Ideas to help FASE individuals

Ideas to Help FASD Individuals

Notes On The Organicity of FASD
and Secondary Symptoms Which May Develop Over Time:

"The one thing we can say about FASD is that no two are the same." (Randels) Because of the wide variability of the nature of the impairment, degree of effect, their manifestation and presence of confounding variables (secondary symptoms) there is no "cookbook" approach to working with individuals who are effected.

Here are some easy ways to change your thinking to help you understand the inner world of living with Fetal Alcohol Effects or Syndrome. A shift in how to understand children with FASD may be helpful. This shift includes moving:

From seeing a child as:	To understanding a child as:
won’t	can’t
bad	frustrated
lazy	tries hard
defended	challenged
lies	fills in
doesn’t try	exhausted or can’t start
mean defensive	hurt, abused
doesn’t care	cannot show feelings
refuses to sit still	Overstimulated
fussy, demanding	Oversensitive
resisting	doesn’t "get it"
trying to make me mad	can’t remember
trying to get attention	needing contact, support
acting younger	being younger
Thief	doesn’t understand ownership
doesn’t try	tired of always failing
doesn’t get the obvious	needs many reteachings

D. Malbin (1994)

The following are a few general indicators of organicity and how they may present themselves. They are organized loosely around the theoretical construct presented by Dr. Barbara Morse and Northland ARC training program.

MEMORY DEFICITS:

Difficulty translating from one modality to another
(hearing into action, talking into action, words onto emotions)

Slow cognitive pace:
Time lag from input to understanding to action (trouble with seeing a movie, taking notes)

Random reinforcement:
Spotty learning, retention (need constant reminders, reteaching)

Unable to recall specific memory when necessary, instead they lie to come up with an answer. To an adult the lie appears diliberate where the person with FASD is just trying to please by coming up with this answer regardless of the truth.

Inconsistent memory:
Their own memory is unreliable for them.
("Aware that they're not doing something right, but can't figure out what it is" Morse)
Learn on Monday, forget on Wednesday

Auditory processing problems

Vision processing problems

Poor short term memory

ABSTRACTIONS IN GENERAL ARE DIFFICULT:

Math, arithmetic - in the beginning math is visible and concrete, once you move to multiplication, division and fractions it begins to be abstract. When doing fractions you must be able to visualize in your mind, rather than actually seeing and touching while adding 2/3 + 6/9

Money - difficult to understand what money means to people and what it represents. To them, taking $100 from a person is the same as taking a penny. They don't understand the difference in purchasing power and therefore don't understand why the rightful owner would feel and act differently.

Time - FASD individuals have not internal clock, this is not able being able to tell time, but being able to feel time, understand and internalize time.

Predicting - is an abstract thought which develops early in most people. Most people can figure out what will happen next. The brain damage caused by prenatal alcohol exposure can make predicting (cause and effect) very difficult. The ability to predict is one of the things that keeps us away from harm and also keeps us out of trouble. Without the capacity to predict people put themselves into dangerous and sometimes unlawful situations. They may live high risk lives because they do not have the vision to see what may happen next.

Learn facts as isolated entities, may have difficulty mastering new skills and integrating these with earlier learning

Role play real life situations over and over to understand cause and possible effects

EXPRESSIVE LANGUAGE IS BETTER THAN RECEPTIVE LANGUAGE:

May have trouble retrieving accurate words from memory

Rely on 'off the wall' comments to attempt to communicate.

Recommend:

Observe patterns, re-frame perception of problem.

Depersonalize.

Provide structure rather than control, invite individual to participate in developing goals and structure.

Articulate goals, expectations and timelines; modify as appropriate.

Provide simple, one step cues, check to assure comprehension.

Introduce information in as many modalities as possible.

Modify the environment as appropriate, either increasing or reducing stimuli.

DIFFICULTY GENERALIZING:

Have difficulty forming links, ie., between behavior and consequence, cause and effect.

Poor predictive skills: Prediction is based on ability to reflect, integrate, relate events, synthesize, compare and contrast, and project abstractly into the future.

Impulsivity: Impulse control is based on prediction.

Poor social skills; may miss nuances, meaning of social cues.

Limited in traditional problem solving skills, planning

May not make associations, ie between clothing and weather, etc.

May not generalize behaviors from day to day, i.e., "Don't hit" then hits the next day, 'Don't ride in the street', rides in other street.

Recommend:

Observe.

Depersonalize.

Teach links.

Walk through process of deduction and prediction.

Specifically teach social skills.

Model appropriate behaviors, conflict resolution, identification of feelings, concerns.

Provide structure rather than control.

Understand learning curve, issues of organicity in planning teaching strategies.

DIFFICULTY SEEING SIMILARITIES AND DIFFERENCES:

Have difficulty filtering and prioritizing external stimuli

May be distractible

Hyperactivity/increased motion may reflect overstimulation

Have difficulty seeing patterns, sequencing and tracking

May have difficulty distinguishing fantasy from real life (especially where protective mechanisms are in place.)

Recommend:

Observe.

Provide visual, multimodality cues.

Simply articulate/demonstrate similarities and differences.

Provide concrete, life-skills related opportunities to explore similarities and differences.

Assure 90%, check for retention periodically.

PERSEVERATION:

May be related to slow cognitive pace, need for time and closure

May relate to resistance to change (to the relative unknown)

May relate to rigidity which reflects attempt to control and make sense of their environment (If one can't anticipate, predict, change may be frightening.)

"Keep on keeping on", have difficulty initiating stopping of a behavior, whether a project, teasing, interrupting.

Recommend:

Observe.

Identify need, modify timelines as appropriate.

Prepare for transitions:
Forewarn,
Anticipate,
State,
Act.

SHUT DOWN:

Secondary characteristics

Cumulative effect of chronic frustration, global defense mechanism.

May have difficulty accessing, processing and relieving stress and frustration. Accurate association of words and internal state may not be readily available; internal discomfort may not be alleviated.

Affect may be flat, responses to painful stimuli may be blunted

Shut down may alternate with explosive episodes with little provocation

May appear as withdrawn, passive, resistant, lying, aggressive, otherwise defensive.

May resist school, act out among peers.

"Peer driven"; many behaviors at home may reflect rigidity and perseveration around affilliative needs and behaviors intended to create or preserve peer relationships

Shut down, defiance/non-compliance appears common for adolescents where there is a perceived threat to peer relationships; not uncommon for adolescents in general - the degree to which behaviors occur and their resolution are reflective of organicity

Recommend:

Observe.

Reframe.

Identify shut down cues, areas of chronic frustration.

Identify strengths, integrate into environment.

Modify expectations to be congruent with actual level of ability.

Refer as appropriate for specific support for psycho- social issues related to FASD.

** Note ** Resolving secondary symptoms may pose a challenge. Since the organicity often impacts individuals' ability to effectively use words to communicate distress, traditional psychotherapy may be ineffective. Perseveration, rigidity, and learned behaviors which are developed as a function of living in an alcoholic/dysfunctional home further dictate the need for realistic expectations for timelines for resolution of these issues.

Sources: Morse, Rathbun, Malbin