"Structure is the framework by which students with FASD operate"

















1. What is Fetal Alcohol Spectrum Disorder (FASD)


Fetal Alcohol Spectrum Disorder (FASD) is an important health issue in Canada. The term Fetal Alcohol Spectrum Disorder describes the range of effects that can occur in infants, children, youth or adults exposed to alcohol while in the womb. You might also hear phrases like prenatal exposure to alcohol, exposure to alcohol before birth or hear FASD described as occurring when a mother drinks while pregnant.
There is a board spectrum of symptoms that coincide with FASD. They can range from physical changes, neurological issues and psychometric brain damage.

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FASD is called a spectrum disorder because of the different effects and the different diagnoses within the spectrum. The most common diagnoses are:
    • Fetal Alcohol Syndrome (FAS)
    • Partial Fetal Alcohol Syndrome (pFAS)
    • Alcohol-Related Neurodevelopmental Disorder (ARND)
    • Alcohol-Related Birth Defects (ARBD)

Partial Fetal Alcohol Syndrome (pFAS) indicates confirmed maternal alcohol exposure. A child with pFAS exhibits some, but not all, of the physical signs of FAS, and also has learning and behavioural difficulties which imply central nervous system damage.

Alcohol-related Neurodevelopmental Disorder (ARND): A child with ARND exhibits central nervous system damage resulting from a confirmed history of prenatal alcohol exposure. This may be demonstrated as learning difficulties, poor impulse control, poor social skills, and problems with memory, attention and judgement.

Alcohol-related Birth Defects (ARBD): A child with ARBD displays specific physical anomalies resulting from confirmed prenatal alcohol exposure. These may include heart, skeletal, vision, hearing, and fine/gross motor problems.

Fetal Alcohol Syndrome (FAS):is used to describe a specific identifiable group of children who all share certain characteristics: a specific set of facial features, central nervous system (CNS) dysfunction, and often growth deficiency and a scattering of other birth defects. FAS is a medical diagnosis involving four key features: alcohol exposure, growth deficiency, facial features and brain damage.


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1.1 Primary Disabilities

The primary disabilities of FASD are those that reflect most directly the underlying brain and central nervous system damage caused by prenatal exposure to alcohol. They include abnormal facial features, growth retardation, and impaired mental functioning; poor executive functioning, memory problems, impaired judgment and other effects.

The common primary disabilities linked with FASD include:
  • Cognitive Disabilities: Cognitive functioning refers to intellectual processes and mental tasks. We use many cognitive processes every day.
  • Behavioural Disabilities: Humans have many behaviours all controlled by brain functions. Our behaviour is linked to social and emotional development.
  • Physical Disabilities:Sensory Disabilities: This gives us the ability to taste, smell, touch, hear, see, know our body position and perceive movement sensations. Sensory impairments in individuals with FASD are often noticed during infancy and continue throughout the lifespan.
    • Delayed motor development—slow to meet developmental milestones
    • Problems with fine and gross motor skills—especially noticeable as children reach school age and begin classroom activities with their peer
    • Poor hand eye coordination
    • Poor balance or coordination—appears clumsy or awkward
    • Lower height or weight
    • Distinct facial features
    • Hearing impairments and auditory processing problems

Primary disabilities are linked to behaviours such as:
Impulsive actions
Resistant to change
Poor judgment
Makes same errors again
Does not "learn a lesson"
Poor memory
Talks "a blue streak"
Doesn't understand
Misses spoken words
Money and time problems
Future planning poor
Cannot generalize
Slow thinker
Confabulates stories
Dismaturity

1.2 Secondary Disabilities

Secondary disabilities are those disabilities that an individual is not born with, and that could be ameliorated through better understanding and appropriate interventions. Secondary issues are interconnected. They tend to stack up over and above the struggles linked with the primary disabilities. Families and professionals see several types of secondary characteristics like the ones listed below:
  • Mental health problems
  • Disrupted school experience
  • Trouble with the law
  • Confinement for treatment or mental health
  • Addictions
  • Gambling
  • Inappropriate sexual behaviour
  • Social isolation
  • Withdrawal
  • Problems living independently
  • Homelessness
  • Victimization
  • Risk taking activities
  • Unplanned pregnancy
  • Problems with employment

Secondary disabilities could include but are not limited to:
Poor social relationships
Irritability, fatigue
Resistance
Sexual inappropriateness
Addiction issues
Anger, aggressiveness
Mental health issues
Other psychiatric diagnoses
Recidivism
Self-destructiveness
Suicidal tendencies

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1.3 Common Strengths in Peoples with FASD

  • Friendly and Cheerful
  • Likable
  • Desire to be liked
  • Helpful
  • Verbal
  • Determined
  • Have points of insight
  • Hard Working
  • Everyday is a New Day!


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FASD IS 100% PREVENTABLE



2. Teaching Strategies & Learning Styles for Students with FASD


Children with Fetal Alcohol Spectrum Disorder (FASD) have permanent brain damage which causes learning difficulties in the area of social and emotional development, understanding rules, expressive language, and problem solving and numeracy. Because of this, they will not follow the general patterns of learning, or be able to generalize rules learned from one situation to another. Educating and caring for these children relies on a unique approach that is based on adaptive teaching techniques.

Teaching strategies for students with FASD will vary for every individual. Each student will have their own strengths and challenges and it is important that as a teacher you are able to discover what their strengths and challenges are so you can assist them in their learning. Teachers should capitalize on students strengths as much as possible to help the student learn and achieve their best. It is important to observe a student’s responses to activities in order to help determine strategies that work well for them and find out those that don’t. The best approach is to keep trying different strategies until you find the ones that work effectively with an individual child. Keep in mind that what may work one day will not necessarily work the next.

The following are some examples of teaching strategies that may help to overcome these learning difficulties and improve outcomes for children with FASD:

Auditory
  • If giving verbal instruction, ensure to not give only a few instructions at once (about one or two). When instructions become more complex, students will become confused and will not be able to remember what the first few steps were
  • Patience! Working with FASD students takes a great deal of patience and empathy.
  • Provide audiotapes or audio CD's of and novels.
  • Introduce new words slowly and repeat them frequently

Visual
  • Limit the number of items or objects that are shown at one time, as they can become confused and overwhelmed
  • Display simple, numbered, concise steps for completing assignments
  • Use pictures to accompany written and verbal instructions, whenever possible
  • Give students photocopies of instructions for multiple-step assignments. Number the steps or separate them into a stapled instruction booklet to further emphasize the order and steps in the process. When possible, provide a finished sample
  • Teach students how to use daily planners. Provide a visual system to record and monitor what tasks need to be done, and check off completed items
  • Visually outline individual students’ work spaces or personal space with tape, color or labels
  • Use visual timelines to develop time-management skills
  • Help older students locate and color code essential information in instructions by underlining, circling or highlighting key words or steps


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Kinesthetic
  • Use communication books for daily communication between school and home. This may also be a way to provide instructions for and track homework assignments
  • Develop homework checklists that students understand and can use to self-monitor
  • Offer extra tutoring after school using volunteers, teachers or a designated school homework coach
  • Move slowly when concepts are introduced, and offer lots of repetition and practice. Students need clear, concise examples and explanations
  • Use consistent language to explain concepts or operations
  • Some students with FASD can learn the operation, but have difficulty understanding the concept behind it. Teach how rather than why at first. Gradually work to develop understanding through multiple presentations with manipulatives.

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Alberta Learning

Worcestershire’s Early Years and Childcare Service



3. How to Teach FASD within a Variety of Environments


Being aware of the child’s physical environment (classroom, gym, etc.) is key to educating them successfully. They may experience sensory overload and create difficulties with processing their sensory understanding. Examples of planning your room to help accommodate FASD children may be:

• Be aware of using large rooms without carpeting (e.g., gyms). They tend to have an echo that can be disturbing to children with auditory sensitivities.
• The sounds of fans, air conditioners, and humming lights can also be disturbing as it causes distraction and sensory overload.
• Artificial lighting can be stressful for a child with visual sensitivities.
• A cluttered classroom with lots of disorganization affects not only you as a teacher but your FASD students as well. This can be an uncomfortable learning environment for them
• Temperatures can cause a child to shut down if it is too hot or too cold.

When in doubt, use Fidgets!
Having an object that the student can play with without having to visually participate with it and without it being a distraction to other students is referred to as a Fidget toy. This is a great way to keep their senses separate but active, allowing them to focus on what is important during class time. Fidget toys help the student focus on the teacher and prevents their need of touching other things and interacting with other people from popping up. Some examples of fidget toys are
  • Stress balls
  • Koosh Balls
  • Bendable toys or pencils
  • Silly Putty
Additionally, doodling is also another technique to allow students to do while class is occurring, keeping in mind that they are still paying auditory attention.

Benefits of Proper Seating for Students
Positioning is very important for learning and development of motor skills in students. If a desk chair is too large or small, proper support for printing and other desk activities lacks causing neck and back strain as well as muscular fatigue – not ideal for positive learning. Some examples of alternate seating for students might be:
  • Wiggle Cushions and Yoga balls
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These are fantastic for students who need that little bit of movement during the day but are able to do it in a way that does not disrupt the class. This allows them to change various positions, massage their spine and keep their attention better focused on their work. However, these methods should only be used 20-30 minutes at a time during moments of fatigue
Overall, creating a very calm and relaxing environment for FASD students is key as they are always dealing with the effects of alcohol during pregnancy. Even creating a soft, calming environment of their own in the classroom such as a quiet corner with a bean bag chair can be very beneficial to their education. They are fragile people who deal with challenging learning difficulties on a daily basis and it is in the best interest of the teacher to make it easier on them in anyway.
Creating awareness and comfort in the classroom for FASD students is one step closer to making life a bit easier for them.


4. Assessing Students with FASD

By understanding how well a student is doing in school will help teachers plan programing strategies for students. As observation continues teachers can see the effects of new strategies on students' day to day learning; more strategies can be worked in later. Make sure that there is an appropriate observation period to see if there is improvement with the new strategies before introducing additional ones. .

Make adjustments to students’ programs as needed:
  • Observe to see what of your teaching strategies should be modified, discontinued or added.
  • Help build on FASD students talents and strengths and support them as they cope with difficulties.
  • Foster a positive learning atmosphere.
  • Let the students build on their feelings of self-worth and experience success.
  • Encourage achievements, even if they are small.
  • Keep in mind that the learning gap between "age" and "FASD age" grows with age.
  • Example- Age 5 going on age 2 developmentally. Age 18 going on age 10 developmentally.
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Assessment of functional life skills should:
  • Be conducted often.
  • Be conducted within the natural environment.
  • Focus on present and future environments in which students will live and work.

When assessing students with FASD teachers should keep in mind that:
Age 5
Go to school
Follow three instructions
Sit still for 20 minutes
Interactive, cooperative play, share
Take turns
Age 5 going on 2 developmentally
Take naps
Follow one instruction
Active, sit still for 5–10 minutes
Parallel play
My way or no way
Age 6
Listen, pay attention for an hour
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 recess
Get along and solve problems
Learn inferentially, academic and social
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
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
Giggles, curiosity, frustration
Need an allowance
Need to be organized by adults



5. Tips From Teens and Young Adults with FASD

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Students with Fetal Alcohol Spectrum Disorder were surveyed in an article and described what they believed were the best and worst characteristics of the teachers they had encountered in school. This article can be a tool for teachers to understand how to modify their teaching towards students who may have FASD in their classrooms with these inclusive intervention strategies.

The worst teachers:
  • Embarrassed students by raising their voice when they did not understand something
  • Brush students off when they need further clarification about a lesson or assignment
  • Single them out and put them down
    • Yelling makes the students feel uncomfortable about asking questions
  • Are poorly organized, sarcastic and unavailable to meet the students’ needs

The best teachers:
  • Are knowledgeable about FASD and the effects of brain damage caused by the exposure to alcohol
  • Understand that for these students it was not that they wouldn’t it was that they couldn’t
  • Are patient and willing to take time to explain things clearly, answer questions and provide accommodations

Students with FASD list recommendations for teachers when teaching them:
When presenting new material:
  • 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

When working on class assignments teachers should:
  • 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
  • Learn the students’ strengths and weaknesses
  • Maintain a structured environment, routines, schedule, classroom rules, and consequences that are repeated often and linked with choices
  • Use multi-sensory approach with hands-on activities and concrete materials to teach concepts
  • Teach shorter lessons with active student involvement and guided practice
  • Give one instruction at a time, demonstrate what is to be done, be very specific and use simple language
  • List sequence of procedures or activities, and post it
  • Teach the student to make lists and use a planner
  • Use praise and positive reinforcement as often as possible to shape positive behavior

6. Further Exploration

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For more information on Assessment and teaching strategies for students with FASD check out the following sites:

http://www.dotolearn.com/disabilities/FASDtoolbox/classroom_management/classroom_environment/overview.htm

http://www.gov.mb.ca/healthychild/fasd/fasdeducators_en.pdf

Students LIke Me: Episodes 2-4, 6-9 can be found:

http://www.youtube.com/watch?v=IXS-dpF-P9I&feature=relmfu




7. References


Alberta Learning. (2004). Teaching Students with Fetal Alcohol Spectrum
Disorder. Retrieved September 29, 2012 from http://education.alberta.ca/media/377037/fasd.pdf

Blackburn, Carolyn. (2009). Fetal Alcohol Spectrum Disorder Focus On Strategies:
Building Bridges with understanding Project. Retrieved September 29, 2012 from http://bit.ly/SYx3mj

Duquette, C., Stodel, E., Fullarton, S., & Hagglund, K. (2006). Teaching Students With Developmental Disabilities: Tips From Teens and Young Adults With Fetal Alcohopectrum Disorder. Teaching Exceptional Children, 39(2), 28-31.

http://education.albertadia/414096/fasd3.pdf