The most important starting point in helping a student with Fetal Alcohol Spectrum Disorder to function effectively in school is for the staff (ie all who will come into contact with the child) to realize that the child has an inherent developmental disorder which causes him/her to behave and respond in a different way from other students. Many of their behavioural difficulties have a neurological basis.

They often have sensory issues, visual-spatial issues, attention deficits, memory deficits, and self perception issues. Irrespective of their IQ, they have an inability to think ahead, think about consequences, make choices and set long term goals. They lack motivation, have impaired judgement and are impulsive.

An Individual Education Plan is critical for success. It is extremely important to build on their strengths, make sure goals are realistic and re-evaluate expectations.

As with any other organically based disorder, it is important that their condition is "named." Too often, behaviours in these children are interpreted as “emotional," or “manipulative," or with some other term or label that misses the point that they respond differently to the world and its stimuli. Their behaviour is not within their control. It follows that school staff must carefully individualize their approach for each of these children. It will not work to treat them just the same as other students. The staff of the school need to explain the resons for these differences to the other students.

Dangerous behaviour by students with FASD is a result of the disability and usually an indication that their environmental needs are not being met. Exclusion will not lessen these behaviours and therefore is not an appropriate way to deal with them in the long term. Managing their behaviour is about predicting and preventing an unwanted behaviour before it happens. Appropriate services and modification to the NEP is necessary to ensure that the precursors to the behaviour are addressed, in order to prevent its recurrence.

These children often show a surprising sensitivity to the personality of the teacher. They can be taught, but only by those who give them true understanding and affection. They require a person who will show kindness towards them and humour. The teacher's underlying emotional attitude influences, both involuntarily and unconsciously, the mood and behaviour of the child.

Many children with FASD can be managed primarily in the regular classroom setting, as long as the environment is physically and psychologically safe and meets their need for structure and support. If learning problems are present, resource room or tutoring can be helpful, to provide individualized explanation and review.

Students with FASD often have language difficulties that may not be obvious. Their expressive language is often very good but their understanding is limited because of receptive language deficits. Direct speech services are sometimes necessary and the speech and language clinician at school can be useful as a consultant to the other staff regarding ways to address this problem.

The school counsellor can provide direct social skills training, as well as general emotional support.

All children will adapt and function more successfully when staff are understanding, supportive, and flexible.

Finally, a few children with very high management needs may benefit from the assistance of a classroom aide/mentor assigned to them.

The following guidelines will lead to more positive learning outcomes for children with FASD:

• They require an environment with low sensory stimulation (small classrooms, not too much clutter) It is important to be aware that children with FASD often have difficulty with sensory overload and self-regulation It is more appropriate to reduce the stimulation in a non-punitive way by providing a comfort corner shielded from the other students. (eg tent, cushions for comfort etc)
• The classroom routines should be kept as consistent, structured, and predictable as possible. Children with FASD often don't like surprises. They should be prepared in advance, when possible, for changes and transitions, including things such as schedule breaks, vacation days, etc.
• Rules should be applied carefully. Many of these children can be fairly rigid about following "rules" quite literally. While clearly expressed rules and guidelines, (preferably written down in simple clear language with visual cues", are helpful, they should be applied with some flexibility.
• There needs to be an understanding that behaviour is neurological and not wilful misconduct. It is not always appropriate for the rules to be exactly the same for the child with FASD as for the rest of the students – their needs and abilities to conform are different.
• Consequences for dangerous behaviour must be applied immediately. You will need to be creative. They need not be severe but they do need to be consistent. It is preferable to add a chore rather than take away a privilege as the child usually forgets what was taken away or does not make the link with the behaviour.
• Try to avoid escalating power struggles. These children often do not understand rigid displays of authority or anger and will themselves become more rigid and stubborn if forcefully confronted. Their behaviour can then get rapidly out of control, and at that point it is often better for the staff person to back off and let things cool down. It is always preferable, when possible, to anticipate such situations and take preventative action to avoid the confrontation through calmness, negotiation, presentation of choices, or diversion of attention elsewhere. Avoid asking ‘why’ questions.
• Staff should take full advantage of a child's areas of special interest when teaching. The child will learn best and show greatest motivation and attention when an area of high personal interest is on the agenda. Teachers can creatively connect the child's interests to the teaching process. One can also use access to the special interests as a reward to the child for successful completion of other tasks or adherence to rules or behavioural expectations.
• Most students with FASD respond well to the use of visuals and cues (again and again and again) eg. schedules, charts, lists, pictures, etc.
• In general, try to keep teaching specific and concrete and explain abstract words with actions and role-plays. Avoid language that may be misunderstood by the child with FASD, such as sarcasm, confusing figurative speech, idioms, etc. Work to break down and simplify more abstract language and concepts.
• Explicit, didactic teaching of strategies can be very helpful, to assist the child gain proficiency in "executive function" areas such as organization and study skills.
• Ensure that school staff outside the classroom, such as physical education teachers, librarians, etc., are familiar with the child's style and needs and have been given adequate training in management approaches. Those less structured settings where the routines and expectations are less clear tend to be difficult for the child with FASD.

A major area of concern as the child moves through school is promotion of more appropriate social interactions and helping the child fit in better socially. Formal, didactic social skills training can take place both in the classroom and in more individualized settings. Approaches that have been most successful utilize direct modelling and role playing at a concrete level. By rehearsing and practicing how to handle various social situations, the child can hopefully learn to generalize the skills to naturalistic settings.

It is often useful to use a dyad approach where the child is paired with another student to carry out such structured encounters. The use of a "buddy system" can be very useful, since these children relate best one on one.

Careful selection of a peer buddy for the child can be a tool to help build social skills, encourage friendships, and reduce stigmatization. Care should be taken, particularly in the upper grades, to protect the child from teasing both in and out of the classroom, since it is one of the greatest sources of anxiety for older children with FASD. These children are very vulnerable to exploitation.

Efforts should be made to help other students arrive at a better understanding of the child with FASD, in a way that will promote tolerance and acceptance. Teachers can take advantage of the skills these children have in other areas, in order to help them gain acceptance with peers. It is very helpful if the child with FASD can be given opportunities to help other children at times.

Many children with FASD require medication, although medication does not "cure" any of the core symptoms. Teachers should be alert to the potential for mood problems such as anxiety or depression, particularly in the older child with FASD.

In attempting to put a comprehensive teaching and management plan into place at school, it is helpful for staff and parents to work closely together, since parents often are most familiar with what has worked in the past for a given child. It is also wise to put as many details of the plan as possible into the NEP so that progress can be monitored and carried over from year to year.

Finally, in devising such plans, it can sometimes be helpful to enlist the aid of outside consultants familiar with the management of children with FASD such as behavioural consultants, psychologists, or physicians.

In complex cases a team orientation is always advisable.

Poor judgement may persist even when other developmental milestones are accomplished. The important thing to remember is that these factors are biological in origin and not always within the control of the child with FASD. What we can control and change is their environment. By modifying their environment we can optimize their ability to behave in a more appropriate manner and achieve success.

References:

Teaching Students with FASD – Building Strengths, Creating Hope 2004 http://www.learning.gov.ab.ca/k_12/specialneeds/fasd.asp

The FAS Community Resource Centre http://www.come-over.to/FASCRC/

FASD Strategies not Solutions www.betterendings.org/strategies_not_solutions.pdf

Online Asperger Syndrome Information & Support – Educational Implications Infhttp://www.udel.edu/bkirby/asperger/education.html#PAPERS