Fetal Alcohol Spectrum Disorder

Most teachers have-or at some point will have-a student or students with Fetal Alcohol Spectrum Disorder (FASD) in their classroom. Yet because affected students may or may not possess the facial abnormalities that are characteristics of the disorder, their condition is sometimes “hidden. ” In other instances it is misdiagnosed. How can you identify students with FASD? And once identified, how can you best address their educational needs?

A diagnosis of FAS is made when an individual has a diminutive stature, small head circumference, the characteristic facial features (i. e. , small eye slits, short nose, long and flat philtrum, thin upper lip, and flat mid-face), as well as central nervous system abnormalities (Stratton, Howe, & Battaglia, 1996). FAE and ARND are diagnostic terms used when an individual demonstrates neurodevelopmental disorders but not the facial abnormalities, the absence of which makes the condition a “hidden” disability. Of note is that the brain damage may be equally severe for all three diagnoses, regardless of the presence of physical and facial characteristics.

Children with prenatal alcohol exposure struggle with cognitive, academic and social, emotional, and behavioral challenges. These challenges are particularly evident in the school setting and negatively affect children’s ability to learn and function successfully in the school environment. Regular education teachers, special education providers, school psychologists, school counselors, speech/language pathologists, occupational therapists, other specialists, support staff, and administrators are called upon to support children with FASD in schools so that they experience academic and social success.

Intervention to Support Children with FASD in Schools Once identified, the child with FASD will require unique interventions that address his/her brain differences affecting academic, emotional, and behavioral functioning. Effective interventions must consider the interplay between behavioral symptoms and the neuropsychological effects of prenatal alcohol exposure. As noted above, EF deficits are directly linked to challenging behaviors (Watson & Westby, 2003).

Instead of viewing a child’s difficulties as behavior problems as a result of the child being “defiant,” “lazy,” “intentional,” or “manipulative,” these behaviors should be viewed as symptoms of underlying neurocognitive deficits in EF. Interventions should then focus on using a variety of strategies to teach the child new skills and to utilize extensive environmental modifications to support the use of new skills. The use of basic behavioral principles such as positive reinforcement and natural consequences will only be effective if EF limitations have been addressed (Watson & Westby, 2003).

Teaching Strategies Teachers should Use in the Classroom To support children with FASD to function effectively in the classroom, intervention plans will call upon strategies and ideas from literature in Positive Behavior Support (PBS) programming, cognitive-behavioral therapy, and interventions for child behavior disorders such as ADHD (Bambara & Kern, 2005). Watson and Westby (2003) have proposed interventions that draw from many of these approaches and specifically address EF deficits in children exposed to alcohol and other drugs.

For example, they recommend the use of visual cues and schedules, teaching of self-directed speech and problem solving, social skills training, role play, cognitive modeling and coaching to support EF difficulties in the areas of nonverbal memory, internalization of self-directed speech or verbal working memory, self-regulation of mood, motivation, and level of arousal and problem solving. Likewise, the PBS approach is particularly valuable.

As described by Bambara and Kern (2005) the PBS model focuses on identifying specific problem behaviors, the environmental and/or setting events that contribute to the problem behaviors, and understanding the function or communicative intent of the problem behaviors. Interventions are focused on changing antecedent and setting events and teaching more appropriate and functional behaviors. A collaborative team approach that includes all service providers and educators as well as the individual’s family and the individual himself/herself is used to develop and implement the PBS plan.

Children with FASD need to learn new skills to effectively manage their behavior and emotions. The use of cognitive-behavioral strategies, such as social skills training, emotion identification, coping skills, anger management, and self-talk, may be helpful for children with FASD. However, many of the children will require ongoing environmental modifications and support to be able to use such strategies. The best teachers as described by the adolescents and young adolescents recommended the following for teachers when teaching students with FASD: * Break concepts into smaller chunks. * Talk slowly.

* Give clear explanations. * Repeat concepts and procedures. * Use hands-on activities and concrete materials. * Demonstrate what has to be done instead of just describing it orally. * Make the lesson enjoyable, for instance, by injecting some humor. They further suggested that when they are working on class assignments, teachers should do the following: * Be willing to answer questions and re-explain the concepts or how to do the assignment. * Provide in-class assistance, either one-on-one or in small groups. * Be approachable; don’t make the student feel uncomfortable about asking questions.

* Know the student’s strengths and weaknesses. * Be aware of times when a student is feeling anxious or frustrated, and redirect activities. * Supervise the student closely. * Maintain a structured environment: routines, schedule, classroom rules, and consequences that are repeated often and linked with choices. * Use a multisensory approach (visual, auditory, tactile) with hands-on activities and concrete materials to teach concepts. * Teach shorter lessons with active student involvement and guided practice. * Break the task down into smaller components, and give breaks between each segment.

* Give one instruction at a time, and demonstrate what is to be done; be very specific, and use simple language. * Make a list of the sequence of procedures or activities, and post it. * Teach the student to make lists and to use a planner. * Predetermine the composition of groups to avoid students’ being left out. * Help the students learn to take responsibility for their actions-do not accept the excuse of “I couldn’t help it” or “It was somebody else’s fault. ” * Use praise and positive reinforcement as often as possible to shape positive behavior (Bernstein Clarren, 2004).

My Reflection on What is Learned about FASD FASD continues to present major challenges among school children. Children with FASD are at risk for difficulties in school related to challenges in academics, EF, attention, social skills, and behavioral control. Early diagnosis and intervention is key in helping children with FASD succeed in a school setting. All service providers, school professionals, and family members must work as a team to develop unique interventions that take into account the child’s brain differences that are associated with prenatal alcohol exposure.

Effective interventions will include environmental modifications and supports, positive feedback for appropriate behaviors, and opportunities to learn new skills. The best teachers for individuals with FASD, should not be judgmental, rude, or mean. They should be knowledgeable about FASD and aware of the needs of the affected students. The best teachers also should understand the feelings of these students, should be willing to listen and talk to them, and should be very patient. References Abel, E. L. , & Sokol, R. J. (1987).

Incidence of fetal alcohol syndrome and economic impact of FAS-related anomalies. Drug Alcohol Dependency, 19, 51-70. Bambara, L. M. and Kern, L. (2005). Individualized Supports for Students with Problem Behaviors. New York, NY: Guildford Press; 2005. Bernstein Clarren, S. (2004). Teaching students with FASD. Edmonton, AB: Alberta Learning. Duquette, C. (2001). Students at risk: Solutions to classroom challenges. Markham, ON: Pembroke Publishers Limited. Duquette, C. , Stodel, C. , Fullarton, S. , & Hagglund, K. (in press).

Secondary school experiences of individuals with fetal alcohol spectrum disorder: Perspectives of parents and their children. International Journal of Inclusive Education. Goldschmidt, L. , Richardson, G. A. , Stoffer, D. S. , Geva, D. , & Day, N. (1996). Prenatal alcohol exposure and academic achievement at age six: A nonlinear fit. Alcohol Clinical and Experimental Research, 20, 763-770. Mattson, S. N. , & Riley, E. P. (1998). A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcohol Clinical Exp Res. ; 22(2):279- 294.

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