1. Ali Pravda, Chelsea Baynham, Shanna Vaughn, Victoria Glass
FASD
“They may forget what you said, but they will never forget how you made them feel.”
- Carol Buchner
Ali Pravda, Chelsea Baynham, Shanna Vaughn, Victoria Glass

2. Outline What is FAS vs. FASD? Understanding FASD
Primary vs. Secondary
Understanding FASD
Identifying FASD in the classroom
Tools for success

3. Drinking During Pregnancy
Drinking at any time during pregnancy (and breast feeding) may affect development.
Stopping drinking at any time during pregnancy improves the outcomes for both parent/child
Alcohol kills brain cells
If large amounts of alcohol are consumed, and enough brain cells are damaged, the brain will actually be smaller.
some people may not show a difference in brain/ head circumference but may show lesions and difference in structure and function of the brain.
Sometimes these lesions are not observable.
Prenatal alcohol exposure can cause a range of disabilities
Each person affected will have different challenges and strengths.
The alcohol directly affects the brain size, structure and function. Brain damage persists throughout the lifespan

4. Effects of Alcohol on the Brain
The brain is more sensitive to the effects of prenatal exposure to alcohol and other drugs.
The Brain is growing and developing throughout gestation and is affected differently and at different times.
Timing of exposure, peak drug/alcohol levels, genetics, nutrition, stress, age of parent etc. all contribute to a wide range of effects.
No two people with FASD are the same.

5. What is FAS?
If alcohol is not consumed in the first trimester, when the fetus is forming the child will not have full FAS.
For a full diagnosis of FAS there must be a medical diagnosis and meet specific criteria.
1) Small physical size including head circumference , body weight, and length
2) Evidence of central nervous system involvement (brain differences affecting learning, activity levels, sensitivity, etc.)
3) Facial Characteristics (small eye openings, thin upper lip, small jaw, etc.)

6. What is FASD? Fetal Alcohol Spectrum Disorder has a range of effects.
Someone with FASD was exposed to alcohol while in the womb, and will have the disorder and symptoms for life.
FASD is a physical disability: People w/ FASD have differences in their brain
Primary disabilities are: cognitive, sensory, physical, and behavioral.

7. What is FASD?
It is the leading cause of developmental disability in North America
Health Canada estimates that ~ 1 in 100 babies will be born with FASD
People without full FAS are more difficult to diagnois / identify as they have few or no physical symptoms.

8. Diagnosis It is known as an “invisible disability”.
Diagnosis is complex. Facial anomalies is a small percent of cases, effected by drinking early on.
Therefore people up to adulthood can be undiagnosed or misdiagnosed.

9. The disorder can co-occur or be misdiagnosed with other mental illnesses:
Attention Deficit/Hyperactivity Disorder
Psychotic Disorders
Autism Spectrum Disorder
Asperger’s Syndrome
Bipolar Disorder
Schizophrenia
Conduct Disorder
Traumatic Brain Disorder
Learning Disabilities
Tourett’s Syndrome
Disruptive Behavior Disorder
Living with FASD and a co-occuring mental illness means that everyday tasks are extremely challenging. Mental health issues are often developed because early FASD diagnosis and interventions did not happen.

10. Central Nervous System Impairment
Structural
Physical / observable damage to the brain
Neurologic
Epilepsy, clumsiness, poor hand-eye coordination, neurosensory hearing loss
Functional
Range of functional disabilities

11. Primary Disability: 1. Cognitive
Slower cognitive pace
Slower auditory processing
Impaired executive functioning (e.g. decision making)
Problems generalizing
Poor memory
Poor judgment
Confabulation and untruths (result from memory problems)
Speech and language problems

12. Common Impairments Cognitively
Lower IQ – especially with areas of language comprehension and math
Average IQ for full FAS is 70 and ranges anywhere from
A person with FASD may have an “average” IQ and still have significant differences in brain functioning.
Conceptual and abstract thinking (e.g. poetry)
Cause and Effect
Generalization
Time and money understanding
Memory

13. Primary Disability: 2. Behavioral
Difficulty reading social cues
Impulsive actions
Immaturity
Vulnerability to peer pressure
Lack of inhibitions – overly friendly
Difficulty regulating emotions
Poor understanding of boundaries and personal space
Difficulty with transitions (perseveration)

14. Primary Disability: 3. Physical
Delayed motor development
Heart defects
Kidney underdeveloped or misplaced
Teeth – poorly aligne, faulty enamel
Cleft palate
Hearing loss
Vision problems
Health problems
Low birth weight/height
Facial features

15. Primary Disability: 4. Sensory
Hypo-sensitive vs. Hypersensitive
Sensory seeking or avoiding
Become overwhelmed and over-stimulated
Very sensitive to touch, movement, light, sound, or smell, therefore difficulty concentration when any of these are in excess.
Pain – high or low tolerance
Do not recognize hunger
Lack of empathy
Overload from sensory input – shut down
Hypo-sensitive (may not feel things ‘properly’, e.g. going out in the winter without a coat), Hyper-sensitive (overly sensitive to sounds, light, touch, smell. e.g. may only want to wear one pair of pants because those are the only ones comfortable).
Important to have a calm learning environment

16. Secondary Disabilities
These occur if there is no support or services for these individuals (resulting in continued failure):
Substance abuse
Relationship difficulties
Employment challenges
Homelessness
Trouble with the law (either offender or victim)
Money management issues
Low self-esteem
Anger management problems
Secondary disabilities that accompany FASD and mental health issues affect how one lives and functions in society. Unfortunately, involuntary secondary disbilites can be mistaken for as intentional, personal faults.
Higher stress response in people with FASD
Harder to feel safe and calm – there is more difficultiy producing serotonin (that helps us feel safe and calm/happy), therefore more depression.
Genetic predisposition to addiction
People with FASD have trouble connecting thinking and feeling because of the thinner corpus callosum in the brain.
Often people expect more than what they can deliver, and this leads to frustration, and low self-esteem.

17. Challenges in Life
Challenges are caused by their primary disabilities (cognitive, behavioral, physical and sensory).
Problems with:
Behavior
Decision Making
Problem Solving
Memory
Social Conditioning
Time Management

18. Possible Chronological-age vs. Developmental-age
Age 13 (going on age 8) Developmental:
Age 13 Expectations:
Act responsibly
Need reminding
Organize themselves, plan ahead, follow through
Need visual cues, modeling
Comply with simple expectations
Meet deadlines after being told once
Need prompting
Initiate, follow through
Kinesthetic, tactile, lots of touching
Have appropriate social boundaries
In your space
Understand body space
Forming early friendships
Establish and maintain friendships

19. Possible Chronological-age vs. Developmental-age
Age 18 Expectations:
Age 18 (going on age 10) Developmentally:
On the verge of independence
Maintain a job and graduate from school
Need structure and guidance
Limited choices of activities
Have a plan for their lives
Live in the “now”, little projection into the future
Form relationships, safe sexual behavior
Easily led, impulsive and sometimes inapproptiate sexual behavior
Budget their money
Organize, accomplish tasks at home, school, job
Need an allowance
Need to be organized by adults, limited self-management

20. Identifying vs Labeling
Identifying is different from labeling, labels are more liberally applied.
One concern about labeling a child with FASD is unlike other conditions who’s cause is unknown…FASD immediately implicates the parent(s)

21. Mental Shifts: Understanding
The “brain – behavior link” has been affected
i.e. alcohol affected the structure and neurochemistry of the brain
The person isn’t lazy, they are tired of failing when they try hard.
The person doesn’t lie, but fills in the blanks
The person isn’t fussy, but oversensitive
The person isn’t trying to get attention but needs contact and support.
The person should not be seen as acting inappropriately, but is instead displaying behaviors of a younger child.

22. 10 Things to Think About in the Classroom:
What is the lighting like?
What is the noise level? Can I introduce calming music or headphones?
Are there smells? Can I add smells?
Visual Distractions? Anything on the walls?
Are students seeking sensual stimulation?
Are students becoming overwhelmed?
What are transition times like?
Do I need to change the seating arrangment?
How do I prepare students for a change in schedule?
Are my students dressed appropriately for the weather?

23. 1st Person Experiences People with FASD:
“It’s like the wiring is scrambled, sometimes things just don’t connect.”
“Inside my head it’s like there are all these sheets of paper. Today they’re all blank.”
“It’s like there’s a window in my brain and sometimes the window is open and sometimes it’s closed.”

24. Students with FASD
-Students with FASD have a wide range of intellectual levels and disabilities
*This reflects the differing degrees of brain damage
-The patterns of FASD are unique to the individual.
-Some students with FASD may learn well in school but may have behavioral or social issues in other areas of life.

25. Students with FASD have Characteristics such as:
Difficulty listening, paying attention and working with others.
Appearing to know something one day, forgetting it the next and then knowing it again after several days.
Being highly verbal but often misinterpreting what others are saying.
Difficultly learning concepts, organizing, sequencing, problem solving and developing age-appropriate social skills.
Difficulty making and keeping friends because of their behavioral difficulties.

26. Students with FASD
Students with FASD do not outgrow the effects over time.
As they get older they may also experience difficulty evaluating situations and using past experiences to cope with current problems.
They may need different degrees of protection, supervision, and structure throughout their lives, especially as teenagers and young adults.

27. Difficulties with Change
Give students transitions ahead of time
Prepare students for change by explaining what is expected of them, give them time to prepare
If possible, prepare them for a sub – keeping consistent.
Distract them if in a power struggle (e.g. using humor)
Keep the rules simple and speak to other teachers to have consistent rules as well

28. Difficulties with Ownership
Ownership issues arise from their behavioral disability (such as stealing or giving items away)
Use words the student can understand
Have all the student’s things marked with his or her names
Store valuables out of sight
If student steals, have them return the item with an apology

29. Classroom Strategies: Self-Esteem
Notice what the student has done well and give reinforcement
Use rewards and positive consequences
Celebrate successes
Find Strengths – Build on them

30. Classroom Strategies: Decision Making and Abstract Thinking
Give only two acceptable choices
Make rules clear
Allow the child time to make decisions
Use pictures or charts to help explain
Do things the same way, use the same words every time

31. Classroom Strategies: Memory Problems
Keep daily routines
Have schedules posted
Break tasks down
Use repetition
Help the student with a day planner
Give only one instruction at a time
Exercise patience (e.g. re-teaching)
Repeat, Repeat, Repeat:
Those with FASD learn best through repetition. The disability typically affects one’s memory and understanding of meaning, repetitious actions help to ingrain ideas that might be forgotten.

32. Classroom Strategies: Slow Cognitive Pace
Slow down your speech
Don’t rely on “talk” to teach
Use visual supports
Give students down time if getting “overloaded”
Use transitions to prevent overload
Increase your wait time with questions
Ask only one question at a time

33. Classroom Strategies: Filling in the ‘gaps’
Break things into smaller steps
Use consistent language (figurative expressions may be taken literally)
Have students repeat instructions (they may have heard something else)

34. Classroom Strategies: Be Clear – Be Direct – Redirect
Make Directions concrete and literal
E.g. “Please walk on the right side of the hallways and leave room between you and other people”; rather than “Watch how you move in the hallways”.
Be direct with students about what to do, rather than tell them what not to do. Phrase questions in positive ways.
E.g. “Walk slowly in the hall”; rather than “Don’t run in the hallways”.
Redirect students who are misbehaving.
If a student is starting to roughhouse with another student in line, simply ask one student to move (“please come here and carry this book for me”).

35. Classroom Strategies:
When misbehavior occurs, the focus should be on identifying what the student needs in order to be successful in this situation.
Many students with FASD don’t always have logical reasons for why they behave the way they do. Because they often have difficulty connecting cause and effect, many conventional behavior management strategies based on consequences (eg. Punishments, rewards or combination of both) have limited effectiveness with these students.
Support Positive Behavior

36. Teach about Drugs and Alcohol
Talk about the dangers early
They are easily influenced and vulnerable to peer pressure
Encourage the child to participate in healthy pastimes and activities.

37. Teach about Sexuality
Prone to sexual exploitation, both as a victim and an offender
Teach about boundaries
Teach about the dangers of the internet and chat rooms
Use clear and simple words – be concrete
Address issues as they arise

38. Necessary Activities Make a “My Strengths Inventory”
Make a “Interest Inventory”
Give child access to “Feeling Better” worksheet
Help fill out a “How I Learn Inventory”
Make a “Circle of Friends” and “Circle of Support” diagram
Have a “My School Day Report”
Feeling Better Guide:
Student fills out a “If I’m feeling (sad/angry/frustrated/worried/overexcited), this is what could help me feel better…”
How I Learn Inventory:
Rating how each technique works for them (speaking aloud, writing on the board, help from another student, trying it on their own and showing another student/check with teacher, etc.)
My School Day Report:
Rating the actions of the student and the teacher (polite voice, hands and feel to myself, following teachers requests)
What went well, what to work on

39. Strengths Inventory Students name: Date:
4 things you did this year that you are proud of:
B. 4 everyday things you do well:
C. 2 things you could teach someone else:
D. 10 positive words to describe yourself:
E. 2 things that really matter to you:
F. 2 things you can do for yourself that always make you feel good
G. 2 people who you can count on for help and support:
Alberta Learning, Make School Work For you: A resource for Junior and Senior High Students Who Want to be More Successful Learners (Edmonton, AB: Alberta Learning, 2001), p. 84.

40. Strengths to consider Affectionate Kind Caring Outgoing Curious
Spontaneous
High energy
Athletic
Musical
Creative
Sense of wonder
Friendly
Artistic
Learn by doing
Concrete thinker
Sense of humour
Enthusiastic
Trusting

41. Individual Student Support Plan
Seating:
front; back; near teacher; away from distractions; allow standing or kneeling; provide alternate workspace
Instructional Presentation:
adapt pace of lesson;
highlight key points of info;
provide regular review time in class;
provide examples completed by other students;
colour code print material;
break info into smaller steps; photocopy notes

42. Individual Student Support Plan
C. Assignment Completion:
allow extra time;
cover parts of worksheet;
increase white space for answers;
reduce amount of info/questions per page;
ensure student records info in agenda;
provide weekly lists of homework/reading assignments;
allow use of calculator;
provide checklist of steps to complete activity;
use computer to complete assignment

43. Individual Student Support Plan
D. Attention Support:
Reduce materials on desk
Provide checklist for organizational tasks
Provide buddy to clarify missed information
Use nonverbal or verbal sign to cue student
E. Behavior Support:
Provide buddy suport to model appropriate behaviour
Use agenda to communicate with other teachers
Provide positive reinforcement
Create opportunities for breaks (e.g. for water, to the library)

44. Individual Student Support Plan
F. Reading Support
Allow extra time
Buddy Reading
Use of text-to-speech software
G. Writing Support
Use of word processor (inc. spellcheck)
Allowing point form to replace paragraphs
Providing copies of notes and teaching students to identify and highlight main ideas
Providing graphic organizers for planning
Shared reading with trained peers or volunteers

45. Individual Student Support Plan
H. Assessment and Evaluation
Smaller chunks of info or simpler concepts
Use individual criteria to evaluate tasks
Use notes or textbook during tests
Allow extra time on tests
Use of word processor
Clarify directions

46. Teacher as Advocate and Team Approach
Make other teachers aware of their needs
Regular contact with the home
Involve students in school activities (reminding of signups, introducing to coaches, etc.)
Watch for issues (e.g. missing their favorite classes)

47. Take Action in School to Student and Beyond
Help school staff build an understanding of FASD
Identify student strengths and interests
Align strategies with student needs
Build rapport with school staff
Keep informed about current research and best educational practices
Support positive behavior
Work with staff to make school a safe place
Help build a circle of peer support
Help build a circle of adult support
Plan for transitions
Support learning at home
Advocate for increased understanding and support for students with FASD

48. Think About:
“The curriculum is so much necessary material, but warmth is the vital element for the growing plant and for the soul of the child.” – Carl Jung
Student throwing his homework away because he forgot how to do it. He said it’s better to appear bad than stupid.

49. Support Mentorship Repeat, Repeat, Repeat
Structure, Routine, and Consistency
Individuals with FASD can need a positive role model; to increase community involvement; practice life skills (like grocery shopping, and social interaction); and to reduce feelings of depression, isolation, and loneliness.

50. Support and Contact FASD Support Network of Saskatchewan Inc.
All services are free
Canadian Mental Health Association (CMHA)
Regina: (306) , Saskatoon: (306)
Saskatchewan Prevention Institute
Info about FASD, presentations, training, family support, referrals, conferences and other events, and various materials and resources

51. Sources
Schemenauer, Carrie Anne. (2012, October). “FASD in the classroom: What to expect and how to help”. Slide Presentation presented at the University of Saskatchewan, Saskatoon, SK.
FASD and Mental Health [Brochure]. FASD Support Network of Saskatchewan Inc.
FASD Family Support Program: Healthy Families, Healthy Communitites [Brochure] FASD Support Network of Saskatchewan Inc.
Re: defining Success: A team approach to supporting students with FASD. (2009). Alberta Education, Learning and Teaching Resources Branch, Edmonton, AB.