Fetal Alcohol Spectrum Disorder (FASD)

Approximately 1% of all babies in Canada are born with Fetal Alcohol Spectrum Disorder (FASD), due to maternal consumption of alcohol during pregnancy. This alcohol exposure causes a permanent brain damage that result in growth problems, birth defects behavioral and learning disabilities as well as psychological problems.

The purpose of this case study is to provide information on FASD, describe its effects and diagnoses, and the permanent implications that affect Christine’s physical, mental, cognitive, social and emotional behavior. This case study provides as well a description of Christine’s history, her symptoms, her needs and the instruction strategies and curriculum adaptations suggested for her success.

Diagnosing (FASD) is relatively difficult, because it requires a multidisciplinary team of an occupational therapist, a physiotherapist, a speech therapist, a psychologist and a pediatrician, to assist the case. This team needs to first confirm if there was an exposure to alcohol, its timing, whether before or during pregnancy, the amount and duration of the consumption. Second, this team must test the effects of the brain damage on the neurodevelopmental impairment in addition to checking the range of functions of the brain and nervous system such as the memory, the IQ, the language and speech and the social skills, while the third thing they look at is some shared characteristics such as facial and physical features, even though that many children with (FASD) have faces that look perfectly normal.

Furthermore, problems associated with understanding social life and linking cause to effect will extend into FADS children’s adulthood. Moreover, attention problems and coping with everyday life, in addition to some concerns that they might pass through due to their behavioral problems might occur during their adolescence, such as addiction and illegal practices. FASD students’ support is needed, and it is important to provide them with the right environment, and understand their functioning ability, their mood, and their interests in order to provide them with the right support and intervention approaches. Collaboration and coordination of the counselors, general teachers, special education teachers and parents is very important because they will need support throughout their entire life, and they need to learn how to control themselves as they grow older.

Background information

In our case, Christine is an 8 year old child, in third grade; she was presented in a hospital to confirm her diagnosis with FASD and check symptoms such as facial abnormalities, developmental concerns, growth delay or maternal alcohol consumption. A team consisting of medical and multidisciplinary professionals including a trained FASD physician, an occupational therapist, a speech language pathologist, a psychologist, a counselor and Christine’s grandparents, helped with the evaluation and the diagnosis.

During the diagnosing process; data was collected to get historical information that helped the team in reaching a conclusion. The team included Christine’s school documents from teachers as well as the school psychologist’s evaluation, such as interviews, her IQ level, and her academic, social and behavioral records. The team has also included documents regarding Christine’s growth deficiency, and neurodevelopment domains records from the family physician. In their evaluation they also included information from Christine’s grandparents regarding their daughter’s alcohol exposure during and before pregnancy, and any medical problems related to drinking during pregnancy, as well as information related the Christine’s cognitive and behavioral concerns. The team included results from a neuropsychological evaluation that evaluated Christine’s level of neurocognitive functioning in areas such as learning, memory, and executive functioning.

In terms of Christine’s academic functions; she was assessed using an IQ test and scored below 70 which indicated a significant limitation in her intellectual functioning, and was diagnosed with a mild intellectual disability, that affected her conceptual learning, such as language, reading, writing, math, reasoning, knowledge and memory. Also it affected her social and communication skills, her independence, personal care, and her organizational and problem solving skills. Christine can learn and acquire new concepts and skills, but at a slower rate than her achieving peers. This reflects the essential functions to age- appropriate academic and social performance.

Christine is facing challenges due to her mother’s death with an overdose when she was 2 years old which affected her psychological development; in addition to she is believed to be at a greater risk of emotional and behavioral problems than other children in general, due to living with her grandparents that might be suffering from high levels of anxiety, and maybe a guilty conscience for losing their daughter in an overdose, which in turn reflects on Christine negatively. Christine’s behavior was affected as well as her intellectual ability in connecting actions with consequences, as a result Christine can sometimes have explosive tantrums, where she loses control over her emotions, and might pose a serious risk to herself and others by screaming and throwing objects around. It is important for her teachers as well as her grandparents to understand her emotions and communicate with her and teach her methods to manage her feelings and express herself, even though she doesn’t have the ability to manage her feelings, but she can still acquire skills to help herself. Teachers can help Christine with her tantrums according to their severity, for example staying calm, ignoring the screaming and shouting, time out for a short period of time or until she cools down, creating a reward system and praising her good behavior when she controls her temper, avoiding the triggers and creating a calm atmosphere which is also important in order to help her control her behavior.

Based on the assessment procedures and the appropriate evaluation of cognitive and behavioral functioning; the team reached a conclusion that Christine is diagnosed with FASD due to prenatal alcohol exposure that affected her developing brain and her nervous system that resulted in a mild intellectual disability as well as severe language delay, in addition to serious behavior problems.

The team has provided information to Christine’s grandparents, teachers and physicians; they stated that she was born with a brain damage that affected her brain function as well as its structure. This damage includes physical, health problems, behavior challenges, and social interaction troubles in addition to poor school performance.

Developing an Inclusive Education Plan

Christine needs intervention while she is in the general setting, there is great potential for her to lead a meaningful life even though she is having difficulties learning in her current environment. Such difficulties include her cognitive functioning ability that perform a slow mental processing, and poor thinking, organizing and planning strategies. She also has difficulty with her behavior regulation, attention and focus. In addition to her great declines in adaptive, social and communication skills, that could be related to the weakness in language. Despite all these difficulties, Christine has strengths and talents that teachers must become aware of and use them in tailoring a supportive program that supports and builds those strengths.

According to the inclusive education plan all students are welcomed to attend schools in age appropriate regular classes; they need to participate in all of the aspects of the life at school. It is important to understand that despite the difficulties in the learning environment, still Christine can acquire new information using a range of inclusive teaching strategies that can assist her with the transition such as differentiated instructions, considering all sensory methods, chunking information, breaking down tasks, and use hands-on activities. In addition to adapting a curriculum that focuses on developing social skills to ease her integration in the community

Special educators should collaborate with teachers to develop a behavioral and instructional support; different strategies can help Christine with her behavior disorder. A speech- language pathologist can set achievable goals, provide a reinforcement system, use self-monitoring charts, and teach her appropriate behavior by letting her observe her peers that show appropriate skills. Improving Christine’s social skills interaction could be achieved by determining her level of social competence and teaching her social skills that promote social relationships. Adaptations need to be applied for Christine’s behavioral problems which might include her input in the process of developing classroom rules and procedures that ensure a well-organized environment.

The physical arrangement has an impact on Christine’s behavior thus teachers should create a calming space where she can do a quiet work or an isolation spot when she can calm down during her temper tantrums, this must be done in a non-punishing manner. Christine will benefit from this life skill to calm down when needed. Teachers need to be consistent with applying misbehavior consequences, in order to prevent inappropriate behavior. In addition to developing a positive behavior support system will reflect positively on Christine’s success academically, socially and behaviorally such as teaching her self-management strategies and using a range of strategies to respond to her inappropriate behavior such as re-teaching, giving her a direct feedback, providing her with a chance to correct her errors, reinforcements, planned ignoring and praising success.

Intellectual functioning, includes how Christine understands and uses the language and describes what she knows, as well as her verbal and communication skills, and her poor ability to solve problems, her working memory and the processing speed all these factors affect her ability with completing her tasks accurately and quickly. It is helpful that teachers use visuals in addition to verbal instruction. Re-teach and provide opportunities to practice, modelling and guided learning, allowing her more time to complete assignments and tests, providing her with short and simple instructions.

Christine has a severe language delay, as a result she acquires language at a much slower rate than her typical peers, she struggles with “semantics” as well as “syntax”, and she might know the word but cannot retrieve it from her memory. Also Christine has difficulty processing information, interpreting and remembering it which affects her ability to follow directions and complete tasks, such problems affect her comprehension, association and generalization, sequencing, working and long term memory. Furthermore, Christine has a problem using the language appropriately; she struggles in taking turns, and greeting people. In order to help Christine with her reading and writing skills, teachers need to develop a balanced program that improve both of her decoding and comprehension skills using simple material with visuals, such as using a picture dictionary to aid her with the vocabulary, also it is important to develop her ability to differentiate and analyze sounds by using eye contact when speaking with her, also by using graphic organizers and checklists which can help her with her daily tasks; using enlarged font sizes in her worksheets and providing her with extra time to complete her assignments and tests, will help her with her intellectual abilities.

Christine struggles in understanding math symbols, learning mathematical concepts as well as memorizing math facts; she also has difficulty in problem solving and life skill concepts such as time and money. Christine needs more practice comparing to her typical peers to learn the basic math concepts before she reaches secondary school, she also gets overwhelmed by the large number of math problems in a single page. Teachers need to consider some modifications and accommodations for Christine to understand and succeed in math such as helping her use manipulatives, the number line and a calculator. Due to her weak memory she needs to practice math facts daily for short periods, or use kinesthetic learning method or songs to help her learn math concepts, in addition to reducing the number of problems in a single page and enlarging the font sizing. Developing graduated word problems and connecting them with real life settings is also important.

Memory skills are a major concern for Christine, she may not be able to respond to questions or complete a task, or even follow rules. It is important for the teacher to observe and assess Christine’s behavior and remind her with the rules using her senses and visuals to help her remember them. She must be taught how to organize information to learn a skill. Teachers must pre-teach, post- teach and remind Christine to better link and remember the material, Christine needs to learn mnemonic memory methods to find the strategy that works well for her.

Teachers need to have an open communication with Christine’s grandparents, to learn about their concerns, ask questions, collect information, and be aware of any changes that occurs in Christine’s life that might help with the intervention plan. Being a part of the team helps reduce the stress and avoid unwanted behavior, by adapting same strategies and consequences in all settings. Also having an open communication with the grandparents is important due to the short memory that Christine has, as she might forget an incident or something important that occurred during the school day that they need to know about. This positive communication can be achieved by using communication journals, phone calls or regular meetings.

Technology usage can help Christine in her learning, it can make her less distracted, motivate her, and provides her with her own space to work, in addition to the amount of information and visuals that are available. Computers and iPads have different scaffolding strategies that can help Christine create her own arts, or maybe type instead of write. Technology opens more doors for creativity and learning in an enjoyable and easy to use way, for example Christine can learn math skills using apps, and she can access digital books and tools and can help her with organizational skills that will reflect positively on her learning journey. Technology is a great tool for the teachers as well, as it allows them to differentiate instruction according to Christine’s needs.

In general, teachers need to adjust the academic expectations to match Christine’s developmental age, such as providing her with extra time to complete tasks and assignments, adjusting instruction to a slower cognitive pace, individualized instruction in areas such as math, and the focus on teaching her life skills.

Conclusion

It is very important for each teacher to know and understand the causes, the diagnoses and the degree of the brain damage that happened to the child, such knowledge is important because (FASD) occurs in all sides of the society due to unplanned pregnancy and not enough knowledge about the alcohol consumption side effects during pregnancy. The big challenge is that each child diagnosed with FASD is different according to the level of damage that happened to the brain, thus a different plan should be implemented according to the case.

Christine can learn in a supportive environment with her achieving peers, if provided with effective educational strategies that help her learn and prepare for her productive life. Thus, including and supporting Christine by special and general education teachers reaches beyond her acquisition of academic skills, it goes to placing her where she belongs in the community, by acknowledging her strengths, helping her make friends, and meeting her needs.

Christine has lost her mother, consequently creating a caring teacher- student relationship is important, getting to know her, understand the life she lives, and making her a partner in creating her own educational plan according to her interests and strengths, listening to her, and asking for her feedback, reflecting on her experience, and celebrating her success. In addition to collaborating with special teachers and counselors to ensure that the curriculum, social and life experience reflect her needs. All these points will help in improving her learning opportunities.