Best Practices in the Behavioral management of...

2010Best Practices in the Behavioral management of Students with FASD

Best Practices in the Behavioural Management of Students with FASD

Promoting Responsible Behavior in Educational SettingsEDUA 5680-A01University of Manitoba

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Best Practices in the Behavioral Management of Students with FASD

Prepared by:

Desiree Armenti Susan Danyluk Don Featherstone

Judith Hilton Sarah Pype Leda Velychko-Simpson

ContentsAbstract…………………………………………….…………...……….p4PART A:

Introduction

Background…………………………...……….…..…………....p.5

Causes…………………………..………….………..…………...p.5

Incidence……………….………….…………..…….………….p.6

Terminology………………………………………..…..………..p.6

Diagnosis………...……………………………………………….p.7

Medications………………………………………..…..………p.10PART B:

Responding to FASD Behaviors with Best Practice

Introduction and Definition……………………….………...p.11

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Definition and Considerations for Education….….........p.12

Physical Motor-gross and fine……………….…..….….…..p.18

Sensory Processing Skills………………….……….………….p.23

Communication Skills…………………..…………………….p.28

Cognition ………………………………….……………..…….p.34

Academic Achievement ……………….………..…………p.36

Memory Skills………………………………..……………...…..p.46

Executive Functioning and Abstract Reasoning…….….p.50

ADHD…………………………………………………...……..p.54Adaptive Skills…………………………………………….....p.56

Support Systems

For Parents………………………………….………………..p.59For Educators………………………………………………..p.61Adult Services……………………..…….…………………..p.62

Resources ……………………………………….………………….p.64

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Abstract

Children that fall within the FASD spectrum are becoming a bigger part of today’s classroom. According to Health Canada, FASD affects children in 9 out of 1000 births. In Winnipeg, approximately 100 children are diagnosed with FASD each year. As educators, we all have students with FASD in our classrooms. The array of challenges encountered is a source of concern for us as we attempt to provide quality education for these students. We want to learn different strategies that will support our FASD students academically, socially and emotionally at the three levels of the education system. Applying these best strategies in our classrooms will benefit all of our students.

This document is not to be reproduced without the permission of the authors.

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PART A: IntroductionPeople affected with Fetal Alcohol Spectrum Disorder (FASD) can be faced with physical, mental, behavioral or cognitive disabilities. The range in which a person is affected is extreme. For example, a person may have severe growth delays, intellectual disabilities, birth defects, and characteristic dysmorphic facial features. On the other hand, a person with FASD could have normal growth, normal facial features, intellectual abilities and lifelong deficits in several domains of brain function.

1. BackgroundFetal Alcohol Syndrome was first described as a medical syndrome in 1973 by two researchers at the University of Washington in Seattle. FASD is a term that refers to a variety of physical changes and neurological patterns of brain damage associated with fetal exposure of alcohol during pregnancy. The brain damage can result in a wide

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range of structural, physiological, learning and behaviour disabilities in individuals. FASD is not a diagnostic term, but it’s an effective way to indicate the spectrum of physical, cognitive and behavioural characteristics that can be seen in such individuals. FASD is often referred to as a “hidden” disability because its physical characteristics can often be subtle and go unnoticed.

2. CausesThere is only one way for an individual to have FASD. It is caused by the mother drinking alcohol during pregnancy. Alcohol damages the developing brain and nervous system of the baby, leading to mental, physical and developmental problems.

The following factors affect whether FASD will occur and how severe the condition may be:

timing of alcohol use during the pregnancy amount and frequency of alcohol consumption the mother's general health resources available to the mother

Consuming alcohol in any form during pregnancy is dangerous to the fetus. Alcohol can cause birth defects in the fetus. The more alcohol a pregnant woman drinks, the greater the risk of the fetus developing FASD. Drinking early in pregnancy may cause changes in the facial features, heart and other organs, bones, and the central nervous system.

3. Incidences

FASD is a nation-wide health concern which does not discriminate on the basis of race, socioeconomic status, or sex. The lack of recognition and diagnosis makes it difficult to be certain how many individuals have some form of FASD. It is estimated that in Canada, more than 3, 000 babies a year are born with FASD, and about 300, 000 people are currently living with FASD. The incidence of FASD is greater than either Down’s syndrome or Spina Bifida. A large number of pregnancies in Canada are unplanned, which means that women in the early stages of their pregnancies, not knowing they are pregnant, may use alcohol and unknowingly cause damage.

4. Terminology

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Fetal alcohol spectrum disorder (FASD) describes a wide range of effects that can occur in an individual who was exposed to alcohol during pregnancy. FASD is not a diagnostic term; it is an umbrella term of four specific medical diagnoses. They are:Fetal Alcohol Syndrome (FAS)

Birth defect caused by prenatal exposure to alcohol Diagnosis is made by a doctor when there is known significant

prenatal exposure to alcohol and child exhibits 3 main characteristics:o Evidence of growth deficitso Evidence of central nervous system damageo Evidence of facial abnormalities

Partial Fetal Alcohol Syndrome (pFAS)

Child exhibits some but not all of the physical signs of FAS Central nervous system damage manifests itself as learning and

behavioural issues.Alcohol-Related Neurodevelopment Disorder (ARND)

Child exhibits central nervous system damage resulting from a confirmed history of prenatal alcohol exposure

Can be demonstrated as learning difficulties, poor impulse control, poor social skills, and problems with memory, attention and judgment

Alcohol-Related Birth Defects (ARBD)

Child displays physical anomalies resulting from prenatal alcohol exposure

These may include heart, skeletal, vision, hearing, and fine/gross motor difficulties.

5. DiagnosisFASD is medical condition that can only be diagnosed by a doctor. It is a seven-step process of diagnosis that can include several different professional. The involved professionals can include, doctors, geneticists, teachers, and social workers among many.

Canadian National Guidelines for FASD DiagnosisThe guidelines recommend a comprehensive multidisciplinary assessment of brain functioning and behaviour, growth and facial

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characteristics as well as consideration of prenatal and postnatal influences on physical, emotional and cognitive development. The Guidelines for diagnostic is organized into 7 categories:

Screening and referral Physical Examine and differential diagnosis's Neurobehavioral assessment Treatment and follow up Maternal Alcohol history in programming Diagnostic for FAS, Partial FAS, ARND Harmonization of Institute of Medicine and 4-digit Code

Approaches.

Screening and ReferralA multi-disciplinary professional team assesses children suspected of being afflicted by FASD. Individuals can be referred for diagnoses if the display the following or a combination of the following traits.

Three characteristically facial features Evidence of significant prenatal alcohol exposure 1 or more facial feature, smaller in size for age, known or

probable prenatal exposure to alcohol. 1 or more facial features, 1 or more nervous system deficits,

known or probable prenatal exposure to alcohol

Characteristic Facial Features and Growth Deficits:Often individuals afflicted with FASD will display distinctive facial features. Three features that are distinctive to FASD include:

Small eyes Smooth philtrum (area between nose and lip) Thin upper lip

Figure 1 and Figure 2 show typical facial features.

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Figure 1 Figure 2

Individuals afflicted with FASD often display delayed growth and can be small in size for their age. For the referral process, an individual meets the referral criteria if they are 1.5 standard deviations smaller the than the normal for their age.

Medical Exam and Differential DiagnosisIn this stage, suspected individual will undergo a physical exam by a medical doctor. The individual may be referred to other specialist such as geneticist and subject to further testing such MRI scans. As part of the process, other medical conditions that have similar symptoms as FASD must be ruled out.Other medical conditions with similar symptoms and facial features as FASD are:

Chromosomal Disorders Fatal anticonvulsant embryopathy Maternal PKU embryopathy And others

Neurobehavioral AssessmentIn this stage, neurobehavioral deficits are assessed. These neurobehavioral deficits are direct manifestation of the brain damage from FASD. The following is list of the neuro-behaviours tested:

Physical motor skills – gross and fine Sensory processing skills Cognition Communication skills Academic achievement Memory skills Executive functioning and abstract reasoning Attention Deficit/Hyperactivity Adaptive skills

What are important at this stage are academic reports and assessments, and documented classroom observations may be used as part of the diagnosis process.

Treatment and Follow upAs part of the diagnosis process the multidisciplinary team may recommend specific interventions or treatments for the suspected FASD. Interventions may include counseling, medications, speech and

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language therapy. Interventions may be applied in the classroom, which are further discussed later in this report.

Maternal Alcohol History One of the key parts of the FASD diagnosis process is the requirement to confirm prenatal exposure to alcohol. This can be one of the most challenging parts of the diagnostic process for two main reasons. Firstly, there can be feelings of shame and guilt that often prevent the mother from admitting to consuming alcohol during pregnancy. Secondly, children afflicted with FASD often come from lower socio-economic groups and can be involved with family services. There are many children with FASD not living with their original family and confirming prenatal exposure can become almost impossible. Without the mother’s admission, confirmation from a reliable source from the child’s community may be required. Reliable source may include:

Social workers Nurses Doctor

Diagnostic for FAS, pFAS, ARNDThe final stage of the FASD diagnosis process is to diagnose and determine where an individual fits along the fetal alcohol spectrum. As part of the diagnosis the student or child’s profile is compared to other FASD diagnostics standards (4- digit code approach) to ensure proper diagnosis.

Issues and Concerns – Diagnostic ProcessDiagnosing a student as FASD has many challenges. It can be long process involving many different professionals. Often suspected individuals may not be open to a diagnosis, as they fear the stigma of being labeled “FAS”. Due to shame and guilt of the mother, it can be difficult to confirm prenatal alcohol exposure. Many children go undiagnosed as they come from communities where diagnostic services are unavailable.Teachers may be involved in the diagnostic process. They may initiate the process or their classroom observation and academic assessment may be used as part of the diagnosis.

6. Medications

FASD is physical neurological damage and can be a lifelong disability. There is no medication that correct or cure the condition. Medication

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can be prescribed to help mitigate certain behaviors. The only primary neurobehavioral where medication is prescribed is if the child is suffers from attention deficits/hyper activity. Attention stimulants, like Ritalin, may be prescribed. As additional consequence of living with this condition, students often suffer from secondary behaviours, which often require medication to mitigate. An individual with FASD may require medications like anti-depressants, antipsychotics, and anti-anxieties in order to help cope with daily activities.

Alcohol use during pregnancy is the leading cause of preventable birth defects and developmental delays in Canadian children.

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PART B: Responding to FASD Behaviors with Best PracticeIntroduction: A new way to look at Best PracticeThe students we meet in our classrooms with FASD experience extreme frustration as they try to meet the expectations and values our school system and our society at large. The environments we create and perpetuate are often a poor fit for these students and ignoring this factor leads to a destructive pattern for our students. These patterns sometimes become so engrained, we as educators are no longer aware of the strengths these students have to build on.

These students come to us with difficulties in many areas such as body awareness, cognitive and reasoning weaknesses, and poor motor skills. It is vital that these weaknesses and the subsequent primary behaviours be attributed appropriately to the brain injury the child acquired in utero.

In her articles “Most approaches to changing behaviours do not recognize brain dysfunction”, and “FASCETS Conceptual Foundation: A Neurobehavioral Construct for Interventions For Children and Adults with Fetal Alcohol Spectrum Disorders (FASD)”, Diane Malkin discusses the need for educators to make a paradigm shift away from using interventions to target presenting behaviours to changing the environment to fit the student. She compares a student with FASD to a student with a physical disability and says that whereas we would make sure the student with a physical disability is able to get into, out of, and around our classrooms, we must also think of students with FASD in this way. She adds that students with FASD “have by definition a physical disability – brain damage from prenatal exposure to alcohol/drugs” (Malkin).

She goes on to suggest that as a result of this primary disability, secondary disabilities will emerge if we do not adapt the environment to suit the needs of the student. If this is done, then these secondary disabilities will be reduced (or eliminated), and the student will learn to function better in the classroom.

Secondary behaviours are not intrinsic to FASD. They are defensive behavioural disabilities that emerge as challenging behaviours that

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Best Practices in the Behavioral management of Students with FASD

develop over time as a function of a chronic poor fit between the person and his or her environment. Findings of a study conducted by Dr. A. Streissguth published in 1996, indicates that children who were diagnosed with FASD and “received standard interventions, e.g. mental health and school services, and traditional parenting techniques” (Malkin) still had a high incidence of secondary problems despite these interventions. On the other hand when the environment is changed to adapt to child’s needs, many challenging behaviours decrease or are eliminated.

It is vitally important that the educators recognize signs and symptoms of FASD early and adapt the environment accordingly. Secondary behaviours often develop in early childhood, frequently becoming patterns of behaviour by adolescence. Secondary behaviours come at a high cost to the individual, their family, and the community. Early identification of both the primary symptoms and secondary symptoms is necessary in order to develop appropriate interventions or accommodations that prevent or resolve the secondary and tertiary behaviours.

Arming ourselves with the best knowledge and research as well as becoming aware of our role in creating an appropriate educational environment for children with FASD are required in order to be engaged in best practice.

For Best Practice we need to consider the following:

a. There are three types of behaviour with only the primary behaviour being a permanent factor for people with FASD.

b. Best practice in behaviour management for students with FASD means the environment needs to be considered and changed.

c. Traditional learning theories are often a poor fit for students with FASD because of the brain dysfunction that defines the disorder.

Three categories of behaviour to consider

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Primary behaviours reflect brain dysfunction and are a permanent physical disability. Weaknesses can be seen in many areas and include memory difficulties, problems with reasoning, and weak motor skills just to name a few.

Secondary defensive behaviours occur because of issues environmental fit. These behaviours develop over time when there is a disparity between the person and the environment. Through understanding and appropriate early intervention, the disabilities may be reduced and in some case eliminated.

Some examples of secondary behaviours are:

Fatigue, frustration Anxiety, fearfulness Rigid, resistant, argumentative behaviour Becoming overwhelmed, shut down (withdrawn) Poor self concept, feeling of failure, low self esteem Isolation Acting out, aggression

Tertiary behaviours are more extreme behaviours that occur when there is a cumulative frustration and failure felt by the person with FASD. These behaviours are preventable when appropriate environmental changes and interventions are employed.

Some examples of tertiary behaviours are:

Family and/or school problems Depression and other mental Health problems Trouble with the law Drug and alcohol problems Problems with employment Homelessness Inappropriate sexual behaviour

The environment and fit

Best practice in behaviour management for students with FASD means the environment needs to be considered and changed. Because of the brain dysfunction, students with FASD are not able to adapt to the environment. It is therefore vital that the environment be adapted for them as is common practice with other physical disabilities. The

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Manitoba FASD Centre (2010) lists and describes 6 factors to consider about the environment that include the physical, societal, relational aspects of our environment. They further suggest that these considerations can lead to difficult decisions, but that they are essential for success for persons with FASD. These are summarized below.

The Impact of Environment on Your Way of Thinking We look at the world through a moral lens which creates our

expectations, understandings and values These personal beliefs can our ability to interact and work

successfully with students with FASD Changing and adapting these personal attributes are both

difficult and important

Physical Surroundings The physical environment can be great tool to cue students

about rules and expectations when organized appropriately for them

A low stimulus environment is important Variety of spaces for both movement and quiet, calm activities

are important.

Schedules and Routines Predictable and slower paced are best Organized and known routine

Expectations and Rules Realistic expectations and rules Explicitly taught rules in every situation Sometimes means limiting students if safety rules cannot be

followed

Language and Communication Often overwhelmed by too many words or instruction Slowing down and fewer words are important

Family, Friends and Community (including school) An environmental asset when they can analyze and adapt the

environment for students with FASD Small accommodations can have a big impact.

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Learning Theories and Strategy Fit

The FASD Manitoba Centre (2010) outlines why standard learning theories are not a good fit for students with FASD. Learning theories such as behaviorism and cognitive theory are based on people without brain dysfunction and on abilities that students with FASD simply do not have. The use of these theories without significant adaptations and consideration will be inappropriate.

For instance, behaviorist learning theory suggests that students learn appropriate behaviour by connecting the positive outcome or reward with the behaviour. This is fraught with problems for students with FASD who have difficulty with generalizing and memory. Cognitive theory can also present a huge difficulty for application for teaching students within the spectrum. The reliance on the very memory and reasoning skills that are often dysfunctional, make the theory a poor fit as a premise for teaching these students.

It follows then that many of the traditional strategies and interventions employed in classrooms that stem from these theories are a bad fit for students with FASD and often cause more harm than good. These include strategies such as time out, behaviour modification activities such as sticker charts, non natural consequences such as detention and lecturing as a form of teaching.

In turn, we can use these theories as a frame of reference to help us understand the challenges students on the spectrum face and as a starting point to how outreaching needs to be different. Especially important is to base our teaching on the specific neurobehavioral characteristics of each student. Building on a student’s strengths as well as specifically teaching skills step by step with repetition should be the basis of the educational programming for the students.

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Primary Behaviour

Permanent

Ie)

Memory

Inconsistent performance

Secondary

Defensive behavioral symptoms

Tertiary Behaviours

Moral LensAssigns intention and therefore affects responses to behavior

Envi

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doe

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fit

Cum

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effe

ct o

f chr

onic

fru

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and

failu

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Secondary defensive behaviours may be prevented and interventions are possible

by adapting environments to achieve a better fit.

Tertiary behaviours are

often preventable

FASD

A physical brain based behaviour

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Physical Motor-gross:a) Primary Behavioral characteristics of the Behavior:

Gross Motor Skills:

Students with FASD may experience difficulty with: poor co-ordination (including eye-hand co-ordination) abnormal muscle tone (usually tightness in the arms and legs

and low muscle tone in the trunk) poor body awareness

Due to poor co-ordination (including eye-hand co-ordination), Students with FASD may show a lack of ability to do everyday activities such as riding bikes, playing on sports teams, and any activity that involves running.

Sports Bike riding Running skills

Due to abnormal muscle tone (usually tightness in the arms and legs and low muscle tone in the trunk), Students with FASD may show a Lack of ability to balance and function in everyday activities. Because static balance is more affected than dynamic, students often move around a lot to maintain balance. Also fixing shoulder and neck are to maintain balance causes difficulty in fine motor activities.

Constant Movement Avoid sitting Fall off chairs Leaning against walls or other for support

Due to poor body awareness (poor proprioception), students with FASD may show a decreased ability to feel where their body is in space.Use of wrong amount of pressure for the task-tag, or animal care

Bump into peers and furniture Breaking of classroom equipment Appear aggressive

Sourced from: Healthy Child Manitoba (2009) What educators need to know about FASD: working together to educate children in Manitoba with fetal alcohol spectrum disorder. Winnipeg, MB: Healthy Child Manitoba and Manitoba Education, Citizenship and Youth.

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b) Values and Expectations for all students/”Fit” within the environment:

The school system value and expects: Students to stay in their own space Be good at sports and physical skills To be able to sit at tasks for an extended period of time To know, and be able to have a gentle touch with others

c) Interpretation of behaviors when expectations are not met:

Aggression Defiance Angry Not trying, lazy

d) Environmental Accommodations :( for the prevention of

secondary behaviors)

Provide breaks and space for students to move and be in different positions to work without negative consequences

Provide hands on learning and large motor movement activities as a way to learn

Teach and accept that accidents happen to the student and the rest of the classroom

Mark boundaries on the floor or create “personal bubble” if poking or touching others is a problem

Provide stable seating by giving a student a chair that the students back rests on

Hips, knees and feet at 90 degrees flexion A chair with armrests if possible Provide structured large motor activities throughout the day

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e) Learning Strategies: (for the prevention of secondary behaviors)

Balance Puzzle

Students are required to use a visual key to put their body in a weight bearing balance position

Creates body awareness and strengthens muscles

Heavy Work

Increases upper body strength as well as provides calm

Wall push ups Wheel barrow Scooter on the

stomach and propelling with the arms

Climbing Students MUST be carefully supervised due to the lack of body

awareness and sense of danger.

Fine Motor Skills:

It takes longer for students with FASD to learn fine motor tasks to automaticity and then some days, these skills might be forgotten. These students may have the following difficulties:

Immature grasp and manipulation patterns (including pencil, scissor grasp and the ability to manipulate small objects)

Decreased hand strength, low muscle tone in hands, instability of joints in hands, all of which may cause students to tire faster than their peers while engaging in fine motor activities such as pencil use

Fine motor tremor Poor bilateral hand use - using one hand for movement and the

other as a helping assist

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No established hand dominance, rather a switching of hands during an activity such as cutting or pencil use

a) Primary behavioral characteristics:Due to delayed fine motor skills, students may have difficulty with:

Self help skills such as tying shoelaces, opening packages, doing up buttons and zipper etc.

Handwriting Scissors and picking up small objects Easily Tiring during tasks

Sourced from: Healthy Child Manitoba (2009) what educators need to know about FASD: working together to educate children in Manitoba with fetal alcohol spectrum disorder. Winnipeg, MB: Healthy Child Manitoba and Manitoba Education, Citizenship and Youth.

b) Values and Expectations in the school environment

The school system values and expects Perseverance Natural abilities to draw and then print Natural abilities to access play and craft materials Learn by watching and then practice

c) Interpretation of behaviors when expectations are not met.

Laziness Resistant Not Trying

d) Environmental Accommodations:

Provide movement breaks to elevate frustration and fatigue Reduce workload by providing students with specific and short

printing and writing practice at the needed level Decrease the amount of fine motor tasks required by allowing

students to Highlight notes instead of taking them Providing a thorough outline of notes so a student will only add any

extra information Avoiding complex scissors tasks. Use students’ strengths by providing other means of learning and

expressing knowledge such as oral presentations, computer

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generated responses, and art projects. These will help to build strengths while providing a larger leeway in terms of product.

Provide subtle supports or alternatives for difficulties encountered while completing age appropriate routine tasks such as tying shoes, doing zippers, and manipulating classroom tools and toys.

Reduce fine motor tremor by providing a pencil with more resistance (2B, 3B, or 4B) and/or with a pencil topper

e) Learning Strategies:

Provide hand strengthening exercises

Picking up and palming or placing bingo chips Working with small toys or play dough Doing ANYTHING that requires small precise hand and finger

movementsUse a printing program that uses

multiple methods of learning

Printing without Tears uses songs, stories, whole body movement, visual aids, and specific practice to learn printing.

Printing and writing aids

Pencil and pens grips provide a better grasp and reduce fatigue if the student is gripping too hard.

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Sensory Processing Skillsa) Behavioral characteristics of the Primary Behavior:

Many children with FASD are affected by a Sensory Processing Disorder. Sensory integration is our ability to take in, sort out, and connect information that we receive from the body and the environment, and then interpret, organize, and execute a response to the input. This means that children may misinterpret everyday sensory information such as touch, sight, sound, movement, and smell. Some children may be over-reactive to stimuli and may feel bombarded by sensory input, while others may be under-reactive and actively seek out intense sensory input. In short, “Sensory Processing Disorder is the inability to use information received through the senses in order to function smoothly in daily life” (Stock Kranowitz, 2005).Problems often occur when children do not have the language to express their needs, and instead express their response to their environment through behavioural means (Malkin). Some students may hide under the desk or in a corner, others may run wildly around the classroom, talk loudly to themselves, or act out in other ways. Contrary to common misperception, these children are not behaviour problems; their nervous system is unable to make sense of the world around them.A typical classroom is a place where there are multiple things happening at the same time. Children with a Sensory Processing Disorder may not be able to filter the sensory input appropriately.Behaviours to look out for include increased agitation, irritability and aggression. Other signs to be aware of include distress with sounds, sensitivity to light, or agitation when bumped by someone in a class line-up. Students who are under-reactive may not react to pain, or complain of earaches, broken bones, and other painful stimuli, and a lack of fear of height.b) Values and Expectations for all students/”Fit” within the environment:

Pay attention Sit Still Ignore distractions


Not trying Undisciplined

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Off task ADHD

d) Environmental Accommodations for students with:

Visual Sensory Disorder

When thinking about the visual stimuli in a classroom and students with a visual sensory disorder, it is wise to think less is better. Visual stimuli in the classroom can be very distracting and can easily lead to over-stimulation. This over-stimulation can lead to secondary behaviours as the student tries to cope with the visual onslaught. Students in classrooms with less visual stimuli have less hyperactive behaviour and are better able to pay attention.

Use natural lighting as much as possible Put blinds on windows to allow adjustment of direct sunlight or to

block out outside stimulation. Use non-fluorescent lighting such as incandescent lighting or full

spectrum lighting when natural light is not available Reduce the information on the walls (use removable sheets to

cover) Put things away in cupboards and close the doors, or cover with

fabric to reduce visual clutter - fabric should be a solid, soft pastel colour.

Use visual timers to help students prepare for transitions and assist in awareness of elapsed time.

Auditory Sensory Disorder

Children with FASD may have difficulty tuning out extraneous noise. The hum from a fish tank or a fluorescent light may be enough to distract the child. A noisy classroom may be too much sensory input for a child and result in the child becoming unfocused and overloaded. Sudden noises may cause anxiety for the child and should be kept to a minimum (Healthy Child Manitoba, 2007).

Prepare students ahead of time for fire drills. Limit announcements to certain times of the day when possible. Use noise reducing materials throughout the classroom –

carpeting, tennis balls on desks and chairs- whenever possible. Use acoustic ceiling tiles.

Tactile Sensory Disorder

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Children with FASD may be over-sensitive or under-sensitive to touch. For some students a light pat on the back will be intolerable, whereas, for other students, they may need a heavier touch in order for them to stay alert. A variety of sensory tools should be available for students to use for self-regulation. Self-regulation refers to a students’ ability to appropriately attain, maintain, and change their level of alertness or attentiveness for a specific task or situation, so they can learn and function appropriately in their environment. They can enhance learning and attention during times when attention is needed. The effectiveness of these strategies can vary from student to student and from day to day (Healthy Child Manitoba, 2007).

Mark visual boundaries on the floor using a tape grid. The textile surface of the carpet squares placed within the grid will help enhance the boundary.

Provide tool options such as brushes for painting or cookie cutters when working with play dough.

Allow student to line up at the end of the line to help avoid being touched by others.

Body Position and Movement/Balance Issues

Proprioception is the sensory input we get from our bodies. This input helps us with balance and coordination (Symons, 2008). For students with FASD, poor proprioception often results in difficulty with body awareness. Students are uncomfortable moving in their environment because movement means touching things. These things include people, clothing, furniture etc… This will affect the child’s development of gross motor skills, fine motor skills, visual discrimination, language acquisition, social skills, and academic learning (Stock Kranowitz. 2005).Vestibular dysfunction, on the other hand, is the inefficient processing in the brain of sensations received through the inner ear. This child has difficulty processing information about gravity, balance and movement through space (Stock Kranowitz. 2005). They exhibit unsure body position, poor planning of movements, are poorly coordinated or have difficulty learning new motor tasks. In the classroom this looks like students who: enter other people’s personal space, stumble over things, bump into furniture or peers, play destructively or break toys (Healthy Child Manitoba). Students may have poor posture, visual problems - the ability to look up and down quickly, focus on stable objects while he/she moves, reading problems,- and language processing difficulties.

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Consultation with a physiotherapist and an occupational therapist can assist in choosing the most appropriate methods to use to aid these students.

A visual line using tape on the classroom floor or hallway helps students line up.

Incorporate movement breaks into students’ schedules.e) Learning Strategies for Students with:

Visual Sensory Disorder

Have one thing on the board at a time. Use visual schedules for daily routine and to prepare students for

changes in the routine. Use highly organized shelves and colour-coded materials (blue

for math, green for science…) to help with organization. Use pictures or symbols to help break down tasks.

Auditory Sensory Disorder

Use a sound field system to help the student hear the teacher’s voice over background noise.

Use soft, relaxing music. Use ear protectors or headphones to help filter out sounds.

Tactile Sensory Disorder

Use of Stress balls Use of Listening aids such as: soft, stretchy key chains or other

soft, manipulative hand-help object. Plastiscene or play dough Chewing gum, sucking on a candy, straw or water bottle (visual

and printed rules are given to them to help them remember how to use these while listening). Other oral motor options include: snacks with foods that involve sucking, crunching or heavy chewing such as sucking on juice boxes, yogurt tubes, carrot sticks, apples or dried fruit, or other non nutritive strategies such as chewing on a non-toxic chewy pencil topper, Chew-Ease bracelet or quiet blow toys.

Body Position and Movement/Balance issues

Weighted vests give students a better sense of where their bodies are and allow them to move around or sit in a more co-ordinated, calm manner.

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Some children benefit from deep pressure touch such as back rubs to help calm or relax them. Weighted blankets, vests or lap blankets may assist in maintaining a calm, alert state to listen or learn.

Chairs with arms. This is to allow for proper positioning of the body to give needed support for printing and other table-top activities. It also allows energy to be used on the task given rather than trying to remain in an upright position.

Move n’ Sit Cushion™ Partially inflated air seat or beach ball Ball chairs or therapy balls. Carrying heavy items such as books or boxes. Pulling apart toys (Lego, snap beads). Pounding or rolling play dough. Thera-band or lycra stretched on their chair legs to allow gentle

pressure when moving their legs T-Stool (Set clear rules when using these tools and ensure that

the child is positioned in a 90 degree angle position at their knees, hips and elbows).

When lining up, allow student to be at the back of the line.

e) Learning Suggestions during recess times or gym class include:

Activities with a jumping and rolling component. Activities with a pushing or pulling component. Climbing on playground equipment. Hanging from the monkey bars Crawling through obstacle courses or swinging on swings or tire

swings. When appropriate using music with a strong beat and varying

rhythm may help to enhance these activities. Catching and throwing heavy balls, bean bags, etc… Body stretched (Yoga). Heavy exercise, such as push-ups, sit-ups, wall push-ups. Pushing against a wall or another person, or pushing hands

together. Walking, hiking with a heavy backpack, biking up a hill, obstacle

courses, stretching exercises.

Direct costs associated with FASD over a lifetime have been estimated at about $1.5 million per person with FASD (Health Canada, FASD: A Framework for Action, 2003)

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Communication Skillsa) Behavioral characteristics of the Primary Behavior:

Students with FASD usually demonstrate some degree of language disability or delayed language development. They often have difficulties communicating regardless of whether or not their overall development is delayed. Difficulty with language affects social communication and academic learning.Communication issues can be broken down into four areas:

Expressive Language Development Receptive Language Development Pragmatics Speech Sound Development


Think fast. Pay attention. Stay on task. Good social Judgment.


Ignoring Teacher Resistant Personality Willful Misconduct Child Abuse

d) Environmental Accommodations: (for the prevention of secondary behaviors)

Keep noise level in the classroom as low as possible. Control the lighting in the classroom so that it is bright enough

for them to see visual cues being used in teaching. Limit the number of visual stimuli in the classroom. Keep transitions calm and structured.

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e) Learning Strategies for students with:

Expressive Language Development

Children with FASD develop language skills at slower rate. They have difficulty using semantics (vocabulary) and syntax (grammar – pronouns, verb form, plural forms, omits prepositions etc…) expected for their age level. They often cannot retrieve words from memory and may use the wrong word from the same general category. They may use non-specific vocabulary (e.g. this and that). Children with FASD often have difficulty distinguishing between effective communication and talking. (Healthy Child Manitoba, 2007).Strategies:

Use a picture dictionary to aid in the development of vocabulary. Create key word and sight word cards for vocabulary building,

phonetic strategies. Encourage student to develop a vocabulary card index. Do not interrupt a student when they are speaking, they may

forget where they are and have to start all over again. Match your communication level to theirs. For example, if they

use two word phrases – use three to increase their vocabulary. Only expand by one word at a time.

Help children visualize conversation skills. For example, if they constantly interrupt, tell that their words are ‘bumping’ into your words.

Squeezing something in their right hands can help stimulate the left brain, and help them better express what it is they want to say.

Provide many repetitions when teaching vocabulary. Learning new words should take place within the context of experience and hands-on manipulation of real-objects.

Use real objects, representations, photographs, and drawings along with visual, auditory, tactile, kinesthetic repetition, demonstration, experimentation, manipulation, and reinforcement of the target concept.

Use cloze techniques to help students remember words or concepts.

Develop language programs that emphasize survival language and social communication.

Encourage daily reading aloud.

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Receptive Language Development

Children with FASD often have difficulty processing information (receiving accurately, interpreting and remembering correctly, then acting on the information). In short, receptive language issues are problems with listening. Areas that may be affected include:

Comprehension: understanding what is meant. Discrimination: understanding whether things or words are the

same or different. Association and generalization: understanding how things are

related by their category, function or physical similarities. Sequencing: doing things in the correct order or following a plot. Selective Attention: knowing what is important to notice and to

what they should pay attention. Memory: immediate (short term) and long-term.

Students with FASD may have difficulty keeping up with the normal pace of the classroom and the complexity of the language of instruction and discussion, remember what has been said, and translate that into action. They may have problems following a story that is being read unless it is accompanied by pictures or concrete representations.They need precise, concrete instructions – “We are going to the zoo. Please put on your shoes.” Vs “Get ready for the field trip”. Some students with FASD have trouble understanding the intent of another speaker; they cannot take the other’s point of view. They may go off topic, use incorrect pronouns or give so few details that a story does not make sense. Students who have problems not knowing how to respond, or to what they should respond may have many conflicts in a day. This may lead to anxiety, and outbursts. Students who do not respond to a request may not be able to understand what the task is. Willful disobedience may actually be an inability to translate verbal directions into action, even if they have repeated the directions to the teacher.Strategies

Speak face-to-face with the student; use the student’s name. Tape record stories for the student to listen to while reading. Use cues and aids to assist the student in following verbal

instructions. Use verbal cues, such as songs, mnemonics, or chants to remind

students what to do next. Use visuals to help aid understanding.

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Avoid using figures of speech, euphemisms, and sarcasm. Abstract language is often hard to understand.

Limit the number of questions asked. Give instructions one step at a time and at a slower pace.

Repeat as needed. This may need to be done several times. Write on board as well.

Break larger tasks into smaller steps. Keep instructions simple and concrete.

Post information that you want students to remember on, or close to, their desk so that they can refer to it. This includes daily schedules, items that need to be taken home at the end of the day, etc.

Use concrete language with visual cues and reminders. Adjust timelines and expectations. Use visual, auditory, tactile, and kinesthetic instructional

strategies. Use visual models to make abstract concepts more concrete. Plan for emergencies keeping in mind how to accommodate

students who may not understand instructions given over a PA system.

Encourage students to watch classmates for clues about what they should be doing.

Use visual cues and role plays to teach students the five listening behaviours: 1) mouth quiet, 2) hands quiet, 3) ears listening to speaker,4) eyes looking at the speaker, 5) feet still.

Provide photocopies or audiotapes of important information.

Pragmatics

Pragmatics refers to the ability to use language appropriately in social settings. These skills include:

Taking turns Understanding conversation rules Greeting people appropriately Asking and answering questions correctly. Recognizing non verbal cues Looking at a situation from another person’s point of view Understanding personal boundaries/ownership Making and/or keeping friends Participating in a conversation Being suggestible or easily led by others.

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Strategies

To make sure a student has understood directions, have them show what needs to be done.

Use art to make abstract concepts more concrete. Social stories are useful in helping students understand certain

situations or events that otherwise may be too overwhelming or difficult. These stories provide a personal, visual story that helps to walk the student through a situation.

Videotape them or a peer acting out a social story so that they can watch the successful completion of a task.

Children with FASD can practice social and play skills through one-to-one work with a peer with adult support.

Use body cues (e.g. the look on a person’s face when angry or sad; what their stomach feels like when they are scared, etc). Label the emotion for the child when it is obvious that s/he is experiencing it. When a child is showing they are happy, you can say, “You’re happy,” and show them a symbol for ‘happy’.

Use words and gestures to praise children for displaying appropriate social skills.

Ensure that adults are role models for appropriate social behaviour in their interaction with the children and each other.

Encourage simple turn taking games such as show and tell, free play activities, memory games.

Plan small group work, and support social skills within this. Read stories that focus on appropriate social skills. Develop role playing scripts for some common social situations

(e.g. taking turns). Share the scripts with parents, and reinforce them in your setting. This will help the child with FASD to act more appropriately because s/he will know what to do next. A role play script will be needed for each new situation. Do not expect the child to generalize from one situation to another or even from one room to another.

Use ‘talking items’ (e.g. a child holds a teddy or toy to indicate it is their turn to talk). This helps with visualization of whose turn it is now.

Children with FASD will not automatically know how to play with some toys, particularly those that require them to perform a sequence of acts (e.g. dressing a doll). Putting your hand over theirs, show the child explicitly how to play appropriately and creatively with a range of toys if this is the case.

Children with FASD will exhibit parallel play long after early childhood, and will find cooperative play challenging. This is because, as children get older, more time is spent in negotiating

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game plots and each other’s roles. This will be difficult to understand for a child with FASD, and they will need the support of an adult to join in.

Pretend play requires children to act against their immediate impulses and follow the rules of the game. This will be difficult for children with FASD who tend to act impulsively and may not remember rules. Adult support and scaffolding will be essential to support children with FASD to participate in pretend or symbolic play, which is an important part in the development of ‘theory of mind’ (knowing and understanding what others may be feeling or thinking).

Use puppets and other media to allow for expression of thoughts and feelings.

Teach social and conversationally skills directly. Teach in situations they will be required to be used in to assist in

generalization Role play Encourage positive self talk “I can do this!” Teach replacements for inappropriate language or gestures.

Speech Sound Development:

Students with FASD may have articulation problems that make them difficult to understand. This may lead to teasing or ignoring by peers. This in turn can affect the student’s ability to develop social skills. Articulation problems are the easiest issues to identify and interventions by a Speech/Language Pathologist often begin before the child begins school. (Healthy Child Manitoba, 2007).

Cognitiona) Behavioral characteristics of the Primary Behavior:

Ask yourself what responsibilities would be reasonable to expect from a 10 year old when confronted by a tall, verbal 16 year old with FASD or ARND. Adjust expectations accordingly. If what you're trying doesn't work, don't try harder, try different. (Adapted from: Research findings of Streissguth, Clarren et al. by Diane Malbin 1994)

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Brain damage is the most serious aspect of FASD and presents the greatest challenges to learning and functioning in school. The damage is permanent. It can be accommodated, but not cured.

Most children with FASD have some form of reduced cognitive functioning. However, every child is different and there seems to be no pattern of deficits. The intellectual functioning levels of students with FASD range from the mentally deficient range up to above average scores. The kinds of cognitive issues differ depending on a variety of reasons which include: the general health of the mother, the amount of alcohol consumed, and the stage of development of the fetus when the alcohol was consumed. (Healthy Child Manitoba, 2007)

The deficits that do appear are usually dramatic. The two hemispheres, which are normally similar, can often be significantly different from each other. Even when the two hemispheres are similar, more specific deficits are often identified (Healthy Child Manitoba, 2007). There may be difficulties with organization and planning, short-term memory difficulties, abstract thought (time and money), and written expression. Students may also have difficulty contextualizing information from one context to another. As a result, inconsistent performance is common. Students may learn something one day, forget it the next, and pull it out two or three days later. This is frustrating to both the student, who is trying their hardest, and the teacher, who may think that the student is not trying hard enough, not paying attention, or misbehaving. (SAMHSA, 2007)

Many students with FASD may process information more slowly than their peers due to their brain’s struggle to process information accurately. This means that the child thinks more slowly. Students may say “I don’t know”, “I forget”, or they may shut down, simply because they have not been able to process the request, let alone a response. These students may need minutes in order to do this; whereas, the classroom environment expects students to process and respond within seconds. Even the normal wait time that teachers give for students with learning disabilities may not be enough. Students with FASD are ten second children in a one second world. As a result, students may need other people to be their “external brain” - to do much of their important thinking and cueing. This, unfortunately, may be something that students will need for the rest of their lives. Structure and supervision are two ways to provide an external brain.

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a) Learning Strategies for students with slow processing speed:

Provide sufficient time to process information – more wait time.

Reduce the speed and/or number of words.

Give one direction at a time.

Present concepts in a concrete fashion.

Use visual supports.

Use a peer helper or study buddy.

Repetition and many practice opportunities.

Teach slowly. Teach, repeat, re-teach, repeat, re-teach, repeat, re-teach.

A “Circle of Support” for the student which will help him or her weave their way through life. The circle may consist of parents, caregivers, educators, friends, and many other social supports.

Further, and more specific, accommodations and strategies will be discussed under the academic, abstract reasoning, and memory headings.

Remember: a slow processing speed + an understanding teacher + accommodations = success.

Academic Achievement a) Behavioural characteristics of the Primary Behaviour:

There may be underlying causes for the behaviours that lead to school disruption as well as other contributing factors. For FASD students some of the possible contributing factors to school disruption

An estimated 9 in every 1000 children born in Canada have FASD (Health Canada, FASD: A Framework for Action, 2003).

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may include the following primary disabilities caused by brain anomalies.

Arithmetic Disabilities Attention deficits Delayed Reaction Time - Students with a Fetal Alcohol Spectrum

Disorder may process information slower and less efficiently than their peers.

Difficulties with Abstraction - often seen as a difficulty understanding consequences.

Difficulties transitioning Between Activities Difficulties with Verbal Learning - Students with a Fetal Alcohol

Spectrum Disorder may learn fewer words. Difficulties with Visual-Spatial Learning - Students with a Fetal

Alcohol Spectrum Disorder often have difficulty replacing objects in their original position.

Disorientation in Time and Space - Often seen as a difficulty perceiving social cues.

Impulsivity - Often seen as poor frustration tolerance. Memory Impairments Difficulties Generalizing


As young children with FASD enter the school system at kindergarten or grade one, their educators face new challenges. This includes their teachers and educational assistants, administrators, office staff, custodians, bus drivers and any others working with the students. All are left wondering how to meet the educational needs of these students, keep other students and themselves safe and meet all the other expectations that society has for its schools. Although they present challenges to the education system it is possible for FASD children to be successful within different parameters. For these students to achieve success all educators must change their expectations of these students. Parameter change is a critical concept and things must change for these students to succeed.

c) Interpretation of behaviours when expectations are not met:

Students with FASD generally present themselves in two ways, the quiet and seemingly well behaved little person who “just doesn’t seem to get it” as well as his or her peers (looks like ADD) and the acting out, uncontrollable child who bites, kicks and punches peers and school staff. (Looks something like ADHD). The latter type of children

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is quickly identified as troublemakers and often faces “Safe School” suspensions even in kindergarten. Neither, child learns as well as their peers and achievement deficits are either immediately apparent or appear by the end of the junior division or grade 4. There is a third, less likely, variant of the child with FASD who has a fairly high IQ but poor behavior and attitude. They never appear to meet their potential and can be very disruptive. Most of these students do not display facial abnormalities.

d) Environmental Accommodations: (for the prevention of secondary behaviours)

An early diagnosis of FASD is considered essential for success. Doing nothing or maintaining the ‘status quo’ of what we are doing now in education will almost ensure a lifetime of failure for these students and huge social costs for Canadians. Educators, therefore, play a pivotal role in the life-long success of a student with FASD.

There are three adapted educational environments which can be identified to help almost all students with FASD, diagnosed or not, succeed and develop their inherent skills. All of these work, but none are easy or inexpensive.

A special class or school just for students with FASD students, using dedicated FASD techniques

Home schooling for one or two children with FASD, using FASD techniques

Regular classroom with integrated Special Education or Special Education withdrawal for FASD techniques.

Special Class: A classroom environment designed for students who display severe behaviour resulting from FASD would include an environment as follows;

low stimulus environment low enrolment classroom focus on social skills, behaviour and academics strong consistent classroom agenda individual education plans predictable routines and expectations of behavior plan consistently reinforced by Teacher Assistants and Support

personnel consistent consequencing

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Speech therapy and occupational therapy

Home Schooling:

Some parents and caregivers will opt for home schooling for their children with FASD. Students who are frequently on school suspension for “misbehaviour” resulting from stimulus overload and an inability to control impulses may do much better at home in a safe, predictable and low stimulus environment.

Integrated FASD Special Education Since the special classroom described above is expensive and most people cannot home school their children, reality dictates that most students with FASD will need to be accommodated in regular classrooms with some Special Education integrated into their program in a way that meets site-based school plans (Program Adaptation, Classroom Assistant, Withdrawal etc.)Any student who has been assessed as possibly having FASD should receive a thorough medical and psycho-educational assessment in early childhood. Ideally, the child’s Parents/Caretakers, Physician, Educators, Therapists and Social Support Workers will meet and begin to develop a realistic, lifelong plan of communication and care to minimize the development of secondary disabilities.All students with FASD receiving Special Education should have a diagnosis and an IEP describing appropriate educational strategies. The IEP should reflect individual student strengths and deficits identified from psycho-educational and other FASD assessments. These assessments should include speech/language, occupational therapy and developmental levels. Educational plans resulting from testing are described in the IEP that should focus on functional skills that will have broad applications. Students with FASD, no matter how they are labeled, will not succeed without effective Special Education support. It is critical that educators understand the range of effects of FASD on students and which students probably have FASD even if it is labeled as something else. Educational professionals should never try to diagnose a student, only assess and recommend a professional diagnosis if FASD (or any other serious condition) is suspected.

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When it comes to educational subject’s students face many challenges within the various subjects. Below are lists of difficulties FAS students face on a daily basis in school and some recommendations of strategies to use to assist FAS students with their challenges. Reading and Writing

FASD Students would have trouble with:

Learning sound/symbol associations Identifying main ideas, making inferences, making predictions Getting started, organizing thoughts and details, and putting

them in written form Understanding figurative language, some forms of humor Abstract thinking and problems solving skills Difficulty with getting started with writing, organizing thoughts in

sequential order, knowing what details to add and translating their ideas to written form

Strategies to help overcome difficulties:

Keep the number of instructions, and the explanations, short. Use graphic organizers, and word webs. Stop at key points to check for comprehension. Make sure students understand what to do. Having students

repeat back the instruction verbatim does not ensure understanding; it is better to have them explain the instructions in their own words or demonstrate what they should do.

Give instructions in more than one way: verbal and visual. Use lists, such as a print or pictorial checklist for daily routine or

daily work. Students need to learn how to use a list.

Slow the tempo and wait at least 10 seconds for students to process and organize a response.

Use gestures and visual signals; exaggerate the signals when the message is important.

Use visual aids to accompany language messages. Be concrete and specific; show students what is expected and

how to begin the task. Non-compliance may mean that the message was too ambiguous.

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Remember these 5 words when teaching the

FASD students;

Structure

Consistency

Brevity

Variety

Persistence


Recognize that students may not understand or may misunderstand complex language (e.g., negatives, passive verb construction).

Enlarge font and spacing on academic worksheets. Reduce the amount of text and put few questions on a page.

Help students to feel comfortable asking questions (and asking again, if necessary) when they do not understand.

Use sequential, repetitive teaching strategies which build on students’ prior knowledge base.

Check in periodically with students to ensure that they understand the task.

Where available, consult with a reading clinician.

Mathematical Skills


understanding symbolism, meanings of symbols responding to a large number of computations on a single page learning multiplication tables and other mathematical concepts

and operation Memorizing math facts Computations and problem solving Life skills concepts (i.e. Time, money) Temporal concepts (i.e. Before/after, yesterday/tomorrow, telling

& judging the passage of time)


Students may need to continue using number lines and concrete manipulatives.

Students may need to practice math facts daily for short periods throughout the school year for the facts to become automatic.

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Be alert to the possibility of students freezing under the pressure of working fast in timed tests. Make allowances for extended time on tests and assignments.

Reduce the number of problems on the page so students are not overwhelmed.

Enlarge the font size and spacing of the questions. Put all the problems of one kind on one page and add different kinds of problems to the same page gradually.

Use a highlighter to help students follow instructions, such as where to start and where to stop.

Students with problems in spatial organization can use graph paper to keep columns and figures straight.

Drawing an arrow above a question and having the arrow point in the direction the question needs to be done for students whom have directional confusion

Allow students to use a calculator for basic computations. Be creative in presenting math concepts and problem solving

with concrete representations (including time and money). To develop and reinforce the sense of time and time sequences

use calendars and written schedules, concrete visual representations such as sand timers, stop watches

Focus on practical, functional math especially in the context in which students will use it. Flyers and other print materials from retail outlets are useful. They provide both pictorial and numerical cues of typical everyday items common in a student’s life.

Find ways to help students get organized and take on responsibility.

Use other means of technology for presentation. For example, use books on tape, overhead projectors or computer resources.

Use multi-modal teaching strategies for instruction delivery. For example, use kinesthetic learning, scripting or role playing.

Use songs or poems to help teach math concepts.

Science Skills

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using/understanding science vocabulary demonstrating abilities in recording, interpreting and discussing

observations moving from computations with concrete materials to mental

problem solving problems with conducting experiments using equipment and problem-solving with an emphasis on

education and inference lack the fine-motor skills necessary to independently manipulate

scientific equipment (eg. a microscope) activities such as slide preparations, staining, adjusting mirrors,

focusing and orienting the image in the visual field may present great difficulties for some students

may have difficulty understanding oral instructions/directions concerning what to look for, and may have some difficulty describing their observations

difficulty reading lab manuals

some FASD may need a compelling reason to learn science


Allow an alternate setting to complete work or tests. Provide students with advance organizers of key scientific

concepts. Adapt the pace of activities. Foster personal involvement through the study of areas of

science that directly affect the student, such as eating and nutritional needs, the nervous system, the brain and how it functions and rehabilitative technology.

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Exemplify scientific ideas through the use of concrete materials such as models.

Arrange for specialized adapted laboratory equipment, such as lower lab tables and specialized microscopes.

Build on understanding by reintroducing information and vocabulary in new contexts with new sub-issues.

Use alternate texts at an easier reading level. Use activity-oriented materials which require less vocabulary,

less independent reading and less written work. Keep work samples for student reference. Use computer programs that provide opportunities for scientific

practice and recording results. Establish a computerized lab report format. Develop post and/or provide material safety data sheets as well

as safety checklists for use of any equipment. Use pictures on the checklist to augment comprehension.

Clearly label all material and equipment. Be alert to the possibility of students freezing under the pressure

of working fast in timed situations. Make allowances for extended time on tests and assignments. Assistance may be required with experiments where procedures are time limited, eg. Working with plaster that hardens quickly.

Use a highlighter to help students follow instructions, such as where to start and where to stop.

Allow students to use a calculator for basic computations. Find ways to help students get organized and take on

responsibility. Use multi-modal teaching strategies to deliver instruction. (ie.

kinesthetic learning, scripting, or role playing) Provide a variety of ways for students to practice new vocabulary

and tasks, such as team games, software programs that provide drill and feedback, worksheets, peer coaching and short daily quizzes.

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Use cooking and other food related activities to augment science curriculum outcomes.

Fine Arts


using/understanding fine arts vocabulary sustaining interest until the completion of a project improvising with materials, props, costumes, music and voice may be too noisy and over-stimulating frustrating remembering lyrics for songs or notes to play Musical instruments can also be challenging in their use and the

noise they produce Significant delays in gross and fine motor skills development

which influences their acquisition skills


Provide students with co-operative and other forms of group learning.

Connect new concepts to the real world of experience. Use multi-sensory experiences in activities. Use multi-modal teaching strategies to deliver instruction. For

example, use kinesthetic learning, scripting or role playing. Provide direct teaching on social skills and etiquette for

performance and audience. Adapt the pace of activities (slow down). Use concrete materials such as models or pictures. Foster personal involvement through the study of areas of fine

arts that directly affect the student. Keep work samples for student reference.

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Find ways to help students get organized and take on responsibility.

Provide a variety of ways for students to practice new vocabulary and tasks, such as team games and software programs.

Use peers, student tutors or volunteers to assist. Use educational assistants to work with small groups of students,

as well as with an identified student with FASD. Use consultants and support teachers for problem-solving and to

assist in developing strategies for fine arts instruction. Use art to label and teach language of the tasks and the

emotional context of the situation. Provide written words or pictures for songs and notes.

Teaching Suggestions

Multi-sensory, whole brain approach provides the greatest opportunity for understanding

Structure provided through teaching social skills or patterns of social behavior

Use formal and informal assessments to help develop a plan to draw on a students’ strengths

Help develop and support students’ self-esteem Teach through the context of daily life Calm, nurturing, structured learning environment.

Memory Skills

Difficulty with memory is a huge issue for students with FASD. Memory requires students to follow through a three stage process of encoding, storage, and retrieval. A student with FASD can experience difficulty in any of these areas. Students are able to remember and access more concrete and visual learning, and find abstract information much harder to retain.a) Primary behavioral characteristics:

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Non-response or unable to answer questions Forget how to do a task that has been completed many times

before Forget classroom or school rules and routines

Sourced from: Healthy Child Manitoba (2009) What educators need to know about FASD: working together to educate children in Manitoba with fetal alcohol spectrum disorder. Winnipeg, MB: Healthy Child Manitoba and Manitoba Education, Citizenship and Youth.b) Values and Expectations in the school environment

The school system values and expects Children to follow rules Students will learn a skill or information and move on Answering questions orally shows intelligence Abstract thinking is required in the curriculum

c) Interpretation of behaviors when expectations are not met.

Refusal Bad Parenting Defiance Unintelligent

d) Environmental Accommodations:

Routine, predictability and repetition are important for both the daily schedule and in learning tasks.

Slow down and explicitly link learning to previous learning. Structure assignments to explicitly teach sequencing, categorizing

and organization information within it. Structure lessons to include pre teaching, reminders, and post

teaching activities. Alter expectation and teach students to find information rather

than memorizing it. Provide concrete learning opportunities

o Kinesthetico Experientialo Relational

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Build on strengthso Visual cues o Relate learning to student’s experiences

Allow for the variability in memory from day to day in order to prevent anxiety

Leave and come back to tasks that are not suddenly not successful Refrain from telling a student “But you know this!” Educate students who are ready about the nature of their

impairment e) Learning Strategies:

Visual Schedules

Used a reference so students do not need to memorize routine

Provides consistent cues about daily activities

aids in reducing anxiety around transitions

Personal Dictionary

own personal reference book Includes digital pictures of students involved in their learning Includes pictures students take to help them learn (uses visual

strengths) A resource for student to engage in pre and post teaching as well as

a reminder in the midst of a lessonMultiple Intelligences Planner

a teaching tool that allows teachers to differentiate learning and assessment

focuses on students strengths gives equal weight to visual, kinesthetic, relational, and experiential

learning which are often strengths for students with FASD

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older students can learn about their strengths and given a choices around ways to learn and be assessed

MULTIPLE INTELLIGENCES PLANNER

TopicLogical/Mathematical Intelligence

Verbal/Linguistic Intelligence

Body/KinestheticIntelligence

Visual/Spatial Intelligence

Musical/Rhythmic Intelligence

InterpersonalIntelligence

Intrapersonal Intelligence

Naturalistic Intelligence

Lesson Planning pyramid

we often present a lot more information and skills than needed to meet curricular outcomes

the pyramid helps teachers pair down the amount some students are taught and responsible for while still meeting curriculum outcomes

strategy allows for a slower pace of learning and time to re-teach students while other students continue on with other enrichment concepts and skills

The strategy also allows for adaptation in instructional methods and assessment.

What some students will

learn.

What most students will learn.

What ALL

students will learn.

Adapted from: Thomas, J. (1996) Success for All Learners. Winnipeg, MB: Manitoba Education and Training.

UNIT PLANNING PYRAMID

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Executive Functioning and Abstract Reasoning Often referred to as common sense, executive function and abstract reasoning includes a myriad of skills that children with FASD have great difficulty with. These include inhibition, flexibility of thinking, working memory planning, fluency of thought, predicting, connecting cause and effect, judgment, strategy employment and organization.

Students with FASD have difficulty relating cause and effect and so often do not learn from repeated consequences. What Educators need to Know suggests three reasons for this difficulty:

The initial behavior is impulsive Sometimes there are not consequences for behaviour

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Consequences and circumstances change and students find it difficult to generalize.

a) Behavioral characteristics of the Primary Behavior:

Difficulty predicting consequences of a behavior Difficulty making and keeping friends Difficulty with boundaries—stealing, lying Overly friendly and affectionate Preservative or stubborn Poor organizationSourced from: Healthy Child Manitoba (2009) What educators need to know about FASD: working together to educate children in Manitoba with fetal alcohol spectrum disorder. Winnipeg, MB: Healthy Child Manitoba and Manitoba Education, Citizenship and Youth.


The school system value and expects:

Breaking boundaries breaks relationships Students must follow rules Authority recognized and respected


Defiant Mean/ Bully- I added this Bad Deliberately Defiant

d) Environmental Accommodations: (for the prevention of secondary behaviors)

Think brain not blame and be conscience of what is in the student’s control and what is not—allow for different expectations

Allow for time and support for consequences to be immediate, corrective, and consistent.

Reteach concepts in different settings Teach skills and routines through demonstration

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Meet with students to formulate solutions and problem solve in a directed, consistent, and structured way

Break down tasks into smaller parts and present visually to aid with organization and retrieving and planning with information

Minimize transitions and prepare the student for them Provide a calming space for students and allow them to calm

down before engaging Do not use too much language Provide limited choice and be firm Adjust workload to achieve closure for tasks Provide a safe, calm place for cooling down, prior to de-briefing. Anticipate and prevent problems by providing close and constant

supervision or partnering with peers. (buddy-system or peer-tutor)

Break organizational tasks into small chunks (include picture cues if required).


Take the time to talk to the student with FASD. This can help you know how they think, and can help develop an appropriate plan.

Be as consistent as possible when imposing consequences.

Organizational aids

Advanced cueing such as a: cueing the student to look at the visual schedule visual timer handing a student a related object for the next task to carry using a traffic light chart with just started, almost done, and

finished symbols visual schedules visual lists for tools required for learning graphic organizers colour code subjects visual cues for routines and expectations

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Re-teach concepts Consider the students’ verbal and memory limitations when

working through an incident. Be aware that the student may not learn from experience and

may repeat the same errors many times. (sometimes inconsistently)

Social Stories

include a narrative and pictures that walk a student through social situations they have difficulty with

they allow for teaching before a situation occurs rather than during when students are upset and unable to comprehend

Helps problem solve especially if student s can participate in writing them.

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External Brain

persons with FASD are at risk of making poor and destructive choices

provide student with a mentor or mentors (an External Brain) in

order to help guide, supervise, and advocate

Attention Deficit Hyperactivity Disorder (ADHD)a) Behavioral Characteristics of the Primary Behaviour:

Some students with FASD have problems maintaining their focus which makes it very difficult for them to learn. The regular classroom can be over stimulating. It is important for teachers to try and keep visual and auditory distractions to a minimum.Some primary behavioural characteristics include:

becoming easily over stimulated easily overwhelmed distractible impulsivity hyperactivity

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b) Fit Within Environments: Values and Expectations: pay attention ignore distractions sit still stay on task listen and learn

c) Interpretation of Behaviours When Expectations Are Not Met:

not trying off task undisciplined disobedient work avoidant acting out

d) Environmental Accommodations: for Prevention of Secondary Behaviours:

Reducing visual distractions is very important. Materials that are not being used should be put in cupboards or boxes and not stored out in the open. Avoid distracting decorations such as mobiles hanging from the ceiling. Reducing the brightness of the lighting may need to be adjusted along with the walls being painted in neutral tones.

Auditory distractions must be limited as much as possible. The teacher’s voice should be louder than any background noise. It also helps to have the child sit close to the source of information. It is also important to teach the students to recognize when there are too many distractions and go to a quieter working space. It needs to be clear however that this is not a punishment; instead it is a space that will help with success. For hyperactive students, the teacher needs to think of ways for movement breaks without distracting the other students in the class. For some students, physical activity followed by a quiet activity helps. However, for others physical activity could be over stimulating and might need different movement breaks such as taking the attendance to the office.

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e) Learning Strategies for Prevention of

Secondary Behaviours:

use concrete reinforcements or reminders teach students to use self-talk to help stay focused students who need stimulation of movement could do activities,

such as reading, in a rocking chair teaching concepts through music can be effective rhythmic activities such as choral reading, spelling and math

chants are effective in holding attention make each activity brief

Adaptive SkillsThe term Adaptive Skills refer to the ability of performing skills crucial to function independently in everyday life. Some FASD students have trouble functioning independently along with understanding daily life skills.

a) Behavioral characteristics of the Primary Behavior:

Students with FASD may experience difficulty functioning independently and acquiring daily living skills.Some Adaptive Skills needed may include:

Eating; feeding self, using utensils, table manners Performing basic hygiene Using a toilet

Rocking chair for movement

Working carrels help to block out distractions

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Sense of direction Crossing the street safely Using a telephone Knowing your home address and phone number

Basic housecleaning tasks and care of possessions Being on time for school, appointments and work Literacy skills; basic reading, writing, and spelling

b) Fit Within Environments: Values and Expectations:

Act your age Be responsible Be appropriate Learn the first time and remember day to day Keep up, try harder

c) Interpretation of Behaviours When Expectations Are Not Met:

Poor social skills Acting like a baby Inappropriate Over-protective parents Not trying Lazy

d) Environmental Accommodations for the Prevention of Secondary Behaviours:

Teaching Adaptive Skills involves:

Modeling, role playing Guided practice

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Praise all successes, give guidance when difficulties arise Use of the same language and process between home and

school Immediate, direct feedback Re-teaching Visual cues

“The shift is from seeing a child as one who won’t do something, to one who possibly can’t” (Diane Malbin M.S.W.)

e) Learning Strategies for Prevention of Secondary Behaviours:

Strategies Include: Include students when developing solutions to problems. Set limits and be consistent. Encourage positive self-talk. (i.e. “I can do this.” “It’s okay to ask

for help”) Develop consistent daily routines with the use of visual steps. Review and demonstrate classroom rules as needed. Be aware that unwanted behaviour is a cue that some element

of the environment needs to be adapted.

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Support SystemsFor Parents

Manitoba FASD Centre

Phone: 204-235-8866 or visit www.fasdmanitoba.com

Fetal Alcohol Spectrum Disorder ProgramPhone: 204-925-3414

Provincial Supported Living ProgramCheck regional listings at www.manitoba.ca/fs/pwd

Community Living Manitobawww.aclmb.ca

The This is Me interactive CD-ROM program uses “Me”, an animated character affected by FASD, and his classmates, teacher, coach and father in a range of common social scenarios that demonstrate typical behaviours and strategies to work with them. http://www.mefasd.com/ThisisMe.pdf

http://www.gov.mb.ca/cgi-bin/exit.cgi?http://www.aclmb.ca

http://www.manitoba.ca/fs/pwd

http://www.fasdmanitoba.com/

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Interagency FASD Program (a Program of New Directions)

Phone: 204-582-8658 or visit www.newdirections.mb.ca/IFASD/index.htm

FASD Information Manitoba1-866-877-0050

FASD outreach TeamPhone: 204-945-2295

PartnersaNew.inc (Services available in the South Eastman area.)Phone: 204-371-9721

Stepping Out on Saturdays Manitoba (S.O.S.MB)Phone: 204-235-8874 or toll free: 1-866-314-0501Respite day camp for children 3-12 years.

Spectrum Connections FASD Programc/o FASD Life’s Journey Inc.Phone: 204-772-1591

FASD Life’s Journey Inc.204-772-1591 or visit www.fasdlifesjourney.ca

Coalition on Alcohol and PregnancyVisit www.capmanitoba.ca

Healthy Child Manitoba OfficePhone: 204-945-2266 or toll free: 1-888-848-0140Or visit www.gov.mb.ca/healthychild

Manitoba Child Care Program219–114 Garry StreetWinnipeg MB R3C 4V6

http://www.gov.mb.ca/healthychild

http://www.capmanitoba.ca/

http://www.fasdlifesjourney.ca/

http://www.newdirections.mb.ca/IFASD/index.htm

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Child Care Information ServicesPhone: (204) 945-0776Fax: (204) 948-2625Toll-free: 1-888-213-4754

Subsidy Information Services102–114 Garry StreetWinnipeg MB R3C 1G1Phone: (204) 945-0286Fax: (204) 948-2143Toll-free: 1-877-587-6224

For Educators Fetal Alcohol Spectrum Disorder Program

Phone: 204-925-3414 MECY: Special Needs Funding:

www.edu.gov.mb.ca/k12/specedu/funding/index.html

Special Needs Services Grant:

www.edu.gov.mb.ca/k12/specedu/ssa_grant.html

Children’s Therapy Initiative:

www.edu.gov.mb.ca/k12/specedu/intersectoral/cti/index.html

Healthy Child Manitoba:

http://www.edu.gov.mb.ca/k12/specedu/intersectoral/cti/index.html

http://www.edu.gov.mb.ca/k12/specedu/intersectoral/cti/index.html

http://www.edu.gov.mb.ca/k12/specedu/ssa_grant.html

http://www.edu.gov.mb.ca/k12/specedu/funding/index.html

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FASD Strategy: www.gov.mb.ca/healthychild/fasd/index.htm andwww.gov.mb.ca/healthychild/fasd/fastfacts.html

Manitoba's FASD Strategy Healthy Child Manitoba's FASD Initiatives Connecting with FASD-related Supports and Services

Adult Services Vocational Rehabilitation Services: access a counselor

through Manitoba Family Services and Housing.School to work transition Program: www.gov.mb.ca/fs/locations/winnipeg.html

Sprectrum Connections: a new team to help people living with FASD to navigate issues around housing, finances, health care, educational training, recreation, crisis services, family connections, and mentoring and addictionsVisit: www.gov.mb.caéhealthychildéfasdéindex.htm#1

FASD Life’s Journey Inc.17-794 Sargent Ave. Winnipeg, MB.Phone: 204-772-1591 or visit www.fasdlifesjourney.ca

Community Living Manitoba

http://www.fasdlifesjourney.ca/

http://www.gov.mb.ca/fs/locations/winnipeg.html

http://www.gov.mb.ca/healthychild/fasd/index.html



http://www.gov.mb.ca/healthychild/fasd/fastfacts.html

http://www.gov.mb.ca/healthychild/fasd/index.htm

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6-120 Maryland St.Winnipeg MB R3G 1L1Phone: 204-786-1607 www.aclmb.ca

Changes Day Program8 -719 Sherbrook StreetWinnipeg, ManitobaR3B 2X3204-953-5301

Employment and Income Assistance (EIA)Visit these websites for persons with disabilities:www.gov.mb.ca/fs/eiafacts/starting_a_job.htmlwww.gov.mb.ca/fs/eiafacts/income_disabilities.html

Provincial Supported Living Programs (SLP): check regional listings at: www.manitoba.ca/fs / pwd

Fetal Alcohol Sprectrum Disorder ProgramMennonite Central Committee3rd Floor, 1200 Portage AvenueWinnipeg, MB. R3G 0T5Phone: 204-925-3414

Substitute Decision Makers: Vulnerable Persons actOffice of the Vulnerable Persons’ commissioner:www.gov.mb.ca/fs/vpco/index.html

http://www.gov.mb.ca/fs/vpco/index.html

http://www.manitoba.ca/fs/pwd

http://www.gov.mb.ca/fs/eiafacts/income_disabilities.html

http://www.gov.mb.ca/fs/eiafacts/starting_a_job.html

http://www.gov.mb.ca/cgi-bin/exit.cgi?http://www.aclmb.ca

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Resources www.livestrong.com/article/14717 Retrieved on May 16, 2010

http://www.worcestershire.gov.uk/cms/PDF/49598%20FASD%20Strategy%20web1.pdf Retrieved on May 16, 2010www.hss.state.ak.us/fas/summit05/book/WB2.pdf Retrieved on May 16, 2010 www.fasdcenter.samhsa.gov/documents/Reach_To_Teach_Final_011107.pdf Retrieved on May 16, 2010http://education.alberta.ca/media/414096/fasd3.pdfwww.fasdoutreach.ca Retrieved on May 16, 2010http://www.intellectualdisability.info/mental_phys_health/fetal_alcohol_mukherjee.htm retrieved on May 16, 2010. http://people.uwec.edu/piercech/FAS/fasfacejohn.gif, retrieved on May 17, 2010.Children’s Research Triangle, Chicago, Ill. http://www.childstudy.org/clinical_services.php. Retrieved on June 1,2010 www.fascets.org/conceptualfoundation.html. (May, 2010)

http://www.fascets.org/conceptualfoundation.html

http://www.childstudy.org/clinical_services.php

http://people.uwec.edu/piercech/FAS/fasfacejohn.gif

http://www.intellectualdisability.info/mental_phys_health/fetal_alcohol_mukherjee.htm

http://www.intellectualdisability.info/mental_phys_health/fetal_alcohol_mukherjee.htm

http://www.fasdoutreach.ca/

http://education.alberta.ca/media/414096/fasd3.pdf

http://www.fasdcenter.samhsa.gov/documents/Reach_To_Teach_Final_011107.pdf


http://www.hss.state.ak.us/fas/summit05/book/WB2.pdf

http://www.worcestershire.gov.uk/cms/PDF/49598%20FASD%20Strategy%20web1.pdf


http://www.livestrong.com/article/14717

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http://www.hss.state.ak.us/fas/AKfiveyrgoal/printable.htm (June 2, 2010)http://www.worcestershire.gov.uk/cms/PDF/49598%20FASD%20Strategy%20web1.pdf Retrieved on May 12, 2010‘Making a Difference’, Yukon Department of Education, Canada, 2006 www.hss.state.ak.us/fas/summit05/book/WB2.pdf Retrieved on May 16, 2010www.fasdcenter.samhsa.gov/documents/Reach_To_Teach_Final_011107.pdf Retrieved on May 12, 2010

http://education.alberta.ca/media/414096/fasd3.pdfwww.fasdoutreach.ca Retrieved on May 16, 2010

http://come-over.to/FAS/PDF/FASManual3.pdf: Retrieved on May 16, 2010

What educators need to know about FASD: Healthy Child Manitoba (2009) working together to educate children in Manitoba with fetal alcohol spectrum disorder. Winnipeg, MB: Healthy Child Manitoba and Manitoba Education, Citizenship and Youth.Teaching Students with Fetal Alcohol Spectrum Disorder, Gov.of AlbertaMalkin, D.,“FASD and Standard Interventions: Poor Fits?” BCAEA Newsletter. (May, 2010)Malisza, K., Allman, A., Shiloff, D., Jakobson, L., Longstaffe, S., Chudley, A. (2005). Evaluation of spatial working memory function in children and adults with fetal alcohol spectrum disorders: A functional Magnetic Resonance Imaging Study. Pediatric Research, 58 (6), 1150-1157.Sood, B., Delaney-Black, V., Covington, C., Nordstrom-Klee, B., Ager, J., Templin, T., Janisse, J., Martier, S., Sokol, R. (2001). Prenatal alcohol exposure and childhood behaviour at age 6 & 7 Years: I. dose-response effect. Perdiatrics, 108, (2), 1-9.Mukherjee, R., Hollins, S., Turk, J. (2007) Fetal Alcohol Spectrum Disorder: An Overview. Department of Environmental and Public Health, University of Wisconsin at Eau Claire. 2003-2004.

http://come-over.to/FAS/PDF/FASManual3.pdf

http://www.fasdoutreach.ca/

http://education.alberta.ca/media/414096/fasd3.pdf



http://www.hss.state.ak.us/fas/summit05/book/WB2.pdf



http://www.hss.state.ak.us/fas/AKfiveyrgoal/printable.htm

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FASCETS Conceptual Foundation: A Neurobehavioral Construct for Interventions For Children and Adults with Fetal Alcohol Spectrum Disorders (FASD). O”Connor, M., Frankel, F., Paley, A., Schonfeld, M., Carpenter, E., Laugeson, A., Marquardt, R. (2006). A controlled social skills training for children with fetal alcohol spectrum disorders. Journal of Consulting and Clinical Psychology, 74, (4), 639-648.

Loomes, C., Rasmussen C., Pei b, J., Manji, S., Andrew G. (2008) The effect of rehearsal training on working memory span of children with fetal alcohol spectrum disorder. Research in Developmental Disabilities, 29, 113–124.FASCETS Conceptual Foundation: A Neurobehavioral Construct for Interventions For Children and Adults with Fetal Alcohol Spectrum Disorders (FASD).

Healthy Child Manitoba. What Educators Need to Know About FASD: Working Together to Educate Children in Manitoba with Fetal Alcohol Spectrum Disorder. 2007.

Manitoba Education, Training and Youth. Towards Inclusion: Tapping Hidden Strengths: Planning for Students who are Alcohol Affected. 2001

Government of Alberta. Teaching Students with Fetal Alcohol Spectrum Disorder. 2004.

Stock Kranowitz, Carol. The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder. New York, NY: Penguin Group. 2005.

Symons, Cam Dr. The Exceptional Teachers’ Casebook. Brandon, MB. Brandon University. 2008

Coles, C., Strickland, D., Padgett, L., Bellmoff, L. (2007) Games that ‘‘work’’: Using computer games to teach alcohol-affected children about fire and street safety. Research in Developmental Disabilities, 28, 518–530.

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