FAS/E is not about having a different looking face – which disappears with age, making diagnosis as an adolescent or adult very difficult, or about being somewhat shorter than normal. It is about having deceptively significant brain damage, even in the absence of mental handicap, with enormous implications for function in all adult domains. Its impact on the ability to parent cannot be overstated.
People with FAS/E have many neurobehavioural problems which inter-relate to produce profound problems with accurately processing information and relating to the world around them. Those with the greatest impact on adult functioning are as follow:
Problems with cause and effect relationships and impulse control
Cause and effect can best be defined as prediction. It is somewhat like having your own crystal ball through which one can accurately foresee the future – both in terms of immediate mid-term, and long-term events. Without the neurological ability to do this, events remain disconnected from one another, and the affected person has great difficulty learning from experience or grasping consequences. They are often unable to understand that their behaviour has an effect on another person and will be bewildered by, or even hostile to our reaction to what they have or have not done. They are frequently described as having no conscience or showing no remorse – which is really a reflection of the problem, and not the problem itself. Cause and effect is also intimately connected to the ability to control impulses. For people with normal cause and effect reasoning and impulse control, the two are seen as a three-part intermingled thought process: action, reflection, consequence, or impulse, reflection, action/lack of action. For those people with FAS/E the middle step, reflection, is faulty, works only sporadically, or is missing altogether. Reflection, something we do in a split second, is a very complicated function comprised of many inter-related thought processes, any one of which, if faulty, will radically alter the way one perceives relationships. Good cause and effect reasoning is also essential to motivation to do just about anything. This is particularly a problem in terms of motivating the individual to long-term changes, a primary reason why both rewards and sanctions, when used, must be immediate and why affected persons seem unable to delay gratification or work towards long-term goals. If you do not have good cause and effect reasoning, you “just don’t get it”.
The ability to take information learned in one situation and use it to solve problems in another similar situation – the ability to generalize – is the essential thinking or problem solving process without which even marginal functions in an adult society is difficult to impossible to achieve. In FAS/E, this thinking process seems to lack movable parts; everything is seen as unprecedented, never having occurred before, and to which no previously acquired social and/or behavioral learning applies. People who are able to generalize see things as sets of shifting possibilities, depending on what has gone on before. People affected by FAS/E do not see those “possibilities”, only what is here and now. They are not flexible thinkers. Decision making is also governed by the ability to generalize. We use general rules of thumb – solution strategies – which we derive and remember from personal experience, and which worked before, to make decisions in new situations. These past experiences guide our thinking and provide a basis for making those choices. For the person with FAS/E, choice making and problem solving are very difficult undertakings because they lack the ability to re-organize – in other words, generalize – this information and perceive new relationships among the pieces of a problem. In FAS/E, the first solution to a problem is usually seen as the only solution to a problem, even when it clearly does not work. People who cannot generalize then, are unable to develop an understanding about something new they come across based on similarities to, or differences from, something with which they are already familiar: i.e.: if a rifle is dangerous, then a handgun is too; if leaving your child unattended causes him to be apprehended, then arranging for his care will prevent that happening. It has been said that the Golden Rule of FAS/E is “Thou shall not transfer”.