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 students 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 our 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 students and adolescents, and what teachers and schools can do to support students with FASD.
Here are the key ideas presented 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 students 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 students 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 students with FASD, and students with FASD 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 students need more processing time. They are “10 second kids in a one second world”.
The KISSSSSS communication strategy can be highly successful for students 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 student 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.
Students with FASD may have developmental delays and meet milestones later than other students. 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 students with FASD can be uneven and confusing; for example, they may have highly developed expressive language but have very poor receptive language.
Many students with FASD have differences in sensory processing because the central and peripheral nervous systems are damaged. This means that students may be extremely reactive to light, sound, touch, or other 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 students with FASD so that they can be successful involves adapting the environment and the way that behaviours are approached and framed. Curricula may need to be modified and students supported in a range of ways to learn and demonstrate their learning. Universal Design for Learning (UDL) principles are helpful, and while necessary for many students, found to be beneficial for all students. For example, ‘chunking’ work into smaller steps may be helpful for students with FASD. A ‘Learner Profile’ which indicates students’ needs and the strategies that work for them is essential. Teachers should be aware that students with FASD have less ‘executive fuel’ than neurotypical students, and therefore will require more brain breaks. Students may also benefit from sensory support.
Students with FASD benefit from strong relationships with their teachers characterised by empathy, understanding, and acceptance. Students with FASD experience many challenges to their self-esteem and are three times more likely to be bullied than other students. Across the lifespan, people with FASD can experience a range of adverse outcomes such as higher rates of mental health issues and suicide. However, students with FASD also have many strengths, and there is much research and anecdotal evidence that children and young people with FASD can be highly successful in their lives.
To learn more about FASD, read our research review here. Our guide to sensory processing differences may also be useful.
