Traditional Approaches to Parenting

Most caregivers parent the way they were parented. When they see good behaviour they reward it, and when they see “bad” behaviour there are consequences.  It is a commonly held belief that good behaviour encourages more good behaviour and consequences whether imposed or natural, discourage unwanted behaviour. This type of intervention is effective if the child is able to process the rules, remember the rules, and do the rules. When brain function is altered due to prenatal alcohol exposure children may not be able to do what is expected without help.

Think about a person whose eyesight is permanently damaged before they are born. No matter the reward or consequence they still won’t be able to see. What is needed is an intervention such as eye glasses or larger print. The same thinking applies to a person with FASD. If the person is unable to meet expectations due to a brain dysfunction the consequence or reward will have no effect on present or future behaviour.

Brain-Based Behaviour Management

The intervention needed to work around challenges caused by brain dysfunction depends on how the child is affected. The first step to determining a possible intervention is to identify the behaviours associated with the brain dysfunction. A psychology assessment conducted by a psychologist will provide this information. If a psychological assessment isn’t available it is possible to journal troubling behaviours. With the help of a detailed inventory of behaviours, a person working with a child may be able to determine which behaviours are brain based and from there develop strategies to help the child work around their challenges.

“A psychological assessment evaluates thinking, learning and behaviour. The assessment may include interviews, observation, testing and consultation with other professionals. . . A psychological assessment is helpful in identifying your child’s strengths and (challenges) and will lead to recommendations for both academic and behavioural intervention. By detecting problems, an assessment can be used to assist in planning your child’s school program, to identify needs for special services in school, and to help you access resources in your community” (SickKids.ca).

Consider the following interventions for working around brain-based challenges:     

• Create a visual schedule to show when changes in activity will occur. (For an example, see Visual Schedule)
• Create a visual routine as a reminder of the next task.
• Use a visual timer to show the passage of time to prepare for the beginning or end of an activity.
• Use verbal warnings to prepare for a change.
• Change the way you communicate changes in activity, for example, “First we are going to do X; then we will do Y.”

If the child has difficulty with organization consider

• colour coding storage bins for like items
• de-cluttering spaces so belongings are easily found
• explaining each step in the cleanup routine as they are cleaning up
• making a check list of materials needed for a task or a list of what needs to be done in a day

General Strategies

No one strategy or list of strategies will work in every situation, but these guidelines outline approaches that have worked in some situations.

Relationship: People with FASD do best with a person who believes in them, sees and builds on their strengths — a person they trust; a person who understands their challenges and helps them work around trouble areas.

Adjust Beliefs about the Meaning of Behaviour: Look at challenging behaviour through an FASD lens. The behaviour may appear to be wilful, but is it? If the behaviour is brain based, instead of trying to change it with rewards or punishments, try a strategy to work around it. 

Adjust Expectations: Consider whether expectations make sense given the person’s challenges.

Supervision and Support: Most people with FASD require active, “eyes on” supervision long after their same aged peers; some people need a high level of supervision their entire lives. The level of supervision and support needed will depend on what they’re good at and their level of challenge. 

Structure: Having a detailed, consistent plan for each day reduces stress and provides a sense of control and certainty. People with FASD don’t usually do well with unstructured time.

Routine: Routine refers to the actions and the order actions need to happen to complete a task. Doing the same thing in the same order at the same time each day helps people remember and reduces stress. The amount of detail in each routine will be different depending on the person’s ability.  For many children a visual routine posted in the area the action needs to take place helps children feel more independent. (For an example, see Visual Schedule)

Communication: Keep communication clear and simple. Be concrete and literal. Talk about what to do instead of what not to do. “Show me, don’t tell me.” Check for understanding by asking the person to repeat what you said in their own words. Use words they understand. Use the same words each time. Use visuals. Speak slowly and allow a lot of time for thinking. 

Sensory Strategies: Remove irritations; use natural light, de-clutter, decrease noise, use calming colours, remove tags from clothing, watch for fabrics or clothing that irritate.  Do calming activities that involve large muscles such as pushing, pulling, or squeezing.

Protective Placements

Protective Placements for Children with FASD

Children with FASD typically do best with a caregiver that has a positive, nurturing relationship with them, understands the disability and has the ability to adapt the way they parent to accommodate brain differences. The most commonly used strategies include a structured environment with consistent routines presented visually. Calming spaces or calming activities help children regulate emotions and behaviours. Successful caregivers are able to identify when behaviour is brain based and respond with appropriate interventions to avoid punishing children for their disability.

A study titled, Understanding the Occurrence of Secondary Disabilities in Clients with FAS and FAE conducted by Streissguth, Barr, Koga & Bookstein in the 1996 notes that there are protective factors that increase the likelihood of more positive outcomes for people with FASD. These protective factors include; a stable nurturing home, a diagnosis before the age of 6 (for early intervention), an IQ under 70 (to qualify for disability services), and never having experiencing violence against themselves.

The qualities of a protective placement: Caregivers who have the ability to:

• adjust expectations to match the child’s ability, and to avoid punishing a child for behaviour brain-based behaviour.
• recognize brain-based behaviour and adjust parenting style to provide appropriate guidance.
• adjust communicate style to work around language challenges.
• provide consistent structure, and routine that makes sense for the child.

When a child is raised in an environment where their strengths are developed and their challenges understood and accommodated destructive mental health issues (depression, panic disorder), early pregnancy, dropping out of school, trouble with the law, confinement (addictions treatment, jail), inappropriate sexual behaviour, alcohol and drug issues, dependent living and issues with employment are less likely. (Streissguth, Barr, Koga & Bookstein, 1996).    

Behaviour Management: Visual Schedule

Transition Routine

Visual Timer

Visual Routine for Toileting