Fetal+Alcohol+Spectrum+Disorder



Fetal alcohol syndrome (FAS) is the total damage done to a child before birth as a result of the mother drinking alcohol during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome. The defects that are part of fetal alcohol syndrome are irreversible and can include serious physical, mental and behavioral problems, though they vary from one child to another. Prenatal exposure to alcohol can cause a range of disorders, known as fetal alcohol spectrum disorders (FASDs). One of the most severe effects of drinking during pregnancy is fetal alcohol syndrome (FAS). FAS is one of the leading known preventable causes of mental retardation and birth defects.
 * What is FAS and FASD?**

Fetal alcohol spectrum disorders (FASDs) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. If a pregnant woman drinks alcohol but her child does not have all of the symptoms of FAS, it is possible that her child has another FASD. FASDs include FAS as well as other conditions in which individuals have some, but not all, of the clinical signs of FAS. Four terms often used are fetal alcohol effects (FAE), alcohol-related neurodevelopmental disorder (ARND), alcohol-related birth defects (ARBD) and partial fetal alcohol syndrome (pFAS).

The term FAE has been used to describe behavioral and cognitive problems in children who were prenatally exposed to alcohol, but who do not have all of the typical diagnostic features of FAS.

The term ARND is used to describe individuals who has central nervous system damage resulting from prenatal exposure. This may be demonstrated as learning difficulties, poor impulse control, poor social skills, problems with memory, attention and judgement (Government of Alberta, 2004).

The term ARBD is used to describe an individual that displays specific physical related defects from prenatal exposure to alcohol including; heart, skeletal, vision, hearning and fine/gross motor skills (Government of Alberta, 2004).

The term pFAS is used to describe individuals with confirmed maternal alcohol exposure with some, but not all, of the physical characteristics of FAS and have learning and behavioural difficulties which implies central nervous system damage (Government of Alberta, 2004).

All FASDs are 100% preventable if a woman does not drink alcohol while she is pregnant.



**How common are FAS and FASDs?** Fetal alcohol exposure is the leading known cause of mental retardation  in the Western world. The reported rates of FAS vary widely. These different rates depend on the population studied and the surveillance methods used. As many as 40,000 babies are born with some type of alcohol-related damage each year in the United States. On average, the FAS prevalence rate is estimated to be between one to two out of every 1,000 births,   comparable to or higher than other  developmental disabilities  such as  Down syndrome  or  Spina Bifida. Other FASDs are believed to occur approximately three times as often as FAS. Yet many pregnant women do drink alcohol. The lifetime medical and social costs  of each child with FAS are estimated to be as high as US$800,000. "In Canada   there are   somewhere between 123 and a 740 babies are born with FAS, and around 1000 babies are born with FAE (based on 370,000 births per year)" (Health Canada). "The prevalence of FAS/FAE in high-risk populations, including First Nations and Inuit communities, may be as high as 1 in 5. The incidence of FAE is 5 to 10 times higher than the incidence of FAS." (Health Canada).

The diagnosis of FAS must be based on solid evidence. FAS is a diagnosis of great importance for the entire lifetime of the child, not to speak of its implications for the child's mother and other family members.
 * Diagnosis:**

To establish a diagnosis of FAS, by convention, the following minimal criteria are met: 1. Growth deficiency: Small height and/or weight before and after birth (below 10th percentile) 2. FAS facial features: There are three distinctive and diagnostically significant facial features known to result from prenatal alcohol exposure and distinguishes FAS from other disorders with partially overlapping characteristics. The three FAS facial features are:  ·  A smooth philtrum — The divot or groove between the nose and upper lip flattens with increased prenatal alcohol exposure.  ·  Thin vermilion — The upper lip thins with increased prenatal alcohol exposure.  ·  Small palpebral fissures — Eye width decreases with increased prenatal alcohol exposure. 3. Central nervous system damage — Central nervous system (CNS) damage is the primary feature of any FASD diagnosis. CNS damage can be assessed in three areas: structural, neurological, and functional impairments. //Structural// - Structural abnormalities of the brain are observable, physical damage to the brain or brain structures caused by prenatal alcohol exposure. Structural impairments may include microcephaly (small head size) //Neurological// - When structural impairments are not observable or do not exist, neurological impairments are assessed. In the context of FAS, neurological impairments are caused by prenatal alcohol exposure which causes general neurological damage to the central nervous system(CNS), the peripheral nervous system, or the autonomic nervous system. //Functional// - When structural or neurological impairments are not observed, all four diagnostic systems allow CNS damage due to prenatal alcohol exposure to be assessed in terms of functional impairments. Functional impairments are deficits, problems, delays, or abnormalities due to prenatal alcohol exposure in observable and measurable domains related to daily functioning. 4. Prenatal alcohol exposure — Confirmed or Unknown prenatal alcohol exposure These criteria are used for the following reasons: (1) FAS can be difficult to diagnose at and after birth; (2) FAS can easily be confounded with many other disorders; (3) there is no one clinical feature that is a giveaway for FAS; and (4) there is no laboratory test to aid in the diagnosis. Although doctors can't diagnose fetal alcohol syndrome before a baby is born, they can assess the health of mother and baby during pregnancy. If you report the timing and amount of alcohol consumption, your obstetrician or other health care provider can help determine the risk of fetal alcohol syndrome. Knowing that you had been drinking while pregnant, your child's doctor can look for signs and symptoms of this syndrome in your child's initial weeks, months and years of life. Doctors commonly rely on these manifestations, such as growth impairment, facial malformations and the presence of heart defects, to diagnose FAS. At times doctors use a variety of tests, including evaluations of IQ and language development, to help make a diagnosis. Doctors may refer children with possible fetal alcohol syndrome to a medical genetics specialist to rule out other disorders with similar signs and symptoms.

Most of the features found in FAS are variable. They may or may not be present in a given child. However, the most common and consistent features of FAS involve the growth, performance, intelligence, head and face, skeleton, and heart of the child. Additionally, the facial features seen with fetal alcohol syndrome may also occur in normal, healthy children. Distinguishing normal facial features from signs of fetal alcohol syndrome in children of varying ethnic backgrounds requires the expertise of a doctor. Signs of fetal alcohol syndrome may include: Children with FAE display the same symptoms, but to a lesser degree.
 * Characteristics:**
 * low birth weight
 * sleep and sucking disturbances in infancy
 * organ dysfunction
 * poor coordination/fine motor skills (weak grasp)
 * poor socialization skills, such as difficulty building and maintaining friendships and relating to groups
 * lack of imagination or curiosity
 * learning difficulties, including poor memory, inability to understand concepts such as time and money, poor language comprehension, poor problem-solving skills
 * poor reasoning and judgment skills
 * abnormal behavior such as a short attention span, hyperactivity, poor impulse control, extreme nervousness, social withdrawal, stubbornness and anxiety
 * distinctive facial features, including small eyes, flattened cheekbones, an exceptionally thin upper lip, a short, upturned nose and a smooth skin surface between the nose and upper lip
 * heart defects
 * deformities of joints, limbs and fingers
 * slow physical growth before and after birth
 * vision difficulties or hearing problems
 * small head circumference and brain size (microcephaly)



Problems associated with FAS tend to intensify as children move into adulthood. With time, FAS children tend to have eye, ear, and dental problems. Myopia (nearsightedness) may develop. Problems with the eustachian tube leading to the middle ear set the stage for ear infections. There is frequent malalignment and malocclusion of the teeth. Children with FAS have enough difficulty in life without the additional burden of not being able to see, hear, and eat normally. These deficits should be treated appropriately. a) Primary disabilities** The primary disabilities of FAS are the functional difficulties with which the child is born as a result of CNS damage due to prenatal alcohol exposure. Often, primary disabilities are mistaken as behavior problems . Functional difficulties may result from CNS damage in more than one domain, but common functional difficulties by domain include:  ·   Achievement — Learning disabilities  ·   Adaptive behavior — Poor impulse control, poor personal boundaries, poor angermanagement, stubbornness, intrusive behavior, too friendly with strangers, poor daily living skills, developmental delays  ·  Attention — Attention-Deficit/Hyperactivity Disorder (ADHD), poor attention or concentration, distractible  ·  Cognition — Mental retardation, confusion under pressure, poor abstract skills, difficulty distinguishing between fantasy and reality, slower cognitive processing  ·  Executive functioning — Poor judgment, Information-processing disorder, poor at perceiving patterns, poor cause and effect reasoning, inconsistent at linking words to actions, poor generalization ability  ·  Language — Expressive or receptive language disorders, grasp parts not whole concepts, lack understanding of metaphor, idioms, or sarcasm  ·  Memory — Poor short-term memory, inconsistent memory and knowledge base  ·  Motor skills — Poor handwriting, poor fine motor skills, poor gross motor skills, delayed motor skill development (e.g., riding a bicycle at appropriate age)  ·  Sensory integration and soft neurological problems — Sensory integration (SI) disorders, tactile defensiveness, under-sensitive to stimulation  ·  Social communication — Intrude into conversations, inability to read nonverbal or social cues, "chatty" but without substance The secondary disabilities of FAS are those that arise later in life secondary to CNS damage. These disabilities often emerge over time due to a mismatch between the primary disabilities and environmental expectations. Secondary disabilities can be treated with early interventions and appropriate supportive services.
 * Prognosis:** **
 * b) Secondary disabilities**

Six main secondary disabilities were identified:  ·  Mental health problems — Diagnosed with ADHD, Clinical Depression, or other mental illness, experienced by over 90% of the subjects  ·  Disrupted school experience — Suspended or expelled from school or dropped out of school, experienced by 60% of the subjects (age 12 and older)  ·  Trouble with the law — Charged or convicted with a crime, experienced by 60% of the subjects (age 12 and older) <span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol; mso-ansi-language: EN; mso-fareast-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-family: Symbol"> ·  Confinement — For inpatient psychiatric care, inpatient chemical dependency care, or incarcerated for a crime, experienced by about 50% of the subjects (age 12 and older) <span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol; mso-ansi-language: EN; mso-fareast-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-family: Symbol"> ·  Inappropriate sexual behavior — Sexual advances, sexual touching, or promiscuity, experienced by about 50% of the subjects (age 12 and older) <span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol; mso-ansi-language: EN; mso-fareast-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-family: Symbol"> ·  Alcohol and drug problems — Abuse or dependency, experienced by 35% of the subjects (age 12 and older) Two additional secondary disabilities exist for adult patients: <span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol; mso-ansi-language: EN; mso-fareast-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-family: Symbol"> ·  Dependent living — Group home, living with family or friends, or some sort of assisted living, experienced by 80% of the subjects (age 21 and older) <span style="FONT-SIZE: 10pt; FONT-FAMILY: Symbol; mso-ansi-language: EN; mso-fareast-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-family: Symbol"> ·  Problems with employment — Required ongoing job training or coaching, could not keep a job, unemployed, experienced by 80% of the subjects (age 21 and older) The ultimate cause is alcohol intake by the pregnant mother. When a pregnant woman drinks alcohol, so does her unborn baby. When you drink alcohol, it enters your bloodstream and reaches your developing fetus by crossing the placenta. Because a fetus metabolizes alcohol more slowly than an adult does, your developing baby's blood alcohol concentrations are higher than those in your body. The presence of alcohol can impair optimal nutrition for your baby's developing tissues and organs and can damage brain cells. The more you drink while pregnant, the greater the risk to your unborn baby. The risk is present at any time during pregnancy. However, impairment of facial features, the heart and other organs, bones, and the central nervous system may occur as a result of drinking alcohol during the first trimester, when these parts of the body are in key stages of development. In these early weeks of the first trimester, many women may not be aware that they're pregnant. Alcohol may affect the brain of the fetus at any time during pregnancy.
 * Causes:**

Alcohol itself may not be directly responsible for all (or any) of the features of FAS. What may be responsible are by-products generated when the body metabolizes ("burns") alcohol. The end result is a decrease in the number of brain cells (neurons), abnormal location of neurons (due to disturbance of their normal migration during fetal development), and gross malformation of the brain.

Two approaches can be taken to this important question. One is the scientific approach. It does not go beyond the facts that most children diagnosed with FAS have had overtly alcoholic mothers (who drank at least 8-10 drinks a day), that children born to women who had 4-6 drinks a day have had subtle signs of FAS/FAE, that at two drinks a day the only indisputable effect noted has been subtly lower birth weight, and that below two drinks a day there is no concrete evidence of an effect on the fetus. Thus, from a strictly scientific viewpoint, one cannot say that one drink a day during pregnancy is dangerous to the baby. The more common approach, and the favored one, is the better-safe-than-sorry approach. This position is endorsed by public health experts. Witness the warning label on all alcoholic beverages in the U.S. indicating that "according to the surgeon general, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects." This conservative approach is also followed by most individuals and groups concerned with preventing FAS/FAE. For example, the National Organization on Fetal Alcohol Syndrome states: "No amount of alcohol has been proven safe to consume during pregnancy. FAS and FAE...are 100% preventable when a pregnant woman abstains from alcohol."
 * How much alcohol is too much?**

No evidence exists that can determine exactly // how much // alcohol ingestion will produce birth defects. Individual women process alcohol differently. Other factors vary the results, too, such as the age of the mother, the timing and regularity of the alcohol ingestion, and whether the mother has eaten any food while drinking. Although full-blown FAS is the result of chronic alcohol use during pregnancy, FAE and ARND may occur with only occasional or binge drinking. Mothers who drink during the first trimester of pregnancy have kids with the most severe problems because that is when the brain is developing. The connections in the baby's brain don't get made properly when alcohol is present. Of course, in the early months, many women don't even know they're pregnant. It's important for women who are thinking about becoming pregnant to adopt healthy behaviors before they get pregnant. Women who abstain from alcohol in early pregnancy may feel comfortable drinking in the final months. But some of the most complex developmental stages in the brain occur in the second and third trimesters, a time when the nervous system can be greatly affected by alcohol. Even moderate alcohol intake, and especially periodic binge drinking, can seriously damage a developing nervous system.

Doctors haven't identified a safe level of alcohol that a pregnant woman can consume. But, experts do know that FAS is completely preventable if women don't consume alcohol during pregnanacy.
 * Prevention:**

These guidelines can help prevent fetal alcohol syndrome:
 * Stop drinking alcohol altogether if you're planning to become pregnant, as soon as you know you're pregnant or if you even think you might be pregnant. Your baby's brain, heart and blood vessels begin to develop in the early weeks of pregnancy.
 * Continue to avoid alcohol throughout your pregnancy. Fetal alcohol syndrome is completely preventable in children whose mothers don't drink during pregnancy.
 * Consider giving up alcohol during your childbearing years if you're sexually active and you're having unprotected sex. Many pregnancies are unplanned.
 * Get help first. If you have an alcohol problem, don't get pregnant until you get help.

If a woman is drinking during pregnancy, it is never too late for her to stop. The sooner a woman stops drinking, the better it will be for both her baby and herself.

Mothers are not the only ones who can prevent FASDs. The father’s role is also important in helping the mother abstain from drinking alcohol during pregnancy. He can encourage her to not drink alcohol by avoiding social situations that involve drinking and by not drinking alcohol himself. Significant others, family members, schools, health and social service organizations, and communities can also help prevent FASDs through education and intervention.

__Students Living With Fetal Alcohol Spectrum Disorder__
Now that we know what FASD is; what can we expect from students living with FASD? FASD is such a wide spectrum that you may have several students with FASD and each one will be unique and can range from needing lots of continued support to needing very little at all. Within this range there is a common thread of behavioural and learning patterns found at certain stages of development. These dysfunctions are caused by brain damage that has changed the structure, chemistry and functioning of the central nervous system. It is important to keep in mind that although there is a common thread not all individuals with FASD will exhibit all of the following characteristics.

In the early stages of a baby’s life dysfunctions are apparent in sensory and motor deficits. These babies may have difficulty adapting to sensory stimuli such as light, sound and touch. They may have problems with increased or decreased muscle tone, swallowing or sucking, rocking or other repetitive motions. They also may have difficulties with motor development such as poor balance, tremors and eye-hand coordination (Alberta Government, 2004).
 * Early Years:**

Once a child is beginning to engage in preschool activities there may be other delays that are present. Children may be slow to acquire language as well as may be delayed in walking, running and riding a tricycle. They may continue to have difficulty with motor skills as well as fine motor skills such as drawing, cutting and manipulating small objects. These toddlers can have trouble focussing more than the average toddler and may seem to be impulsive and inattentive. Learning colors and rhymes may be more of a challenge as well as adaptive skills such as dressing and brushing teeth. Toddlers living with FASD often have difficulty regulating their emotions (Alberta Government, 2004).
 * Preschool Years:**

Students with FASD may have difficulty learning the basic skills of reading and writing and learning their math facts. Once students reach middle years they experience persistent difficulties with more complex learning tasks. Adaptive skills and social emotional functioning tend to show the greatest decline as individuals with FASD age. As students enter the middle years not only are they faced with greater academic challenges but they are often forced to become more autonomic and are caught in many more complex social situations (British Columbia Government, 1996).
 * School Years:**



__Language__: Students with FASD may be very talkative and able to express themselves with little difficulty. The difference between their language and that of their peers normally lies in quality not quantity. Students with FASD often have non-complex, more superficial and literal language skills. It is often said that they, “talk better than they understand.” This can lead to difficult social situations as understanding metaphors, satire, parodies and catching and interpreting social cues can be quite challenging (Alberta Government, 2004).

__Memory:__ Students with FASD may have difficulty with short rote memory causing them to be unable to retrieve and follow a series of directions. Long term retrieval difficulties can occur as well and this can lead a student to know something one day, such as all their time tables, but be only able to recall half of them the next (British Columbia Government, 1996). This is sometimes seen as being lazy or not trying hard enough when in reality it is a memory deficiency and the student needs patience, understanding and encouragement, not blame. Source memory deficit can also occur and this can cause a student to confuse certain pieces of their memory. When a student is called upon to recall something specific often they will include it with another set of information that has nothing to do with the first (Alberta Government, 2004).

"People may not see FASD when they look at my son's face, but I see it. I see it in the way his eyes flash in anger when he is frustrated and I see it in the tears that pour down his face when he is trying so hard to understand his math problems. I see it in his blank stare when he shuts down after working so hard in school all day, a place that has labeled him as lazy and defiant, and I see it in his silly smile when he is being impulsive or inappropriately friendly with strangers." Kari Fletcher, Adoptive Mom to 2 children with FAS and advocate/trainer at MOFAS, the Minnesota Organization on Fetal Alcohol Syndrome FASlink Fetal Alcohol Disorders Society ([|http://www.faslink.org/)]

__Cognitive Functioning:__ Many students with FASD think concretely and literally and have difficulty with abstract ideas and reasoning. Linking more than one idea to another and grasping complex concepts can be difficult. These students can be gullible and led easily by others. Planning and organization on physical and conceptual levels is difficult and can complicate a student’s day (Alberta Government, 2004). A middle year’s student’s day is often dependant on retrieving materials from their locker. If their locker is unorganized they may have great difficulty transitioning from one class to another. This may be compounded if they have difficulty adapting to sounds as the hallways are often quite loud between class changes (British Columbia Government,1996). Students also have difficulty with the concept of time, although they may know how long a minute is they may not be able to grasp the actual time it takes for that minute to pass. Mathematics is an area where students have more difficulty because they have touble organizing their thoughts, understanding and processing symbols as well as problem solving (British Columbia Government, 1996).

__Behaviour Regulation:__ Students living with FASD may have mood swings, show volatile and angry behaviour or may shut down completely. Many of these students are diagnosed with having ADD or ADHD because of their difficulty focusing and shifting their focus from one task to another. It is important to be ware that the traditional medication prescribed for students with ADD or ADHD has varying affects on people with FASD. Some students with FASD have a tendency toward an obsessive repetitive action (Alberta Government, 2004).

__Physical__: Having difficulty with motor skills may continue throughout a student’s life and this may be as minor as having difficulty tying one’s shoe to as severe as having difficulty learning to chew and swallow one’s food. Sometimes these students have a very high pain threshold and may not realize they are as hurt as they are. These students many also have difficulty perceiving extreme temperatures. Individuals with FASD have a higher incidence of having difficulty with hearing, vision, heart problems, growth deficiency, neurological conditions such as seizure disorders and impaired bone and joint development (Manitoba Government, 2001).

__Social/Emotional:__ Students with FASD may have difficulties making and keeping friends. Many of their social/emotional difficulties have to do with a language difficulty where they may not be able to separate fact from fiction and may have difficulty grasping humour (Alberta Government, 2001). FASD children can often be overtly friendly and affectionate and very approachable by stragers. These students often feel more comfortable and get along better with students that are younger than them (Manitoba Government, 2001).

// Having FASD means that there are some things that are harder for me. I have a hard time remembering what people tell me. I hope you will understand and tell me again. Sometimes I can’t understand the words you are using. I hope you will be patient and try and use different words so that I can understand. Sometimes I have a hard time making friends. I try really hard because I like having friends. Sometimes I don’t always know what to say. Sometimes I have a hard time if the rules change because my brain gets stuck. I hope friends will understand and help me. Some days I feel really mad that I have FASD. Some days I just don’t know why I am having a bad day. Sometimes there are too many noises or I worry a lot about being good. So I only come to school for 3 days a week because it’s easier for me. I do my homework at home with my mom. // Excerpt from Alexis's Story Circle of Friends Fetal Alcohol Family Association of Manitoba Inc. Volume 7, Issue 3 Winter Edition January 2008

__Talents and Strengths:__ Students that are identified with FASD and have the proper supports and expectations placed upon them can grow to live fulfilled lives. These individuals, like all our students, have lots of wonderful talents and strengths. They are often positive, committed and persistent individuals in low stress situations. Students with FASD often enjoy repetitive work and succeed in structured situations. Their learning strengths may include, although are not limited to, exploring, doing, visual memories, good verbal fluency and a positive use of visual language techniques. They often have high energy levels enabling them to participate in many activities (British COlumbia Government, 1996). These students are often animal lovers and seem to have a special gift for caring for them. As friends they are usually kind, loyal and trustworthy and posses a strong sense of fairness. Although FASD students have many different interests many enjoy gardening, constructing and doing mechanical things for which they often have a knack. When children with FASD are surrounded by love and support they often have a strong sense of self, a good sense of humour, are spontaneous and curious and have a great sense of wonder. Imagination and creativity can be a great asset and talent for these students (Manitoba Government, 2001).


 * Secondary Disabilities:** FASD children are not born with secondary disabilities but these often develop over time when there is a mismatch between the individual and their environment. Some of these can improve over time as the environment around the individual improves. Some of these secondary disabilities are frustration, fatigue, anxiety, fearfulness, poor self concept, low self esteem, feelings of failure, drug and alcohol abuse, depression and difficulties with employment. These secondary disabilities can affect anyone with a mismatched environment; it is just that people living with FASD are more often mismatched with their environment (Manitoba Government, 2001).



“They feel that they are failing and it affects their self-esteem,” Kay says. “They get punished for things that they can’t help. So it builds up on them and creates additional problems outside the original disability.” October 18, 2007 : Volume 34 #21
 * Wawatay News Online **
 * Parents working to improve life of children with FASD **
 * http://www.wawataynews.ca/node/12245 **

Some FASD students have been removed from thier families and are in foster or adoptive care. Others are still with their birth families. In some cases alcohol is still a major factor in these students lives. The students who live in an alcohol saturated environment may be subject to abuse and neglect. These are also always factors that are going to affect a child and their ability to learn. Please always put the safety of that child first (Manitoba Government, 2001).

Connection to Learning

 * //Strategies for the Classroom Environment and the Development of Educational Plans//

Identifying and understanding Individual Needs and Strengths:**

In order to successfully assess and plan for a child with FASD, a multitude of people must be involved to acquire a clear picture of the child's needs, both academically and developmentally.

"Speech-language pathologists, occupational therapists and psychologists can suggest developmental experiences that may have substantial impact during the first six years of life when the brain experiences significant growth. These consultants can continue to assess and provide valuable suggestions to address the unique learning patterns, strengths and needs of students throughout their life spans" (Alberta Government, 2004).

Teachers should begin with a classroom observation of the child. At the same time, discussions with the parents on any behaviors they notice at home as well as potential causes of those behaviors need to be looked at. In order to start an instructional plan for a child with FASD, developmental level needs to be established. The developmental age will help to set appropriate expectations and identify what level of support is needed.

“Successful instruction is dependent on thoughtfully matching strategies with students’ needs, trying out strategies in more than one context, observing and assessing how students respond, and using this new understanding to adapt instruction” (Alberta Government, 2004).

__**Children with FASD and the Classroom**__

Organizing for Instruction:

· Structure the physical learning environment: Many students with neurological disabilities react to their learning environments in a variety of ways. They can become distracted by bright lights, loud noises, and a number of different activities. This results in a number of reactions like talking to themselves or hiding under desks (Manitoba Government, 2001).
 * Create a calm and quite environment. Students that are affected by alcohol learn better with natural light and they get startled easily by loud noises. To prepare a child affected by FASD for school establish routines with them to ensure things as simple as music or the occurence of a fire alarm does not distract or disturb them, leading to problematic behaviors.
 * Organize the space and furniture for flexibility. Room dividers are an easy addition to the classroom as they can help students with FASD get less distracted by the other students and activities.
 * Organize personal workspaces to develop independent work habits. Notebooks and supplies can be organized by colors and labels and stored in easy to access containers.
 * Ensure lockers are easy to access.
 * Establish Routines. Routines can help a student who has been alcohol affected, they provide stability for the student especially when activities change and transitions occur.

Important Concepts to Consider while Planning and Teaching:

-Teach time concepts: Many students with FASD have a difficult time using and practicing different time concepts. They may be able to tell time but they might not understand how long a minute really is. This could affect their understanding of class time and transitions into other subjects (Alberta Government, 2004).
 * Create concrete ways to teach concepts on time. This could be done by creating a class schedule with the student. This 6 day chart could include the times of each class, their room number, and the breaks the student receives.
 * Teach time management skills. Teachers could practice time management skills with the whole class by doing a timed activity. A student with FASD may also learn time management skills by doing things as simple as dressing for recess under a time limit.

-Build Skills for participation in whole class instruction: Children with FASD are not that different from other students, they all want to participate in group work with their classmates. However, because of cognitive and behavioral difficulties they lack skills for participating in groups. They also may be over stimulated by group activity (Alberta Government, 2004).
 * Use instructional techniques that increase students’ capacity to focus and attend. Give a type of warning when a time limit is up or the activity is going to change. Warnings will also work to help with transitions. For example, "There is five minutes left to do this math problem, and then we are all moving on."
 * Use planning and pacing to increase students’ capacity to attend to and follow oral instruction. Start out by using visual as well as oral instructions. Slowly move forward to oral, however be careful to speak at a slow clear pace. Students could be paired up with one another; one could listen and write down instruction just in case the other did not get everything. They could switch for the next time. Pairing a child with FASD up with another student would be a simple and easy way to introduce group work.
 * Allow movement and nontraditional approaches to eye contact during listening activities. If a student with FASD is having difficulty keeping eye contact while listening, the teacher may have them play with something in their hands to release tension, improving their capacity to learn.
 * Structure student groupings. Observe which children work well in pairs and form groups accordingly.

-Teach social and adaptive skills: Assess social and adaptive skills on an ongoing basis. Constantly be in contact with parents on changes in behavior (Alberta Government, 2004).
 * Teach skills students need in daily life. These skills could be as simple as safety when crossing a busy intersection or simple money management.
 * Create a supportive learning environment to develop social skills. Set guidelines for class that ensures a safe and respectable classroom environment for all who enter the class.
 * Use role playing and practice in context.
 * Use social stories to teach social understanding.
 * Teach bully proofing skills.
 * Provide appropriate health and sexuality education.

-Plan for non-classroom settings.
 * Prepare children for activities out of the classroom such as recess, lunch, gym and music. Practice routines and help students to expect that other places around the school are not going to be the same.
 * Put a child with FASD with a buddy that can be there for them in different situations.
 * Provide limited choices.
 * Provide routines for non-classroom activities, such as what a child with FASD will do at lunch and on the bus. This can include buying lunch from the cafeteria, where to throw things out, where to sit etc.

-Plan for transitions.


 * Students with FASD will often have difficulty transitioning from one thing to the next. It is important to practice routines, give limited choices and organize their day with them.
 * Help students identify, compile, think about and share relevant information with receiving teachers, such as:
 * 1) What they like, their strengths and their difficulties
 * 2) Aspects of their lives that are important to them, e.g., share pictures of families or pets, the subjects or times of the day they find most difficult
 * 3) The subjects or times of the day they do best in
 * 4) Friends or individuals with whom they identify (Manitoba Government, 2001).

__**Creating a Positive Classroom Climate**__


 * Consider the neurological basis of behaviors. Children suffering from FASD will often have difficult behaviors because of memory problems, difficulties with problem solving, and instances of becoming overwhelmed and stimulated. Knowing the different behaviors a child with FASD might struggle with is vital to understanding the **//cause and effect//** of their actions. Consequences need to be consistent and immediate. Examples of common behavior are: lying and stealing. Teachers need to educate students on personal space, reminding them of what supplies or belongings are theirs. Present classroom rules verbally and through signs around the class. Remind students what is real and not real, children with FASD will sometimes have difficulty distinguishing what is fiction and what is true (Alberta Government, 2004).
 * Manage the environment to avoid behavior problems. Practice routines and transitions. Structure classroom to fit active behaviors. This will aid in the planning of lessons and other activities. Establish clear rules with the use of visuals whenever possible to enhance communication (Alberta Government, 2004).
 * Use language and nonverbal communication that students understand. Verbal directions as well as visual.
 * Focus on building positive relationships. Have students be aware of the classroom code of conduct, what behavior is and is not accepted to each other and to the rest of the school. Provide as much choice as possible, invite student interaction in learning, planning and activities (Alberta Government, 2004).
 * Modify students’ challenging and their negative behaviors. Involve as many people as possible, other teachers and parents to convey positive classroom behavior and values. Teach other supports as well as the routines and rules the child is aware of to have consistency as well as easier transitions (Alberta Government, 2004).

There is no “typical” student who is alcohol-affected. Each has a unique set of strengths and individual needs. It is not possible to predict what type of neurological damage a student has. Thus, no one recipe will work for every student. Educators who are working effectively with students who are alcohol-affected use a variety of strategies and approaches. They recognize the need to understand how students learn, what strengths they possess, and what strategies and supports are required to address their areas of need.(Manitoba Government, 2001) Develop an Individual Behavior Plan(Manitoba Government, 2001) It is important to be aware of the difficulties children with FASD have. In order to write a successful IPP (individual program plan), it is important to know and have examples of how to deal with each effect. Students with FASD can have difficulties in a wide range of areas of functioning. Many of these difficulties are linked to prenatal alcohol exposure. The **//eight domains//** are important when considering how a child with FASD will learn and what will affect their IPP. (Alberta Government, 2004) • Sensory processing: difficulty with processing and organizing information. Manage environment by taking out bright lights and unneeded noises. • Motor skills: difficulty learning to write and using hands to manipulate objects. Computer usage. • Behavioral regulation: Cannot always control one’s emotions. Establish and practice routines. • Adaptive behaviors and social skills: Has difficulty interacting with classmates. Establish classroom conduct code. • Attention: Has difficulty paying attention for long periods. Provide area with no distractions, headphones and a study carrel might be a good option. • Memory: Has difficulty remembering certain things. Use instructional techniques that enhance memory. Have the student make individual schedule. Routines could be a good way to improve memory of subjects and class times. • Language and communication: In order to improve on language, visual cues should be integrated in combination with oral. Use concrete language and pictures. • Academic skills: Might be at different developmental level than their classmates. Adjust academic skills to match developmental age. Adapt class curriculum to meet level. Students should be learning the same things as the other students, but modified to fit their needs and strengths.
 * 1) Establish a planning team
 * 2) Identify the issues and behaviors that need to be addressed
 * 3) Collect existing information
 * 4) Collect data on the identified behavior
 * 5) Conduct additional assessments
 * 6) Develop a hypothesis
 * 7) Develop an intervention plan to address the behavior
 * 8) Monitor and evaluate the intervention plan

__**The Learning Climate**__ According to the Manitoba document __Planning for Students who are Affected by Alcohol__, the learning environment includes all of the factors that can affect the learning in the classroom (e.g., method of presentation, involvement of students, materials, and resources). The examples below illustrate how the learning environment can be adjusted for the student who is alcohol-affected (Manitoba Government, 2001). • Lessons for the alcohol-affected student need to consider learning styles. Students require activities that are concrete, hands-on, and visual. • Children who are alcohol-affected need to be carefully prepared for all transitions. This can be accomplished by pre-teaching, reviewing routines, and using social stories and visual cues. • Teachers need to develop and teach routines for as many classroom activities as possible (e.g., completing assignments, entering the room, asking for assistance). • Teachers should use a variety of techniques to involve the alcohol-affected child in the classroom activities (e.g., student buddies, student helpers).

Children who are affected by alcohol can be taught in an inclusionary classroom with other general education students. Teachers need to take into consideration a wide variety of contributing factors to the development of educational plans and programs. It takes a comprehensive assessment of development and behavior to truly give a honest picture of what the student's strengths and challenges are. Observation by educators, parents and other support staff will aid in the development of their learning.

= Services for Children with FASD = = = Children’s Treatment ** Child and Adolescent Mental Health Centre PsycHealth Centre, Health Sciences Centre 771 Bannatyne Avenue Winnipeg, MB R3E 3N4 Phone: (204) 787-3873 Fax: (204) 787-4975 Child and Adolescent Mental Health Program St. Boniface General Hospital 409 Tache Avenue Winnipeg, MB R2H 2A6 Phone: (204) 237-2690 Fax: (204) 233-8051 Child Development Clinic Children’s Hospital of Winnipeg CK253-840 Sherbrook Street Winnipeg, MB R3A 1S1 Phone: (204) 787-2424 Fax: (204) 787-1138 Clinical Health Psychology PsycHealth Centre, Health Sciences Centre 771 Bannatyne Avenue Winnipeg, MB R3E 3N4 Phone: (204) 787-7469 Fax: (204) 787-4975 Clinical Services for Children and Youth- Community Services Program Manitoba Adolescent Treatment Centre 228 Maryland Street Winnipeg, MB R3G 1L6 Phone: (204) 958-9600 Fax: (204) 958-9618 Mental Health Services at the local Regional Health Authority Office (outside urban centres) Regional Support Services Phone: (204) 786-7255 Clinic for Alcohol and Drug Exposed Children Children’s Hospital of Winnipeg CK253-840 Sherbrook Street Winnipeg, MB R3A 1S1 Phone: (204) 787-1828 Fax: (204) 787-1138 Fetal Alcohol Support Team FAS Tele-Diagnostic Clinic Thompson General Hospital 871 Thompson Drive South Thompson, MB R8N 0C8 Phone: (204) 677-5314 Fax: (204) 677-5339 Fetal Alcohol Family Association of Manitoba, Inc.  210-500 Portage Avenue Winnipeg, MB R3C 3X1 Phone: (204) 786-1847 Fax: (204) 789-9850 New Directions for Children, Youth and Families — Support Group for Parents 400-491 Portage Avenue Winnipeg. MB R3B 2E4 Phone: (204) 786-7051 ext. 303 Fax: (204) 772-7069 FAS/FAE Resource and Information Centre Addictions Foundation of Manitoba 1031 Portage Avenue Winnipeg, MB R3G 0R8 Phone: (204) 944-6361 Fax: (204) 772-0225 William Potoroka Memorial Library Addictions Foundation of Manitoba 1031 Portage Avenue Winnipeg, MB R3G 0R8 Phone: (204) 944-6277 Fax: (204) 772-0225 Association for Community Living — Manitoba 210-500 Portage Avenue Winnipeg, MB R3C 3X1 Phone: (204) 786-1607 Fax: (204) 789-9850 CAPC/CPNP Regional Programs 420-391 York Avenue Winnipeg, MB R3C 0P4 Phone: (204) 983-7690 Fax: (204) 983-8674 Canada Prenatal Nutrition Program Health Canada — Manitoba Region 300-391 York Avenue Winnipeg, MB R3C 4W1 Phone: (204) 983-3637 Fax: (204) 984-7458 Canadian Centre on Substance Abuse FAS/FAE Information Service 1-800 559-4514 www.ccsa.ca/fasgen.htm Coalition on Alcohol and Pregnancy 210-500 Portage Avenue Winnipeg, MB R3C 3X1 Phone: (204) 786-1607 Fax: (204) 789-9850 Publishers of //FAS News// Healthy Child Manitoba 219-114 Garry Street Winnipeg, MB R3C 4B6 Phone: (204) 945-2266 Fax: (204) 948-2585 Manitoba Child Care Association 364 McGregor Street Winnipeg, MB R2W 4X3 Phone: (204) 586-8587 or 1-888-323-4676 Fax: (204) 589-5613 Children’s Special Services Directorate 219-114 Garry Street Winnipeg, MB R3C 4V6 Phone: (204) 945-5898 Fax: (204) 948-4656 FAS/FAE Outreach Team Unit 3-139 Tuxedo Avenue Winnipeg, MB R3N 0H6 Phone: (204) 945-8137 Fax: (204) 948-1735 FAS/FAE Prevention Program Aboriginal Health and Wellness Centre of Winnipeg, Inc.  215-181 Higgins Avenue Winnipeg, MB R3B 3G1 Phone: (204) 925-3700 Fax: (204) 925-3709 Interagency FAS/FAE Program 49-476 King Street Winnipeg, MB R2W 3Z5 Phone: (204) 582-8658 Fax: (204) 586-1874 Macdonald Youth Services 175 Mayfair Avenue Winnipeg, MB R3L 0A1 Phone: (204) 477-1722 Fax: (204) 284-4431 Nor’West Mentor Program 103-61 Tyndall Avenue Winnipeg, MB R2X 2T1 Phone: (204) 632-8162 Fax: (204) 632-4666 Oski-Keesekow Project P.O. Box 250 Norway House, MB R0B 1B0 Phone: (204) 359-6968 Fax: (204) 359-6011 Rehabilitation Centre for Children 633 Wellington Crescent Winnipeg, MB R3A 1M5 Phone: (204) 452-4311 Fax: (204) 477-5547 St. Amant Centre Inc. 440 River Road Winnipeg, MB R2M 3Z9 Phone: (204) 256-4301 Fax: (204) 257-4349 Society for Manitobans with Disabilities, Inc. 825 Sherbrook Street Winnipeg, MB R3A 1M5 Phone: (204) 975-3010 Fax: (204) 975-3073
 * Diagnosis **
 * Family Support **
 * Information **
 * Organizations **
 * Outreach and Support Services **

Online Resources: [|Fetal Alcohol Spectrum Disorder] [|FAS World] [|Fetal Alcohol Association of Manitoba] [|Healthy Child Manitoba] [|Addictions Foundations of Manitoba] [|Planning for Students who are Alcohol-Affected] [|Teaching Students with Fetal Alcohol Syndrome] [|FASlink Fetal Alcohol Disorders Society Research, Information, Support & Communications]