LEARNING CHALLENGES: 
fetal alcohol syndrome disorder

Definition

Fetal Alcohol Spectrum Disorder (FASD) refers to the array or spectrum of possible birth defects and brain damage that can result from prenatal alcohol exposure (PAE).  Alcohol use in pregnancy can affect the physical structure of the brain. As a result, the harm done by PAE is permanent and can result in life long challenges. Most people with FASD have average to above average intellectual abilities but may have weaknesses in areas such as executive functioning, self-regulation and adaptive functioning. Difficulties with learning, remembering, attending, and communicating may also be in evidence. Some individuals with FASD will be able to live independently while others will require lifelong supports.  In Canada, FASD is the leading known cause of cognitive and developmental disabilities.

Canadian Guidelines for the diagnosis of FASD were revised in December of 2015. These guidelines outline two possible diagnoses under the term FASD:

  • FASD with Sentinel Features – Sentinel features include: short palpebral fissure length (i.e. fewer millimeters between the inner and outer corner of the eyes than normal); smooth philtrum (i.e.  little or no indentation in the philtrum which runs between the bottom of the nose and the center of the upper lip); and, thin upper lip. In addition, there must be evidence of impairment in three neurodevelopmental domains (see below) or, evidence of microcephaly in infants and young children. Confirmation of prenatal alcohol exposure is not required.
  • FASD without Sentinel Features – There must be evidence of impairment in three or more neurodevelopmental domains and confirmation of prenatal alcohol exposure at a level known to be associated with neurodevelopmental effects.

In addition to these diagnoses, there is a designation of at risk for neurodevelopmental disorder and FASD, associated with prenatal alcohol exposure.  While not a diagnosis, this designation may be given to an individual when there is confirmation of prenatal alcohol exposure at a level known to be associated with neurodevelopmental effects and some indication of neurodevelopmental impairment in at least one domain. A child who receives this designation should be reassessed by a multidisciplinary team when he or she reaches school age.

Individuals who were diagnosed prior to December of 2015 may have a valid diagnosis of any of the following: Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (pFAS), Alcohol Related Neurodevelopmental Disorder (ARND), Fetal Alcohol Effects (FAE) or Alcohol Related Birth Defects (ARBD).

Neurodevelopmental Domains Affected by FASD 

  • Neuroanatomy or neurophysiology – brain structure
  • Motor skills
  • Cognition
  • Language
  • Memory
  • Attention
  • Executive functioning
  • Affect regulation (e.g. emotional control, mental health, dysregulation)
  • Adaptive behaviour
  • Academic achievement

Incidence

“In Canada, it is estimated that between 2 and 5 percent of people may be living with FASD making it the leading known cause of Developmental Disability. ” (Annual Report on the State of Public Health in Canada 2015 – Chief Public Health Officer of Canada)

Diagnostic Challenges

Limited diagnostic capacity in many communities and, in some cases, difficulty confirming prenatal alcohol exposure are factors that can make getting a diagnosis challenging.

Learning Challenges

  • Dysmaturity – social-emotional level may be half that of their chronological age and as a result their social skills are weak relative to same-aged peers. This can affect other areas of development as well and as a result, some skills may be at the level of same-aged peers and others may be delayed
  • Weaknesses in memory make repeating and re-teaching mandatory
  • Inconsistent performance from day to day - they have good days and bad days which leads to frustration for students and teachers. They may recall information one day but not the next day.
  • Do not learn from mistakes – keep making the same mistakes over and over
  • Usually require more time to process information and formulate answers (10 second kids in a one second world)
  • Often experience difficulty attending
  • Organizational weaknesses may make it difficult for them to start and continue doing a task or assignment
  • May perseverate and have difficulty stopping a task until it has been completed
  • Weak problem solving skills
  • Difficulty with abstract concepts such as time, math, money and ownership
  • Language weaknesses may result in difficulty understanding all of the information that they hear especially abstract language (e.g. soon, raining cats and dogs, wait a minute)

General Strategies

Individuals with FASD are unique and will present with their own strengths and weaknesses. Identify their strengths and build on them rather than focusing on their weaknesses.  They cannot be ‘fixed’ but with appropriate supports they can reach their full potential. Trying to ‘fix’ them can do irreparable damage.

  • Consistency, structure, routine are critical for a successful day. They provide predictability and comfort.
  • Reduce visual and auditory stimuli. Cover boards that are not being used, limit the number of items on their desks. Provide quiet areas. A calm and ‘safe’ environment is a strong need for success.
  • Do not remove supports that are working for them. Think of supports as a ‘wheelchair’ for the brain.
  • Given weaknesses in executive functioning and adaptive functioning, build interdependence and not independence. Have one or two ‘go to’ adults in the school that they can go to when they are feeling upset or overwhelmed
  • Remember, they are trying just as hard on a good day as they are on a bad day
  • See Education Essentials

Resources

Education Essentials FASD ONE

POP fasd – www.fasdoutreach.ca

Neurodevnet – FASD