School-age children with FASD may continue to grow slowly. They may appear thin and malnourished even though the diet is adequate. Their slow growing head size is related to slow brain growth and development.

The elementary school years mark the time when additional problems may begin to show. Children with FASD may have difficulty "fitting in" and making friends. They may want to play with younger children or adults. It is important to teach your child social skills. Skills must be taught early and repetitively to become habits.

Children with FASD may not be able to learn from experience. They may also have difficulty following rules. Rules may be known, but cannot be applied. They may lack understanding of action and consequence.

The complex school environment can be especially challenging. Children may feel overwhelmed which can result in problems with learning. Anger, frustration, temper tantrums and refusals can be signs your child is having difficulty. Listen to your child’s complaints. The school environment may need to be modified to suit special needs. It is important to work closely with the school to assure that your child’s needs are being met. PACER Center can help parents work with schools. See the General Resources section of this booklet for more information.

Due to problems with short-term memory, skills must be taught over and over again. This can be frustrating for parents and teachers. However, repetition and practice help in learning.

Continue regular health care as discussed in the Periodic Health Care section of this booklet. Concerns for this age group include 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:

• Height and weight need to be obtained and graphed. Children with FASD tend to grow slower than other children. They may not catch up later.
• A nutritious and balanced diet is important. A nutritional assessment may be done.
• Exercise is important for all children. Exercise helps increase and maintain muscle strength. Exercise also builds stamina. Releasing energy through activity may help a child focus on learning. Find activities, sports or exercise which fit your child’s physical abilities. Discuss any concerns with your health provider or professional.

• Provide your child with specific information about FASD and related conditions. Encourage questions. Remind him or her that concerns can be discussed with parents, health providers and other professionals.
• Provide your child with opportunities to:

• Play with other children the same age. However, some children with FASD are more comfortable playing with children one to two years younger
• Learn to start and complete activities during play
• Play outdoors in a safe area
• Succeed and gain self-confidence
• Maintain a balance between structured activities and free time

• Offer assistance or aids to help your child overcome difficulties which may hinder progress. For example, a computer may help a child who has difficulty writing.
• Difficulty making and keeping friendships may continue. This can result in an increased dependency on caregivers.
• Parents may need a break from caregiving. Try to arrange respite care. Family and friends may be of assistance. Respite care may also be obtained through county services or parent organizations for children with disabilities. Sometimes trained volunteers can provide babysitting for a few hours or days. See the Resources and General Resources sections of this booklet for more information.
• Children with FASD may have difficulty with abstract concepts such as time, money and math. They may not be able to tell time even by the age of 12. Problems understanding the concept of time may continue after mastering the skill. The value of money is also a difficult concept to grasp. Your child may not associate value to items. For example, $5.00 for a piece of candy or for a television may seem acceptable. Monitor your child’s money. Limit access to money when you cannot directly supervise its use. Give your child money only in small amounts. Do not expect understanding of equal values such as four quarters being the same as a dollar.
• Teach your child about ownership. A child with FASD will often take something which catches his or her eye. The concept of stealing may not be understood. Teach your child to ask before taking anything which does not belong to him or her.
• Teach your child visual and verbal gestures to help understand directions. Limit directions to 5-10 seconds. Use eye contact. Direct one task at a time. Avoid using words with more than one meaning. Be specific when telling your child what to do. Repeat directions as needed.

• 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 children slow down.
• Have a place where your child 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 also 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 child who has trouble learning and remembering rules. Your child may not learn from past mistakes. Mistakes may be repeated over and over again. Consistency helps all children 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 child 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.
• Children 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 child 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 child predict coming events. Before bedtime, prepare for the next day. For example, lay out clothing and shoes.
• Clearly define your child’s space. Children with FASD may benefit from a comfortable area they can call their own. Avoid clutter and distractions.

• Encourage your child to assume responsibility and complete tasks. Allow increased opportunities for decision-making. Teach your child to ask for help. Provide guidance when needed.
• Give your child 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 child can be successful.
• Help your child feel valued. Give responsibilities which can be managed successfully.
• Allow your child increasing control over when to take medication. Mastering self-care gives all children a feeling of control and accomplishment. Keep in mind that this task may not be possible for some children with FASD.
• All children are better able to manage life if they feel good about themselves. Praise your child often to build self-esteem. Praise accomplishments. Reward rather than punish. Offer support, not criticism. Praise the behavior rather than the child. For example, say "good work" rather than "good boy" or "girl". Separate your child from the behavior. Do not make your child feel as if he or she is a bad person. Encourage positive self-talk.
• Children with FASD may need to be reminded that you like them. Notice good qualities and behaviors. Thank them for their efforts.
• Provide your child with opportunities to meet others with the same disability. Often this helps with self-esteem and acceptance.

• Behavior may be changed by redirecting activities. Try to engage your child into positive play. Learn how to read and respond to emotional cues. This may help avoid behavior problems.
• If anger is a problem, discuss and practice acceptable ways of noticing and dealing with feelings. Provide a way and place to express anger in a physical way such as kicking a ball. During tantrums, make sure children are in a safe place where they cannot hurt themselves or others.
• Protect your child from viewing or participating in violence. Remember he or she may not be able to differ fact from fiction.
• Limit choices. Frustration results from difficulty in choosing between a variety of options.
• Learn to recognize signs that a problem is about to begin. Negative events may then be avoided.

• At the beginning of each school year, meet with your child’s teacher and school nurse. Inform them of your child’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 a list of topics to discuss with school staff.
• If your child 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 child to be involved in activities appropriate for his or her abilities.
• An Individual Education Plan (IEP) will be developed if your child 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 child 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 your child’s needs.
• Try to take another parent or friend along with you to important school meetings. Their support may be helpful.

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