Assessments are used to determine eligibility for special education and appropriately guide services. Because educators in California are not formally trained about FASD and it is often an invisible disability, it is critical for you to be involved in creating an assessment plan if you suspect prenatal alcohol exposure. The
assessments commonly used may not accurately show the need in someone with FASD, which may result in not qualifying or inadequate services. Having the psychological portion done by someone trained in FASD will ensure accuracy. Read on and find a brief
explanation of critical areas to assess and why. You may have to advocate for these to be included.
Critical Assessment Areas
Working Memory Emotional Control Cognitive Flexibility
Sustained Attention Task Initiation Planning and Prioritization
Organization Self Talk Goal Directed Persistence
Judgement Impulse Control Time Management
Self Awareness Hindsight and Foresight
Executive function skills guide everything we do. They are the processes in the brain that help it plan, organize, initiate and perform tasks. For example, poor emotional self-control, decreased judgment and impulsivity are part of the FASD profile. A student with FASD and poor executive functioning may be impulsive and talk out in class or decreased judgment may cause difficulty with peers. Executive Functions intermingle and are working all the time. Comparing the above box of executive functions to the examples below of typical struggles students with FASD might have, will help make the connection between your student's executive functioning and the areas of concern.
Behavior problems Following rules
Learning from mistakes Getting to school on time
Independent classwork Homework initiation
Using a work planner Copying assignments from the board
ADHD is an executive function disorder and many kids with FASD also have a diagnosis of ADHD. There are a few distinctions between the two that is important. Executive function skills in children with FASD are typically worse than those seen in children diagnosed with just ADHD. Research is also showing that executive functioning gives a much better picture of the ability of a person with FASD than IQ testing. For children with FASD, medication is often less effective.
Having a real understanding of your student’s individual deficits with regard to executive functioning will give intervention accuracy and meaning and hopefully reduce everyone’s frustration. Please check out the resource pages for in-depth information on this extremely broad and important subject.
Processing speed is the pace at which you take in information, make sense of it and respond. People with slow processing speed have a slower response time because their brains take longer to decipher information and use it. Think of processing speed as the motor that determines how efficiently we use our other skills.
Slow processing speed is a common problem for children with FASD. An expert in FASD, Diane Malbin explains that children with FASD are "10-second kids in a 1-second world".
Processing speed impacts all other skills so keep these scores in mind when reading other results in your
Relationship between Processing Speed and Working Memory
Length of time needed to read a short passage
Length of time able to retain what is read and use it
In school, poor memory can impede learning and performance. Memory is a key deficit in FASD, both recall of what is heard and seen can be impaired.
Working memory is often poor in FASD. Working memory refers to how one temporarily stores information and manipulates it to complete the task at hand. Following instructions, remembering a list, writing a sentence, completing reading and math work are examples of tasks that rely heavily on working memory. Common deficits in FASD such as processing speed and impulse control can compound working memory deficits.
As time goes by, these short term memories are systematically filed in long term memory. The filing of the memories can often be chaotic with FASD, causing difficulty with retrieval and resulting in inconsistent performance. The student may know something one day, but not the next. One phenomenon that can happen due to poor recall of events is called confabulation. A child may not remember what happened and will then just simply fill in the blanks. This is not lying and the child will believe the story of what happened.
Students with FASD can learn. Repetition of instruction helps information get past the poor working memory and into storage. Prompting can be a helpful way to assist in the retrieval of information when long term memory is inefficient.
Prenatal alcohol exposure can result in deficits that make it difficult for individuals to successfully function in the community. By measuring communication, socialization and daily living skills with a full-scale adaptive functioning test, like the Vineland Adaptive Behavior Scales, a clear picture of how well someone navigates through demands placed on them by the environment can be realized.
Ability in adaptive function and IQ typically match, however, people with FASD demonstrate lower levels of adaptive functioning relative to their IQ. This means that a person with FASD can have typical IQ and still have significant problems operating in the world. An early understanding of your child's adaptive skills may pre-empt misunderstanding when IQ is average to high.
This is a critical component for your assessment plan because it will help the IEP team to understand that to be successful, expectations around independence and responsibility need to be adjusted for a child with FASD and functional academics need to be taught, such as money, time and travel training. This is particularly true as children mature and demands increase.
Sensory processing describes how the central nervous system takes in messages from the senses, interprets them and responds. When sensory processing is impaired the information goes in but the brain is not able to organize it into an appropriate response.
Most people with an FASD have sensory integration deficits. They may feel an overload of information (hypersensitive) or they may not feel enough (hypo-sensitive) and seek out stimulation. This leads to feelings of anxiety and overwhelm which reduces the student's ability to function as needed in the classroom and may bring on undesirable behaviors due to discomfort.
Sensory processing deficits impair how a person responds to their environment. The physical learning environment is a key element in reducing stress and would include smaller class sizes, reduction of stimuli, a well-structured routine, and reduction of fluorescent lighting. With FASD, less can be more.
An intelligence quotient (IQ) test is used to estimate ability. Although FASD is the leading known cause of intellectual disability, most students will show a typical IQ. A hallmark of FASD is widely varying individual scores within the test. This variation of ability is not expected and can be frustrating for both child and teacher.
Students with a high IQ will often express the learning and behavioral difficulties associated with prenatal alcohol exposure. It is considered to be a risk factor to have a high IQ with FASD because appropriate services may take longer to implement.
Remember the role executive and adaptive functioning have on one's ability to use IQ when considering IQ scores. Because it is typical that IQ and adaptive functioning score similarly, understanding that FASD is an exception to this rule and being able to clearly explain it to educators early on, will reduce everyone's frustration.
Children with FASD often show an unusual profile for language. They are typically articulate which can hide problems in their understanding of language. In young children vocabulary may be high but grammar will be poor. Difficulty making all the sounds correctly can also happen.
Social communication means how a person is able to interact with others and understand nonverbal cues. Nonverbal cues are gestures such as body movement and facial expression that give meaning to what we communicate - even more than words! People with FASD often do not understand the intent or meaning from others and do not comprehend how they affect others. This is called “Theory of Mind” and is a key deficit area in FASD, similar to Autism. So, a person with FASD may have good grammar, vocabulary, and be articulate but they have difficulty in knowing how to be effective communicators when interacting with others.
Social Communication and Language
Children with FASD not only have difficulty processing and remembering what they hear; they can also have difficulty with what they see. Visual processing is an important part of learning to read. A child must be able to visually track words across the page and then move to the next line of words, as well as be able to see the breaks between words. For some children, it is difficult to process or “see” what is written on a page when the page includes a lot of writing or numbers. With this type of visual overwhelm, part of the page may not be processed at all. Difficulty copying information from the board is also a sign of visual-spatial difficulties. All of the above issues can occur in FASD.
Tip: Give a child a page of information rather than asking to read or copy from the board, reduce
information on a page, colored overlays to help process information.
Visual Spatial Skills
Children with FASD often have difficulty in fine and gross motor skills. Fine motor skill deficits look at the use of one's hands and can result in difficulty with writing, the formation of letters and with pencil grip. Balance, gait and how a child runs are examples of gross motor skills.
Motor planning difficulties relate to how the brain and the senses work together to plan movement. Delays in learning how to form letters automatically, dressing, brushing teeth, tying shoe and typing are examples of motor planning problems.
People with prenatal alcohol exposure are often misunderstood and misdiagnosed by professionals. It is important to make sure the person doing your assessment is educated around FASD, or at a minimum, open to your input and willing to research and/or collaborate with those who are educated.