention. For example, every few minutes call
out the names of a few students and say, “give yourself a point if you are paying
attention.” Accumulated points can be handed in for free homework passes.
• Reduce the length of time sustained attention or engagement is required. Break
long sessions into multiple shorter sessions with brief movement breaks between
sessions. Movement breaks can include going to the water fountain or delivering
a message to the office.
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Fetal Alcohol Spectrum Disorders Education Strategies
• Set specific time limits on activities so that the student has a sense of how long
his/her attention is required.
• Write start and stop times on the assigned task to help the student persist with
tasks long enough to complete them.
E
M
H
- Set up the schedule by using visual aids, such as nesting cups or pictures. Set
out 6 nesting cups to show the student that 6 activities need to be completed
before taking a break.
- You can also use visual cues for the older student. Create a flip chart that
the student can use as he/she completes each task. When finished with the
predetermined number of tasks, the student will flip the chart to the break
card.
• Make tasks interesting by incorporating interaction or action. Try turning the task
into a game or challenge.
• Help the student become aware of his/her attention span and provide
encouragement to increase concentration:
E
- Determine how long the student is able to work on a given activity before
taking a break. Once you have determined the attention span for an activity,
expand it by one more try and reinforce the student. If the student is drawing
circles on a paper and decides to quit, have the student draw “one more” circle.
You should never make them do the activity more than once if you said “draw
one more circle.”
M
H
- Use the following activity to improve sustained attention:
• Use a stopwatch while the student completes a small task or assignment
and take note when the student loses attention by starting to play with an
item or looking around.
• Stop the time when attention is lost. • Then give the student a goal to try to focus for a longer period of time (i.e.
15 seconds longer than they sustained attention during the timer session).
Executive
Functions
• Provide external motivation for the student to increase sustained
attention.
• Continue adding more time to the goals until the student can repeatedly
sustain attention for 5 minutes at a time.
• You can award points or give free homework passes for completed work or work
completed in a specified time period.
• Rhythmic activities such as choral reading, spelling and math chants are effective
in holding attention.
• Use games to over-learn rote material. It is important that these games are not
competitive in nature.
• Have the student use computers to make the learning process more exciting. The
use of technology has the potential to lengthen some student’s attention span.
The use of the computer in the classroom can provide a method of repeating
Fetal Alcohol Spectrum Disorders Education Strategies
79
lessons, such as math problems, which may be helpful.
• Determine what activity the student can attend to longest and what provides
him/her with the interest needed to complete that activity. Generalize these
features into other activities whenever possible. For example, if the student enjoys
drawing, use this concept when teaching math.
• If it is not always possible to make the task or activity fun and interesting for the
student, then alternate between high and low interest tasks. Have the student
complete the less preferred task first and then more interesting task last.
• Use a tape recorder and earphones for when the student needs to listen to an
oral presentation. While the speaker is talking, tape their presentation. Allow the
student to listen to this tape during class or at home so he/she can have another
chance to gather the information that was presented.
E
M
H
• Novelty is an excellent attention getter!
- Have a fun prop that is related to the topic you are teaching. For example,
have the students use stuffed animals when they are learning counting or
bring in apples when you are teaching them about Johnny Appleseed.
- Have the students create a newscast with information from a book they read
for class. Allow the students to create the props, write the script and videotape
themselves. Invite parents and community members in to view the newscast.
- At the beginning of class, share an interesting article from the newspaper with
the students. Allow the students to bring in articles that they find interesting
or funny.
Store Information
Executive
Functions
Long term memory is the result of permanently storing, managing and retrieving
information at a later time to solve problems. Meaningfulness, or connecting new
information to information already stored in long term memory, is key to facilitating
storage. One concept or piece of information is more meaningful if the learner
can make a number of connections between that piece of information and other
information already in long-term memory. There are many types of strategies that can
be used to enhance the storage of information.
• The Number/Rhyme technique works by helping you to build up pictures in your
mind, in which you represent numbers by things that rhyme with the number.
You can then link these pictures to images of the things to be remembered. For
instance, the number one is always associated with a picture of a bun so if the
first word on the list is milk, you could visualize a bun dipped in milk. The usual
rhyming scheme for numbers 1 through 10 is:
80
1
=
Bun
6
=
Sticks
2
=
Shoe 7
=
Heaven
3
=
Tree 8
=
Gate
4
=
Door
9
=
Line
5
=
Hive 10
=
Hen
Fetal Alcohol Spectrum Disorders Education Strategies
• To assist students in remembering the information they need to commit to longterm memory, have them make up a story that connects the items or facts they
need to remember, thus making them easier to recall. The idea here is that it is
easier to remember more information when one fact or item connects to another.
While making up the story, have students create a strong mental image of what is
happening either mentally or by drawing pictures as they go.
• Teach students the difference between understanding and remembering. Listening and reading are typically not enough for them to perform well on tests.
Engaging in activity will help them remember what they understand.
• Activate prior knowledge by asking questions. “What do you know about….?”
“What do you want to know about…?” At the end of the activity, ask “What did
you learn?”
• Have the student use visual representations such as concept maps, webs or other
visual organizers of diagrams or flow charts and if needed convert that information
into outlines for review. See Appendix 2 for examples.
• Using mnemonics is a popular strategy for remembering. Many students learn
“Please Excuse My Dear Aunt Sally” to remember the order of math operations
(parentheses, exponents, multiply, divide, add, subtract), or HOMES for
remembering the great lakes (Huron, Ontario, Michigan, Erie, Superior). A list of
sample mnemonics can be found in Appendix 1.
- Model and teach students to make up their own mnemonics using “FIRST”:
Form a word that incorporates important parts of the skill. For example,
HOMES is a mnemonic for the names of each Great Lake.
I nsert extra letters to form a mnemonic word if needed. BrACE is a
mnemonic for remembering scientific objects that have never been
seen (black holes, antimatter, cosmic rays and earth’s core).
Rearrange letters to form a mnemonic word when order is not
important.
Shape a sentence to form a mnemonic.
Executive
Functions
Try combinations of first four steps to create a mnemonic.
• Preview new concepts and vocabulary at the beginning of learning activities to
activate prior knowledge and personal experience.
• Model, teach and practice using mind mapping for taking notes. Mind maps can
be used during lectures, content reading or research. Mind maps show not only
facts, but also the overall structure of a subject and the relative importance of
individual parts of it. These tools help to associate ideas and make connections
that might not otherwise be made.
- Write the title of the subject you are exploring in the center of the page and
draw a circle around it.
- As you come across important facts that relate to the subject, draw lines out
from this circle. Label these lines with these facts.
Fetal Alcohol Spectrum Disorders Education Strategies
81
- As a deeper level of information is taught related to the facts, draw these as
lines linked to the fact lines.
- Finally, for individual facts or ideas, draw lines out from the appropriate
heading line and label them.
- As you come across new information, link it in to the mind map appropriately.
• Use multiple varied activities such as projects, group work and field trips as active
learning experiences which enhance memory.
• Engage in activities to teach students to understand how their memory works. Ask
students how they remember and collect the strategies they use. When it comes
time to remember new information, review the memory strategies.
• Use colored highlighters or shapes for specific themes, details or concepts when
reviewing material for a test.
• Have the student study with a friend. The students should share their ideas with
each other and then critique what they think is right or wrong about the concepts.
• Use multiple sensory and format instruction.
- Seeing: Use visual representations such as concept maps, webs, diagrams or
flow charts.
- Hearing: Use music in the classroom to help cue different activities.
- Touching: Use movement to represent a certain concept. For example, use
students standing up and sitting down to illustrate subtracting a number from
another.
- Smelling: Try having students close their eyes when you read a poem to them.
Have the students describe what type of smell they connect with what they
heard.
- Tasting: When teaching about geography, try bringing in regional foods for
the students to try.
Executive
Functions
• Use consistent teaching strategies and teach the student the method you will be
using.
- Introduce subject.
- Introduce topic.
- Describe the lesson objectives.
- Provide student with outline and cue him/her when to add notes or details.
E
- Repeat as necessary.
• Use as much sensory stimulation as possible to teach each concept.
82
- Teaching the color “orange.”
• Wear orange clothes.
• Paint with orange paint.
Fetal Alcohol Spectrum Disorders Education Strategies
M
• Use orange construction paper for projects.
• Serve oranges for a snack.
- Use basketball as a theme in multiple lessons.
H
• Write a poem about the sport.
• Shoot hoops to learn about a math concept.
• Use pictures of basketball on all papers that week.
- Use music during certain lessons.
• Listen to a song and have the student journal what she/he believes the
song is about.
• Use the song lyrics during a poetry lesson.
E
• Have the student create an album cover for the song using different
shapes and colors.
• Use objects as much as possible to teach concepts.
- Teaching the student about circles.
• Laminate polka dot fabric.
M
H
• Use a cookie cutter to cut circle sandwiches.
• Cut circles from construction paper and glue cheerios to the paper.
- Teaching the student about division.
• Create flash cards.
• Use beans or small candies to demonstrate the concept.
- Teaching the American Revolution.
Executive
Functions
• Put up the American flag.
• Have the student bring in something he/she is proud to own and describe
how that ownership feels.
• While teaching a unit, have students write down the main idea of each section
on a sticky note and stick it to the last page of the section they are summarizing.
Once students have completed that unit, review that material at a later time by
going back and reading the main ideas on the sticky note. Use the information
often as review questions on tests or by integrating it into other lessons.
• Utilize noncompetitive games to review previously learned materials. Here is an
example of review basketball game:
- Have each student write five questions found in the literature.
- Divide the class into 2 groups.
- Teams will take turns asking the opposing team questions that they have
written. Textbooks or other resources can be used if appropriate.
Fetal Alcohol Spectrum Disorders Education Strategies
83
- A team that answers correctly receives one point and an opportunity to “shoot”
for an additional point. The “shooting” can involve throwing a soft ball into a
container or you can have the students draw a point card out of a container.
Point cards can include different amounts (0 points, 1 point, etc.).
- If the team asking the question stumps the other team, they do not
automatically receive a point, but they do have the opportunity to shoot for a
point.
- Points can also be deducted for inappropriate behavior.
- The team that is ahead at the end of the pre-established time frame is the
winner.
- Consider using several of the questions for the exam. The activity gives the
students a chance to work as a team when learning the material.
• Move into new areas of academic instruction gradually, always reviewing past
material so students can experience success.
• Work with the student on no more than one or two concepts within one week. Repeat and review these concepts often throughout the week and take steps
to carry these concepts through into future lessons. It is important to assess the
student’s learning more frequently than you might for other students.
• When the student appears to have learned a rote skill, have the student continue
to practice the skill with the aim for over-learning.
Retrieve Information
Executive
Functions
Retrieval is a process of accessing stored memories. For instance when taking an exam,
students need to be able to retrieve learned information from their memory in order
to answer the test questions. Research has shown that long-term memory is enhanced
when students engage in retrieval practice.
• It can be very helpful for students to take practice tests. When reviewing
information prior to tests and exams, ask the students questions or have the
students make up questions for everyone to answer rather than just retelling
students the to-be-learned information. If students are required or encouraged to
make up their own tests and take them, it will give their parents and/or teachers
information about whether they know the most important information or are
instead focused on details that are less important.
• Provide hints or clues that help lead the student to the information needed. For
example, reminder of the first letter in the word, how many letters in the word,
how many words in the phrase or steps in the sequence or if the answer is a detail
or big picture concept.
• Provide multiple options and formats for demonstrating knowledge of stored
information based on the student’s areas of interest and strength.
- Have the student make up a poem, song, rhyme or mnemonic and produce
their knowledge verbally or through an action project.
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Fetal Alcohol Spectrum Disorders Education Strategies
- Ask the student to create a poster, concept map, timeline, character map or
episodic organizer (beginning, middle, end) representation of the material
learned.
• Have students hand in a memory map the day before a test explaining their plan
for learning and remembering the material.
E
• Prepare an outline as a study guide for the student. - Use a picture study guide for younger students. Use pictures that are
relevant to the information or are of interest to that particular student. Have
the student color the pictures in the study guide so she/he can feel some
ownership to the materials.
• Prompt the student to go beyond rote memorization and help him/her move
toward meaningful rather than rote recall of information:
- Ask questions during class that require the application rather than recitation of
principles. The responses from the student may take longer as she/he is being
asked to complete a more complex task.
- Allow students to use concept maps, diagrams, outlines or other notes when
taking tests.
- Avoid asking any trivial questions that can easily be answered by
memorization.
- Give credit for incorrect answers that are accompanied by truly plausible
explanations.
- Use recognition questions rather than open-ended ones on tests.
Problem Solving
Problem solving is at the foundation for improving all executive skills. Awareness of
the problem and making a plan to solve it should be the objective of all plans. The
basic parts of problem solving include:
Executive
Functions
• Identify the problem.
• Brainstorm solutions.
• Choose a solution and try it.
• Evaluate.
• Choose a new solution if needed.
Students with an FASD may not be aware of the problem and will need guidance
recognizing when to use the steps and apply them to their individual situations.
• Using mnemonics can be very helpful when teaching students to remember
the steps or routines of problem solving strategies. See Appendix 1 for more
examples of mnemonics. Use the following letter strategies for problem solving.
- SODA
Fetal Alcohol Spectrum Disorders Education Strategies
85
Situation (what’s the situation?)
Options (brainstorm solutions)
Decide (which solution makes most sense?)
Analyze (how did it work?)
- STAR
Search the word problem.
Translate the words into an equation in picture form.
Answer the problem.
Review the solution.
- FAST
Freeze and think! Have the student identify the problem he/she is
encountering.
Alternatives? Have the student identify what possible solutions there are to
the problem at hand.
Solution evaluation. Decide upon the solution that would be safe, fair and
effective.
Try it! Have the student try the solution slowly and carefully. Then have the
student ask “Did it work? Is there anything I could have done differently?”
- SQRQCQ: This strategy is an approach to solve word problems by finding
important elements and determining how it should be solved. This
questioning encourages students to find and correct their own mistakes.
Survey the problem: Read the problem to get a general idea of its nature.
Executive
Functions
Questions: Ask yourself questions about the problem: Reflect on the reading
to determine what the problem is asking you to do. Is the question asking
you to estimate, calculate area, multiply or other operation?
Read the Problem: Read the question again. This time, focus on the specific
details of the problem. Should the answer be in inches, miles, liters, time
units or some other form?
Question yourself about the operations involved: Reflect again. This time,
determine the specific math operations the problem is asking you to
perform and list the operations on paper in the order to be performed.
Calculate the problems: Perform each operation in the order you listed it.
Check off each step as finished.
Question yourself about the steps you took: Review each step you took.
Determine if your answer seems reasonable. If possible, check your
answer against the book’s answers or have a teacher look at your work to
determine if you are on the right track. Check your answers at each step of
the operation. Were they correct? If not, make those corrections.
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Fetal Alcohol Spectrum Disorders Education Strategies
• Model, teach and practice the use of a problem solving strategy and prompt the
use of it. Eventually teach the student to monitor the situation to determine when
thinking or problem solving is required.
Monitor and Modulate
The use of monitoring can cue appropriate routines for checking the accuracy of
registration, manipulation, storage and retrieval of information or the performance of,
or final product of, a motor routine. Difficulties with monitoring often result in careless
errors due to a lack of adequate checking of thoughts, emotions or work products.
Correcting cues appropriate routines for correcting errors or altering performance
based on feedback from other modules. Difficulties with correcting result in failure to
correct errors or alter performance.
• When implementing self monitoring or classroom monitoring, remember to:
- Define behaviors in terms that students can understand.
- Teach the self-monitoring procedure before implementing the plan.
- Provide students with the support they need.
- See examples of self monitoring forms in Appendix 5.
• Provide guided practices for monitoring routines by actively assisting students to
perform the motor movements necessary to complete the monitoring routine.
- If possible, use self-correcting materials or make a game out of checking the
completed work.
- Do a preliminary check of work and send back for editing before grading
occurs.
- Have the student complete the first few items of an assignment, then check to
make sure he/she understands the task.
• Provide information to the student about the amount of effort that will be needed
to perform a task. For example, “The first part of this section is going to be difficult
so you’ll need to work hard for a few minutes at the beginning.”
Executive
Functions
- Provide a demonstration of the entire task or assignment, explaining that
some portions of the task may be very easy while some will require much more
effort.
- For some students, you will need to clearly break up the sections of the task
and only describe the amount of effort as you move forward with each step.
• Show the student examples of his/her performance to help gain awareness. For example, point out how well the student did on tasks where good effort
was exhibited and how poorly the student did on tasks where poor effort was
exhibited. Examples help students understand the connection between their level
of effort and the results that can be achieved.
• Provide a checklist of instructions for the student to follow. Use visual cues with
each item and allow the student to check off the items as they are completed.
Fetal Alcohol Spectrum Disorders Education Strategies
87
Remind the student of written instructions when he/she is questioning what to do
next. It is important that the student first try to figure it out on his/her own.
E
M
H
- For younger students, create a picture list. Once an activity is completed, have
the student check it off by putting a picture of a checkmark on top of the item.
The student can help you create this picture list.
- Older students can use a paper checklist. Make sure that the checklist is not
too busy and does not have multiple colors on it. The checklist should be very
specific in the different tasks needed to complete an activity. Follow up with
the student often throughout the activity to make sure that he/she is marking
off completed items.
• Involve the students in selecting the skills they want and need to learn. The
student may have skills that he/she is very interested in learning and this will help
to excite him/her into learning new concepts or ideas. It will also provide the
student motivation in putting forth a best effort in the task.
Executive
Functions
88
Fetal Alcohol Spectrum Disorders Education Strategies
Section 6:
Brain-based Teaching Methods
Visual (Spatial) Learners
Auditory (Verbal/Linguistic) Learners
Kinesthetic Learners
82
88
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Fetal Alcohol Spectrum Disorders Education Strategies
95
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Fetal Alcohol Spectrum Disorders Education Strategies
Section 6:
Brain-based Teaching Methods
Description:
Damage from prenatal alcohol exposure is seen to affect particular areas of the brain.
Those regions and their functions are:
• Cerebrum, specifically the frontal lobes - Controls the executive functions such as
judgment, attention, cognitive flexibility, planning and impulses.
• Cerebellum - plays an important role in the integration of sensory perception and
motor control.
• Corpus Callosum - A bundle of fibers that helps the left and right hemispheres of
the brain to communicate with each other.
• Basal Ganglia - Plays a role in controlling cognition, emotion, motor activity and
executive functions.
• Hippocampus - controls memory functions, the connection between memory
and emotion, and it is sometimes called the gateway to memory. It prepares
information for long term storage, connecting memories with other memories and
giving the memories meaning. The hippocampus also plays a role in controlling
aggression.
What to look for:
Students with an FASD may have average or above average ability in one academic
area while having significant difficulty with another. They may process and respond
slower than average or may have trouble talking and listening to others. Students
with an FASD may have difficulty with reading and writing, planning or understanding
the order in which events happen (sequencing). They may have difficulty forming
even basic concepts of math and language due to trouble with encoding visual and
auditory information.
Brain-based
Teaching Methods
Students with an FASD often have difficulty with mathematics, especially arithmetic.
Deficits in math are seen to be more pronounced than in other academic and
cognitive areas and the cause for these deficits could be in the student’s difficulty
with working memory. Older students with an FASD may have additional problems
with math concepts that involve math terms, formulas, sequences and other number
Fetal Alcohol Spectrum Disorders Education Strategies
97
patterns. Early intervention can be critical in teaching math skills to students with an
FASD.
Reading, speaking and writing are the three language processing skills necessary
for language development. Working memory plays a significant role in learning to
read as knowledge of the world, vocabulary, sentence construction and the ability to
comprehend the written and spoken words are all linked to working memory capacity.
Students with an FASD may have trouble connecting sounds to symbols (decoding/
phonics), or they may be able to decode words without comprehending what they
read.
Strategies
Multisensory teaching is the integration of visual, auditory and kinesthetic-tactile
senses to enhance memory and learning. Links are consistently made between what
we see, what we hear and what we feel in the process of learning and remembering.
Teachers may have students with each of the different learning styles summarized in
the next sections. Teaching to the student’s learning styles means helping a student to
learn through more than one of the senses.
In addition to the specific strategies listed below, try utilizing these exercises as a
way to help the student with an FASD focus on the work you are providing to him/
her. These exercises and others can be found through the Brain Gym® website: www.
braingym.com.*
• Brain Buttons: This exercise helps improve blood flow to the brain to “switch on”
the entire brain before a lesson begins. The increased blood flow helps improve
concentration skills required for many tasks.
- Put one hand so that there is as wide a space as possible between the thumb
and index finger.
- Place your index and thumb into the slight indentations below the collar bone
on each side of the sternum. Press lightly in a pulsing manner.
- At the same time put the other hand over the navel area of the stomach.
Gently press on these points for about 2 minutes.
Brain-based
Teaching Methods
• Cross Crawl: This exercise helps coordinate right and left brain by exercising the
information flow between the two hemispheres. It is useful for spelling, writing,
listening, reading and comprehension.
- Stand or sit. Put the right hand across the body to the left knee as you raise it,
and then do the same thing for the left hand on the right knee just as if you
were marching.
- Just do this either sitting or standing for about 2 minutes.
• Hook Ups: This works well for nerves before a test or special event such as making
a speech. Any situation which will cause nervousness calls for a few “hook ups” to
calm the mind and improve concentration.
*Brain Gym® is a registered trademark
of Brain Gym® International/
Educational Kinesiology Foundation.
98
- Stand or sit. Cross the right leg over the left at the ankles.
Fetal Alcohol Spectrum Disorders Education Strategies
- Take your right wrist and cross it over the left wrist and link up the fingers so
that the right wrist is on top.
- Bend the elbows out and gently turn the fingers in towards the body until
they rest on the sternum (breast bone) in the center of the chest. Stay in this
position for several moments.
Visual (Spatial) Learners
The sense of sight and the ability to create images in their head allows visual/spatial
learners to ‘see’ and remember an object or idea. The students rely on their sense of
sight and ability to visualize an object. Visual learners take in information by taking
notes and making lists to read later, reading information to be learned, learning from
books, videotapes, filmstrips and printouts and/or seeing a demonstration.
Teachers can pair visual and verbal instruction by using demonstration, presentations
and copies or overheads of an outline of the lecture. It is just as important to allow
students to demonstrate knowledge through color, drawings and building projects
such as tables, charts and graphs. Visual learners often take in information through:
• Underlining • Different colors
• Highlighting
• Symbols
• Flow charts and timelines
• Charts and graphs
• Pictures, videos, posters, slides
• Different spatial arrangements on the page
• Flashcards • Textbooks with diagrams and pictures
• Lecturers who use gestures and descriptive language
Provide students visual cues of strategies in the classroom. The strategy can be posted
on classroom walls or on a bulletin board. Strategies can also be written on individual
cue sheets. Students can then keep the written strategies at their desk or in a folder.
Some students may also benefit from keeping a folder or notebook that contains all
of the strategies that student needs. This folder or notebook could be used by the
student as a resource when he/she is working independently.
Brain-based
Teaching Methods
Reading and Language
• Use visual language such as: “I see what you’re saying” or “That looks right”.
• Teach the student to visualize spelling words, lists and concepts by using the
Fetal Alcohol Spectrum Disorders Education Strategies
99
multisensory methods, VAKT, described below in the Kinesthetic Learners section.
• All students with an FASD can benefit from the use of illustrations. Choose
reading materials with some illustrations that are appropriate to the age level
and simple. Small detailing marks in a picture can distract the student. It is
better to have the illustrations on one page with the script on its own page.
M
- Separate the class into peer groups and have one student in each group
summarize the information by telling the other student what he/she
understood. Have the second student continue the process by filling in any
blank spots or by describing how he/she felt about the material that was
presented or read.
H
- Older students can journal their thoughts about the material. Have the
student use a separate notebook for this journal. Allow the student to
draw pictures or write a poem to summarize ideas. Before reading any new
sections in a book, have the student review the entry from the previous
section.
• Use regular note-taking systems like outlining the material read to help the
student better understand the developing concept of the information he/she is
reading.
• One method of teaching spelling is to write the word in large, colored print. Have the student close his/her eyes and visualize a picture of the word, spell the
word out loud and then write it once. Making visualizations connecting letters,
blends and words to pictures helps trigger memory for the student.
• Some students may have difficulty focusing their eyes on the left side of the
page and moving their eyes to the right:
- Use a plain piece of paper to put under each line of reading material to assist
the student with her/his reading or try using a see-through reading aid.
Some of these aids include magnification which could help with students
who also have vision difficulties.
- Use green marker at the left side changing to red at the right side for written
work.
- Use colored arrows to signal starting points and direction from right to left.
Brain-based
Teaching Methods
- Put your finger under the word you are reading, so that the student can see
the connection between the written word and the word you are saying. Have
the student do the same when appropriate.
• Borrow or buy extra large books with very large print. These were developed
for classroom use with large groups, but they are fun for beginning readers as
well. Large print text and text surrounded by increased white space helps visual
learners cope with large amounts of text rather than becoming frustrated and
giving up.
• Promote awareness of printed words by pointing them out on signs or other
tangible items. Use language to describe the objects so that the student can
have a more vivid image to remember.
• Allow the students to create books with photographs of their favorite people
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Fetal Alcohol Spectrum Disorders Education Strategies
and pets, with the name written under each picture.
• Borrow books without words from the children’s section of the library or make
up your own. Have students tell the story from the pictures. Record the student’s
stories on the tape recorder, then dictate and print the stories on the computer
in large print to add to the pictures.
• Create a picture dictionary for difficult words that the student may encounter
in his/her reading materials. Allow the student to add to this dictionary as new
difficult words come up.
M
- Have older students use word processing and look up images on the internet
to match their words.
• Teach the student to translate what he/she hears into images and record
those images using webbing, mind-mapping techniques or pictorial notes. For
example: a data collection process would include classifying and organizing the
data into tables.
• Videotape students reading or acting out their creative writing or readings you
have chosen. The videotape can be reviewed often to help the student increase
his/her confidence in doing things correctly.
Graphic Organizers
Graphic organizers can be used to help students understand and remember
concepts, content, stories and sequence of events. There are many types of graphic
organizers. For more information on graphic organizers, see the resource section
of this book.
• Venn Diagrams: This type of graphic organizer can be used with students to
describe the similarities and differences between two ideas. The students can
compare and contrast two ideas by titling each of the two large circles with the
two ideas to compare. The students can list individual characteristics of each in
the large portions of the circles and the similar characteristics in the middle. A
blank Venn Diagram to use in the classroom can be found in Appendix 2.
Noun
Person
Place
Thing
Subject
Verb
Part of
speech
Used in
writing
complete
sentences
Action word
Brain-based
Teaching Methods
Tells what
the subject
is doing
Fetal Alcohol Spectrum Disorders Education Strategies
101
• Concept Maps and Webs: Concept maps and webs visually illustrate relationships
between information. In a concept map, two or more concepts are linked by
words that describe their relationship. These organizers link major and minor
concepts and help organize characteristics in a visual manner through examples.
Examples of a completed web diagram and concept chart are shown below. As
you can see, many more circles extending from the primary ones will enhance
understanding and help fully develop a concept. Maps and webs are easily
drawn on the board and may be copied for studying. A blank concept web is
included in Appendix 2.
Fact
Used in
schools,
businesses,
homes
Fact
Internet
capable
Fact
Replacing
paper
documents
Fact
Research
Concept
Idea
Theme
Fact
Processing
Computers
Fact
Many
different types
and speeds
Fact
Collecting
data
Fact
Information
sharing
Brain-based
Teaching Methods
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Fetal Alcohol Spectrum Disorders Education Strategies
Fact
Machine
The Concept
Elephant
Important
Characteristic
3 species:
African Bush,
African Forest,
Asian
Related
Concepts
Descended
from the
sauropsid
In the
carboniferous
periord
Important
Characteristic
Important
Characteristic
Mammal
Largest land
animal alive
today
Related
Concepts
Warm
blooded,
vertebrate,
milk glands,
sweat glands,
hair
Related
Concepts
Long trunks
Ivory tusks,
extremely
tough skin,
large flopping
ears
Example
Example
Example
Example
Example
Example
African
Elephant
poplulation
470,000
and
690,000
Protected
species
worldwide
Give birth
to live
young,
22 month
gestation
Form social
groups and
train their
young
At birth
they weigh
about
250 lbs.
The largest
elephant
on record
weighed
26,400 lbs.
• Time Lines: Time lines can be organized to include events or data between the
two end points on the chart. These organizers may be horizontal or vertical.
Shown below is the general format of linear flow charts. For example: Use a time
line to visualize the life stage of the butterfly, starting with the egg, moving to
the larvae (caterpillar), the pupa and finally the butterfly.
Life stages of the butterfly
1. Egg
2. Larvae/Caterpillar
3. Pupa
Egg
Larvae/Caterpillar
Pupa
4. Butterfly
Brain-based
Teaching Methods
Butterfly
Fetal Alcohol Spectrum Disorders Education Strategies
103
Color in the Classroom
• Instruct the student to use color to review notes after class. Use one highlighter
color for the major topics and highlight all the most important details to each
topic using the same color. Another option is to use one color to highlight the
main topics and another for the supporting details.
• Students can write flash cards on different colored cards by category or major
topic.
• Use color to organize study materials and school supplies. Buy notebooks,
binders and folders of different colors and coordinate so that all materials are the
same color for each class.
• The use of colored pens in class is a great way to help students learn tenses in
language. Use color coding for the various tenses students learn to associate that
color with the tense.
Math
• When designing worksheets for the student, limit it to three or four problems per
page with a large amount of white space for the student to use when working
through the problem.
• When creating worksheets or using print materials for examples, make the
operation symbols extra large, bolded or color coded. This will draw the
student’s attention to the important information.
• Make sure to put similar problems on the same sheet of paper or the same
line so the student can easily practice the concept. The student may become
confused or may distort his/her knowledge of the different concepts.
• Use tables and charts to organize information in a visual format.
Teaching Time
• To teach time, pair a visual representation of a clock with the activity on the class
schedule. The following example illustrates the use of this strategy:
Brain-based
Teaching Methods
104
Fetal Alcohol Spectrum Disorders Education Strategies
Time
Activity
Done
Auditory (Verbal/Linguistic) Learners
Verbal/linguistic learners relate to words and language, both written and spoken.
These learners learn by saying, hearing and seeing words. They can easily memorize
names, dates, places and trivia. Verbal/linguistic learners are good at creating
imaginary worlds from things they see and hear and often enjoy discussions and
debates. These types of learners are tuned in to all the sounds in the environment and
often benefit when trying to concentrate with soft music playing in the background.
Auditory learners frequently need to “say it to themselves” or move their lips when
reading to process the material in the most efficient way. Auditory learners take in
information by:
• Attending lectures
• Attending tutorials
• Discussing topics with other students or lecturers
• Explaining new ideas to other people
• Adding rhymes or tunes when studying
• Using a tape recorder
• Remembering the interesting examples, stories, jokes
• Describing the overheads, pictures and other visuals to someone who was not
there
• Speeches
• Debates
Sounds in the Classroom
• To help auditory learners, use descriptive language whenever possible in the
instruction.
• Use varying words, tones and volumes when speaking and describing
something. Vary between a whisper to using a loud voice or using high pitch
and then low pitch.
• Use words that have a sound meaning to them whenever possible. Some
examples include:
- “When that heater starts, it sounds like a jackhammer.”
Brain-based
Teaching Methods
- “That rings a bell.”
• Play games and sing songs that use repetitive phrases as a way to enhance
auditory memory. Songs that use memory include: “There Was an Old Lady
Who Swallowed a Fly,” “Old McDonald Had a Farm” and “The Twelve Days of
Christmas”. Examples of repetitive stories include “Brown Bear Brown Bear” by
Bill Martin and “Chicken Soup with Rice” by Maurice Sendak.
• Play auditory memory word games to make the learning fun and to help
Fetal Alcohol Spectrum Disorders Education Strategies
105
auditory learners with their memory.
- I’m Going on a Picnic Game: The first person says, “I’m going on a picnic and I’m
going to bring an ___________” (e.g. orange, etc.). The second person repeats
what the first person says and adds something else to the list (e.g., “I’m going
on a picnic, and I’m going to bring an orange and a banana.”) The next person
repeats what the second person has said and adds something new. The game
continues until no one can remember all of the previous items. Use beginning
letters of the alphabet in order or other categories such as animals.
Music
• Music can be a critical tool for students who are auditory learners. Examples of
music for teaching include:
- Grammar: musical patterns such as Mozart, Bach, Handel, Vivaldi
- Imagination exercises: Ravel, Debussy, Satie
- News in the world: Rap, ethnic music from the country discussed
- Making future plans: fun, upbeat, jazz
- Serious issues: Beethoven, Brahms, Mahler
• There are a variety of high quality academic recordings available for purchase. - Reading
• Learn to Read Sing-Along Series Pre K to second grade (songs on
cassette that accompany student books and big book series) available at
www.creativeteaching.com
• Rockin’ Readers K-3 (12 student books plus CD with narrative reading
and song lyrics) available at www.musicK8.com
• Schoolhouse Rock: Grammar Rock (catchy tunes for each part of speech)
• Leapfrog DVD’s
- Math
Brain-based
Teaching Methods
• Addition/Subtraction/Multiplication Rap & Hip Hop Booklet and tape
series available at www.twinsisters.com
• Multiplication/Addition/Subtraction Unplugged Recordings by Sara
Jordan Publications
• Math in Motion: Wiggle, Gallop, and Leap with Numbers Book by Betsy
Franco and Denise Dauler. Basic math skills such as counting, add/
subtract, time/money and patterns are paired with movement games.
Available at www.creativeteaching.com.
• Schoolhouse Rock: Multiplication Rock
- History, Science and Social Studies
106
Fetal Alcohol Spectrum Disorders Education Strategies
• Schoolhouse Rock: Science Rock, America Rock
• Rap of the States, Rap of the Presidents, Rap of the Solar System: booklet
available at www.musick8.com.
• Weather, Oceans, Chemistry, Space, Celebrate America, States & Capitals
available at www.twinsisters.com.
Reading
• Have the student verbally paraphrase material just read in order to ensure
understanding. For longer materials, have the student read with a partner and
paraphrase the information every couple of pages.
• Read to your students of all ages and as often as possible! Read anything and
everything, not just children’s books.
• Encourage the student to memorize stories or books, especially those with
repetitious phrases. “Green Eggs and Ham” and other Dr. Seuss books are good
examples.
• Use rhythmic, rhyming books with tapes in the classroom. Have the student
follow along in the book while listening to the tape.
• Tape record stories so the student can listen and read along. Many school and
public libraries now have a wide array of recorded books. Keep this in mind
when selecting reading materials for the class as an option for students who
may need this extra help. Taped texts for readers with reading disorders have
long proven to be successful. Students are able to hear the spoken word and
conceptualize understanding rather than struggle with difficult words and lose
all facets of comprehension.
E
M
- Younger students who are just learning to read can record themselves
reading out loud. Students can utilize these tapings to read along with the
stories.
- There may be peers in the classroom who are willing to assist in recording
novels and/or textbooks for students to listen along with. In addition, many
companies sell audio recordings of their materials that can be purchased
along with the textbook.
• Tell stories throughout the day by utilizing Round Robin or String a Story
techniques. These techniques allow you to start the story with an idea, sentence
or title and each student continues adding sentences until you have created an
original (and sometimes silly) story.
Brain-based
Teaching Methods
• Some students may benefit from computer-based programs when reading. Textto-speech converters are software programs that read text aloud, often while
highlighting the text on the computer screen as the story or chapter progresses.
A free text to speech program can be downloaded from www.naturalreaders.
com.
• Use scripting to teach subjects and increase generalization skills. Short, easy to
read teacher plays can be used for social skills and specific situations.
Fetal Alcohol Spectrum Disorders Education Strategies
107
• Subvocalization has long proven successful for students who need to hear print
spoken in order to comprehend meaning. Subvocalization is the internal speech
made when reading a word, allowing the reader to imagine the sound of the
word as it is read. Sticking fingers in their ears and whispering the words is
helpful for auditory learners.
• Provide uninterrupted silent reading periods on a regular basis. Provide the
student with books that follow his/her interest and independent reading level.
Independent reading level means the student can read 90% of the words in the
book without assistance. Reading materials should be culturally appropriate
when possible.
• Incorporate popular magazines, newspapers, the school paper or other
unconventional reading materials into a reading program.
• Emphasize to the student that reading is a means to communication. Work
with the student’s family and friends to have them write notes or letters to the
student. Have the student read the written words out loud to you. The same
concept can be used with email if that is available in the classroom.
Math
• Use listening centers for math. Record or purchase CDs with verbal instructions
which correspond to a math lesson. While students listen to the CD they
complete the activities. CDs would cover skill-building activities (adding &
subtracting with money, solving word problems, measurement) one step at a
time.
• Teach students to talk their way through the steps of a problem. Write the steps
on a cue card and use the card to work practice problems.
• Mnemonics are a great way to help auditory learners with math. Examples
include:
- Minus times minus is plus, the reason for this we need not discuss.
- Even times even is even, even times odd is even, but odd times odd is always
odd.
- Celsius: 30 is hot, 20 is nice, 10 is cold, 0 is ice.
Brain-based
Teaching Methods
108
- Other mnemonics can be found in Appendix 1.
• There are a number of assistive technology devices, including talking scientific
calculators, which will assist the auditory learner. A lot of the calculators are
perfect for students of junior high school algebra to college calculus and
is permitted for use on college board tests. Some scientific and graphing
calculators allow the student to use self-voiced sounds, print options and tactile
graphics.
Fetal Alcohol Spectrum Disorders Education Strategies
Kinesthetic Learners
Kinesthetic learning is the style in which learning and remembering take place
through motion. Students with this learning style need to touch, smell, hear and
experience concepts to process them. Students do best with hands-on activities,
such as sports, dancing, acting and crafts, as this type of active learning helps make
connections to real life experiences. Kinesthetic learners take in information by using:
• All senses (sight, touch, taste, smell, hearing)
• Laboratories
• Fields trips
• Examples and demonstrations
• Exhibits, samples, photographs
• Lecturers who give real-life examples and engage in role play and drama
• Applications • Hands-on approaches (computing)
• Trial and error
• Projects such as posters, panorama and shadow boxes
Environmental Adjustments
• It is important to allow kinesthetic learners many opportunities to incorporate
movement into their learning process. Students with an FASD can become
overwhelmed, though, if they are not provided with a quiet period between the
more active learning activities.
• If there is room in the classroom, provide the student with more than one option
for seated work. Allow the student to move between two desks or areas of the
classroom when he/she feels the need to. Another option is to allow the student
to stand to do work.
• Provide student with an inflatable cushion for their chair to provide movement
opportunities while he/she sits in the chair.
• Use experimental learning opportunities such as lab and studio courses, as
opposed to straight lecture classes.
Brain-based
Teaching Methods
- Role play
- Field trips or trips in and around the school
- Body demonstrations where a motion means a concept
- Make colored strips of paper that represent different concepts and link those
papers together.
Fetal Alcohol Spectrum Disorders Education Strategies
109
• Some hands-on learning tools to try in the classroom include:
- Abacus
- Modeling clay
- Sidewalk chalk
- Geoboards
- Calculators
- Shapes and pattern blocks
- Number lines
- Models
- Sandpaper, wood and carpet to trace letters, shapes and numbers
- Drawing materials
- Puppets
- Puzzles
- Water brushes on chalkboard
- Globes and maps
- Blocks and cubes
- Felt boards
- Computers
• Provide a tactile center in the classroom that is large enough to allow for the
students to move within it. This area can include a variety of tactile items
including sand, water, rice, flour, beans, counters, abacus and magnetic numbers
on magnetic board. Squeeze balls or elastic bands for relaxation or creativity
can also be housed here. This spot can be designated as the place where highly
kinesthetic students or those with mild behavior issues can pace, do relaxation
poses or be active.
• Technology is a great interactive tool to use while studying. Games and
simulators allow the learner to be physically involved in the learning process by
practicing the subject in a variety of scenarios and situations.
Brain-based
Teaching Methods
Reading and Language
E
110
• When speaking to kinesthetic learners, use phrases that have a feeling
connotation to them. Examples include: “That feels right,” “That hit the nail on
the head.”
• Try having younger students use different movement and tactile options when
learning letters or spelling.
Fetal Alcohol Spectrum Disorders Education Strategies
- Write letters and words in finger paint or shaving cream.
- Writing the letter or word in the air.
- Make letters with paper and have the student glue other objects to the
letter. Match the objects being glued to the letter.
- Cut a letter out of sandpaper and have the student follow the sandpaper
letter with his/her finger.
- Draw the letter or spelling word really large on the carpet, tile, in the sand or
with a clear water paintbrush on the chalkboard or desk.
- Make dots on a paper in the shape of the letter and have the student
connect the dots to make the letter, gradually decreasing the number of
dots to connect to make the letter.
- Create letters out of jiggler jello and allow the student to play with the letters
by putting them in the correct order.
• Clap, step or tap out syllables on a drum when practicing new vocabulary.
Example: Jump or skip each syllable of “ex-pla-na-tion”.
• Students may draw pictures to go along with the words as visual reminders.
• Use rhymes and mnemonics that correspond with important spelling rules or
grammar techniques. The following are some examples for students:
- “I before E except after C”
- CLIPS (C - Capitalize, L - Leave space between words, I - Ideas are complete,
P- Punctuation, S – Spelling)
- Other mnemonics can be found in Appendix 1.
• A multisensory method like the VAKT (Visual-Auditory-Kinesthetic-Tactile) can
be used to help students remember words. Select words needed to be learned
and write these words on cards using a crayon so that the letters or words have
texture. Using VAKT, the teacher models and the student repeats for each word:
- Say the word, trace the word with two fingers while saying each part of the
word, say the word again;
- Write the word without looking at the word card and then compare what
was written to the word card; and
- Repeat the first step until the word is written correctly three consecutive
times without looking at the prompt card.
Brain-based
Teaching Methods
• Another highly recommended multi-sensory teaching resource is the OrtonGillingham Literacy Program from The Institute for Multi-Sensory Education. This
is a curriculum which offers phonetic, sequential and success-oriented programs
for teachers and parents to use to enhance student skills in reading, spelling and
writing. This method primarily addresses how letters or words look, sound and
feel.
Fetal Alcohol Spectrum Disorders Education Strategies
111
Math
• Try the Touch Math program. Touch Math emphasizes the involvement of
all major learning styles. Students see, say, hear and touch the numerals and
problems without directing their attention away from the paper and use large
print, plentiful workspaces and a manageable number of problems on each
page. The program lessons range from Pre K to upper grade lessons which
include time, money and fractions (www.touchmath.com).
• Utilize physical objects when teaching the concept and have the student
manipulate the object.
E
M
H
- Have the student cut the numbers out of paper and glue oatmeal, rice or
glitter to the number. The student can see, feel and hear the number.
- Have the student bounce a ball when he/she is counting. This will help
focus his/her mind on the task at hand and will provide the student with a
reference to keep in mind for future math activities.
- An older student could use play money to count when learning how to
balance a checkbook. Have the student write out the check and then take
the amount of money for the check out of the stack of money. This will help
the student to understand the concept of the checking process and how it
uses real money.
• Use math and computer games which are motivating and fun for the student. These games can be used to learn new concepts or to practice concepts that
were previously learned.
• Adapt task materials for the student’s frustration tolerance. Observe the student
closely to determine what processes lead to frustration and ultimately shut
down in learning.
• Teach the strategy instead of teaching to memorize answers. If the student
memorizes how to count to ten, this does not ensure that he/she understands
the numbers or the concept behind the process.
E
Brain-based
Teaching Methods
- Use movement to teach number concepts. Teach the student to learn what
the number “one” means before any more numbers are taught. “Give me one
crayon.” “Put one napkin on the table.”
• Pair songs with corresponding visual material or written text that relates to
the content. Provide the students with a verbal quiz or related worksheet after
the song to review the information that was covered. Implement other fading
techniques of the music such as moving from sung addition facts, to chanted
addition facts, to spoken addition facts.
• When teaching money concepts, use real money and actual purchases to
estimate cost and check for correct change. Have students work in the school
store to practice counting change or use a cash register. Teach to estimate how
much items cost and determine if they have enough money to purchase it in
everyday situations.
• Teach the student to use his/her hands to remember 9’s multiplication facts. - Spread hands out.
112
Fetal Alcohol Spectrum Disorders Education Strategies
- Label fingers from 1-10 starting with left pinkie finger.
- Hold down the number of the finger that is the multiplicand of nine.
- Count the fingers to the left of that finger as tens and the fingers to the right
of it as ones.
- For example: 9x3=27: Spread hands out, hold down the number 3 finger,
you will have 2 fingers to the left = 20, and 7 fingers to the right = 27.
• Construct graphs and tables using poster board and pictures cut from
magazines. For example, collect “Me Data” about the students. Create picture
graphs of physical features such as eyes and hair color.
• Measurements can be difficult for students with an FASD to understand. - To teach the kinesthetic learner how to identify and describe the attribute
of length, measure body parts such as arm length, head circumference or
height to compare lengths.
- Try using informal units to estimate and measure length. Use blocks to
measure distance travelled by rolling a toy down an incline.
- When comparing two or more objects according to mass, make shot-puts
from socks filled with sand. Compare the mass of the shot-put against the
distance that it could be thrown.
• Practice multiplication facts incorporating action words. Some examples
include:
- 2 x 2 = 4: Two shoes kicked the door, two times two equals four.
- 3 x 8 = 24: A tree on skates fell on the floor, three times eight is twenty-four.
- 5 x 5 = 25: Two fives jump off the high dive; five times five is twenty-five.
- 6 x 8 = 48: Six asked eight for a date, six times eight is forty-eight.
- 8 x 8 = 64: He ate and ate and sticks in the door, eight times eight is sixtyfour.
- 9 x 9 = 81: He stood in line and ate a ton; nine times nine is eighty-one.
• Math games can be used to reinforce facts. Be careful not to use too many
games requiring quick processing speed or are too competitive where one or
two students always win.
- “Buzz” game is a review of a specific fact family. Choose a number between 2
and 9. The first person in the group says 1, the next player says 2, and so on.
When someone comes to a multiple of the number chosen, the player says
“buzz” instead of the number. If a player forgets to say buzz or says it at the
wrong time, he or she is out. Play continues until the group reaches the last
multiple of the number times 9.
Brain-based
Teaching Methods
- “What’s Your Number” is a game that includes repetition of multiplication,
subtraction, addition or division facts. On a name tag write a problem (e.g.
4 x 5). The answer to the student’s fact becomes his/her name for the day.
Fetal Alcohol Spectrum Disorders Education Strategies
113
When the student speaks to someone else, they call them by the answer to
their name tag fact (20).
- “War Review” game allows students to review multiplication facts. Write on
the board: Ace = 1, J = 0, Q = 11 and K = 12. Pair the students up and give
each pair a deck of cards. Deal all the cards in two stacks, one stack in front
of each student. Students turn over their top card at the same time. They
multiply the 2 cards and shout the answer. The winner puts the cards in
his/her winning pile. If a tie occurs, keep turning cards until someone wins
the pile. When the whole stack is played, have the students count their
winnings. The winner can earn a point if keeping score.
- “Flashcard Password” game is a fun way to have students enter back into
the classroom after an activity. Use a set of flashcards with facts you want
to review. As students re-enter the room, flash them a problem. The correct
answer is their password. They have to give you the password to enter the
classroom. If a student misses the problem, he/she must step to the side and
work it out before coming into the room. You will want to choose flashcards
according to individual student’s ability as needed.
Generalization Tips
• Help the student to recognize when and how to apply and generalize a skill to a
new situation by employing something that has been learned over time.
H
- If the lesson is about balancing a checkbook, work with the student to
understand what it means financially to purchase his/her favorite snack.
Before going to the store, have the student review his/her current checkbook
balance. When returning from the store, have the student figure out his/her
current balance after purchasing the snack.
• Present new concepts to the student in a way that he/she is familiar with and
illustrate or demonstrate the concept in the context in which the skill will be
used.
E
M
H
- Students who have recently learned the alphabet can be shown often about
the use of letters in everyday activities. As you walk by posters or signs with
the student, stop and have the student tell you what letters are represented.
Brain-based
Teaching Methods
- When learning about fractions, students can have a difficult time
understanding the basic concepts. Plan the lesson time around lunch or
snack time. Have the student separate out a portion of the food in half and
work with the student to explain how he/she figured it out.
- Older students should be taught speaking skills so they can become more
comfortable with presenting information in front of an audience. Work with
the student to prepare a speech giving directions to do something that he/
she is very familiar with. Have the student present the speech in front of a
small group of peers or family members.
114
Fetal Alcohol Spectrum Disorders Education Strategies
TOWARDS INCLUSION:
TAPPING HIDDEN STRENGTHS
Planning for
Students Who Are
Alcohol-Affected
2001
Manitoba Education, Training and Youth
Classroom Behavioural Strategies and Interventions
5. CLASSROOM BEHAVIOURAL STRATEGIES AND
INTERVENTIONS
This section will
•
examine classroom techniques for addressing behavioural issues
•
explain the process and strategies for working with behavioural
concerns
•
provide examples of the positive strategies and resources
available to address behaviour
Before anything else, This section will focus on classroom strategies and interventions that address
the discipline/behavioural challenges of students who are alcohol-affected. It is
getting ready is the
important to remember that these students have permanent neurological damage
secret of success.
that will make changing behaviour difficult. Some of the behaviour management
strategies used with other students may not be successful for the child who is
alcohol-affected.
Unique and individual interventions are more important than any prescribed
behaviour program. Some examples of useful interventions include building
relationships, adapting the environment, managing sensory stimulation,
changing communication strategies, providing prompts and cues, using a teach,
review, and reteach process, and developing social skills.
The classroom teacher needs to ensure acceptance for all students in the
classroom. Teachers’ actions that can promote acceptance include
• choosing learning materials to represent all groups of students
• ensuring that all students can participate in extra activities
• valuing, respecting, and talking about differences
• celebrating cultural and ethnic differences
• ensuring that learning activities are designed for a variety of abilities
• ensuring that all students are protected from name-calling or other forms of
abusive language
• modelling acceptance
Setting the Stage
This subsection will provide suggestions for how a teacher can prepare the
groundwork for working with a student who is alcohol-affected. This
preparation can assist in preventing behavioural difficulties.
Developing Classroom Rules
Well-defined rules in the classroom can prevent many behavioural difficulties.
When students are involved in the development of the rules, they are more
likely to adhere to them and understand why they have been put into place.
5.1
Towards Inclusion: Tapping Hidden Strengths
Students who are
alcohol-affected do
better in classrooms
that are structured,
predictable, and
consistent.
Classroom rules should be limited in number (usually five or less) and
stated in positive terms. Once the rules have been developed and taught, they
should be applied consistently. Most students, and especially those who are
alcohol-affected, will perform better in classrooms that are structured,
predictable, and consistent.
Teaching Classroom Rules
Creating the rules is only the beginning. Once agreed upon, the rules should be
taught to the students and posted in the classroom in both print and visual
formats. The rules should be explained using clear, concise language. As well,
they should be explained through the use of specific examples and role-playing.
These concrete activities are very beneficial for the student who is alcoholaffected. As well, the teacher should teach that rules may be different in special
areas (e.g., the lunchroom, hallway, school bus, or playground).
Teaching rules:
1. Teach
2. Review
3. Reteach
A rule should also be explained according to “what it is” and “what it is not.” Each
rule should be explained in detail to ensure
Example of Classroom Rules*
that students understand what is included in
• Keep your hands and feet to
the rule. The first week of a new school year
yourself except for
is an effective time to develop and teach the
rules. The classroom rules should also be
something nice.
shared with parents at the start of the year,
• Do your job.
and reviewed frequently throughout the year.
• Respect yourself and others.
Students who are alcohol-affected may need
• Act safely.
additional instruction and reminders to be
• Take care of the
sure the rules are understood and
environment and the things
remembered. Teachers should remind the
in it.
student of the rules at key times, and in a
variety of contexts, during the day. Students’
behaviours should be acknowledged and reinforced when the rules are followed
appropriately.
Positive Classroom Discipline
Teachers need to build a classroom
environment where positive
interactions are the norm and punitive
consequences are minimized. Research
indicates that coercive or punitive
environments actually promote
antisocial behaviour.
*
5.2
For more information,
see Preventing
Antisocial Behaviour in
the Schools (Mayer, G. Roy,
1995).
Reproduced by permission of Lakewood School, St. James Assiniboia S.D. No. 2.s
Classroom Behavioural Strategies and Interventions
It is important that teachers provide immediate, frequent, and positive feedback.
The value of a positive versus a punitive procedure is summarized in the
following chart.
Comparison of Punitive Methods and Positive Classroom Discipline*
Management Strategies
Punitive Procedures
• rapidly stop behaviour
• provide immediate relief
(reinforcement) to the teacher
• teach the student and peers what
not to do
• decrease positive self-statements
(self-concept)
Positive Classroom Management
Strategies
• slowly stop behaviour
• provide no immediate relief to the
teacher
• teach the student and peers what
to do
• increase positive self-statements
(self-concept)
• decrease positive attitudes toward • increase positive attitudes toward
school and schoolwork
school and school work
• promote enhanced participation
• cause withdrawal (tardiness,
truancy, dropping out)
• decrease likelihood of aggression
• cause aggression (against property • teach students to recognize the
positive
and others)
• can enhance student-teacher
• teach students to respond in a
relationships
punitive manner
• can harm student-teacher
relationships
Positive feedback
should occur three
times as frequently
as negative feedback.
Effective feedback should be immediate and follow the demonstration of an
appropriate behaviour, the use of a routine, or the successful completion of
teacher instructions. Research has shown that positive reinforcement can lead to
improved behaviour. A good general rule is that positive feedback should occur
three times as frequently as negative feedback. The positive feedback does not
always have to be verbal – it can also include praise, hugs, smiles, handshakes,
nods, and eye contact.
*
From “Preventing Antisocial Behaviour in the Schools” by G.R. Mayer and B. SulzerAzcroff. Journal of Applied Behaviour Analysis 28. Reprinted by permission.
5.3
Towards Inclusion: Tapping Hidden Strengths
As well, the use of positive reinforcers
For additional
can have a positive influence on
information on the use
behaviours. Remember, because
of positive reinforcers,
students who are alcohol-affected have
see Classroom Management: A
difficulty with cause and effect, this
California Resource Guide
approach may not always be
(Mayer, G. Roy, 2000).
successful. A reinforcer is an object or
event that is given to the student for
performing a desirable behaviour. Reinforcers need to be carefully chosen to ensure
they can be delivered with relatively little effort or planning. Teachers need to have
a wide variety of reinforcers available because they will not all work equally well
with each student. A good way to choose reinforcers is to involve the student in the
selection process. As the student’s behaviour improves, the teacher should gradually
move away from external rewards and replace them with intrinsic rewards. A list of
possible positive consequences is included at the end of this section.
Consequences may not always work with students who are alcohol-affected.
However, their use is appropriate in specific situations. All of the students will
face consequences in their daily lives as adults. Therefore, they will need to
learn to deal with the consequences in the same way that other students do. The
consequences should be carefully selected, pre-determined, consistently applied,
and used expeditiously.
It may be important to remember that these children may learn best when the
consequences are “real” and immediate rather than convenient and delayed. For
example, it might be more useful to require a child to finish up his or her work
during ‘choice time’ rather than impose a detention (Jones, 2000).
Teaching Classroom Routines
5 Steps
in Teaching
Classroom
Routines
1. Explain
2. Demonstrate
and Model
3. Rehearse/
Guided Practice
4. Perform
Independently
5. Review/Reteach
5.4
Classrooms with structured routines and clear procedures are recommended for
students who are alcohol-affected. Teachers should establish routines for
students and set expectations regarding classroom procedures (e.g., getting
down to work, arrivals, departures, completing assignments, keeping occupied
after work is finished, and transitioning from one assignment or subject area to
the next).
Most students learn routines and procedures quickly. Students who are alcoholaffected may need additional instruction. For these students, teachers may wish
to consider the following five-step process.
1. Explain. The teacher explains the routine and the reasons for its use. It is
explained in easy to understand language using short, concise sentences. Key
messages are repeated.
2. Demonstrate and Model. If the routine is complicated, the teacher breaks it
down into smaller steps. A visual or written chart supports the verbal
instruction. Once the routine is explained in detail, the teacher demonstrates or
models the task, using the student’s visual or written plan. The teacher then asks
the students to repeat the step. Occasionally, parts of the routine will need to be
adapted in order to increase independence.
Classroom Behavioural Strategies and Interventions
3. Rehearse/Guided Practice. As students practise the routine, corrective
feedback is provided by the teacher. Advanced students can role-play the steps
or act as a “buddy” to a student who is alcohol-affected. The teacher uses subtle
prompts to help students who forget steps. If the routine is to be used in several
areas of the school, practices are arranged in the different locations.
4. Perform Independently. The student performs the routine during the course
of the regular school day. Students who are alcohol-affected are given cues as to
when the strategy should be used. Praise and encouragement are given for
successful completion of the routine.
5. Review/Reteach. The teacher periodically reviews the routine and reteaches
it. For students with memory problems, cue cards (which outline the steps of the
routine, and can be taped to notebooks or on desks) may be useful.
Some key routines that need to be taught to students who are alcohol-affected
include procedures for
• using a locker
• entering a classroom
• getting ready to work
• problem solving
• asking for help
• completing assignments
• checking completed work
• turning in projects on time
• leaving the room
• using an agenda book
“External Brain”
Some students who are alcoholaffected will require the
assistance of an “external brain”
to help them make decisions,
remember rules and routines,
and problem solve. The role of
the “external brain” may be
filled by a classroom peer, senior
student, volunteer, or
paraprofessional.
• handling the lunch room
• controlling anger
• transitioning to the next class
• using a computer
• keeping occupied
• writing a book report
Some students will
require routines for
everything.
Teachers should only focus on two or three routines at any one time. Examples
of routines with visual prompts are included at the end of this section.
Classroom Meetings
Classroom meetings are a useful way to promote a positive classroom
atmosphere. They encourage effective communication between the teacher and
the students, and provide a good opportunity for the teacher to remind students
of individual differences and to involve special students in all classroom
activities. The meetings should be held on a regular basis. The teacher and
students should work together to establish ground rules for the meetings.
5.5
Towards Inclusion: Tapping Hidden Strengths
Meeting ground rules might include:
• Students must show mutual respect.
• Only one student speaks at a time.
• Students help each other.
• Issues (e.g., resolving conflicts, planning special activities or events, sharing
information, reviewing classroom rules) are addressed.
Part of the ground rules should also involve deciding how the outcomes of the
meeting will be recorded (e.g., minutes, board summary).
For a student who is alcohol-affected, the above rules may require oral and
visual explanation, demonstrating, role-playing, and positive reinforcement.
Home-School Communication
Maintaining close contact between the school and the home can prevent
misunderstandings. One of the ways is to use a “communication book” to
review the day’s events and share information. The book should be designed
carefully to ensure that it is easy to use and understand.
A home-school communication book has several benefits for the student. It can
• assist with organizational skills
• improve self-esteem
• assist with homework/assignment reminders
• help with self-monitoring
• involve students in the communication process
The student’s parents should meet with the in-school team to plan for the use of
the communication book. The planning should address the following questions:
• How will the book travel back and forth?
• What type of information will be documented by the school? by the home?
• Who will write in the book at the school?
The front of the communication book should list the staff who are involved with
the student and the school’s key contact person. The school may wish to
develop a pre-formatted, duplicated sheet to use in the book (to keep the
communication structured and limited to a reasonable length). Whenever
possible, students should help to prepare the communications between home
and school. For students who are alcohol-affected, a form with visuals can be
useful. For Middle and Senior Years students, it may be possible to modify the
existing school agenda book to serve as a communication tool.
Home-school communication books can create challenges for both parents and
the school. These include
• transporting the book back and forth
• maintaining positive communication
• developing responsibility for monitoring
• ensuring it is age-appropriate
5.6
Classroom Behavioural Strategies and Interventions
• ensuring the book is utilized by several teachers in a day
When writing in a communication book, parents and teachers should
• keep comments as positive as possible
• keep communications short and to the point
• respond to each other’s questions and comments (this ensures the book is
being read on a daily basis)
• ask each other for suggestions and ideas
• have the student contribute to the book when possible
• record reminders of upcoming dates and events
Teachers should ask parents for suggestions on what works at home.
*
*
From Teaching Students with Autism: A Resource Guide for Schools by Autism Society of
British Columbia. Reprinted by permission.
5.7
Towards Inclusion: Tapping Hidden Strengths
Classroom Strategies
This subsection will provide strategies for addressing behavioural concerns of
students who are alcohol-affected.
Teaching Social Skills
The goal of social skills instruction is to teach socially acceptable behaviours
that will help students be accepted by their classroom peers and teachers, and
provide life-long skills.
Students who are alcohol-affected often require extra attention in the
development of social skills. Social skills can be taught to the entire classroom,
to individual students, or to small groups of students.
Several examples of social skills are included in the chart below.
Academic Survival Skills
Peer Relationship Skills
• complies with teacher’s requests
• introduces self by name
• follows directions
• shares with others
• requests help when needed
• asks permission
• greets the teacher
• takes turns
• provides appreciative feedback
• invites others to participate
• nods to communicate
• assists others
understanding
• cares for physical appearance
• demonstrates listening skills
• gets attention appropriately
• develops play repertoire (Early
• has conversation skills
Years)
• problem solves
• displays control
• negotiates
• gives and receives compliments
• respects personal space
• displays empathy toward others
• identifies and expresses emotions
in self and others
• uses appropriate language
All of the above skills can be measured or rated by teachers using rating scales or
observation. Once a teacher has identified skills that need to be taught, he or she can
begin to develop appropriate instructional strategies on a formal or informal basis.
Once taught, the skills need to be prompted and reinforced in many settings to be
used effectively.
5.8
Classroom Behavioural Strategies and Interventions
Teaching Social
Skills
Some students will
require individual
interventions to
1. Identify the skill
address their social
to focus on
skills. Individual
skills that require
2. Teach, review,
attention should be
reteach
identified and
3. Model and role- prioritized by the
play
teacher. The teacher
then uses a structured
4. Provide
teaching process with
feedback and
the student. The skills
reminders
need to be taught,
reviewed, and
5. Transfer and
retaught until they
generalize to
can be generalized to
other locations
the settings, times,
and situations. Based
on the work of Ellen
McGinnis and Arnold
Goldstein in their
Skillstreaming books,
a four-step process is
recommended.
For additional information on social
skills instruction, see:
• “Second Step” program (The Committee for
Children, Seattle, WA)
• “Skills for Growing Lion’s-Quest Program”
(Lion’s-Quest Canada)
• The Tough Kid Social Skills Book (Sheridan,
Susan, and Tom Oling, 1995)
• Skillstreaming in Early Childhood: Teaching
Prosocial Skills to the Preschool and
Kindergarten Child (McGinnis, Ellen, and
Arnold Goldstein, 1990)
• Skillstreaming the Elementary School Child:
New Strategies and Perspectives for Teaching
Prosocial Skills, Revised Edition (McGinnis,
Ellen, and Arnold Goldstein, 1997)
• School Success: A Self-Concept Approach to
Teaching, Learning, and Educational
Practice. 3rd ed. (Purkey, W.W., and J. M.
Novak, 1996)
• Skillstreaming the Adolescent: New
Strategies and Perspectives for Teaching
Prosocial Skills, Revised Edition (McGinnis,
Ellen, and Arnold Goldstein, 1997)
1. modelling
2. role-playing
3. performance feedback
4. transfer training
Teaching Social Stories
Social stories are used to help students with disabilities develop social skills.
The concept of social stories was first developed by Carol Gray, a consultant for
Jenison Public Schools in Jenison, Michigan. Social stories can be used to teach
new social skills, routines, behaviours, and transitions.
Social stories present appropriate social
behaviours in the form of a story. The
stories are designed to include the
answers to questions about acting
appropriately in social situations
(usually who, what, when, where, and
why). Some social stories include
visuals to help students understand the
social situations.
For additional
information on social
stories, please see
Writing Social Stories with Carol
Gray and/or The New Social
Stories: Illustrated Edition (Gray,
Carol, 1994). These materials
are available from “Future
Horizons.”
5.9
Towards Inclusion: Tapping Hidden Strengths
Social stories are often read to
or with a student prior to a
specific social situation (e.g.,
the lunchroom, recess, or bus
ride). They can also be used to
teach routines (e.g., asking for
help, responding to anger,
completing a task). Social
stories appear to be a promising
method for teaching social
behaviours.
*
Self-Calming Procedures
When students who are alcoholaffected become disruptive or
overstimulated in the classroom,
the teacher may need to provide
a space for them to calm down.
This space can be selected by
the student and might include a
carrel, special corner of the
room, or an area removed from the general classroom. The students will need to
be told when they need to move to their calming space. These placements
should be short in duration (5-10 minutes). At the end of the calming time, the
teacher should welcome the student back to the main classroom area.
The calming space might receive a special name (e.g., Student office, Sharon’s
space). For younger students the area should be in the classroom; for older
students an area outside the classroom may be considered (e.g., the school
lounge, resource area, or guidance room). This area should contain items to help
the student calm down, such as calming music. The main benefit of a calming
area is that the students can use the space and time to regain control. As much
as possible, students should be encouraged to enter their calming space on their
own.
If more intrusive forms of calming are being considered, parents, guardians, the
school administration, and the school psychologist should be involved in
developing a formal plan for the intervention. The plan will require parental
involvement, parental permission, specific procedures, staff training, and a
systematic method of record keeping.
*
5.10
Reprinted from the Xplanatory Research Seminars. Available online at dddddddd
<www.thegraycenter.org>. Reprinted by permission.
Classroom Behavioural Strategies and Interventions
Personal Safety Programs
Students who are alcohol-affected can
be very vulnerable to abuse. It is
therefore important for the student to
be involved in existing or specially
designed school safety programs, such
as Feeling Yes, Feeling No (National
Film Board). If an existing program is
being used, an individual follow-up to
the program should be planned.
Group Programs
Personal Safety
Programs: One
program that can be
used for students who are
alcohol-affected is the Circles
Program (James Stanfield
Publishing Company), which
helps students establish
appropriate boundaries when
dealing with others. Another
effective program is The
Friendship Circles Program,
found in Tough Kids and
Substance Abuse (Jones et al,
2000 — see p. 5.35).
There are several programs that can
be used to address behavioural
concerns. These programs can be used
with students who are alcohol-affected
and the general student population.
There are also many strategies and interventions that can be used by the
classroom teacher and paraprofessional in the classroom. The chart below shows
a selection of strategies or areas being addressed in many schools across
Manitoba.
Conflict Resolution Skills
Anger Management
Stress Management
•
•
•
•
•
•
•
•
•
•
•
•
•
playground conflict
manager
talk-it-out corners
mediation programs
Lions-Quest
RID
Empathy
Second Step
relaxation techniques
deep breathing
walking
exercise
positive talking
How Does Your Engine
Run?
After School Programs
Community Service
Support Groups
•
•
•
•
•
•
•
•
•
•
•
•
academic enrichment
recreation
friendship centres
personal development
senior centre
daycare
hospital
group home
relationships
women’s issues
drinking/drug issues
family
Bullying Prevention
•
•
•
•
victimization
bullying
vulnerability
awareness
5.11
Towards Inclusion: Tapping Hidden Strengths
Resolving Behavioural Incidents
Addressing a
Problem
1. Speak slowly
2. Speak calmly
Teachers and administrators are often called upon to resolve behavioural
incidents involving students who are alcohol-affected. The following
suggestions may be useful to reduce the escalation of behavioural incidents.
Review the incident as soon as possible. Try to deal with the incident as
quickly as possible once the student has calmed down.
Actively listen. Take time for the student to tell you his or her side of the story.
3. Use short
concise phrases Paraphrase and use eye contact to demonstrate that you are listening. Note that
students who are alcohol-affected may shut down when confronted by an
4. Avoid blame
authority figure. Sometimes, a walk around the school with the student can help
him or her to relax and begin talking. The teacher or administrator may
5. Review/reteach
encourage the student to draw his or her story.
6. Build
Use non-threatening questions. Ask questions that focus on “how” and “what”
relationships
instead of “why.” Students who are alcohol-affected may not remember,
understand, or be able to articulate what happened, or may have acted
impulsively. Open-ended questions may be most useful. Questions should be
asked in a calm, quiet tone using slow, short, concise phrases. A simple problemsolving procedure using graphics or pictures may be helpful (see p. 5.23).
Try not to blame. Focus on teaching the right behaviour or a replacement
behaviour. For example, ask “How can we avoid this problem the next time?” or
“What behaviour would have worked better than hitting?” Consider using roleplay, modeling, and rehearsing to teach a new behaviour. Present new ideas in a
concrete way, one at a time. Remember that ideas may need to be reinforced
and re-taught several times.
Show personal interest in the student. End the review of the incident with a
positive comment or a personal question. Follow up with the student and other
classroom teachers in order to reinforce the new skill that is desired.
5.12
Classroom Behavioural Strategies and Interventions
Special Consequences
Is it unfair to treat
students differently?
No. It is
unprofessional to
treat them the same.
Most schools have developed a code of conduct that addresses student
behaviour. Often these codes of conduct outline the consequences of particular
behaviours (e.g., a suspension for hitting or fighting). However, students who
are alcohol-affected may need consequences to be modified in order to meet
their needs. Consider the following suggestions when handling exceptions to the
code of conduct:
• Every effort should be made to
include proactive prevention
and exemplary supervision
strategies to avoid the need for
a major consequence.
• The student’s support team
should discuss with the
administration and staff
exceptions that might be
required. The communication
of special circumstances can
prevent issues from arising at a
later time.
• An Individual Education Plan
documents the plan to address
the behavioural difficulties that
have been addressed by the
planning team.
• Suspension and expulsion for
students who are alcoholaffected should be limited to
exceptional circumstances.
Explaining Differences to Students
It is sometimes necessary to explain
to students that each is a unique
human being. Teachers must
address students’ individual needs.
For example, a teacher may ask a
student with a vision or hearing
problem to sit in the front of the
classroom. In the same way,
teachers need to address
behavioural problems based on
each student’s needs. (For
example, that is why two students
who are in a fight may sometimes
be treated differently). Often,
the students will see that it makes
sense to treat students in unique
ways.
5.13
Towards Inclusion: Tapping Hidden Strengths
Student-Specific Interventions
The strategies below should be student specific and include a specific strategy
for evaluation.
Classroom Settings
Strategies for Easing Frustration with
Directions
Day 1
• use concrete language (stay away from
generalizations)
Gym
• keep directions short and to the point
• rephrase instructions, breaking them down
into small steps
ELA
• use visual cues
• use pictures to illustrate steps in a process
• use sign prompts (e.g., red traffic light or stop
sign)
• print task-related steps on a chart using short,
concise sentences
Lunch
Science
Strategies for Reducing Stimulation
• use preferential seating or create a lowdistraction seating area
• keep the student’s desk uncluttered
Social
Studies
• designate a special classroom space where the
student can go for quiet time
• adapt the classroom to reduce stimulation (e.g., use velcro covers for bulletin
boards)
• use study carrels or work stations in the corner of the room
• use earphones with relaxing music
Strategies for Reinforcing Routine and Structure
• make the student aware of his or her timetable
• post timetables (with pictures) to show daily routines
• prepare students for transitions or changes
• make special arrangements for recess and lunch time, if necessary
• use a “buddy system” for bus travel
• establish rules that are easy to follow and understand
• establish a routine for everything
5.14
Classroom Behavioural Strategies and Interventions
Strategies for Dealing with Overactivity
• provide squeeze balls to students
• send the student on a “school walkabout” (with an assistant)
• arrange for physical time in the gymnasium
• use a rocking chair or floor cushions
• precede focused activity with movement
• build breaks into the schedule
• use a signal to tell students to return to their tasks
Strategies for Transitions
• use visual, colour-coded, or written plans
• use social stories
• pre-warn the student of transitions
• use the same substitute teacher whenever possible
• provide early release from classrooms
• use consistent rules and consequences between classroom teachers and
specialists
• ensure ongoing communication among team members
Strategies for Handling Outbursts and Tantrums
• anticipate and identify warning signs
• remove students from the classroom
• debrief the student after the incident – focus on what could have been done
differently
• teach the correct behaviour (don’t blame)
• teach a routine for preventing an outburst
• invite the student to help solve future problems
• avoid power struggles and put-downs
• determine the cause of the outburst
Strategies for Dealing with Peer Problems
• teach disability awareness to all children
• use the “Circle of Friends” strategy
• involve all students in special activities
• teach students how to make and keep friends
• ensure that staff members model acceptance and accept differences
• set up recess and noon-hour activities that result in success
• involve students in a social skills instructional group
5.15
Towards Inclusion: Tapping Hidden Strengths
Non-Classroom Settings
Students who are alcohol-affected often experience difficulty adjusting to nonclassroom school settings such as the playground, school bus, lunch room,
gymnasium, and library. For a student to be successful in non-classroom
settings, extra planning and supports may be required. In addition, special
training may be necessary for the support personnel working in these areas (e.g.,
the bus driver, lunchroom supervisor, library technician).
Strategies for Addressing Playground/Recess Challenges
• consider an alternate recess time
• structure recess activities (e.g., arrange specific activities, teach games,
assign specific equipment, designate specific areas)
• consider alternatives to recess (e.g., use of computer room, games room,
gymnasium activity)
• ask a student to act as a buddy or helper during recess
• provide clear choices to the student (keep them limited in number)
• assign a paraprofessional to a small number of students to participate in a
closely supervised activity on the playground or in the school
• involve students who are alcohol-affected in helping younger students
• prepare students for recess by reviewing expectations and procedures
• develop a plan for handling emergency situations that occur on the
playground
• make sure the student is ready for the transition to recess and back into
school
Strategies for Addressing Lunch Hour Concerns
• provide information and training to students about lunch room expectations
and procedures
• post lunch room rules in print and visual formats
• provide training to lunch room supervisors
• consider an alternate lunch setting for a small number of students
• develop a plan with the school administration for handling emergency
situations
• teach a lunch hour routine
• arrange activities for students to fill the remainder of the lunch break (e.g.,
extracurricular activities, intramurals, clubs, videos)
• assign seating in the lunchroom with appropriate peers
• develop a safety plan
5.16
Classroom Behavioural Strategies and Interventions
*
*
From Tough Kids and Substance Abuse by the Addictions Foundation of Manitoba. Reprinted
by permission.
5.35
Learning Strategies, Supports, and Interventions
Task Analysis
Sometimes in individualized programming a task analysis is required. Teachers
and parents may need to break complex tasks down into small, teachable steps.
The sub-steps should be taught in order and reinforced as they are taught. Life
skills, social skills, and academic skills can all be broken down into small steps
for instruction. The life skills example below illustrates the sub-steps required
for sweeping the floor and the academic example illustrates the preparation
tasks for an art class.
Life Skills Example:
Cleaning a room
Academic Example:
Preparing for Art Class
1. Get the broom.
1. Find the classroom.
2. Get the dust pan.
2. Get folder with project directions.
3. Clear the floors.
•
Put chairs on the table.
3. Take the folder to assigned work area. Open
the folder.
•
Pick up big pieces of garbage.
4. Check folder; assemble and set up supplies.
4. Sweep up the dust and dirt into a
pile.
5. Sit appropriately and follow directions as
teacher explains.
5. Sweep the pile into the dust pan.
6. Follow the sequence of listed steps to
complete.
6. Empty the dust pan into the
garbage can.
7. Put the dustpan and broom away.
8. Put the chairs back onto the floor.
9. Place chairs and tables in rows as
shown on the room diagram
located on the wall.
7. Try to finish the project or complete the step
(if not completed, mark stopping place to
complete next day.)
8. Follow termination procedure, put materials
and project away. Clean area.
9. Check area and materials. Is folder put
away?
10. Check schedule and map. Move to next
class.
4.13
Classroom Behavioural Strategies and Interventions
*
*
Reprinted from Orchestrating Positive and Practical Behaviour Plans by Dawn Reithaug.
Copyright © 1998 Dawn Reithaug. Reprinted with permission.
5.29
Classroom Behavioural Strategies and Interventions
-
?
5.23
Classroom Behavioural Strategies and Interventions
Recess & Choice Time Plan
5.21
Towards Inclusion: Tapping Hidden Strengths
A Closer Look at Individualized Programs
Close
Up
This “Close Up” of Pauline illustrates how her learning plan is developed using
an individualized program.
“Pauline” is a Grade 8 student with significant developmental
delays and some fine and gross motor difficulties due to
skeletal abnormalities. Pauline has been diagnosed with Fetal
Alcohol Syndrome. Her needs and interventions are addressed
by individualized programming and she receives some
paraprofessional assistance. Pauline lives in a supportive foster
placement in her local community.
Pauline stays in the regular classroom about 75% of the time.
She is engaged in both parallel and personalized activities with
her classmates (depending on the subject area). The parallel
activities tend to take place during language arts and
mathematics, and focus on the goals outlined in her Individual
Education Plan. In mathematics, Pauline focuses on the
functional skills of time, money, and consumer purchasing. She
is currently working on these concepts while making shopping
trips to a local store. In language arts, the receptive and
expressive communication outcomes outlined in her Individual
Education Plan are addressed. Recently she has been working
on captioning photos, and responding to who, what, and where
questions.
Pauline’s teacher includes Pauline in classroom activities by
providing her with opportunities to participate in similar
activities. For example, a recent project involved students
presenting biographies of famous people. Pauline’s
individualized assignment involved her creating a biography of
the classroom teacher, and then presenting the information to
the class. Her presentation was illustrated with computergenerated pictures.
Pauline participates in science and social studies by listening to
classroom presentations and engaging in hands-on activities
with her peers. While students conduct written work, Pauline
conferences with the teacher about the important parts of the
lesson. The teacher scribes the key parts, then Pauline copies
the notes independently on the computer.
Pauline participates in music and gym class. In gym class, she
leaves the classroom ten minutes before her peers so that she
(continued)
4.14
Learning Strategies, Supports, and Interventions
can dress herself independently. The teacher encourages her
independence in the classroom, as well, by having Pauline
complete tasks such as handing out papers and making
deliveries around the school. During her breaks, Pauline is
paired with a “buddy” to visit her locker and go to the
cafeteria.
During Pauline’s independent time, she follows a plan that
includes gross motor exercises. Currently she is working on
balance, flexibility, and trunk strength. These exercises help
her to walk in a more erect fashion. Some of her gross motor
goals are also addressed within her weekly swim program, and
swimming also provides her an opportunity to work on dressing
and bathing skills. Many of her fine motor skills are addressed
within the math program when she works with small
manipulatives (e.g., little crystal “counter” beads that promote
a more refined pincer grasp).
The other functional life skills Pauline works on include
shopping and cooking. Once a week she participates with
another student in preparing a meal. This involves a trip to the
store, the purchasing of ingredients, and the preparation of
the meal. While walking to and from the store, Pauline works on
traffic safety. A social story with photographs has been
developed to help her prepare for the outings. While at the
grocery store she follows a picture-based shopping list and is
working on opening her change purse and paying the clerk.
Pauline is exposed to the Circles personal safety program (see
page 5.11 for more information). This program was introduced
due to a fear that she was vulnerable because she has
difficulty saying “no” and does not always respect personal
space. The program helps her to understand different types of
relationships and the types of gestures that are appropriate in
different relationships. She is reinforced positively during the
day for standing the correct distance from others and keeping
her hands and feet to herself.
4.15
Classroom Behavioural Strategies and Interventions
*
*
Reprinted from Orchestrating Positive and Practical Behaviour Plans by Dawn Reithaug.
Copyright © 1998 Dawn Reithaug. Reprinted with permission.
5.27
Acknowledgments
This booklet was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA) by Westat under contract number 277-00-6102, with SAMHSA, U.S. Department of Health
and Human Services (DHHS). Ammie A. Bonsu, M.P.H., served as the Government Project Officer.
Numerous people contributed to the content and development: Daksha Arora, Ph.D.; Rebecca M.
Buchanan, Ph.D.; Kay Gallagher; Shayna Heller; Ana Vionet Horton; Barbara Morse, Ph.D.; Elizabeth
Wetmore Naab; Jacqueline Nemes; Beth Rabinovich, Ph.D.; and Joshua P. Rubin. Reviews were provided
by SAMHSA’s Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence and two anonymous peer
reviewers.
Disclaimer
The views, opinions, and content of this publication are those of the developers and do not necessarily
reflect the views, opinions, or policies of SAMHSA or DHHS. The listing of non-Federal resources is not
all inclusive and inclusion on the listing does not constitute an endorsement by SAMHSA or DHHS.
Public Domain Notice
All material appearing in this booklet is in the public domain and may be reproduced or copied without
permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be
reproduced or distributed for a fee without the specific, written authorization of the Office of
Communications, SAMHSA, DHHS.
Electronic Access and Copies of Publication
Electronic copies of the booklet can be downloaded from SAMHSA’s FASD Center for Excellence Web
site: www.fasdcenter.samhsa.gov/. Printed copies can be ordered free of charge from SAMHSA’s National
Clearinghouse for Alcohol and Drug Information (NCADI) at 800-729-6686 or 1-800-487-4889 (TDD).
Or, visit http://ncadi.samhsa.gov/.
Recommended Citation
Reach to Teach: Educating Elementary and Middle School Children with Fetal Alcohol Spectrum Disorders,
DHHS Pub. No. SMA-4222. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse
and Mental Health Services Administration, 2007.
Originating Office
Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration,
1 Choke Cherry Road, Rockville, MD 20857.
DHHS Publication No. SMA-4222
Printed 2007
A NOTE TO PARENTS AND TEACHERS
Reach to Teach is a valuable resource for parents and teachers to use in educating
elementary and middle school children with fetal alcohol spectrum disorders (FASD). It
provides a basic introduction to FASD, which results from prenatal alcohol exposure and
can cause physical, mental, behavioral, and/or learning disabilities, and provides tools to
enhance communication between parents and teachers.
Parents with a child identified as having an FASD can reach out to the child’s
teachers, school principals, special education professionals, religious school personnel,
and camp counselors by passing along copies of this booklet.
Teachers and other staff, in turn, can reach out to the child, using specific
classroom strategies to assist learning. These strategies, detailed in the booklet, include
structuring a caring and consistent environment, shifting attitudes and improving
understanding, learning to translate misbehavior, changing classroom teaching style,
restructuring the physical space in the classroom, and engaging the whole school
community.
Parents, students, and teachers can use the forms on pages 47 and 49 to create
consistent routines for students throughout the day. As the student moves from grade
to grade, parents, students, and teachers can use the forms on pages 51 and 53 to
communicate strengths, challenges, and successful techniques.
Parents also may want to use the booklet during individual educational plan (IEP)
meetings with teachers and child study team meetings. They can provide copies of this
booklet to school administrators and others in the school community.
Teachers will find this booklet useful not only in their day-to-day work but also as
a tool to share with others at conferences.
We welcome your comments and any additional ideas you may have concerning
the content and design of Reach to Teach. Please use the reply card on the last page to
provide your input.
REACH TO TEACH
Educating Elementary and Middle School Children with
Fetal Alcohol Spectrum Disorders
INTRODUCTION TO FETAL ALCOHOL SPECTRUM DISORDERS . . . . . . . . . . . . . . . . . . . . 1
The Definition of FASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The Cause of FASD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
The Benefits of Early Identification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
FASD
IN THE
CLASSROOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
The Scope of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
FASD and Brain Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
STRATEGIES
FOR IMPROVING
SCHOOL SUCCESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Structure a Caring and Consistent Environment . . . . . . . . . . . . . . . . . . . . . . . . 17
Shift Attitudes and Improve Understanding . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Learn to Translate Misbehavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Change Classroom Teaching Style . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Restructure the Physical Space in the Classroom . . . . . . . . . . . . . . . . . . . . . . . 27
Engage the Whole School Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
REACH
TO
TEACH: APPLYING SUCCESSFUL STRATEGIES . . . . . . . . . . . . . . . . . . . . . . . 35
Working with Shauna and Jesse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
The Unique Talents and Skills of Children with FASD . . . . . . . . . . . . . . . . . . . . 39
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
TO FETAL ALCOHOL SPECTRUM DISORDERS
arents and teachers can join together to nurture the unique talents
and skills of children with fetal alcohol spectrum disorders (FASD). This
booklet begins the journey by defining FASD, detailing its cause,
introducing two students who are affected, and citing the benefits of
early identification.
The Definition of FASD
FASD is an umbrella term used to describe the range of effects
that can occur in an individual whose mother drank alcohol during
pregnancy. These effects may include physical, mental, behavioral, and/or
learning disabilities with possible lifelong implications. The term FASD is
not intended for use as a clinical diagnosis.
While the term FASD is relatively new, it encompasses a number
of conditions with which you may be familiar. These include fetal
alcohol syndrome (FAS), alcohol-related neurodevelopmental disorder
(ARND; formerly called possible fetal alcohol effects or FAE), and
alcohol-related birth defects (ARBD).
✿ The term fetal alcohol syndrome (FAS) is a medical diagnosis
characterized by a combination of distinct facial features,
small or slow physical growth, and brain damage that can
result in learning difficulties and/or behavioral disorders.
1
✿ The other conditions under the FASD umbrella are cases in which
children do not have the distinct facial features associated
with FAS, but have significant learning and behavioral problems
due to prenatal alcohol exposure. These children are typically
identified as having alcohol-related neurodevelopmental disorder
(ARND), or fetal alcohol effects (FAE).
The Cause of FASD
FASD can only occur when a woman drinks alcohol during her
pregnancy. However, many children prenatally exposed to alcohol are not
affected. The following factors help determine whether any given
pregnancy will result in a child with an FASD:1-5
✿ Amount of alcohol consumed during pregnancy,
✿ Timing of drinking during pregnancy,
✿ Vulnerability of a particular fetus,
✿ The mother’s genetic background, and
✿ Other maternal factors, including the number of previous births.
2
Meet Shauna
hauna is an adorable, petite 6-year-old entering first grade.
She seems very eager and happy to be in school, if a bit young
for her age. Her teacher, Mrs. Watkins, finds her expressive and
talkative, although Shauna does not seem able to follow
directions. Even the smallest distraction in class, the hall, or
outside seems to pull her away from the subject at hand. In
writing or drawing exercises, Shauna still uses an immature grasp
on her pencil. Things that Mrs. Watkins is sure Shauna knew one
day seem to be gone from her memory the next. And
Mrs. Watkins is surprised that Shauna still has not grasped
classroom routines after six weeks. In a conversation with
Shauna’s mother, Mrs. Watkins learns that Shauna has been
identified as having an FASD.
3
FASD can only result from
a woman’s use of alcohol during pregnancy.
It does not result from previous use of alcohol,
living in an alcoholic home, or from
paternal alcohol use. FASD
cannot be inherited.
The Benefits of Early Identification
One in every 100 babies born each year is affected by prenatal
alcohol exposure.6 However, FASD is usually not identified until children
reach school.7
In Shauna’s case, she was identified at an early age. A recent study
found that early identification and a good stable environment can improve
the odds of avoiding adverse life events by 2- to 4- fold.8 Knowing that
Shauna has an FASD will allow Mrs. Watkins to learn as much about FASD as
she can, enlist the support and expertise of Shauna’s parents, and draw
upon her existing knowledge of how to help children with various types of
learning issues. Using this information, Mrs. Watkins and other teachers and
staff will be in the best possible position to get Shauna’s school career off to
a good start.
Unlike Shauna, Jesse, who is introduced on page 14, was not identified
with an FASD until middle school.
4
IN THE CLASSROOM
ecognizing the extent of the problem and understanding the challenges
to learning and functioning caused by the resulting brain damage is key
to being able to accommodate students with FASD.
The Scope of the Problem
It is likely that there are children with FASD in every school system.
While it is difficult to give a precise estimate, a school system with
10,000 students might have 80 to 100 students with learning problems
related to FASD.
Some of these children will have problems severe enough that they
are best served in self-contained special education classes. The majority,
however, will be enrolled in regular classrooms. Within this majority, some
students with FASD will have resource room support, but many others will
be unidentified and may be struggling to learn.
5
Parents are often aware
that there is something different about
the way their child behaves and learns
but may not know exactly why that is. Early
experiences in school are often the first time
that specific concerns are raised and a family
is encouraged to seek medical or
psychological evaluations.
Checking Shauna’s Progress
y winter break, Shauna is already far behind her classmates.
Despite new information about Shauna’s disability, Mrs. Watkins
has not been successful in helping her catch up. While Shauna
is making progress in reading, her math and writing skills are
at the level of a preschool or kindergarten student. She has
made only one friend in the classroom because her immature
behavior alienates the other children. She has had several
temper tantrums, often when the schedule for the day has
changed unexpectedly.
6
FASD and Brain Damage
Brain damage is the most serious aspect of FASD and presents the
greatest challenges to learning and functioning in school. FASD affects
cognition, behavior, and social skills. This damage is permanent. It can be
accommodated, but not cured.
Cognition. Children with FASD can have diminished cognition.
While some will have mental retardation, most will have average or low
average IQ scores.9 Even those with average intelligence scores often seem
to function at a lower level than predicted by their scores.
Many aspects of this poor performance will be familiar to teachers from
experience with other disorders (such as attention-deficit/hyperactivity
disorder or ADHD, autism, and traumatic brain injury), since the brain reacts
to damage from a variety of causes in similar ways. For instance, children
with FASD may exhibit learning disabilities such as information processing
deficits, difficulty with planning and organizing, and short-term memory
disorders. In addition, many children with FASD are context-specific
learners, meaning they cannot easily transfer information learned in one
context to another.
As a result of these disabilities, inconsistent performance is common.
For example, material that is learned one day is forgotten the next day,
then is remembered two or three days later. This pattern is frustrating for
students, who are trying hard, but without consistent success. Inconsistent
performance also is frustrating for teachers, who may think the child needs
to try harder, is willfully misbehaving, or is simply not paying attention.
7
Common Learning Challenges:
✿ Lower than average IQ
✿ Difficulties with planning and organizing
(deficits in executive functioning)
✿ Short-term memory problems
✿ Context-specific learning and difficulty
accessing information on demand
✿ Poor grasp of abstract concepts
(such as time or money)
✿ Developmental delays in language,
motor, and social skills
✿ Difficulty reading social cues for
appropriate behavior
✿ Poor sensory integration
✿ Math deficits (dyscalculia) causing
difficulties in counting money, making
change, maintaining budgets, and
reading analog clocks
Many children with FASD are concrete learners. Hands-on activities
often are strengths for these students. In contrast, math and other subjects
that rely on abstract concepts often are difficult for these children to
understand. Children may perform unevenly in language skills. Most
children with FASD have good expressive language skills. However, they
often have difficulty understanding and acting on what is said.
8
How I Learn Best
t
By Sidney Guimon
e,
tal alcohol syndrom
fe
of
s
om
pt
m
sy
e
out that I had th
everyone
When I first found
I was different from
at
th
t
gh
ou
th
I
d angry.
I was confused an
n for what I have.
ow
kn
be
d
ul
wo
I
at
l alcohol syndrome
ta
fe
of
else and th
s
om
pt
m
sy
e
arned that th
the
Since then, I have le
e of the pregnancy
ag
st
t
ha
w
to
e
du
,
to individual
ed. My symptoms
um
ns
vary from individual
co
e
sh
l
ho
co
the amount of al
.
mother drank and
ptoms I’ve heard of
m
sy
r
he
ot
e
th
of
e
red to som
my problems when
ve
are very small compa
lie
be
to
le
ib
ss
it impo
alcohol
Some people find
cal] signs of fetal
si
hy
[p
e
th
ow
sh
t
e I don’
I explain them, sinc
hen I’m
syndrome.
es confuses me. W
im
et
m
so
ns
io
ct
ru
st
or
Following verbal in
I won’t understand
e,
ag
rb
ga
e
th
t
ou
ng like take
ther gives
asked to do somethi
example, my stepfa
or
F
d.
in
m
y
m
in
ed up
even
the words get all mix
n’t hear him clearly,
do
I
e
lik
s
’
it
d
an
,
something
me a command to do
words and phrases.
t
ou
k
oc
bl
I
e
lik
’s
It
om.
n
if he is in the same ro
learning for me. Whe
of
y
wa
t
an
rt
po
im
very
Visual contact is a
it.
pic, I can understand
to
ng
a
s
ow
sh
r
he
ac
te
a
er strikes. I am acti
st
sa
di
if
y
lit
ea
r
on
cus
lems seem
I am not able to fo
a lot and make prob
y
rr
wo
I
e
tim
e
th
t of
on excitement. Mos
make myself sick.
I
y,
rr
wo
I
n
he
W
.
rs.
impossible to handle
ide myself and othe
gu
e
m
lp
he
to
is
er
tt
This le
hool
grade, her sc
th
in
n
g
in
h
is
fin
was 15 and
–When Sidney
her s to
h school teac
ig
h
er
h
to
te
ested she wri
counselor sugg
n.
to help her lear
ys
a
w
nd
ta
rs
help them unde
9
Behavior. Children with FASD often are described as friendly,
chatty, and helpful. However, they often have behavior problems.
✿ Difficulty with learning, attention, and memory can cause
frustration that these children may be unable to express
through words.
✿ Hypersensitive sensory systems may cause students to
overreact to light, sound, or touch. When their senses
are flooded with information they cannot process, students
can become overwhelmed and may react with anger,
aggression, or tantrums.
✿ Problems with transitions can cause these children to become
upset when the usual order of the day is changed.
✿ Children may be impulsive, act before thinking, and seem
confused by the consequences of their actions. Sometimes
this confusion is described as a lack of judgment or a failure
to learn from their mistakes.
These behavioral
characteristics can make students
with FASD more vulnerable to the negative
influences of others. When asked why they
did something inappropriate, they
often answer, “I don’t know.”
10
’s very
e
h
,
t
r
a
p
t
s
o
m
e
“ For th
But it
.
ly
d
n
ie
r
f
y
r
e
v
,
mellow
e
h
t
f
o
t
u
o
’s
It
.
h
doesn’t take muc
could
e
h
n
e
d
d
u
s
a
f
o
blue. All
he’s
n
e
h
T
.
e
g
a
r
a
g
be havin
time
d
r
a
h
a
s
a
h
d
n
a
,
over it
e
h
id
k
e
h
t
y
h
w
g
understandin
it.”
r
e
v
o
’t
n
is
h
it
w
was fighting
g son’s
her youn
lking about
ta
r
e
th
o
m
–A
behavi
FASD-related
or
11
Social Skills. Children with FASD can experience lifelong social
skill problems. These problems can become apparent in early childhood,
and often become particularly difficult in adolescence. Students who may
have coped reasonably well through elementary school may encounter
different challenges once they reach their teens.
Poor social skills can lead to interpersonal problems. The ways in
which people react and relate to others are critical for successful
functioning both in and out of school. Poor social skills in elementary age
students, such as standing too close and using bad language, may be
perceived as simply “acting young for their age.” By middle or high school
age, students with FASD may engage in inappropriate behavior such as
touching and stroking others’ hair or clothing. They may be unable
to recognize appropriate sexual boundaries, interpreting any attention
from a peer as “true love.” They may conduct personal or private activities,
such as adjusting their underwear, in public.
Students with FASD are often described as having trouble reading
social cues. They may misinterpret (or simply miss) the meaning of gestures,
tone of voice, or facial expressions. Most children pick up these skills
on their own. However, the child with an FASD may need to be reminded
continually about how to interpret cues and emotions, how to use them
appropriately, and about the difference between appropriate public and
private behavior.
12
In the context of these social skill challenges, the desire for friends
and the need for some measure of social success may lead older students
to fall in with the wrong crowd. They may be eager to do whatever is asked
of them, and be unaware of signals that the behavior is wrong.
about
e
r
u
c
e
s
in
y
t
t
e
r
p
“ I was
cene.
s
g
in
t
a
d
e
h
t
in
myself
d
So when I did fin
ared
c
y
ll
a
e
r
o
h
w
y
d
somebo
cared
I
t
a
h
t
d
n
a
e
m
r
o
f
be
o
t
t
u
o
d
e
n
r
u
t
e
for, h
etty
r
P
.
g
in
ll
o
r
t
n
o
c
very
ally.”
abusive emotion
lling
an FASD reca
oman with
–A young w
ye
ring her teen
socially du
how she felt
ars
13
Meet Jesse
esse is a 14-year-old in the seventh grade. Although he was
diagnosed with ADHD in elementary school, new information
about his prenatal alcohol exposure suggests that he has an
FASD. Because his teachers have thought his poor school
performance was due to his attention problems rather than to
FASD, it will be necessary to help them understand his struggles
from a different perspective.
Until this year, Jesse has managed with some resource room
help, where he did well on a one-to-one basis. On some days
he is able to function very well, but on other days he cannot get
through even two classes without causing a scene. Lunch and
recess are particularly difficult times of the day. He has gotten
into fights several times in the hallway after striking another
student, whom he said hit him first. He has no real friends.
He has been in trouble at school for some minor vandalism
and for following a girl into the bathroom on a dare from some
other boys. When he was asked why he did these things, Jesse
had no explanation. The principal suspended him from school
for a week, but that did not seem to have any obvious impact
on his behavior.
Now that Jesse’s teachers understand that his cognition, behavior,
and social skills may be impaired due to FASD, they can gain insight into his
problems. By applying the strategies for school success in the following
section, they can help him to progress.
14
FOR IMPROVING SCHOOL SUCCESS
t is important to remember that FASD is a lifelong condition with effects
that differ from age to age throughout the lifespan. These effects cannot be
changed, but they can be accommodated. In turn, accommodations may
lead to some degree of amelioration, although there is no cure for FASD and
the need for accommodations may continue throughout an individual’s life.
Nevertheless, there is hope for improving students’ long-term
achievement and success. Teachers are skilled at adapting their classrooms
and teaching styles for students with disabilities, such as autism, hearing
disorders, nonverbal learning disabilities, and ADHD. Many of the same
strategies will be helpful for the student with FASD, whether or not that
child has been identified as having an FASD. As with other disabilities, these
changes not only will help the student with an FASD but also will benefit all
the children in the classroom.
15
Drawing on the skills that teachers already have, this section presents
simple strategies that are easy to implement:
✿ Structure a Caring and Consistent Environment,
✿ Shift Attitudes and Improve Understanding,
✿ Learn to Translate Misbehavior,
✿ Change Classroom Teaching Style,
✿ Restructure the Physical Space in the Classroom, and
✿ Engage the Whole School Community.
Please note that few of these strategies require extra resources or
materials. While some target the elementary age child, they also can be
adapted for older students. Of course, some students may require the care
of other experts such as doctors and/or speech/language therapists, and
teachers may need to make referrals to these professionals.
16
Structure a Caring
and Consistent Environment
In general, students with FASD benefit from consistent, unwavering
structure. A typical student will adapt to the school environment
and understand what is expected in different situations. Students
with FASD will not adapt as easily and are less able to generate their
own structure. It will be easier for students with FASD to learn when
the guidelines for learning and behavior are made clear and visible.
When the structure changes or is withdrawn, the student’s learning
and behavior will suffer.
External structure is like
a handrail on a steep ramp. Using the
handrail, you can walk up the ramp easily.
Without the handrail, you might eventually get
up, but it will take much longer and be much
more difficult. You might have to stop along
the way to get your bearings. You might
even get frustrated and give up.
17
Parents often find
that simply convincing schools that
their child has a disability is both the most
frustrating and the most important activity
they undertake. They often have
to do it over and over again.
(Note: See form on page 51.)
Shift Attitudes and
Improve Understanding
As physical features are present only in a small percentage of children
with FASD, they are not a reliable indicator. Children with FASD often test
well on standardized tests and may have IQ scores in the average range.
These results often lead teachers and parents to believe the student could
do better if only he or she tried harder. But children with FASD may not be
able to do better, regardless of their scores, without classroom modification
and accommodation.
18
Simply recognizing that a child is trying hard, but is nevertheless
struggling, goes a long way toward facilitating learning. Strategies to bolster
this attitudinal shift include the following ideas.
✿ Think “this child can’t” rather than “this child won’t.”
✿ Recognize that some disabilities are invisible.
✿ Think “strengths,” not “problems.”
✿ Use bridges to help a student reach the real goal (for example,
Velcro sneakers allow children to dress themselves even if they
cannot tie a shoe). Try not to get stuck on the idea that the
bridge may become a crutch.
✿ Enlist parents as members of your team; they understand your
student better than anyone.
✿ Use testing to identify learning styles and abilities; use the
findings to guide your teaching.
✿ Remind yourself frequently that you have the skills to help
this child.
19
Learn to Translate
Misbehavior
The strategic ability to translate misbehavior will help both you and
your students. Here are some examples.
✿ Getting fidgety during an assignment may mean, “I don’t
understand what to do.” Try restating your request differently
and have the child demonstrate what you asked to check for
understanding. Do not simply ask if the child understands, as you
will likely get a “yes” answer meant to please you.
✿ Hitting another child while standing in line or walking in the
hall may mean, “That kid bumped into me and startled me.”
Make sure that the child has space at the head of a line, or has a
buddy to help walk him or her from one class to another. Get an
occupational therapy consult to check for sensory integration
disorders.
✿ Being able to repeat instructions back to you, but still not being
able to do what is asked may mean, “I know what you said,
but I don’t know the steps for how to put that into action.”
Being able to repeat what was said and being able to do it
are very different tasks for the brain. Do not assume defiance.
Instead, make sure your instructions are concrete and literal.
Break down the work into specific steps and discuss how to
approach each step.
✿ Having trouble with anything that requires sequencing, ordering,
or taking turns may mean, “I lost track of the order and I don’t
know where to start.” Try restating your request one step at
a time, or put the steps for routine activities on a small chart.
20
Make sure that parents
know when a transition at school is going
to take place so they can help
prepare their child.
✿ Becoming upset or unfocused when a schedule change occurs
may mean, “My usual understanding of how and when things
are going to happen has changed, and it upsets my whole
being. It will take some time for me to adjust.” Give as much
advance warning about schedule changes as possible and preview
the transition with a brief, concrete description. Have a plan in
place for when changes do occur — 10 minutes in a calm corner, a
buddy to review the change, or the patience to wait for the
student to readjust.
my
to do
list
21
When teachers and parents
share effective strategies and routines,
consistency improves, and the
child will benefit.
Change Classroom
Teaching Style
Most children with FASD are educated in the regular classroom.
While these students may receive special education services to supplement
regular classroom time, small adaptations to the classroom can ensure that
all instructional time is productive for both teacher and child.
Emphasize consistency
✿ Develop a consistent routine in the classroom and stick
to it all year.
✿ Minimize transitions and provide clear and specific warnings in
advance.
✿ Use a consistent signal (such as, a soft bell, a pencil tap)
as a warning that a transition is occurring.
✿ Show related visuals to reinforce transitions (such as, a book
for reading time).
✿ Provide a transition buddy for students who must change classes.
✿ Share the schedule so that parents can be equally consistent
at home (see the schedules on pages 47 and 49).
22
Manage social skill challenges that impact learning
✿ Give directions by telling students what they should do, rather
than what they should not do.
✿ Reinforce appropriate behavior. Redirect most poor behavior.
✿ Use immediate short-term consequences clearly related to the
inappropriate behavior.
✿ Place a student at the head of a line to minimize bumping.
✿ For a child who cannot stop interrupting other students while
they are working, give a routine task that involves getting up and
moving around (for example, sharpening pencils, going to the
office, feeding fish).
✿ Provide one-on-one supervision during recess and lunch.
✿ Ask parents what strategies they use for appropriate behavior
at home.
✿ Teach personal space (for example, stand no closer to someone
else than an arm’s length).
✿ Teach self-talk for self control. Use very specific short phrases,
such as, “Count to 10 first.”
✿ Use role-playing or videotaping to help a child see and learn
appropriate skills for specific situations.
23
Use learning accommodations
✿ Post a copy of the schedule in an obvious place. This is useful
even for older students.
✿ Tape the alphabet or other frequently needed materials (for
example, class schedule) to the student’s desk.
✿ Encourage students to use low-tech assistance like calculators,
upright manila folders placed on a desk to create a private
workspace, rulers to keep their place on a page, etc.
✿ Use computers to reinforce the curriculum. Computers give
immediate and consistent feedback and can compensate
for slow or poor fine motor skills.
✿ Build in frequent breaks for students and gradually increase
time on a task (for example, 15 minutes of work followed by
a 5-minute break).
✿ Tape-record classroom lessons for review at home.
✿ Provide a duplicate set of textbooks to be kept at home.
✿ Work with the student to provide a written checklist of daily
homework assignments. If possible, send the homework list home
by email or, phone home to leave the list on the answering
machine or voice mail.
24
Rethink presentation style
✿ Be concrete and literal at all times.
✿ Use materials and approaches that might be appropriate
for a student two or three years younger.
✿ Teach in multiple modalities (for example, keep lectures short
and include activities and audiovisual materials).
✿ Use concrete representations of time (for example, kitchen timer,
stop watch) and other math concepts.
✿ Let students choose reading books that are available on tape.
✿ Repeat everything you say and provide ample time
for practice. Be patient.
✿ Give the student extra time to complete work. Mastery
is the goal, not speed.
✿ Design worksheets with fewer problems and lots of white space.
Use large-scale graph paper for arithmetic.
✿ Modify homework assignments so students can complete work
within the grade-appropriate amount of time.
✿ Get the student’s attention before giving directions. Give
directions one step at a time, and wait until that step
is completed before giving the next step. To check for
understanding, have the student re-explain or show you
what he or she is supposed to do. If the student simply
repeats what you said, try explaining it a different way.
✿ Allow the student to stand at the back of the room to
work if that is more productive. For young children, let them
lie on the floor.
25
✿ Enlist parents for ideas about what they use to get tasks
done at home.
✿ Remember, there are at least 20 ways to teach everything.
The teacher may need to try all 20 to reach the student with
an FASD.
26
Quiet
Area
Play
Area
Reading
Area
Restructure the Physical
Space in the Classroom
Children with FASD often are particularly sensitive to their
environments and may be distracted from learning by common features of
classrooms. Simple changes to a classroom can make the environment
calmer and less distracting, enabling all students to function better.
✿ Make seating assignments at the beginning of the year
and keep them.
✿ Make sure the desk and chair fit the child (for example, feet
touching the floor to improve focus).
✿ Keep bulletin boards tidy and uncluttered. Keep papers flush
against the wall. Avoid suspending materials from the ceiling.
27
✿ For maximum attention, stand in front of a blank space when
speaking (for example, a clean black or whiteboard, a movie
screen, or a hanging sheet).
✿ If posters are used to designate areas of the room, make sure
the poster content reinforces the area’s intended use.
✿ Cover up materials that are not currently being used.
✿ Provide a calm or quiet corner (for example, a bean bag or rocking chair, large pillows on the floor, a large appliance carton with
pillows inside, a quiet room) to allow students to refocus. Do not
use this same area for “time-out” discipline.
✿ Define students’ physical boundaries (for example, desk and chair
space, where to stand in line) with masking tape on the floor or
rug squares for seats.
✿ Keep the door closed to minimize noise from the hall.
28
Techniques and modifications
that can help a child with an FASD
can help all children.
Engage the Whole
School Community
While students with FASD will benefit from any accommodations
teachers can make, they are best served when the entire school is involved.
The first step for engaging the whole school community is to get
information out about these disorders to as many staff as possible, from
custodians to superintendents, and build support from there. Fortunately,
there are many simple ways that schools can come together to better
understand FASD and improve the educational experience for affected
students and their families.
✿ Investigate school-wide training on FASD or make videos
available (see resource list on page 43).
✿ Ask parents to come in and share what they know with
the entire school staff.
✿ Encourage teachers to share tips for structuring classrooms
in ways that benefit students.
29
Parents often have the
best strategies for managing a child’s
difficult behaviors. Solicit their
advice often and use it.
✿ Seek testing and assessment for the child.
✿ Ask that another adult in the school be assigned as an advocate
for your student with an FASD. Anyone who relates well to the
student, from principal to custodian, can serve in this role.
✿ Include parents as active team members.
✿ Ask for classroom support whenever possible, using volunteers
if necessary.
✿ Advocate for teaching and classroom styles you think will help
even though they may be contrary to current educational theory
(for example, keep seating assignments consistent all year; put up
fewer, calmer classroom displays; cover up materials not in use).
✿ If you are teaching a student with an FASD, seek out other staff
members for support to reduce the sense of being overwhelmed.
✿ Stay involved with your student for a year after they leave your
class, offering assistance to the next teacher. You may be able
to help with classroom assignments (Note: Use the form on
page 53 of this booklet).
30
Strategies I can try in my classroom…
Structure a Caring and Consistent Environment
Shift Attitudes and Improve Understanding
31
Strategies I can try in my classroom…
Learn to Translate Misbehavior
Change Classroom Teaching Style
32
Strategies I can try in my classroom…
Restructure the Physical Space in the Classroom
Engage the Whole School Community
33
Strategies I can try in my classroom…
Additional Thoughts
34
:
APPLYING SUCCESSFUL STRATEGIES
arents and teachers will find some strategies relevant to Shauna at age 6
and others applicable to Jesse at age 14. Not only are these students distinct
in their disabilities and age, but also the stage at which they were identified
with FASD.
In addition, each has unique talents and skills which also will be
identified and encouraged.
35
Working with Shauna and Jesse
oth Shauna and Jesse would benefit from a number of the
strategies suggested to improve school success. Shauna’s
elementary school teacher could immediately rearrange the
desks in her class so that Shauna was seated in the front, where
the distractions would be minimized. She could make sure that
the hall door remained closed, and if necessary, could close the
shades on the outside windows. Mrs. Watkins could tape the
day’s schedule to Shauna’s desk, using pictographs, along with
the alphabet. She could get reading and writing materials from
the kindergarten teacher to use with Shauna. A line of tape
along the floor could be a visual reminder to let Shauna know
where to stand. Mrs. Watkins could start singing a simple tune or
clap her hands to alert all the children that it was almost time to
move from one activity to another.
If Shauna has fallen too far behind her classmates,
a resource room placement may allow her to catch up and to
feel less frustrated. Mrs. Watkins also could request a sensory
integration consultation (usually conducted by an occupational
therapist). Shauna’s mother could come in and meet with
Mrs. Watkins and any of Shauna’s other teachers to help describe
the techniques that she has found to be most helpful with
Shauna at home. Shauna’s mother might be willing to help
design a “calm corner” for the classroom, for Shauna’s benefit
as well as for any other student who might like to use it.
36
Interventions for Jesse may be more challenging because
his disability has been identified only recently. But that does
not mean that shifting perspective and getting help for him
now will not make a difference. The first step would be to get
information about FASD to all of Jesse’s middle school teachers.
This could begin with some simple printed literature or one of
many available videos that could be shared with the entire
school staff. Shifting their attitude about why Jesse has
difficulties in school and easily gets himself into trouble will go
a long way toward improving his educational experience.
Jesse also needs help with transitions to minimize his
fighting in the halls. Assigning him a hall buddy, a mature
student who will walk with and talk to Jesse, may accomplish
this. This student, who would need special training from school
staff, also might help model better social behavior and give Jesse
a much needed social boost. Jesse’s difficulties after lunch and
recess are probably due to trouble regrouping after unstructured
activities. Bringing him in 5 to10 minutes before the other
students may allow him time to get refocused. Also, providing
one-on-one supervision during lunch and recess should prove
helpful.
37
An in-school advocate would be a real boon for Jesse.
This person should be someone who likes Jesse and who is willing
to serve this role for him. He or she would function as someone
Jesse could go to when things were not going well and when
there is something to celebrate. This advocate also could help
explain Jesse’s behavioral and learning problems to the many
different teachers with whom he has to interact.
Jesse also may benefit from a restructured academic
program that emphasizes classes with practical, hands-on
approaches. He may learn best when his more traditional
academic classes are held in the morning, with more hands-on
classes in the afternoon (for example, physical education, art,
music). In preparation for his next year at school, Jesse would
benefit from being able to visit the school for a couple of hours
per day in the week prior to the formal opening of school. The
visit will give him familiarity with the building and his schedule
and lessen his transition time.
As Jesse and other children with FASD get older, they may
be more vulnerable to daily stresses. Their teachers need to be
alert to depression and anxiety disorders and be prepared to
make referrals to medical professionals.
38
The Unique Talents and
Skills of Children with FASD
With so many problems confronting students with FASD, it is easy
to forget that these children have many wonderful talents and skills. For
instance, parents and teachers have noted that students who have great
difficulty with traditional academics often are skilled with their hands.
Adults with FASD have found success as artists, art teachers, chefs, and
plumbers. Empathy and understanding, especially with young children,
are other strengths shared by many individuals with FASD. Thus, students
may find success volunteering in child care facilities or working with
young children. After graduation, some students have found success in
the military, where the rules are very clear and the environment is
extremely structured.
Success is important for every student and for the school
communities that nurture them. Even the most academically and
behaviorally challenged student needs to feel that he or she is good at
something. We hope that the strategies we have presented will help you
uncover the secrets of success for you and your students with FASD as
you Reach to Teach.
39
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40
References
1
Maier, S.E., & West, J.R. (2001). Drinking patterns and alcohol-related birth defects.
Alcohol Research and Health, 25,168-178.
2
Savage, D.D., Becher, M., de la Toree, A.J., & Sutherland, R.J. (2002). Dosedependent effects of ethanol exposure on synaptic plasticity and learning in
mature offspring. Alcoholism, Clinical and Experimental Research, 26, 1752-1757.
3
Stratton, K., Howe, C., & Battaglia, F. (Eds.). (1996). Fetal alcohol syndrome:
Diagnosis, epidemiology, prevention, and treatment. Washington, DC:
The National Academy Press.
4
Rosett, H., & Weiner, L. (1984). Alcohol and the fetus: A clinical perspective.
New York: Oxford University Press.
5
Plant, M. (1985). Women, drinking and pregnancy. London: Tavistock Publications.
6
May, P.A., & Gossage, J.P. (2001). Estimating the prevalence of fetal alcohol
syndrome: A summary. Alcohol Research & Health, 25(3), 159-167.
7
Stratton, K., Howe, C., & Battaglia, F. (Eds.). (1996). Fetal alcohol syndrome:
Diagnosis, epidemiology, prevention, and treatment. Washington, DC:
The National Academy Press.
41
8
Streissguth, A.P., Bookstein, F.L., Bart, H.M., Sampson, P.D., O’Malley, K., & Young,
J.K. (2004). Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal
alcohol effects. Journal of Developmental and Behavioral Pediatrics, 25 (4), 228-238.
9
Streissguth, A.P. (1997). Fetal alcohol syndrome: A guide for families
and communities. Baltimore, MD: Brookes Publishing.
42
Web sites
✿ http://www.fasdcenter.samhsa.gov/ (FASD Center for Excellence Resource
Database: a resources, journals, and information database)
✿ http://www.ncadi.samhsa.gov (SAMHSA’s National Clearinghouse for
Alcohol and Drug Information [NCADI], P.O.Box 2345, Rockville, MD
20847-2345, 800-729-6686)
✿ http://www.stopalcoholabuse.gov/ (A comprehensive portal for Federal
resources on underage drinking prevention)
✿ http://arbi.org/education/educatio.html (Alcohol Related Birth Injury
[FAS/FAE] Resource Site, a web site from Alberta, Canada that includes
an educator’s consortium)
✿ http://www.bced.gov.bc.ca/specialed/fas/ (Teaching Students with Fetal
Alcohol Syndrome/Effects: A Resource Guide for Teachers, maintained by
the British Columbia Ministry of Education)
✿ www.psychiatry.emory.edu/PROGRAMS/GADrug/facts (FAS research
and treatment program at Emory University, including frequently asked
questions and educational strategies)
✿ http://depts.washington.edu/fasdpn (FAS Diagnostic & Prevention
Network, a resources web site from the University of Washington,
including screening, diagnosis, and intervention information)
✿ http://education.gov.ab.ca/fasd/ (Teaching Students with Fetal Alcohol
Spectrum Disorder, and other resources covering kindergarten to grade 12,
from the Alberta, Canada Government Learning Resources Center)
43
Videos
Vida Health Communications. (Producer). (1996). Students Like Me
[Videotape] (Available from Vida Health Communications,
6 Bigelow Street, Cambridge, MA 02139, 617-864-7862)
This video includes the following:
✿ How to recognize a child with FAS in the classroom,
✿ How to modify the class environment and adjust teaching methods, and
✿ How to communicate clearly and plan transitions and unstructured time.
Vida Health Communications. (Producer). (1996). Worth the Trip
[Videotape] (Available from Vida Health Communications,
6 Bigelow Street, Cambridge, MA 02139, 617-864-7862)
✿ The film presents strategies for meeting the developmental
and behavioral challenges faced by children with FAS and the
parents and professionals who care for them.
SAMHSA’s FASD Center for Excellence. (Producer). (2005).
Recovering Hope [Videotape] (Available from National Clearinghouse
for Alcohol and Drug Information [NCADI], 800-729-6686 or
http://www.ncadi.samhsa.gov)
✿ Recovering Hope: Mothers Speak Out About Fetal Alcohol Spectrum
Disorders is an intimate and evocative picture of families whose children
are affected by FASD, created for viewing by women in recovery and
their counselors.
44
Books
Kleinfeld, J., & Wescott, S. (Eds.). (1993). Fantastic Antone succeeds: Experiences
in educating children with fetal alcohol syndrome. Fairbanks, AK:
University of Alaska Press.
Kleinfeld, J., Morse B., & Wescott, S. (Eds.). (2000). Fantastic Antone grows up.
Fairbanks, AK: University of Alaska Press.
Kranowitz, C.S. (1998). The out-of-sync child: Recognizing and coping with sensory
integration dysfunction. New York: Perigree Book.
Kulp, L. & Kulp, J. (2000). The best I can be — Living with fetal alcohol syndrome
or effects. Brooklyn Park, MN: Better Endings New Beginnings. (Available
from Better Endings New Beginnings, http://www.betterendings.org.)
Morse, B.A., & Weiner, L. (2004). FAS: Parent and child. (Rev. ed.). Boston, MA:
Boston University School of Medicine. (Available from the Fetal Alcohol
Education Program, 1975 Main Street, Concord, MA 01742.)
Plant, M. (1985). Women, drinking and pregnancy. London: Tavistock Publications.
Substance Abuse and Mental Health Services Administration. (2006). What do I do?
Helping your kids understand their sibling’s fetal alcohol spectrum disorder.
Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse
and Mental Health Services Administration.
Villarreal, S.F., McKinney, L.E., & Quackenbush, M. (1991). Handle with care:
Helping children prenatally exposed to drugs and alcohol. Santa Cruz, CA:
ETR Associates.
45
46
Teachers:
Share the student’s classroom schedule with parents.*
play time,
recess, or
sports
nap time
or sleep
meal times
or
snacks
reading
2
+ 2
math
science
Classroom Schedule
Time
Activity
*Remove this form and share the classroom schedule with parents and students to
improve continuity between school and home. For additional copies, you may
photocopy this form or request additional printed copies of Reach to Teach
through the Substance Abuse and Mental Health Services Administration’s
(SAMHSA’s) National Clearinghouse for Alcohol and Drug Information (NCADI). To
47
order publications, call 800-729-6686 or access the web site:
http://www.ncadi.samhsa.gov
Parents:
Plan a structured environment at home.*
play time
or sports
nap time
or sleep
meal times
or
snacks
reading
2
+ 2
homework
bath
time
Home Schedule
Time
Activity
*Remove this form and share the home schedule with teachers to improve
continuity between school and home. For additional copies, you may photocopy
this form or request additional printed copies of Reach to Teach through the
Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National
Clearinghouse for Alcohol and Drug Information (NCADI). To order publications,
49
call 800-729-6686 or access the web site: http://www.ncadi.samhsa.gov
Parents:
Pass it on*
Applying helpful strategies
is
(age) and in the
grade.
His / her unique talents and strengths are:
✿
✿
You know your child best. Please list three helpful techniques,
such as organizing the home environment, making checklists for
daily tasks, and creating a routine for after school/weekend
time, and provide details.
1
✿
He/she has particular
challenges in the following areas:
1
2
2
3
3
Additional comments from the parents: (Please let us know if you
have any diagnostic or assessment results you’d like to share.)
Comments from the student:
Please feel free to contact us if you have any questions.
Parent
Student
Phone/email
Phone/email
*Remove this form and use it to share useful information about the student with teachers.
For additional copies, you may photocopy this form or request additional printed copies of
Reach to Teach through the Substance Abuse and Mental Health Services Administration’s
(SAMHSA’s) National Clearinghouse for Alcohol and Drug Information (NCADI). To order
publications, call 800-729-6686 or access the web site: http://www.ncadi.samhsa.gov
51
Teachers:
Pass it on*
Applying helpful strategies
was a student in my class this past year.
His / her unique talents and strengths are:
✿
Please list and provide details for successful strategies you have
learned, such as structuring a caring and consistent environment,
shifting attitudes and improving understanding, learning to
translate misbehavior, changing teaching style, restructuring
physical space, and engaging the whole community.
1
✿
✿
He/she has particular
challenges in the following areas:
2
1
2
3
3
Additional comments:
Please feel free to contact me if you have any questions.
Teacher
Phone/email
*Remove this form and use it to share useful information about the student with teachers.
For additional copies, you may photocopy this form or request additional printed copies of
Reach to Teach through the Substance Abuse and Mental Health Services Administration’s
(SAMHSA’s) National Clearinghouse for Alcohol and Drug Information (NCADI). To order
publications, call 800-729-6686 or access the web site: http://www.ncadi.samhsa.gov
53