Assessment+for+FASD

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=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.



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.**



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 ||  ||

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!



__** 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




 * 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.

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 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.
 * When in doubt, use Fidgets! **
 * Stress balls
 * Koosh Balls
 * Bendable toys or pencils
 * Silly Putty

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: 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.
 * Benefits of Proper Seating for Students **
 * Wiggle Cushions and Yoga balls

=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.

**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**: 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 || 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 || 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 || 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 || 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 ||
 * **Age 5**
 * **Age 6**
 * **Age 10**
 * **Age 13**
 * **Age 18**

=5. Tips From Teens and Young Adults with FASD= == 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

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

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