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Fetal alcohol spectrum disorder (FASD)

Information and resources to support children and young people with fetal alcohol spectrum disorder (FASD) in education and care.

Fetal Alcohol Spectrum Disorder (FASD) is a diagnostic term for severe neurodevelopmental impairments (generally seen as difficulties with physical activities, language, memory, learning and behaviour, including self-regulation) that result from brain damage caused by alcohol exposure before birth.

The effects of FASD may not be seen at birth, and may have different impacts in different situations. For example, linguistic abilities may appear “average” until they are expected to communicate about more complex subjects. People within the FASD spectrum will have damage to different parts of the brain which can cause structural and functional impairments which can be physical, cognitive and behavioural. Some people with FASD will have other birth defects such as heart and eye problems. Some people with FASD will have distinctive facial features, but most do not.  

Every person within the FASD spectrum will have strengths and difficulties in different areas. This depends on the parts of the brain that have been most damaged by exposure to alcohol. There is no 'one size fits all' for people with FASD and not everyone will experience the same difficulties.

Although the use of ‘fetal’ may imply that it only relates to babies, FASD has lifelong consequences and can be diagnosed in children, young people and adults.

Where there are concerns about a child the family should be encouraged to seek help from a health professional.  

Diagnosing FASD

FASD is often referred to as the ‘invisible disability’ as it often goes undetected. When children have no visible signs of alcohol exposure their problems may be wrongly blamed on poor parenting or on other disorders (for example Oppositional Defiant Disorder, ADHD or Autism). Assessment and diagnosis of FASD is important as it may provide answers for families and improve access to services that can improve life outcomes.

Assessment and diagnosis of FASD is undertaken by clinicians based on the Australian Guide to the Diagnosis of FASD and refers to FASD as a diagnostic term with two diagnostic sub categories:

  • FASD with three sentinel facial features
  • FASD with less than three sentinel facial features.

Key components of the FASD diagnostic assessment include documentation of:

  • history – presenting concerns, obstetric, developmental, medical, mental health, behavioural, social
  • birth defects – dysmorphic facial features, other major and minor birth defects
  • adverse prenatal and postnatal exposures, including alcohol
  • known medical conditions –including genetic syndromes and other disorders
  • growth.

Education implications of FASD

Children and young people on the FASD spectrum may demonstrate significant differences in competencies across a range of areas. Teaching strategies need to be based on an ongoing assessment of the child’s skills, needs, and abilities, not assumptions related to age. 
It is important to note that only approximately 30% of people with a FASD diagnosis have an intellectual disability, therefore adjustments to the curriculum may not be necessary or sufficient on their own to achieve the best educational outcome. Other adjustments may be environmental, and/or working on the underlying barrier to learning (eg difficulty with emotional regulation).

Learning difficulties that children and young people with FASD experience include:

  • understanding cause and effect, this impacts on interactions and provides challenges for building strong social relationships and incidence of risk-taking behaviour with serious implications on health and wellbeing
  • speech, language and communication delays/disorders including verbosity, difficulty comprehending, poor social cognition and communication skills, and difficulty using sophisticated language in social contexts
  • cognitive difficulties, including poor short-term memory and poor concentration
  • difficulty understanding mathematical concepts, such as time and money
  • frontal lobe damage to the brain associated with FASD, results in impaired executive functioning leading to struggles such as impaired ability to organise, plan, understand consequences, maintain and shift attention, and process and memorise data. 

Managing FASD in education and care

It is important that education and care services understand the strengths and difficulties of a child or young person with FASD and work in partnership with the family.

There is a growing research and knowledge base about the effects of antenatal alcohol exposure on brain structure and function, including memory, cognition, executive functioning, gross and fine motor control, sensory processing, language and behaviour. While the barriers and challenges to learning are many for children and young people living with FASD, it is important to frame these challenges in a strength-based educational context. Many children with FASD have learning strengths around literacy and practical subjects, such as visual arts, performing arts, sport and technologies.

Children and young people with FASD benefit from targeted learning strategies. They may require explicit instruction to acquire skills that typically developing children would learn through observation or generalisation, often related to working memory and attention issues.

Understanding and addressing the needs of children and young people living with Fetal Alcohol Spectrum Disorders (FASD): a resource for teachers

This practical education resource has been developed by the Marulu Unit and it's partners to support school leaders, teachers, Aboriginal educators and the broader school community to recognise, understand and work effectively with students living with FASD in schools. While the resource was originally written for teachers and school communities in the Kimberley region of Western Australia, the materials are relevant for all school communities across Australia meeting the complex needs of students with this challenging and often difficult to diagnose set of disorders.

FASD Hub Australia has a range of information available on managing FASD including their ‘what teachers can do’ webpage which includes resources and videos.

NOFASD have a free webinar that will assist education and care staff to understand the challenges that children with FASD face in their learning journey including 

  • outlining what FASD is
  • helping to respond to a child with FASD
  • providing strategies to support the child in the classroom
  • advising where to go for more assistance and information.

Interoception

Many children and young people on the FASD spectrum have low levels of interoception, which means they are unable to understand or connect with their bodies in ways that would enable them to self-regulate. It is important to integrate the teaching of interoception activities to develop interoceptive awareness.  

An interoception support plan HSP421 (DOC 170KB) may be completed by the education or care service, family and the child or young person (where possible). This will provide a detailed understanding of the interoception issues and support the development of individualised strategies to increase interoception.

Refer to the interoception 101 (PDF 3MB) for strategies to incorporate interoception into class activities.

Sensory overview

Children and young people with FASD may show signs of being hyper-sensitive (feeling things too much) or hypo-sensitive (not feeling things enough) to the senses of touch, taste, smell, sight and sound.  They may be so focused on what they hear, see or feel on their skin that they can’t focus on other things. They they may shut down or act out as they try to stop the thing that is bothering them.

The sensory overview support plan HSP431 (DOC 389KB) should be completed by the education and care service in consultation with the parents and child or young person.  The sensory overview provides a detailed understanding of the individual sensory issues and assists in developing strategies to minimise sensory overload in the education or care setting.

Regulation scale

The regulation scale HSP432 (DOC 182KB) is a tool that can be used for any child or young person to identify what is happening around them that is impacting on their mood change, what signals their body is giving them, and ways to respond to their body’s signals that will help them manage the change in mood. 

The child or young person should be involved as much as possible in developing the scale, with input from parents and staff to support them. 

The scale can evolve and change over time as the child develops better interoceptive awareness and expands their vocabulary (non-verbal/verbal). This scale is designed to be used in conjunction with interoception activities so the child is working towards meaningful development of interoception skills. 

Interoception is the foundation for developing emotional regulation skills and some children will require explicit teaching to develop these. Some children (especially those who have experienced trauma and/or neglect) struggle to manage mood changes which may be associated with a minor increase in stress levels (new learning, trying something different). For these children, minor stress may induce uncomfortable feelings which trigger a ‘flight, fight, freeze’ response. These children require support to differentiate between feeling slightly challenged/minor discomfort and feeling unsafe/in danger so they can respond differently.

Some examples of completed regulation scales include:

Care plan

A non-specific care plan HSP110 (DOC 166KB) may be completed by a health professional in consultation with parents or legal guardians for children and young people with FASD requiring support in education and care services.

Health support agreement

A health support agreement HSP120 (DOC 243KB) and safety and risk management plan HSP121 (DOC 147KB) may be completed where a parent indicates their child requires additional support and assistance. There does not need to be a care plan completed by a health professional in place. The support agreement is completed by the parent and education or care service to document specific risk minimisation strategies, individualised management and treatment for the child in the context of the education or care service. 

The Health Support Agreement should clearly identify cultural, spiritual and language needs. 

Educational adjustments

Once the strengths and needs of a child on the FASD spectrum are determined, through formal and informal assessment, strategies can be developed to support their needs. Documenting the modifications, accommodations and support strategies is important for ensuring understanding and facilitating successful placements, transitions, emotional regulation and academic success

Educational adjustments are designed to support children and young people on an individualised basis.  Adjustments should be determined by the parents and education and care service and documented in the support agreement. 

Supporting children and families with FASD

The Department for Education has developed an interoception curriculum that can help children and young people with anxiety improve their emotional awareness and self-regulation.  

That National Organisation for Fetal Alcohol Syndrome Disorder NOFASD Australia is an independent not-for-profit charitable organisation funded by the Australian Government Department of Health. They are the national peak organisation representing the interests of individuals and families living with Fetal Alcohol Spectrum Disorders (FASD).

FASD Australia Hub is a website developed by an alliance of organisations working to provide a 'one stop shop' for information, tools and resources that are current and evidence based.

The Russell Family Fetal Alcohol Disorders Association runs online support groups as well as face-to-face support groups across Australia.

The Marulu Knowledge Hub has a range of resources designed to support families, communities and carers impacted by FASD throughout different phases of their life.

Resources

Care plans

HSP110  Non-specific care plan (DOC 166KB)

Support plans

Health support agreement

Planning and management tools

Contact

Disability and complex needs team

Phone: 8226 3620
Email: education.health [at] sa.gov.au