Fetal Alcohol Spectrum Disorders
Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a child whose mother drank alcohol during pregnancy, resulting in permanent brain damage. These effects can include physical disabilities and struggles with behavior and learning, or a mix of both. While there is no cure for FASDS, early intervention can help improve a child’s development, according to the Centers for Disease Control and Prevention (CDC).
What You Might Notice
The effects of FASD can range from mild to severe, and will affect each child in different ways, according to the CDC. A child with an FASD might have:
- A smooth ridge between the nose and upper lip, called the philtrum
- Small head size, low body weight, and shorter than average height
- Poor coordination
- Hyperactive behavior and difficulty with attention and memory
- Learning disabilities and difficulty in school, particularly in math
- Speech and language delays
- Intellectual disability and poor reasoning and judgment skills
- Sleep and sucking problems as a baby
- Physical problems with seeing, hearing, heart, kidney, or bones
Before Meeting the Child
Ask parents/caregivers for any tips in preparing the setting. Children with FASD can become easily overwhelmed and distracted, particularly in unfamiliar settings. Some children are distressed by noises, stimulation, florescent lights, too much clutter, and too many people. Children with FASD may have a hard time sitting still. “Fidget” items such as bean bags, koosh balls, or other items help some children; others may become more distracted by them. Children with FASD often learn skills to accommodate their disability. They do best when information is concrete and repeated and routines are consistent, according to MN Adopt.
Every child with FASD will be different, but common traits include having difficulty:
- translating verbal instructions into what they are being asked to do
- understanding cause and effect
- sitting still
- remembering what they learned yesterday
- understanding time, because it is an abstract concept
- interpreting social cues
- being either hyper or hypo sensitive to touch (may feel things too much or not enough)
Learn from the child’s teacher, Individual Education Plan (IEP), parents, or caregivers about the child’s disability and how it affects them in practical terms. Ask about what adaptations help the child function in school and at home, and modify them for your interaction.
Find out the child’s schedule, including times of regular television shows, school, therapies, and other activities.
If the child has difficulty understanding written or spoken language, consult with teachers or caregivers about how to make your questions as understandable as possible.
Children and youth with FASD function better with specific routines for morning, meal times, and bedtime. Caregivers often go over the order of these routines through discussion, pictures, or writing. Talk to parents, educators, and caregivers about how to best prepare the child for the criminal justice process. A child who knows what is going to happen, and in what sequence, will have more tools for coping with stress.
(Adapted in part from Edmonton and Area Fetal Alcohol Network.)
During the Meeting
Tell the child who you are and why you are there. Keep questions as short and uncomplicated as possible.
Children with FASD:
- are literal, so speak in plain and concrete language.
- often have difficulty making choices, so avoid offering multiple options.
- can mimic having Attention-Deficit/Hyperactivity Disorder – they may fidget, have difficulty sitting still, not be able to stop talking.
Children with FASD may have a large vocabulary, but still not understand what you are asking them verbally. They also may not be able to interpret nonverbal cues. This combination can make it difficult for them to answer questions. To address this issue, pay attention to body language, communication, and how you ask questions, as follows.
- Maintain good eye contact. It will help the child focus and may also help them understand you.
- Use exaggerated expressions and gestures to fit what you are saying – shaking your head when you say "no", shrugging your shoulders when you say "I don’t know."
- Try to make your point in as few words as possible.
- If you are giving instructions, give them the same way each time.
- Say specifically what you want the child to do, rather than what you don’t want them to do.
- List specific tasks one at a time. Wait until the child finishes the first one before introducing the next.
- If you are interrupted in the middle of giving directions, start all over again. When you are done with a thought, stop and pause before beginning a new thought.
- Avoid open-ended or why questions.
- Don’t interrupt when a child with FASD is answering a question. They may forget what they were going to say.
- Because children with FASD are literal, be clear and ask specifically for the information you want. As an example, if you ask, "Where do you live?" the child might say, "in an apartment," vs. giving their town or address.
- Children with FASD may not tell what happened in the order of events. You may have to ask additional questions to clarify.
- Speak at the same or just a slightly higher level as the child. If the child uses 2 words to express an answer, speak in 3 words.
- Some children with FASD have difficulty with memory. They may not remember what happened or have the language to express it. For these children, drawing what happened may help.
If a child is struggling or shuts down during part of the interview, one strategy recommended by MN Adopt is to:
- Stop the process for a moment.
- Observe what is going on with the child.
- Maintain eye contact.
- Ask the child what would help and where they are struggling.
(Adapted in part from Edmonton and Area Fetal Alcohol Network and MN Adopt.)