Cause and Defect
2001 Teresa Kellerman

Making a "choice" implies thinking ahead:

Thought                weigh                 action
  or       ---------->  the   ----------->     or
Impulse                risks               consequence

When the child with FAS/E weighs the risk and takes an action anyway, in spite of the high risk of a negative consequence, that child is showing poor judgment. This is a process of "executive function" of the frontal lobe, which does not function properly in persons with FAS/E. The "choice" may be a poor one, but may be one that they cannot make well on their own.

Sometimes the child does not weigh the risks and just acts without thinking. This is acting on impulse, and most individuals with FAS/E have been known to have poor control of their impulses.

Thought         action
  or     --->     or
Impulse       consequence

Again, this is a matter of dysfunction of the frontal lobes and possibly the corpus callosum as well. Sometimes the child can think things through and make a good decision, and sometimes the child cannot. Sometimes the child will be able to control impulses, sometimes not. It is the inconsistency of this ability to use good judgment and control impulse that is baffling. It misleads us into having higher expectations for behavior than the child can handle. It allows us to give these children more freedom than is safe for them. This sets them up for failure, because you can't predict when they will be functional and when they will be in FAS mode.

I talk with John when he has made a poor choice. I may even apply a consequence. But I spend more time talking about good choices we can make and the positive consequences. We do some role playing, and I seek out healthy role models for him. But I don't expect him to always learn from the consequences. I know that sometimes his brain is going to be working and sometimes it won't. The tricky part is, I don't know ahead of time if he will be able to make a good judgment or control his impulses, so I have to be vigilant and provide the degree of supervision I think he needs to avoid serious trouble. I have to remember that I can only hold John accountable according to his ability to function, which I can judge by looking at his behavior in the recent past and by remembering how he scored on functional adaptive behavior assessments like the Vineland.

John's poor judgment and lack of impulse control are really not a matter of choice at all, but a matter of defective thinking caused by brain damage. That's the reality of FAS/E that I have to accept.

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