Typically, the thin build of children with FASD begins to change during adolescence. Girls tend to become obese. After puberty, the facial features of FASD are more difficult to recognize.

• Teenagers with FASD may display problem behaviors such as lying and stealing. They may have poor judgment. They may have difficulty with peer relationships. Alcohol and drug abuse are common. There is also a greater risk for depression and suicide.
• Teenagers with FASD usually look like typical adolescents. However, their developmental level may only be that of a six year old. Extra guidance and protection may be needed.

In guiding adolescents with FASD, stress the following:

• Structure - create a structured environment which includes limited choices. Have clear and set routines. Adjust the environment for slower development and understanding.
• Supervision - carefully supervise adolescents so they do not place themselves in dangerous situations.
• Simplicity - state instructions briefly and clearly. Use simple directions and orders.
• Steps - break tasks down into small steps. Teach each step through repetition. Lists may be helpful. Use rewards as incentives.
• Setting - teach desired skills in the way in which they will be used. Adolescents with FASD may not have the ability to transfer skills from one setting to another.

Continue regular health care as discussed in the Periodic Health Care section of this booklet. Routine health visits should address both the medical and psychosocial aspects of health. Adolescence is a time of significant change in development and behavior. There may be new needs which relate to special issues of this age. Concerns include screening for health risk behaviors and promoting optimal growth and development and activities of daily living (ADLs) skills. Special needs related to FASD also need consideration. The following may be included:

• A discussion of health prevention topics such as:

• Use of tobacco products and use and abuse of alcohol or other drugs
• Severe or recurrent depression and suicide attempts
• Physical, sexual and emotional abuse
• High blood pressure
• High cholesterol
• Infectious diseases
• Learning problems

• A discussion of health promotion topics such as:

• Adjustment to puberty and adolescence
• Healthy eating habits, proper nutrition and prevention of eating disorders or obesity
• Safety and injury prevention
• Physical fitness
• parent’s ability to respond to health needs of their adolescent

• A discussion of mental health issues such as:

• Anger and violence management
• Ruling out other diagnoses such as personality disorders and depression
• Self-esteem
• Emotional abuse

• A discussion of sexual health topics such as:

• Birth control
• Victimizing others and becoming victims
• Sexually transmitted diseases (STDs)
• Inappropriate sexual behavior

• Health services should meet the needs of the individual teenager. Information shared with health providers is personal and confidential.
• Health care for teenagers with FASD may be difficult for health providers and professionals. They need to be aware that teenagers with FASD may not be able to provide accurate information. Due to memory gaps, they may be unable to report symptoms or take medication.
• Exercise is important for all teenagers. Exercise helps increase and maintain muscle strength. Exercise also builds stamina. Releasing energy through activity may help a teen focus on learning. Find activities, sports or exercise which fit your teen’s physical abilities. Discuss any concerns with your health provider or professional.

• Teenagers understand factual information about FASD. Give them specific information about their condition. The information can be more detailed than for younger children. Encourage your teen to read about FASD.
• Teenagers may need encouragement to ask questions. Remind them that concerns can be discussed with parents, health providers and professionals.
• Allow your teenager increasing control over when to take medication or do other treatments. Encourage him or her to be responsible for remembering these things. Mastering self-care skills gives all teens a feeling of control and accomplishment. It may still be necessary to remind a teen to take his or her medication. Many teens with FASD are not be able to manage their medication or treatments.
• Provide opportunities for your teenager to be faced with opinions, values and beliefs which differ from his or her own. Peers are of increasing importance to teens. Teenagers with high self-esteem can better resist peer pressure. They will also be less concerned about being different from their friends.

• Some teenagers may be vulnerable to pressure to be sexually active or to use alcohol and drugs. They may seek acceptance from their peers through these activities. Parents can help prevent these behaviors by discussing concerns with their teen. Ask a health professional for ideas on how to deal with specific problems and promote self-esteem.
• Independence is necessary for teenagers to develop responsible behavior. They will need encouragement to increase their independence and make the transition to adult life.
• It is important to remember that teenagers will not outgrow the effects of FASD. It lasts a lifetime. Regardless of age, mental and emotional functioning may be much lower. Teens may continue to require supervision to keep out of trouble or dangerous situations.

• Limit activities which cause overstimulation. Activities such as pillow fighting, wrestling, television, video games or rock music may overstimulate. Alternate activities requiring attention with those requiring physical exercise. Quiet and focused activities such as painting or drawing may help teenagers slow down.
• Have a place where your teenager can go when overstimulated or overwhelmed. It should be a comfortable and calm area. It should not be treated as a punishment.
• Teach self-calming techniques. Soft music can be calming and may help to develop listening skills. If one technique is not working, try something different.

• Set both expectations and limitations. Consistent direction and discipline are important for a teenager who has trouble learning and remembering rules. Your teen may not learn from past mistakes. Mistakes may be repeated over and over again. Consistency helps all teens develop self-control.
• Develop a system of rewards and discipline. Try to use the same system for all your children. Children may notice if one child receives special privileges.
• Discipline should be immediate. Do not delay. Your teenager may have trouble connecting cause and effect. This means there may be difficulty in seeing a connection between the behavior and the punishment. Discipline should be viewed as an opportunity to teach appropriate behavior. A reward system may work best. Sometimes praise and hugs can be just as effective. Change rewards often to keep interest high. To avoid frustration, make sure there are more successes than failures.
• Do not debate rules. Be brief. Avoid lecturing and threats. Review and repeat consequences of negative behavior. Take time to teach and encourage positive behavior.
• Avoid statements which place a value on behavior. For example, do not say "that is a bad word." Say "you may not use that word." Offer a different word which is acceptable.
• Teenagers with FASD may copy behavior they have experienced or observed. For this reason, never use physical punishments. Avoid all forms of violence. Monitor television, movies and radio programs.

• Establish a few simple rules. Write them down or use picture cues. Use the same language repetitively. Avoid using words with more than one meaning. Be specific when telling your teenager what to do. Repeat directions as needed.
• Speak slowly. Pause between sentences to allow time for understanding.
• Daily routine is very important. Daily routine helps your teenager predict coming events. Before bedtime, prepare for the next day. For example, lay out clothing and shoes.
• Clearly define your teenager’s space. Teens with FASD may benefit from a comfortable area they can call their own. Avoid clutter and distractions.

• Encourage your teenager to assume responsibility and complete tasks. Allow increased opportunities for decision-making. Teach your teen to ask for help. Provide guidance when needed.
• Give your teenager only as much freedom as can be handled successfully.
• Focus on daily living and survival skills. Daily "to do" lists may be helpful. Set realistic expectations.

• Identify a sport or social activity at which your teenager can be successful.
• Help your teenager feel valued. Give responsibilities which can be managed successfully.
• Allow your teenager increasing control over when to take medication. Mastering self-care gives all teens a feeling of control and accomplishment. Keep in mind that this task may not be possible for some teens with FASD.
• All teenagers are better able to manage life if they feel good about themselves. Praise your teen often to build self-esteem. Praise accomplishments. Reward rather than punish. Offer support, not criticism. Praise the behavior rather than the teen. For example, say "good work" rather than "good boy" or "girl". Separate your teen from the behavior. Do not make your teen feel as if he or she is a bad person. Encourage positive self-talk.
• Teenagers with FASD may need to be reminded that you like them. Notice good qualities and behaviors. Thank them for their efforts.
• Provide your teenager with opportunities to meet others with the same disability. Often this helps with self-esteem and acceptance.
• Notice what is right in a situation and offer encouragement regularly.

• Teenagers with FASD may have problems with impulsive behavior. They may not have internal controls on their behavior. They may be uninhibited and lack good judgement. Remove temptations through close supervision. Try to anticipate situations when your teen may act impulsively. This may avoid or lessen problems.
• The need for instant gratification and poor judgement may contribute to sexual behavior. A lack of understanding between actions and consequences may lead to inappropriate sexual activity. Teach teenagers specific rules about when and where sexuality is appropriate. Teach them how to say no to peer pressure. Offer alternatives. Ask them to tell you if they are feeling pressured or uncomfortable. Practice planning how to react in stressful situations.
• Your teenager may be exposed to manipulation or criminal behavior. Close supervision can protect your teen from harm from others. Close supervision may also be needed to protect from pregnancy, HIV or other sexually transmitted diseases (STDs).
• Avoid asking yes or no questions. Encourage sharing of feelings and concerns. Thank them for being honest.
• Teach social skills. Teenagers with FASD may need help learning how to give and accept compliments. They may need to learn how to start a conversation or how to ask for things. Practicing how and what to say in different situations may help them remember longer. Also help your teenager learn how others express themselves nonverbally.
• Recognize positive behaviors as achievements. Reward successful efforts.

• At the beginning of each school year, meet with your teenager’s school nurse and teachers. Inform them of your teen’s development and any special needs related to FASD. Keep them informed of changes throughout the year. See the Family Support and Services section of this booklet for more information.
• If your teenager has asthma or allergies, ask about pets and plants in the classroom.
• Make sure the school has instructions from your health provider about use of medication if needed. The school nurse will need a pharmacy label on all medications given at school. Contact your child’s school for policies on medication given at school.
• Encourage your teenager to be involved in activities appropriate for his or her abilities.
• An Individual Education Plan (IEP) will be developed if your teenager has special education needs.
• Medical appointments may conflict with family and school schedules. Decide on priorities and then arrange appointments. Try to arrange appointments during slow times at school.
• If your teenager is absent from school, request that schoolwork be sent home. If schoolwork causes too much conflict at home, work with teachers to develop alternatives.
• If possible, get to know your teachers and let them know you. If you have time, volunteer. Develop relationships with school staff. This helps to promote sharing of information and understanding of the child’s needs.
• Try to take another parent or friend with you to important school meetings. Their support may be helpful.
• Career counseling is available to teenagers during high school. Career options should be realistic and relate to the skills of the individual. Many individuals with FASD may not be able to maintain a job or live independently. Contact the school counselor for more information.

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