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What I wish health professionals knew about FASD

What I wish teachers knew about FASD

Children, adolescents and adults will have severe neurodevelopmental impairments such as difficulties with language, memory, learning, motor skills, impulse control, hyperactivity and planning.

Some (<20% in Australia) will have distinctive facial features such as:

  • small palpebral fissures (length of eye opening),
  • smooth philtrum (lack of ridges between the upper lip and nose), and
  • thin upper lip

Individuals may also have other health issues such as problems with hearing and vision, kidney infections, congenital heart defects, and musculoskeletal conditions (rheumatoid arthritis and osteoarthritis).

People with FASD often present with a range of diagnoses. FASD can co-occur with trauma, intellectual difficulty, ADHD, ASD, mental health problems and specific learning disorders. 

Key messages for teachers

  • It's important that everyone uses the same language and the same messaging when working with people who have FASD. Having a flow of communication between home and school can create a stronger, more predictable and consistent environment for the child.
  • Acknowledgement from the person with FASD that they understand what you are saying doesn’t necessarily mean they have understood. Smiling and nodding and repeating back exactly what has been said doesn’t show understanding. Feedback from them and rephrasing if necessary is important.
  • Taking away an activity they enjoy (whether they have a particular interest in it or achieve some recognition for their skills) as a consequence for unwanted behaviour often doesn’t stop that behaviour from occurring again. Some individuals with FASD can have challenges learning from consequences or forget this learning from one day to the next. This should not be seen as defiant or intentional behaviour, rather a result of brain differences.
  • Conventional techniques such as time-outs may not work for children with FASD. Students with FASD can have difficulty learning from mistakes or learning from consequences. Having a safe place for a child to go to where they can calm down and express anger or frustration (with supervision, even if it is from a distance) can be a helpful strategy. Wait until a child has calmed down (which may not even be on the same day) and focus on re-teaching alternative behaviours for the area that they are having challenges in.

Key messages for health professionals

  • Learn more about assessment and diagnosis of FASD. Understanding the brain-based origins of FASD will help you to understand our children better and pick better interventions and strategies.
  • Most children with FASD don’t have distinctive facial features. Don’t use a lack of facial features to exclude an assessment for FASD. Missing a diagnosis of FASD just because a child does not have these facial features could mean suitable strategies are not implemented, leading them to face lifelong challenges without support.
  • Understand the complexity and uniqueness of a FASD diagnosis. What works for one person with FASD might not necessarily work with another. This diversity occurs because the areas of impairment vary from individual to individual with FASD.
  • FASD typically co-occurs with other conditions such as ADHD. FASD also exacerbates the effects of trauma.
  • People with FASD can be easily overwhelmed when there are too many different people interacting with them. Caregivers and family members can also be feeling stressed and overwhelmed. It can be helpful to take a coordinated and integrated approach to providing care - for example, having one health professional take the lead on case management and the sharing of information between professionals.
  • The reality of everyday life for someone living with FASD is not always reflected in the direct formal assessments results. For example, formal assessments take place in a quiet room, with one-to-one support and supervision, not in a noisy classroom with a 25:1 supervision ratio. It is always important to see children and young people across multiple contexts to gather an understanding of how they are functioning in different environments and settings.
  • It is important to seek input from those who have FASD, and it's equally important to draw on past history and the knowledge of parents/carers when developing support plans for individuals with FASD.
  • Many therapeutic services have been developed presuming people have neurotypical brains and will respond to interventions in particular ways. For example, they presume that if people really want to change they will make sure they turn up for appointments on time. They don’t understand that some people with FASD can have problems with the abstract concepts of time and others can have challenges with impulsivity. Conventional services may not always be suitable for people with neurodevelopmental impairments and FASD. These services need to be adapted to support those with specific impairments.

FASD has lifelong impacts on individuals, their families and carers, and the wider community. While everyone is different and has their own strengths and difficulties, these are some important things that people living with FASD wish you knew about them.

Find out what individuals and families say about living with FASD here.

If you are an individual living with FASD or a parent/carer or family member seeking support, you can contact NOFASD Australia.