Education of Children affected by Fetal Alcohol Spectrum Disorders (FASD)

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Eileen Calder from FASD Scotland provides an overview of the impact on children of Fetal Alcohol Spectrum Disorders (FASD) and provides helpful strategies for schools and nurseries.

What is FASD?

FASD are a range of physical and mental birth defects caused by prenatal exposure to alcohol. Included under the FASD umbrella are the medically diagnosable conditions of Fetal Alcohol Syndrome (FAS) which includes facial characteristics, Partial Fetal Alcohol Syndrome (PFAS), Alcohol Related Birth Defects (ARBD) and Alcohol Related Neurodevelopmental Disorders (ARND).

FASDs are lifelong conditions that have significant impact on the life of the individual and those around them. Exposure to alcohol prenatally can interfere with normal development to cause growth deficiency, alterations to the internal organs, skeleton and central nervous system.

The FASD conditions are wider ranging than commonly understood

Although the first medical diagnosis of a FASD, a Fetal Alcohol Syndrome diagnosis, was given in 1973, many people even today are not aware that drinking alcohol during pregnancy can cause such detrimental life-long effects. It is estimated that about one percent of the general population may be affected by FASD. In high risk populations this number may be much higher. This means that in a primary school with a roll of 300 pupils there may be 3 children for whom learning and day to day life are affected by FASD. In any educational setting difficulties arise when the school are not aware their pupils have FASD as part of their history. Academic, social and behavioural expectations are set too high with little hope of the child being able to meet them.  In a secondary school of 1000 pupils, there may be 10 teenagers or more with FASD who require additional support for learning. They are also likely to need social and emotional input to prevent overload and the development of secondary disabilities.

Secondary FASD disabilities are those that occur, usually later in life, often emerging over time due to a lack of support (or the wrong type of support) provided. Education staff and other professionals, along with parents, play a crucial role in the prevention of secondary disorders.

Secondary FASD disorders include: –

  • mental health disorders
  • disrupted school experience
  • employment problems
  • dependant living
  • homelessness
  • alcohol and drug addictions
  • involvement with the criminal justice system

FASD touches us all logoHow does FASD affect learning and performance?

In children with FASD normal brain development has been impacted. Although no two children are affected in exactly the same way (as it can be dependant on the amount, timing and pattern of prenatal exposure to alcohol as well as other factors such as genetics, nutrition and stress levels) there are typical characteristics that have an adverse effect on learning. These are:-

  • attention deficits
  • impulsivity
  • distractibility
  • poor fine motor skills
  • hearing issues
  • memory problems
  • written language difficulties
  • below average math skills
  • hyperactivity
  • Poor habituation (an inability in adaptive behavioural learning to familiarise with new stimuli (sights, sounds, touch, smell and tastes) so these do not ‘demand our attention)
  • difficulty with abstract concepts (such as time and money)
  • lack of cause and effect thinking (i.e. not learning from experience)

Other FASD symptoms may add to learning difficulties such as sleep problems, difficulty in mood regulation, feeding issues, poor balance and coordination, eyesight irregularities, weak immune system and a range of other medical issues.

In addition, the impact of prenatal exposure to alcohol can affect in varying degrees, the ability to mature (referred to as dysmaturity) including social, emotional, cognitive, language and behavioural development. Although in the majority of cases children’s IQ scores will be within the normal range for their age, and their verbal language development may exceed that of their peers, for many children with FASD, the ability to meet age appropriate expectations in areas of social, emotional, cognitive, academic and behavioural development are unrealistic.

Since FASD have no obvious outward appearance, the effects of developmental dysmaturity on those with FASD can be puzzling to them and a challenge to those around them. Children often appear more able than they can consistently achieve.

Teaching methods and learning support interventions based on assumptions about typical brain functioning and principles of learning theory are often not suited to children with FASD. Rewarding good behaviour usually encourages more of the same. Discipline is used to persuade children away from certain behavior. However such techniques based on normal brain development don’t always work  – and can be damaging – when the learning and behaviour issues relate to pupils FASD conditions.

Central Executive Functioning

Our brain coordinates many functions including our senses, cognitions, emotions and impulses. Central Executive Functioning (CEF), brain processes that supervise and control the highest level cognitive functions, is detrimentally impacted in children affected by FASD. As a result the child’s ability in areas such as problem solving, abstract thinking, planning ahead, adaptability and goal directed behaviour are reduced.  IQ, which gives an indication of academic ability, does not necessarily correctly predict performance in other areas. IQ is not an accurate measurement of adaptive behaviour or the ability to deal with the demands of their school or social environment. The majority of children with FASD have IQ scores in the normal range yet have difficulty with memory and CEF. Due to poorer CEF children with FASD are more prone to acting on impulse. This can affect the child’s ability to focus on learning and make their behaviour in school and social settings seem inappropriate. Also impacted with poor CEF is the ability to learn from past mistakes, experience or knowledge. The detrimental impact on learning social rules, sustaining friendships and gaining peer acceptability often means that children with FASD are socially isolated. It is important to recognise that inappropriate behaviours displayed by children with FASD are often not willful behaviours but rather symptoms of an underlying neurological developmental disorder.

Neuroplasticity, how the brain adapts to new conditions and environments, learns new facts and develops new skills, is also affected in children with a FASD. They may not be able to demonstrate age-appropriate adaptive skills such as problem solving, emotional coping and life skills. This greatly impacts learning and behaviour. Children may not be able to demonstrate learning of what has just been taught. They may continue behaving in an inappropriate manner despite being corrected. This can be interpreted as ‘not trying hard enough’ or ‘bad behaviour’ when in fact both can primarily reflect symptoms of the FASD condition. The children, not able to predict risky situations, need constant supervision to keep them safe.

Ages and stages

As a neurodevelopmental disorder, the symptoms of FASD, often displayed as behaviours, will indicate the child’s stage of maturity, stress level and ability to meet (or not) the demands of any given task.

The impact of dysmaturity means a child’s behaviour may appear like that of a younger child, yet more correctly reflects a younger developmental stage. The behavioural symptoms and support needs of a particular child with FASD will change with age, environmental stressors (including peer group influences), developmental stage and coping ability. Often children affected by FASD are easily led by others which can cause them to get into trouble at school and in the community. Other children, not understanding the reason for such immature and impulsive behaviour, may tease or bully a child with FASD. Children exposed to alcohol prenatally often have difficulty achieving at school. Inappropriate adaptation of teaching methods and environment can worsen symptoms and can lead to increased risk of behavioural problems, maladjustment with the educational setting and secondary disabilities.

Cognitive Fatigue

Cognitive Fatigue is a problem for children affected by brain injury. It occurs in children with FASD because their brain has to work harder and utilise more brain areas to concentrate on tasks that other children of the same age can do easily. Cognitive fatigue accumulates and children’s academic performance may deteriorate as the day progresses or toward the end of the school week or term. Children with FASD may not be able to concentrate for as long as their peers. Cognitive fatigue can also occur when a task is overwhelming or if expectations are set too high. Without appropriate support children with FASD, experiencing cognitive fatigue, can exhibit behavioural problems, educational problems and mood swings. Without appropriate ‘time out’ the child may become irritable, unmotivated, muddled, or physically ill.

How can professionals support children with FASD?

Learning and educational achievement rely on an ability to take in, process and store information to be recalled usefully at a later date. Children affected by FASD can have lifelong difficulties in each of these areas.

Parents and carers often understand the child’s strengths and needs best. They may also know what strategies will work for their child. For children with FASD to achieve success in education and other areas of their lives, long-term multidisciplinary planning involving professionals such as educational psychologist, learning support and community paediatrician, as well as parents or carers, must be in place

The best way to support is by first learning about FASD and using this knowledge to better understand the individual child’s unique set of strengths and support needs. Understanding these will allow you to adapt the environment and learning style to suit the child’s realistic potential. Children affected by neurological disorders such as FASD will require consistency in structure and routine. Changes to structure and routine will overstimulate and stress the child. This may lead to mental exhaustion and unexpected behavioural issues. To prevent these occurring, changes in structure must be planned in advance and take the child’s needs into account.

This list indicates some of the most useful strategies to assist a child with FASD

Teaching Strategies

  • Learn about FASD – to understand the condition and impact on learning and behaviour.
  • Talk with parents and carers – as they are often experts on their child and will know particular strengths and which developmental areas have been most affected by FASD. They will often know what strategies work (and do not work) for their child.
  • Structure and routine – are crucial for a child with neurodevelopmental disorders. This is essential to reduce anxieties and allow the child a sense of predictability while learning.
  • Support – FASD-driven adaptations in the same way as you would a pupil with a physical disability by providing support in both the classroom and playground.
  • Adapt the environment – to best suit the child’s learning style and ability.
  • Think younger according to the child’s developmental stage (not chronological age).
  • Supervise – as you would a younger child. Children and adolescents with FASD are usually trusting and friendly but lack the ability to discriminate between a genuine friend and someone who might harm them. Safety is paramount for those responsible for a child or adolescent with FASD.
  • Strategies – to deal with dysmaturity and challenging behaviours. Recognise that the child is behaving appropriately for their developmental age, which is often less than their chronological age.
  • Avoid sensory and cognitive overload – by employing calming strategies and time-out. Maintain low stress environments where possible.
  • Strengths – every child with FASD has a unique set of strengths e.g. creativity, artistic ability and helpfulness. Identify and build skills and competencies around these and watch the child bloom and grow.
  • Life skills – normally learned indirectly by observation and experience need to be taught specifically to those affected by FASD. Tuition on life skills should include advice on planning time, managing money and keeping safe.
  • Teamwork – You will not be able to do it all on your own. You will need to join other professionals and parents to form multidisciplinary teams.

The Importance of Assessment and Diagnosis

Many children with FASD are currently undiagnosed. Many are misdiagnosed because their behaviours are often misunderstood as behaviour characteristics of other conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Autism, Attachment Disorder, or Depression. Without correct diagnosis and appropriate interventions and supports, children with FASD can be incorrectly labelled as ‘rule breakers’ and ‘disruptive’. Diagnosis allows education staff to match teaching materials and methods to the child’s developmental stage.

Education professionals play a key role in identifying children who may be affected by FASD. Referral to an educational psychologist should set in motion the multi-disciplinary assessment to esablish if a child is affected by FASD. Teaching staff and parents should be involved, providing essential information to build a picture of strengths and deficits. Diagnosis allows appropriate expectations to be set, ensure the right multi-disciplinary team members are involved and sets in place the long term planning needed to provide the appropriate interventions to meet the complex and life-long needs of a child with FASD.

For more information

FASD Scotland can offer information and professional advice and training on supporting children and families affected by FASD. Please contact eileen@FASDscotland.com for further information.

Helpline:
0345 123 2303
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