It is estimated that 2-5% of the population has Foetal Alcohol Spectrum Disorder (FASD), meaning that most teachers will knowingly or unknowingly come across children in their classes who are living with FASD. FASD affects individuals in different ways, but can include complex physical, behavioural, social, learning and intellectual differences that persist throughout the lifespan. In a webinar, Kim Milne, Principal Advisor at FASD-CAN (FASD Care-Action-Network) and mother to a son with FASD, talks to us about what FASD is, how it affects children and adolescents, and what teachers and schools can do to support children with FASD.

Here are the key ideas discussed in the webinar:

FASD is a brain- and body-based disorder that occurs as a result of a pregnant woman drinking alcohol during pregnancy. Alcohol is a teratogen that is toxic to the body and to the formation of the foetus, causing malformations. This is because alcohol passes directly through the placenta, and without the liver to filter alcohol, the foetus can have higher alcohol levels in the blood than the mother. FASD affects brain function, body organs, and the central nervous system. It is distinguished from other developmental disorders as it is caused by brain damage.

Between 2% and 5% of the population may have FASD according to a New Zealand Ministry of Health estimate. However, there is a lack of prevalence data, due to the limited opportunities in Aotearoa New Zealand for diagnosis, and underreporting because of the high levels of stigma attached to FASD. There is a high co-morbidity of FASD with ADHD (in fact children with FASD can often be misdiagnosed with ADHD), and with autism.

FASD is a spectrum of disorder, dependent on the unique pattern and timing of alcohol consumption. It can inhibit executive functioning, social skills, and motor skills, and affect regulation (mood disorders), memory, language, cognition, and attention. Only 5% of people with FASD have the characteristic sentinel facial features. FASD should not be associated with maternal alcoholism, as much of the damage is caused in the early weeks of pregnancy, often before mothers know they are pregnant.

Typical difficulties with which children with FASD may present include struggling with comprehension, working memory, and concepts such as consequences. Typical behavioural management strategies are not likely to work for children with FASD, and they may need more support to process information. Because the alcohol damage results in pockets and holes within the brain architecture, the brain has to develop longer, more circuitous routes, meaning that these children need more processing time. They are ‘10 second kids in a one second world’.

The KISSSSSS communication strategy can be highly successful for children with FASD. KISSSSSS stands for Keep It

Short: use one or two short sentences followed by at least a 10 second pause

Simple: use unambiguous words, not colloquialisms or irony

Same: use the same terminology and phraseology to avoid confusion and to support transfer to long-term memory

Slow: talk slowly and check for understanding by asking the child to repeat back in their own words

Specific: be clear and use positive rather than negative phrasing, for example ‘I want you to…’ not ‘I don’t want you to…’

Show: build on the strengths that people with FASD often have in kinaesthetic, tactile, and visual learning, by using demonstration and diagrams.

Children with FASD may have developmental delays and meet milestones later than other children. Some experts suggest imagining the child with FASD to be about half their chronological age: teachers can start by pitching their interactions and teaching there, and then going up if needed. The maturity and development of children with FASD can be uneven and confusing; for example, they may have highly developed expressive language but have very poor receptive language.

Many children with FASD have differences in sensory processing because the central and peripheral nervous systems are damaged. This means that children may be extremely reactive to light, sound, touch, or other forms of sensory input. Many have a heightened threat perception, and are constantly on alert (think ‘fight or flight’), ready for the next potential threat. This is because the temporal lobe that houses that threat response is closer to the brain stem and less likely to be damaged than the frontal lobe in which abstract and logical thinking (used to keep the fight or flight reflex in check) takes place.

Meeting the needs of children with FASD so that they can be successful involves adapting the environment and the way that behaviours are approached and framed. A ‘Learner Profile’ which indicates children’s needs and the strategies that work for them is essential. Teachers should be aware that children with FASD have less ‘executive fuel’ than neurotypical children, and therefore may require more time for rest and quiet play. Children may also benefit from sensory support.

Children with FASD benefit from strong relationships with their teachers characterised by empathy, understanding, and acceptance. Children with FASD experience many challenges to their self-esteem and are three times more likely to be bullied than other children. Across the lifespan, people with FASD can experience a range of adverse outcomes such as higher rates of mental health issues and suicide. However, children with FASD also have many strengths, and there is much research and anecdotal evidence that children and young people with FASD be highly successful in their lives.

To learn more about FASD, you can read our research review here. While this guide was written for school teachers, much of the information will also be useful for early childhood teachers. Our guide to sensory processing differences may also be useful.