B R E A K I N G D O W N B R I C K W A L L S F O R F A S D

ORGANICITY OF FASD AND 
SECONDARY SYMPTOMS WHICH MAY DEVELOP OVER TIME:

Alcohol is toxic at all concentrations. Alcohol damage to the fetus occurs over a wide continuum. Damage varies due to volume ingested, timing during pregnancy, peak blood alcohol levels, genetics and environmental factors.      Bruce Ritchie,FASlink@acbr.com

FAS/E is a lifetime disability. It is not curable. A child does not "grow out of it". However, early diagnosis and intensive, and appropriate, intervention can make an enormous difference in the prognosis for the child. There is a small window of opportunity, up to about age 10 or 12, to achieve the greatest potential for an alcohol affected child. That period is when the greatest development of fixed neural pathways occurs. That is when alternative "coping" pathways are most easily built as "work-arounds" to damaged areas of the brain. Time is of the essence.

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. 

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.

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)

• 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, vision processing problems

ABSTRACTIONS IN GENERAL ARE DIFFICULT:

• Math, arithmetic

• Money

• Time

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

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 behaviour 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, ie, "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 behaviour, 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, Ritchie

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This site provided to families and professionals as an informative site to bridge understanding and help make connections when dealing with FAS/E. It is not to replace professional medical, legal, nutritional or educational counsel.  The information contained within this website are ideas that have worked for our 
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