Q: I have a 14 year old student with FAS and ADD. He has been suspended twice in the past 3 months for petty theft at school (from teachers). There seems to be a recent escalation in unacceptable behaviors. His mom and I are trying to get the school district to move him to another program with lower student teacher ratios. This is an adoptive parent, a great gal, but she has an "in your face" demeanor that I'm pretty sure is not the way to deal with the recent problems. Can you recommend a procedure or "scripted speech" that works with these kids in these situations. I've talked with him calmly, have bribed him with payoffs for good behaviors, and recently put a Band-Aid on his shoulder to remind him to think before acting. I told him about Pinocchio and Jiminy Cricket acting as the puppet's conscience. School staff DO NOT GET IT !!!!! I am this boy's resource teacher and have known him for 5 years. He is on Adderall - when do they reevaluate the ADD meds? I have encouraged mom to access the NOFAS site. Any other suggestions? Thanks.

A: It sounds like this boy is right on track (for FAS development). I can't tell you how many other kids his age with FAS disorders are going through exactly the same behaviors, with consequences that just don't work. Some kids are into lifting cool things like cell phones and CD players or money from the teacher's desk or other students. Some are into inappropriate sexual behavior. Both are very common at this age, and neither is easy to deal with. Most FAS experts will tell you that suspension is not an appropriate or effective means of dealing with FAS behaviors. Self-talk with learned scripts might work, but only sporadically, as memory deficits, poor impulse control and poor judgment will interfere.

It looks like you have three challenges: the boy's behavior, the mom's behavior, and the school's behavior. The easiest way to change the boy's behavior is to change the environment and the behavior of those who are attempting to help/educate him. He can't always remember and he can't always control his impulses because of permanent brain damage which manifests itself inconsistently and in unpredictable ways. (Some days he can do fine, and other days he just blows it.) A bandaid on the shoulder might work as a reminder for a non-disabled student, but it is probably pretty useless for a child with FAS. What he needs is that smaller classroom and more attentive staff who can provide the supervision he needs. Our kids almost always fail in the larger classroom that has more sensory stimulation than they can handle and usually not enough supervision to keep them out of trouble. Here is a list of my SCREAMS model of intervention strategies for FAS: http://www.come-over.to/FAS/ScreamsArticle.htm

I know lots of adoptive moms who have that "in your face" attitude. I keep trying to tell them that they will more easily get what the child needs if they are reasonable and calm, but to tell you the truth, I have to fight to control my own attitude sometimes, because it is so frustrating to have to deal with teachers and "helping" professionals who just don't get it. I would try to be more understanding of the chronic frustration this mom has had to go through all these years, having to deal with one professional after another who not only doesn't get it, but probably blames the boy's behavior on poor parenting (which is seldom the case with adoptive homes). Once she realizes that you are her ally, she will probably soften up a little when it comes to advocating for her boy. I hope that this mom appreciates your efforts to really understand this boy. Not many teachers are willing to search out info on the internet and to ask questions the way you are.

There are a few things that this boy needs in his IEP:

1) A communication book that is not the responsibility of the boy but the responsibility of the school staff and mom to write in everyday, one thing positive and whatever issues each needs to be informed about. There is an attitude today that we need to hold kids accountable for their own behavior, and I agree, when the ability to control is there. This boy does not have the ability to control his behavior or to be responsible for notebooks, backpacks, communication logs, homework, notes, etc. His having what he needs when he needs it should be the responsibility of teachers and parents, and we can praise him when he does remember, but we can't expect him to have the same ability to be responsible as another student without disabilities. His level of ability for responsibility is about that of a kindergartener. Praise for his successes should be written in the communication book and read to him each day to encourage him. Heaven knows, he makes enough mistakes about which he is reminded constantly. The communication log can be used for relating both the positive and the negative, and even that can be put into more positive terms.

2) A one-on-one aide would be ideal, but I know this is difficult to get. But at the very least, this boy needs close supervision AT ALL TIMES, including on the bus, on the playground, in the cafeteria, before, during, and after classes. I insist that these particular situations be written into the IEP. That someone makes sure that a responsible person (not another student) is monitoring the boy at any given time. The boy has mental disabilities that prevent him from controlling his behavior and his impulses. This is not an excuse, it is an explanation, a statement of fact. His conscience does not always work. It is as if he were riding downhill on a bike with no brakes. We have to be there to be sure he doesn't crash. He can't STOP on his own. He needs 24/7 the same way a boy with MS needs a wheelchair, or a child with impaired vision needs Braille or a child who is hearing impaired needs a signer.

3) The staff who work with the boy need to be educated about FAS disorders and the nature of his behavior issues. Reading a brochure might help, but it will be difficult to relate second-hand all they need to know. They need to be trained with a workshop, or they need to attend a conference, in order to apply methods that will help him learn and to prepare him for transition when he is done with school. I hope you can encourage the teachers to check out my web site as well. There are brochures on my website that you can download and share if you want: http://come-over.to/FAS/brochures/

If there is only one brochure that is shared with the teachers, the best one is FAS and the Brain. This explains that the behaviors are neurological in origin, not psychological, and therefore we need to approach the behavior management from a different perspective than we would for problems that are psychological in origin. We can help this boy learn what the rules are, what is right and wrong, what the consequences are. He can learn all that. But we cannot teach him to control his impulses. Rewards and consequences work, but not very well, not all the time, and when they don't work, it is more a matter of his brain not working efficiently that day, not a matter of choice on his part. If you ask him if he wants to get into trouble, he will say no. If you ask him if he wants to get good grades and rewards, he will tell you yes. He doesn't mess up on purpose. Even when he may appear to be manipulative, it is more a matter of poor judgment, which also is beyond his control, a matter of neurological dysfunction of the frontal lobes. I hope you print and share all the brochures there.

Another thing that is absolutely necessary is proper evaluation using the right assessment tools. I don't know which IQ test has been administered, but the best one to use for FAS is the Woodcock-Johnson, because it has so many sub tests with scores in each area that will indicate where he excels and where he has deficits, especially in the different areas of information processing and memory. The other basic test that is a MUST for kids with FAS is the Vineland Adaptive Behavior Scales. It seems that kids with FAS score about 20 or more points lower on the Vineland than they do on the IQ test, indicating that he functions in real life at a lower developmental level socially and emotionally than would be indicated by his academic achievement. This is important in that we need to adjust our expectations for him to control himself and his ability to function at his level of development, which socially and emotionally usually is stunted at the 5 or 6 year old level. Read the rationale for using the Vineland, which was written by a mother of a boy very much like your student: http://www.come-over.to/FAS/VinelandRationale.htm

About medications. He has a chemical imbalance in his brain that is permanent. He needs his Adderall the same way a child with diabetes needs insulin. If a child has classic ADHD, meds will help, and after a few years the child may be able to cope without meds. If the child has ADHD caused by alcohol exposure (permanent brain damage), the child may need to be on meds for this the rest of his life. Adderall seems to be the most effective for kids with FAS and FAE. As the child grows older, the doctor may consider the need for an increased dose due to increased physical growth. My son John is 4'11" and is fully grown, so his dose is up to 60 mg of Adderall per day. He takes 40 mg in the morning, which is a double dose, as this gets him through the day without a lunchtime dose, then he gets a 10 mg booster in the afternoon or early evening if he needs it. John is also on Paxil (60 mg per day in the evening). Most teens with FAS do well on this combination of Adderall and an SSRI like Paxil or Zoloft or Prozac. The SSRI is not for depression but it helps with the emotional outbursts and tends to help somewhat with the impulse control as well. I understand you may not legally be able to make suggestions about meds, but you can relay information about meds. There is an entire section on my web page about which meds work for FAS: http://www.come-over.to/FAS/meds.htm

You might want to purchase a very inexpensive book (about $7.50) from the FAS Book Store. It is the one called "Fetal Alcohol Syndrome, Fetal Alcohol Effects, Strategies for Professionals." This is easy to read and easy to understand, great for parents and teachers alike: http://come-over.to/FAS/store/books.htm

If the Mom has Internet access, I hope she has found my web site, as well as online support, like Faslink, an online support group mail list, or Olderfas, a mail list for parents of teens and young adults. Online support links are here: http://www.come-over.to/FAS/fasonline.htm

I love your analogy of Pinocchio and Jiminy Cricket! This is exactly what a child with FAS needs, someone else to help keep him on track. I'm glad that YOU get it, and I think you could be the ONE person to help the others to get it. This boy is very fortunate to have you for a teacher. Let me know if you have any more questions.

Teresa Kellerman