Would you be surprised to hear that Foetal Alcohol Spectrum Disorder (FASD) is thought to be the most common non-genetic cause of learning difficulty? A study completed by the University of Bristol in 2018 indicated that 6% of the research cohort had FASD. This is equivalent to 4 million people in the UK, which is higher than the number of people with Autism Spectrum Disorder (ASD). This means that you are very likely to come across children in school affected by this condition.

FASD is an umbrella term representing the range of effects caused by exposure to alcohol in utero. It is a neurodevelopmental condition resulting in lifelong cognitive, emotional and behavioural challenges, as a result of damage to the brain. Many people will have heard of the term Foetal Alcohol Syndrome (FAS), which is a type of FASD.

Despite the prevalence and impact of this condition, many children go unidentified, due to it being known as a hidden disability. It is a common misconception that children need to present with specific facial features in order to get a diagnosis, however it is estimated that less than 10% of children on the FASD spectrum have these distinct facial features. Some children do not present with any obvious characteristics and their symptoms will be purely behavioural, meaning that many go undiagnosed.

Is it estimated that 85% of children with FASD are in the care system, and this can make diagnosis more challenging as information about maternal alcohol use may not be available. It is important to remember, however, that FASD occurs across socio-economic groups. The amount of alcohol necessary for damage to occur is unclear, therefore there is no known safe amount of alcohol that can be consumed during pregnancy.

In addition, many children with FASD are misdiagnosed as having ASD, ADHD or OCD. These co-existing disorders usually have overlapping symptoms; students with ADHD present with hyperactivity and impulsivity, which are common features of FASD.

These challenges mean school settings are often unaware that they have children with FASD in their classrooms; the children’s difficulties are not identified, and appropriate strategies are not in place. Having FASD can be a considerable barrier to learning because the child’s affected brain learns in a different way to their peers. This unusual style of learning and, at times, challenging behaviour can be very difficult for school staff to manage.

“Keeping routines, rules and expectations consistent between home and school helps children to learn and remember what is expected of them.”

Each child with FASD will have individual learning strengths and difficulties, as these depend on the extent of damage caused to the developing brain. There is, however, a typical profile of shared characteristics that many children with FASD will present with. Their spoken language skills are often in advance of their understanding, meaning that they can present as very articulate, masking their difficulties understanding what is being asked of them. They often present with symptoms of hyperactivity, impulsivity, inattention, and sensory-seeking behaviours. They have significant difficulty with executive functioning, working memory and social communication skills.

FASD has a significant impact for learning across the curriculum as the damage results in difficulty acquiring new information, linking new information to previously learned information and generalising knowledge to other contexts – all the things that make you a successful learner. The good news is there are strategies that can help children with FASD in the classroom. Some strategies may work with a particular child, and some may not, and this may change on different days, so persistence is essential.

Strategies to help children with FASD in the classroom

Develop a child profile

If you are informed that a child has FASD, or you are concerned about a child, start by gathering information during focused observations to develop a profile; what is known about the child, what are their learning strengths and needs, which learning methods appear to be the most beneficial (e.g., visual, kinaesthetic), and how do they cope with obstacles and react to change? This can help to identify priority learning needs that will guide staff in determining appropriate strategies.

Work as a team

Children with FASD are best supported when those around them work together. Parents know their children better than anyone and can often provide invaluable information about their child’s strengths and difficulties. Keeping routines, rules and expectations consistent between home and school helps children to learn and remember what is expected of them. Seek advice from professionals to support your understanding of the child, such as Occupational Therapy (OT) to support sensory processing needs.

Adapt the environment

Often the most successful strategies are those that change the environment around the child, rather than trying to change the child, who has a lifelong neurological condition. Try and create a calm classroom space and remove as many distractions as possible, to support the child to focus on what is important. Have clear and consistent routines and rules, backed up by visual support, and try to prepare the child for any changes. Provide time for regular learning breaks, including opportunities for movement.

Keep it simple

Children with FASD often have difficulty understanding and processing spoken information. They will have difficulty carrying out multi-step instructions and often need considerable help to organise and complete tasks. Break down instructions and tasks into small steps and provide visuals, such as task management boards. Abstract language and concepts, such as mathematical or time concepts, can be particularly difficult for children with FASD. Use concrete, visual representations, such as calendars or sand timers, to back up abstract spoken language. Be prepared to repeat key learning as children with FASD need more practice to learn and make tasks automatic.

You can find out more information about FASD and lots of strategies to support children at https://nationalfasd.org.uk/

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