Q: I have worked with and continue to work with children that I strongly suspect are kids with FASD. We are dealing with pervasive behaviors that make it extremely difficult for the student to function in the classroom and also inhibits the rest of my class from reaching their goals. Please share any information you can about working with the behaviors that come along with FASD. Also, how can I approach discussing this with the parent? There is no "diagnosis" in the file and the parent does not volunteer information, but there are two brothers with the same "disability." All suggestions are welcome.

A: This is a tough one. I don't have a lot of experience in approaching parents who don't have a clue (or who do and don't want to face it), but I know that some parents become defensive. You can approach it as any other undetermined disability that interferes with the child's ability to learn. (When we meet the child's needs, then the classroom will run more smoothly.)

There are several kinds of brain dysfunction that can cause disruptive behaviors. Even when we can't find the cause, we can still determine the areas of deficit, and adapt the curriculum to compensate for the weak areas.

First thing you might want to do is suggest an in-depth evaluation by the school psychologist, including IQ and Vineland (teacher and parent versions to compare).

The test that shows memory processing deficits is the Wookcock-Johnson, and the Bender test will show the visual-motor deficits that are common in our kids. A good occupational therapist could test for Sensory Integration Disorder (SID), and a trained speech pathologist can do an assessment for Central Auditory Processing Disorder (CAPD). Most kids with FASD have some symptoms of SID and CAPD, which are information processing disorders. When we can accurately determine at what level the child is functioning in different areas, then we can teach at that level.

When you talk to the parent, say that even though the child presents with behaviors that interfere with his ability to learn (don't mention right now that it disrupts the class yet), that you think they are not actually behaviors that are due to psychological factors (like abuse, neglect, or poor parenting), but that you think they could possibly be caused by brain dysfunction, according to some things you have read. Ask if they would mind going over the checklist with you. Review symptoms from "Soft Signs" article. You can say that it is not always known what causes this brain dysfunction, but sometimes kids might have Aspergers syndrome or Tourette syndrome with very mild symptoms, and that these could cause the behaviors problems you see. It could be ADHD (with or without the hyperactivity) and the child is having problems paying attention to class work.

When children with FASD become disruptive, it can be a combination of different factors, both psychological and neurological:

• frustration with not being able to keep up with the work

• embarrassment about seeming to be "stupid"

• reaction to being teased or corrected in front of others

• stress of failure or bad grades

• inadequate fluid intake

• fluctuating blood sugar levels

• medications (wearing off, missed dose, ineffective, lack of, etc.)

• overwhelmed from sensory stimulation (kids and noise)

• reaction to additives like MSG, food coloring, etc.

• neurochemicals are just out of balance

About age 10 is when we see the disruptive behaviors really show themselves. This is when academic materials become more abstract, as do the teaching methods, and our kids just don't get it, when it seemed so easy the first few years of school, when learning was more concrete.

There are also hormonal and neurochemical changes taking place at this age that seem to make existing problems even worse. About half the kids react by becoming loud and almost aggressive, and half react by withdrawing and possibly becoming depressed. The loud ones are more likely to get into trouble, but the quiet ones are at higher risk of suicide later (23%). Both types need intervention.

I teach a 2-hour class once a week to first graders. My son John (25, full FAS) is my assistant. He works great with this group because his emotional development and learning abilities are at about the 6 year old level (but he looks and acts and talks like a man). I have the same expectations for behaviors for John as for the first graders. Here's what I suggest teachers do:

Classroom rules should be concrete and simple, review daily:

• Be Respectful (abstract concept needs to be explained constantly)

• Be Safe (another abstract concept to be discussed often)

• Have Fun (this one requires the first two rules to be in effect)

Token rewards don't work as effectively with our kids, but it might help a little. Rewards have to be instant. IE: Blackboard with names down the left, with star drawn next to each child who is working appropriately at any given moment, with teacher manipulating the amount of stars to reinforce wanted behaviors of the children with the most issues. Try to avoid punishment, as this seems to just get the child into a negative cycle that is hard to break out of. Unfortunately, they thrive on the attention they get from the other kids, even if it is not positive.

Be vigilant to look for signs of a child about to lose control, and give cues, or redirect them somehow.

Gentle pressure of hands to the shoulders could give enough sensory input to relax and calm a child. If you do this with other children too, then the difficult child will not feel singled out. It can just be something you do.

Music always helps, for calming, to help them learn, to change the mood, to get attention.

Use visible boundary markers, like masking tape on the floor, or cafeteria trays on the table.

Watch out for unrealistic expectations. It's difficult for some kids to sit still longer than 15 seconds. If they need to move, let them move, walk around, bounce - whatever they need to function.

Don't expect the child to copy off the blackboard and get everything accurately in a timely manner. Hand the child a paper copy of the notes you expect the typical child to copy from the board.

Provide a helper for the class, in case a child gets stuck or has difficulty understanding the directions completing a task.

Cut down on homework or eliminate it altogether. With more 1-on-1, all necessary work can be completed in class. Homework can be restricted to 30 minutes or might be optional, depending on the child’s ability to attend to the assignment later. Academics can be the focus in the classroom. Parents can work on social skills and self-care skills at home. School is probably stressful enough without extending schoolwork into personal family time.

Use a communication log between school and home, with notes about homework or projects or events, with daily notations by teacher and parent, including one positive statement followed by current issues, if any. Do not expect the child to be responsible for remembering papers to be turned in or signed and returned. The attention deficits and memory deficits make this very difficult.

Strip the walls of “busy” posters. Encourage quiet, gentle communication.

Give simple cues and directions. “Sit on the chair.” “Hands to yourself.”

Provide a "safe haven" for the child who is losing control. It can be a person or a place. A chair in the hall may or may not be a good idea, depending on the level of supervision needed. The nurse's office or even the principal can provide the quiet place for the child to regroup and regain control before coming back to join the class. But it should be a person or place of the child's choosing - you offer three workable choices and let the child pick one or two. This is like a "time out" but is not a discipline tool, just a coping tool, and should not be referred to as "time out" - maybe "quiet place" instead. It can be a bean bag chair or a pillow or a big box cubby, or even headphones that can help tune out the chaos that is causing feelings of being overwhelmed.

Build on their talents. Look for their gifts of art and music.

The important thing is to have reasonable expectations. That means all the staff need to be educated about FASD (print out a set of brochures for each person) so that they understand the following:

• 90% of FASD is undiagnosed and unrecognized by professionals

• The behaviors are more neurological in origin than psychological

• Behaviors are not necessarily a result of poor parenting or abuse

• Behaviors do not change easily with behavior management.

• Behaviors are inconsistent and often not within the child's control

• The emotional/social development is stunted (1/2 chronological age)

• The actual ability to function is well below what it appears to be

• The good expressive language skills mask the areas of deficit

• Failure to address issues properly may increase risk of serious secondary conditions later.

Teaching the Student with FAS or FAE

FAS Community Resource Center