Tuesday, November 30, 2010

FASD Reflections

FASD the preventable disability. Working with people with FASD can be extremely challenging. Not only do they have neurological deficits but social and learning difficulites as well.

Compromised executive functioning D
Difficulty planning, predicting, organizing, prioritizing, sequencing, initiating, and following through. Difficulty setting goals, complying with contractual
expectations, being on time, or adhering to a schedule.

➤ Difficulty with memory
Information input, integration, forming associations, retrieval, and output. Difficulty learning from past experiences. Often repeat the same mistake over and over again in spite of increasingly severe punishment. Inconsistent memory or performance; may remember on Monday, forget by Tuesday.

➤ Difficulty with abstract concepts
Such as time, math, or money.

➤ Impaired judgment
Often unable to make decisions. Difficulty understanding safety and danger, friend and stranger, or differentiating fantasy from reality.

➤ Inability to generalize information
Difficulty forming links and associations, unable to apply a learned rule in a new setting; learns to not take Johnny’s bike, but then takes Mary’s bike.

➤ Communication challenges
Appears to understand instructions, nod and agree, but is unable to comprehend. Often repeats rules verbatim, then fails to apply the rules — “talks the talk” but doesn’t “walk the walk.”

➤ Language problems
Difficulty comprehending the meanings of language and accurately answering questions. May agree or confabulate — comply or fill in the blanks. Many talk
excessively, yet are unable to engage in a meaningful exchange. The sheer volume of words creates the impression of competence.

➤ Slow cognitive pace
May think more slowly, say “I don’t know,” shut down, or require minutes to generate an answer rather than seconds. Those with fasd are “Ten‑second people in a one second world.”

➤ Slow auditory pace
Central auditory delays means language is processed more slowly, requiring more time to comprehend. Many only grasp every third word of normally paced speech.

➤ Preservation
May be rigid, get stuck, have difficulty switching gears, stopping an activity, or transforming to a new activity. Often react strongly to changes in setting, program or personnel.

➤ Dysmaturity
Often function socially, emotionally, and cognitively at a much younger level developmentally than their chronological age. A 5-year old may be developmentally more like a 2-year old, a 12-year old more like a 6-year old; and a 25-year old more like a 13-year old.

➤ Impulsivity
Coupled with inability to abstract and predict outcomes; acts first and then is able to see the problem after the fact.

➤ Sensory systems dysfunctions
May be over-reactive to stimuli — e.g. tactile defensiveness. May be easily overwhelmed by sensory input, may be unable to filter out extraneous stimuli; symptoms include increased agitation, irritability, and aggression. May under-react to pain — may not complain of earaches, broken bones, and be unable to experience painful stimuli.

Secondary Behaviours

Secondary behaviours are defensive behaviours that develop over time when there is a chronic “poor fit” between the person and his environment. Defensive behaviors are normal protective reactions to frustration and are helpful cues for identifying points of intervention.

By definition, these are preventable when a good fit is provided. Again, these are not exclusive of fasd.

• Inappropriate humor — the “class clown.”
• Pseudo-sophistication; may echo words, phrases, manners, and dress in order to “pass” as competent beyond their actual ability, often to their detriment.
• Fatigued, irritable, resistant, argumentative.
• Anxious, fearful, chronically overwhelmed.
• Frustrated, angry, aggressive, destructive.
• Poor self-concept, often masked by unrealistic goals or self-aggrandizement.
• Isolated, few friends, picked on.
• Family or school problems including fighting, suspension, or expulsion.
• May run away, have other forms of avoidance.
• Trouble with the law, addictions.
• Depressed, may be self-destructive, suicidal.

Secondary behaviors often develop in early childhood, frequently becoming patterns of behavior by adolescence. Secondary conditions come at a high cost to the individual, their family, and the community. Early identification of both primary symptoms and secondary behaviors is necessary in order to develop appropriate
interventions, or “accommodations” that prevent or resolve secondary behaviors.
Section 4 of this document (“Reason”) provides a useful table outlining primary and secondary behaviours and the kinds of interventions or “accommodations”
that work and don’t work in coping with them

(This breakdown of primary and secondary behaviours has been adapted from a presentation by Diane Malbin at the 2005 FASD National

Special Class An example of a school that has special classrooms for students with fasd is the David Livingstone Community School in Winnipeg, Manitoba.

“This is an Early Childhood Behavioural Treatment Program … designed for students who display severe behaviour resulting from fas/fae or other neurological difficulties. A description of the program is as follows:
low stimulus environment,low enrolment classroom, focus on social skills, behaviour and academics, strong consistent classroom agenda, individual education plans, predictable routines and expectations, behaviour plan consistently reinforced by Teacher Assistants and Support personnel, consistent consequencing, speech therapy on site two times a week, occupational therapy on site once a week.”

This program has had demonstrated success with students seriously affected with fasd.
Conference, “Equality of Access: Rights and the Right Thing to Do.”

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