1. health and fitness
2. disorders

Fetal
Alcohol
Spectrum
Disorders
handbook
A U n i ve r s i t y Ce n te r fo r E xce l l e n ce i n D e ve l o p m e n t a l D i s a b i l i t i e s E d u c a t i o n , R e s e a rc h a n d S e r v i ce
The Fetal Alcohol Spectrum Disorders Handbook was developed in part using federal funds
through a grant from the South Dakota Council on Developmental Disabilities, visit their
website at <http://dhs.sd.gov/ddc>.
Center for Disabilities
Department of Pediatrics
Sanford School of Medicine of The University of South Dakota
Health Science Center
1400 West 22nd Street
Sioux Falls, South Dakota 57105
1-800-658-3080 (Voice/TTY) or 605-357-1439
On the web at www.usd.edu/cd
Via e-mail at [email protected]
Table of Contents
Welcome to the FASD Handbook! ............................................................................. 1-2
FASD FAQs.............................................................................................................. 3-4
Historical Overview of Fetal Alcohol Spectrum Disorders ............................................. 5-6
Incidence and Prevalence of Fetal alcohol Spectrum Disorders ....................................... 7
Characteristics of Fetal Alcohol Spectrum Disorders .................................................. 8-10
Current Diagnostic Criteria for Fetal Alcohol Spectrum Disorders ............................... 11-13
Primary Disabilities in Fetal Alcohol Spectrum Disorders ........................................... 14-15
Executive Skills .....................................................................................................16-17
Secondary Disabilities in Fetal Alcohol Spectrum Disorders ....................................... 18-21
Prevention ............................................................................................................... 22
Strategies for Home ..............................................................................................23-25
Introduction to Educational Techniques .................................................................. 26-27
Educational Techniques for Preschool Students ....................................................... 28-32
Educational Techniques for Elementary School Students .......................................... 33-39
Educational Techniques for Junior and High School Students .................................... 40-45
Websites .............................................................................................................. 46-49
Organizations ....................................................................................................... 50-53
Resources ............................................................................................................ 54-58
Bibliography ......................................................................................................... 59-60
Welcome to the Fetal Alcohol Spectrum
Disorders Handbook!
The Center for Disabilities is pleased to provide you with this overview of Fetal Alcohol
Spectrum Disorders (FASD). This handbook uses the Institute of Medicine terminology.
Fetal Alcohol Spectrum Disorder is not a diagnostic term but rather an umbrella term that
covers both Fetal Alcohol Syndrome and Alcohol Related Effects. That terminology divides
Fetal Alcohol Spectrum Disorders into two broad categories: Fetal Alcohol Syndrome (with or
without confirmed maternal alcohol exposure) and Alcohol Related Effects which
encompasses Partial Fetal Alcohol Syndrome, Alcohol-Related Birth Defects, and AlcoholRelated Neurodevelopmental Disorder - see the Current Diagnostic Criteria for Fetal Alcohol
Spectrum Disorders article on page for more information. These terms do not include Fetal
Alcohol Effect which is still frequently used in literature regarding Fetal Alcohol Spectrum
Disorders. The term Fetal Alcohol Effect was often used as a diagnosis when full Fetal
Alcohol Syndrome wasn’t present. The Institute of Medicine terminology helps to better
identify the different categories within Fetal Alcohol Spectrum Disorders. While the term
Fetal Alcohol Syndrome has often been used to refer to the entire spectrum of physical
developmental and behavioral disabilities, it is important to remember that Fetal Alcohol
Syndrome is only one part of an entire spectrum.
This handbook is meant to provide a brief overview of some of the issues associated with
Fetal Alcohol Spectrum Disorders and to direct readers to other resources. It is not meant
to act as a diagnostic tool or as a comprehensive study of Fetal Alcohol Spectrum Disorders.
In an effort to provide the reader with the most up-to-date information on Fetal Alcohol
spectrum Disorders, the articles in this handbook refer to some of the latest books and
journal articles on the subject. If you would like more detailed information, please consult
the resources listed in the bibliographies on page 59 or the resources listed beginning on
page 54 of this handbook.
This handbook focuses on seven specific issues related to Fetal Alcohol Spectrum Disorders.
History of Fetal Alcohol Spectrum Disorders
Incidence and Prevalence of Fetal Alcohol Spectrum Disorders
Characteristics Associated with Fetal Alcohol Spectrum Disorders
Current Diagnostic Criteria for Fetal Alcohol Spectrum Disorders
Primary Disabilities in Fetal Alcohol Spectrum Disorders
Secondary Disabilities in Fetal Alcohol Spectrum Disorders
Prevention of Fetal Alcohol Spectrum Disorders
A section of frequently asked questions regarding Fetal Alcohol Spectrum Disorders begins
this handbook to give the reader a quick overview of some of the most often discussed
issues surrounding Fetal Alcohol Spectrum Disorders. This handbook also includes
educational techniques for students with developmental disabilities which may be applicable
to students with Fetal Alcohol Spectrum Disorders. A listing of resources is included to give
the reader places to go for more information. These resources include websites,
1
organizations, books, videos, and journal articles. A glossary of terms is included to provide
further explanation of some of the terms used in this handbook.
As you read and use this Fetal Alcohol Spectrum Disorders Handbook, please keep in mind
that the term Fetal Alcohol Spectrum Disorder (FASD) is used to describe a variety of
diagnoses which encompass a wide range of physical characteristics, developmental
difficulties and behaviors. Not every individual diagnosed with a Fetal Alcohol Spectrum
Disorder exhibits every characteristic, developmental difficulty or behavior listed in the
diagnostic criteria. There can be a great deal of variation in the severity of the
characteristic, developmental difficulty or behavior. It is also important to remember that
while there is no cure for Fetal Alcohol Spectrum Disorders - Fetal Alcohol Spectrum
Disorders are 100% Preventable.
2
FASD FAQs
When were Fetal Alcohol Spectrum Disorders first described?
The effects of drinking alcohol during pregnancy have long been noted. It wasn’t until 1973,
however, that the term “Fetal Alcohol Syndrome” was first coined to describe the physical
characteristics, developmental difficulties and behaviors associated with alcohol exposure
during pregnancy. In 2004, the term “Fetal Alcohol Spectrum Disorders” was agreed upon
by a group of national experts to be used as an umbrella term to encompass all the
disorders caused by prenatal alcohol exposure. For more on the history of Fetal Alcohol
Spectrum Disorders, see the “Historical Overview of Fetal Alcohol Syndrome” on page 5 of
this handbook.
How many people are affected by Fetal Alcohol Spectrum Disorders?
For a detailed look at the incidence and prevalence of Fetal Alcohol Spectrum Disorders, see
page 7 of this handbook.
What is the cost of Fetal Alcohol Spectrum Disorders?
When discussing the costs associated with Fetal Alcohol Spectrum Disorders (FASD), it is
important to remember that no dollar amount can begin to express the costs to the
individuals with Fetal Alcohol Spectrum Disorders. The costs of a disability on the life of a
person and their family is immeasurable.
The National Organization on Fetal Alcohol Syndrome (NOFAS) reports that “Fetal Alcohol
Syndrome (FAS) alone costs the United States 5.4 billion annually in direct and indirect
costs. [An] individual with full-blown FAS [can] incur an average lifetime health cost of
$860,000, although costs can be as high as $4.2 million. Costs associated with FAS are just
the tip of the iceberg. Individuals with FASD make up a much larger group and the total
costs associated with FASD are estimated to be much higher.” Another reports the
estimated “annual costs of FASD in the United states reached $4 billion by 1998” (Hoyme, et
al, page 39).
Do all people with a Fetal Alcohol Spectrum Disorder have mental retardation?
No. While Fetal Alcohol Spectrum Disorders are the leading cause of mental retardation and
the only preventable cause of mental retardation, not all people with Fetal Alcohol Spectrum
Disorders have mental retardation. In fact the range of IQ for individuals with Fetal Alcohol
Spectrum Disorders can range from 29 to 140.
Aren’t Fetal Alcohol Spectrum Disorders only a problem for some racial or
economic groups?
No. Fetal Alcohol Spectrum Disorders are caused by maternal alcohol consumption during
pregnancy. Fetal Alcohol Spectrum Disorders affect every segment of the population. All
racial groups and economic classes are affected by Fetal Alcohol Spectrum Disorders. While
studies indicate there are higher rates of Fetal Alcohol Spectrum Disorders in certain groups,
3
it is not solely the race or economics of the group that accounts for this difference. Social,
economic and environmental factors all contribute to the higher rates of Fetal Alcohol
Spectrum Disorders in some populations.
Is there a cure for Fetal Alcohol Spectrum Disorders?
No. The effects of prenatal alcohol exposure are irreversible. Individuals with a Fetal
Alcohol Spectrum Disorder and their families deal with the effects of the syndrome by
managing the behaviors it causes and addressing the medical implications of the syndrome.
But an individual with a Fetal Alcohol Spectrum Disorder will always have the disorder, there
is no cure.
Is it ever safe to drink alcohol during pregnancy?
No. There is no time during pregnancy when drinking alcohol is safe. In fact, it is
recommended that women stop drinking when planning to become pregnant. The effects of
prenatal exposure to alcohol can occur even in the earliest weeks of pregnancy, before some
women know they are pregnant. Studies indicate that alcohol consumed at anytime during
pregnancy can cause damage to the developing fetus. This applies both to sustained and
habitual consumption of alcohol as well as occasional events of binge drinking.
Can a father’s drinking cause Fetal Alcohol Spectrum Disorders?
To date, there is no physical link between a father’s drinking and Fetal Alcohol Spectrum
Disorders. However, a mother’s drinking behavior can be influenced by the drinking
behaviors of those around her, including her partner. A partner can have a positive or
negative effect on a mother’s drinking behaviors during pregnancy. A supportive nondrinking environment can be a great help to the pregnant woman.
If a person with a Fetal Alcohol Spectrum Disorder has children, will their
children have Fetal Alcohol Spectrum Disorders?
No. Unlike some disabilities which are passed genetically from one generation to another,
Fetal Alcohol Spectrum Disorders are not genetic. Fetal Alcohol Spectrum Disorders only
occur when alcohol is consumed during pregnancy. Women with Fetal Alcohol Spectrum
Disorders can have children without a Fetal Alcohol Spectrum Disorder if they refrain from
drinking while pregnant.
What are the most important pieces of information to remember about Fetal
Alcohol Spectrum Disorders?
Fetal Alcohol Spectrum Disorders are a wide spectrum of disabilities caused by prenatal
exposure to alcohol.
Fetal Alcohol Spectrum Disorders are the leading cause of mental retardation.
Fetal Alcohol Spectrum Disorders are the only entirely preventable cause of mental
retardation.
Bibliography - See page 59.
4
Historical Overview of
Fetal Alcohol Spectrum Disorders
The connection between prenatal maternal alcohol consumption and the subsequent
difficulties encountered by children has seemingly been known throughout history. Perhaps
the most frequently quoted ancient reference is in the book of Judges in the Old Testament
of the Bible. One verse says, in part, “Behold, thou shalt conceive, and bear a son: and now
drink no wine or strong drink” (Judges 13:7). Another of the most commonly quoted
sources is the Greek Philosopher Aristotle who wrote, “Foolish, drunken and harebrained
women, most often bring forth children like unto themselves, morose and
languid” (Streissguth, page 35). And then there is the Carthaginian ritual that “forbade the
drinking of wine by the bridal couple so that a defective child would not be
conceived” (Streissguth, page 35). While these ancient references cannot indicate that
history has always been sure of the connection between prenatal alcohol consumption and
the subsequent developmental difficulties encountered by children, it seems likely that even
in ancient times the connection was noticed.
Even with these ancient references, it wasn’t until relatively modern times that the medical
profession took notice of the connection between prenatal maternal alcohol consumption
and developmental difficulties in children. Among the first well known historical references
to the connection between prenatal maternal alcohol consumption and the development of
children was during the “gin epidemic” in England during the 1700’s. During this time period
the price of gin dropped dramatically and in “1714 the annual consumption was about two
million gallons of gin; by 1750 consumption was up to 11 million gallons” (Abel, page 4). In
1725, the College of Physicians drafted a letter to Parliament which read in part,
“the fatal effects of the frequent use of several sorts of distilled spirituous liquors upon
great numbers of both sexes rendering them diseased, not fit for business, poor, a
burthen to themselves and neighbors and too often the cause of weak, feeble, and
distempered children [italics Abel’s].” (Abel, page 4)
One of the first scientific studies on the effect of prenatal maternal alcohol consumption and
its effect on children was published in 1899. In the study, Dr. William Sullivan, a Liverpool,
England prison physician, compared the
“pregnancy outcomes in 120 female prisoners who were alcoholics. . . . Sullivan
compared these alcoholics with 28 of their blood relatives who were married to sober
husbands and had also given birth to children. . . . Compared to the 44% mortality
rate among the alcoholic populations, the mortality rate among children born to these
nonalcoholic blood relatives was 24%. . . . [H]e also found that women who entered
prison early in their pregnancies gave birth to children who were healthier than
women who entered prison late in their pregnancies. Presumably this was because
those who entered prison late in pregnancy had been drinking for a longer time during
pregnancy.” (Abel, page 6-7)
Despite historical evidence for Fetal Alcohol Spectrum Disorders, it wasn’t until modern times
5
that the connection between maternal drinking and child development began to be studied
in depth by the medical profession. In 1973, Dr. David Smith and Dr. Ken Jones, pediatric
dysmorphologists at Harborview Hospital in Seattle, Washington, began to study the effects
of prenatal alcohol exposure. Another physician at the hospital brought to their attention
“six infants with failure to thrive [who] all had alcoholic mothers. . . . [Drs. Smith and
Jones] perceived an unusual pattern of physical anomalies in these children that were
unlike any they were aware of. A child psychologist, Dr. Ann Streissguth, was
subsequently asked to examine these children, and she diagnosed varying degrees of
mental deficiencies in them.” (Abel, page 10)
Drs. Smith and Jones published their initial findings in Lancet. A second Lancet article that
same year finally provided the characteristics pattern of physical and mental characteristics
with a name - Fetal Alcohol Syndrome (often known by it’s acronym FAS). In the following
years, Fetal Alcohol Syndrome was recognized as only one part of the spectrum of
disabilities resulting from prenatal alcohol exposure. This spectrum included Fetal Alcohol
Effect (FAE) and Alcohol Related Birth Defects (ARBD). In the following years, many
professionals working in the field replaced the terms Fetal Alcohol Effect (FAE) and Alcohol
Related Birth Defects (ARBD) with terminology created by the Institute of Medicine. This
terminology created five categories on the Fetal Alcohol Spectrum - Fetal Alcohol Syndrome
(FAS) with confirmed maternal alcohol exposure, Fetal Alcohol Syndrome without confirmed
maternal alcohol exposure, Alcohol Related Effects (ARE) which includes three categories Partial Fetal Alcohol Syndrome (PFAS), Alcohol-Related Birth Defects (ARBD) and AlcoholRelated Neurodevelopmental Disorder (ARND).
In April of 2004, a group of national experts representing the Centers for Disease Control
and Prevention (CDC); the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the
Substance Abuse and Mental Health Service Administration (SAMHSA), Health Canada and
professionals in the fields of research, psychiatry and justice attended a meeting facilitated
by the National Organization on Fetal Alcohol Syndrome (NOFAS). At this meeting, the
descriptive term Fetal Alcohol Spectrum Disorders (FASD) was coined. Fetal Alcohol
Spectrum Disorders is an umbrella term describing the range of effects that can occur in an
individual whose mother drank alcohol during pregnancy. These effects may include
physical, mental, behavioral or learning disabilities with possible lifelong implications.
Ancient reference, the “Gin Epidemic” and Sullivan’s Liverpool prison study show that the
link between prenatal alcohol exposure and developmental delays or disabilities have long
been the subject of speculation. But it is only in recent history that the disorders on the
spectrum were given names much less were studied with rigorous scientific methods. Each
year scientists continue to devote their time and energy to understanding the biological and
psychological effects of prenatal alcohol exposure. Through their efforts, the effects of
alcohol on the developing fetus are being better understood. In addition, there is a better
understanding of individuals affected by Fetal Alcohol Spectrum Disorders and the difficulties
they face.
Bibliography - See page 59
6
Incidence and Prevalence of
Fetal Alcohol Spectrum Disorders
Finding statistics for Fetal Alcohol Spectrum Disorders (in particular Fetal Alcohol Syndrome)
is relatively simple. Finding statistics that agree with each other is another story all
together. There are several things that affect the variations in statistics for Fetal Alcohol
Spectrum Disorders the type of study used to generate the statistics,
the under diagnosis of Fetal Alcohol Spectrum Disorders,
the lack of standard diagnostic criteria,
the lack of a national registry,
the stigma of identifying children as having Fetal Alcohol Spectrum Disorders,
the lack of standard research, and
the difference between incidence and prevalence.
Incidence quantifies the new cases of Fetal Alcohol Spectrum Disorder occurring within a
certain period of time (usually in the form or births). Prevalence quantifies the number of
existing and new cases for a particular population during a certain period of time.
There are three main ways in which Fetal Alcohol Spectrum Disorder statistics are calculated
- passive surveillance systems, clinic-based studies, and active case ascertainment. In
passive surveillance systems, researchers review existing records in order to look for
documented or probable cases of Fetal Alcohol Spectrum Disorders. The types of records
generally used are “birth certificates, special registries for children with developmental
disabilities or birth defects, and/or the medical charts of hospitals and physicians.” (May and
Gossage) Clinic-based studies are “generally conducted in prenatal clinics of large hospitals
where researchers can collect data from mothers as they pass through the various months
of their pregnancies.” (May and Gossage) Active case ascertainment focus on large areas in
a particular geographic area or institution. This type of study is “unique in that they actively
seek, find, and recruit children who may have FAS[D] within the population under
study.” (May and Gossage) Each type of study has both advantages and disadvantages (for
more on the advantages and disadvantages, see the article referenced in the bibliography on
page 59).
A summary using all three types of studies completed by Philip A. May, Ph.D. and J. Phillip
Gossage, Ph.D. and published in 2001 provides the latest statistics. According to the May
and Gossage,
“FAS [Fetal Alcohol Syndrome] prevalence in the general population of the U.S. can
now be estimated to be between 0.5 and 2 per 1,000 births, and the prevalence of
FAS and ARBD [Alcohol Related Birth Defects] combined is likely to be at least 10 per
1,000, or 1 percent of all births.”
Bibliography - See page 59.
7
Characteristics of
Fetal Alcohol Spectrum Disorders
The characteristics of Fetal Alcohol Spectrum Disorders fall into three categories - Growth
Deficiency, Facial Characteristics and Central Nervous System Dysfunction. It is important to
remember that all the characteristics below can be present in the individual to varying
degrees. In individuals diagnosed with certain Fetal Alcohol Spectrum Disorder, the
following characteristics may not be present. It is not necessary for all the following
characteristics to be present for a diagnosis.
Growth Deficiency
In Height
In Weight
In Both Height and Weight
Prenatal or Post Natal
Facial Characteristics (Most Notable in Fetal Alcohol Syndrome)
Smooth or Long Philtrum (Ridges between nose and mouth.)
Short Palpebral Fissures (Eye Slits)
Thin Upper Lip
Minor Anomalies May Include
Flat Midface
Short Upturned Nose
Illustration from Fetal Alcohol Syndrome
Treatment & Education Centre, Inc. website
at <http://www.starflashdesign.com/fastec/
FASTECinfo.html>.
8
Central Nervous System Dysfunction
Microcephaly (Small Brain Size)
Tremors
Seizures
Hyperactivity
Fine Motor Difficulties
Gross Motor Difficulties
Attention Deficits
Learning Disabilities
Mental Retardation
Developmental Delays
Intellectual Disabilities
Fetal Alcohol Spectrum Disorders, especially where there is no confirmed history of prenatal
alcohol exposure, are often diagnosed based on the complete set of characteristics present
in the individual. As the person with a Fetal Alcohol Spectrum Disorder ages, the effects of
the disorder can be seen in a variety of ways. The following list of characteristics seen in
individuals with a Fetal Alcohol Spectrum Disorder at various developmental stages. It is
important to note that not every individual will exhibit all of the characteristics at any given
age.
Characteristics often seen in Newborns or Infants
Difficulty Sleeping - Unpredictable Sleep/Wake Cycle
Electroencephalogram (EEG) Abnormalities
Failure to Thrive
Feeding Difficulties including Weak Sucking Reflex
Heart Defects, Kidney Problems or Skeletal Anomalies
Increased Sensitivity to Light and Sound - Easily Overstimulated
Neurological Dysfunctions
Poor Fine Motor Control
Poor Gross Motor Control
Seizures, Tremors or Jitteriness
Small Size
Susceptibility to Infections
Characteristics often seen in Preschool Aged Children
Emotional Overreaction and Tantrums
Hyperactivity
Lack of Impulse Control
Mental Retardation
Poor eye-hand and physical coordination
Poor Judgment (Often see as difficulty recognizing danger including not fearing
strangers. Children of this age may seem overly friendly.)
Small Size
Speech Delays (May include poor articulation, slow vocabulary or grammar
development, or perseverative speech.)
9
Characteristics often seen in Elementary School Aged Children
Attention Deficits
Hyperactivity
Language Difficulties (Delayed Development or Difficulties with Expressive or
Receptive Language)
Learning Disabilities or Cognitive Disabilities
Memory Difficulties
Poor Impulse Control (Often seen as lying, stealing or defiant acts.)
Small Size
Social Difficulties (May include over friendly, immaturity, easily influenced and
difficulty with choices.)
Characteristics often seen in Adolescents and Young Adults
Difficulties with Abstract Reasoning
Difficulty Anticipating Consequences
Low Academic Achievement
Low Self-Esteem
Memory Impairments
More Pronounced Impulsiveness (Often seen as lying, stealing or defiant acts.)
Poor Judgment
School Failure
Bibliography - See page 59.
10
Current Diagnostic Criteria for
Fetal Alcohol Spectrum Disorders
In 1996, the Institute of Medicine published Fetal Alcohol Syndrome: Diagnosis,
Epidemiology, Prevention and Treatment. This book provided a diagnostic criteria for all the
disorders on the Fetal Alcohol Spectrum. The diagnostic criteria was updated in 2005 with
the publication of “Practical Clinic Approach to Diagnosis of Fetal Alcohol Spectrum
Disorders: Clarification of the 1996 Institute of Medicine Criteria” written by a group of
professionals working in the field of Fetal Alcohol Spectrum Disorders (for a detailed citation
of this article, see the bibliography on pages 59-60). The following diagnostic criteria is
taken from the 2005 article. Please consult the article for more detailed information.
Fetal Alcohol Syndrome (FAS) with Confirmed Maternal Alcohol Exposure
(This diagnosis requires the presence of all features A-D listed below.)
A. Confirmed maternal alcohol exposure
B. Evidence of a characteristic pattern of minor facial anomalies, including at least two
of the following 1. Short palpebral fissures (Eye slits)
2. Thin vermillion border of the upper lip
3. Smooth philtrum (Ridges between the nose and mouth)
C. Evidence of prenatal and/or postnatal growth retardation
1. Height or weight ≤ 10th percentile, corrected for racial norms (if possible)
D. Evidence of deficient brain growth or abnormal morphogenesis, including at least 1
of the following 1. Structural brain abnormalities
2. Head circumference ≤ 10th percentile
Fetal Alcohol Syndrome (FAS) without Confirmed Maternal Alcohol Exposure
(This diagnosis requires the presence of all features A-C listed below.)
A. Evidence of a characteristic pattern of minor facial anomalies, including at least two
of the following 1. Short palpebral fissures (Eye slits)
2. Thin vermillion border of the upper lip
3. Smooth philtrum (Ridges between the nose and mouth)
B. Evidence of prenatal and/or postnatal growth retardation
1. Height or weight ≤ 10th percentile
C. Evidence of deficient brain growth or abnormal morphogenesis, including at least 1
of the following 1. Structural brain abnormalities
2. Head circumference ≤ 10th percentile
11
Partial Fetal Alcohol Syndrome (PFAS) with Confirmed Maternal Alcohol Exposure
(This diagnosis requires the presence of all features A-C listed below.)
A. Confirmed maternal alcohol exposure
B. Evidence of a characteristic pattern of minor facial anomalies, including at least two
of the following 1. Short palpebral fissures (Eye slits)
2. Thin vermillion border of the upper lip
3. Smooth philtrum (Ridges between the nose and mouth.)
C. One of the following other characteristics
1. Evidence of prenatal and/or postnatal growth retardation
a. height or weight ≤ 10th percentile corrected for racial norms (if
possible)
2. Evidence of deficient brain growth or abnormal morphogenesis, including at
least 1 of the following
a. Structural brain abnormalities
b. Head circumference ≤ 10th percentile
3. Evidence of a complex pattern of behavioral or cognitive abnormalities
inconsistent with developmental level that cannot be explained by genetic
predisposition, family background or environment alone
a. This pattern included marked impairment in the performance of
complex tasks (complex problem solving, planning, judgment,
abstraction, metacognition, and arithmetic tasks); higher-level
receptive and expressive language deficits; and disordered behavior
(difficulties in personal manner, emotional liability, motor dysfunction,
poor academic performance, and deficient social interaction)
Partial Fetal Alcohol Syndrome (PFAS) without Confirmed Maternal Alcohol
Exposure
(This diagnosis requires the presence of all features A-C listed below.)
A. Evidence of a characteristic pattern of minor facial anomalies, including at least two
of the following 1. Short palpebral fissures (Eye slits)
2. Thin vermillion border of the upper lip
3. Smooth philtrum (Ridges between the nose and mouth.)
B. One of the following other characteristics
1. Evidence of prenatal and/or postnatal growth retardation
a. height or weight ≤ 10th percentile corrected for racial norms (if
possible)
2. Evidence of deficient brain growth or abnormal morphogenesis, including at
least 1 of the following
a. Structural brain abnormalities
b. Head circumference ≤ 10th percentile
3. Evidence of a complex pattern of behavioral or cognitive abnormalities
inconsistent with developmental level that cannot be explained by genetic
predisposition, family background or environment alone
12
a. This pattern includes marked impairment in the performance of
complex tasks (complex problem solving, planning, judgment,
abstraction, metacognition, and arithmetic tasks); higher-level
receptive and expressive language deficits; and disordered behavior
(difficulties in personal manner, emotional lability, motor dysfunction,
poor academic performance, and deficient social interaction)
Alcohol Related Birth Defects (ARBD)
(This diagnosis requires features A-C listed below.)
A. Confirmed maternal alcohol exposure
B. Evidence of a characteristic pattern of minor facial anomalies, including at least two
of the following 1. Short palpebral fissures (Eye slits)
2. Thin vermillion border of the upper lip
3. Smooth philtrum (Ridges between the nose and mouth.)
C. Congenital structural defects in at least one of the following categories, including
malformations and dysplasias (if the patient displays minor anomalies, at least two
must be present):
1. cardiac: atrial septal defects, aberrant great vessels, ventricular septal
defects, conotruncal hearth defects; skeletal: radioulnar synostosis, vertebral
segmentation defects, large joint contractures, scoliosis; renal: aplastic/
hypoplastic/dysplastic kidneys, “horseshow: kidneys/ureteral duplications;
eye: strabismus, ptosis, retinal vascular anomalies, optic nerve hypoplasia;
ears: conductive hearing losss, neurosensory hearing loss; minor
abnormalities: hypoplastic nails, short fifth digits, clinodactyly of fifth fingers,
pectus carinatum/excavatum, camptodactyly, “hockey stick” palmar creases,
refractive errors, “railroad track” ears
Alcohol Related Neruodevelopmental Disorders (ARND)
(This diagnosis requires both A and B listed below.)
A. Confirmed maternal alcohol exposure
B. At least 1 of the following
1. Evidence of deficient brain growth or abnormal morphogenesis, including at
least on of the following
a. Structural brain abnormalities
b. Head circumference ≤ 10th percentile
2. Evidence of a complex pattern of behavioral or cognitive abnormalities
inconsistent with developmental level that cannot be explained by genetic
predisposition, family background or environment alone
a. This pattern includes marked impairment in the performance of
complex tasks (complex problem solving, planning, judgment,
abstraction, metacognition, and arithmetic tasks); higher-level
receptive and expressive language deficits; and disordered behavior
(difficulties in personal manner, emotional lability, motor dysfunction,
poor academic performance, and deficient social interaction)
13
Primary Disabilities in
Fetal Alcohol Spectrum Disorders
Most of the primary disabilities associated with Fetal Alcohol Spectrum Disorders can be
related to damage to the brain during the development of the fetus. Alcohol’s affect on the
developing brain is an area in which extensive research is being conducted. Alcohol is a
tertogenic drug. According to the Oxford English Dictionary, a teratogen is “an agent or
factor which causes malformation of the developing embryo.” Alcohol can affect the embryo
as well as the fetus. It is important that women abstain from drinking not only when they
know they are pregnant, but also when they are planning to become pregnant since alcohol
can damage the embryo even before a woman knows she is pregnant.
How exactly does alcohol affect brain development? Ann Streissguth, Ph.D. a leader in the
study of Fetal Alcohol Spectrum Disorders, points to two different ways, one affecting the
structure of the brain and the other affecting the function of the brain.
“[E]xposure to prenatal alcohol can disrupt the normal proliferation and migration of
brain cells, which produces structural deviations in brain development. . . . Prenatal
alcohol exposure can also disrupt the electrophysiology and neurochemical balance of
the brain, so that messages are not transmitted as efficiently or as accurately as they
should be.” (page 96)
Researchers have traditionally used autopsies and Magnetic Resonance Imaging (MRI) to
study the damage caused to the structure of the brain. To study the function of the brain,
researchers use electroencephalograms (EEGs) and Positron Emission Tomography (PET).
Recent technological advances have allowed researchers to study the brain as a whole
through the use of functional MRIs and brain mapping (Riley, et al.)
Given the vast variety of characteristics exhibited by individuals with a Fetal Alcohol
Spectrum Disorder, it stands to reason that the effect of prenatal alcohol exposure on brain
development can be influenced by several different variables. Streissguth discusses these
variables, as seen in animal research, in her book Fetal Alcohol Syndrome: A Guide for
Families and Communities.
“Dose, timing and pattern of exposure modify the prenatal effects of alcohol. . . . Not
only are children of mothers who are chronic alcoholics at risk. . . . Women who drink
before they know they are pregnant or have an occasional heavy dose of alcohol
(binge) may also cause damage to their children.
Individual differences in the mother and child modify the effect of prenatal exposure
in the individual. . . in terms of both the severity and the type of offspring effect. . . .
The fact that some offspring appear unaffected by prenatal alcohol at any point in
time does not mean that alcohol is not tertogenic or that an individual who is free of
alcohol-caused disabilities at one age will necessarily be free of them at another.
14
Brain-behavior relationships have been well established in animal studies. . . . Many of
the puzzling and bizarre behaviors that people with FAS [Fetal alcohol Syndrome]
engage in may be caused by their brain damage. This has major social implications
for their daily living and their social interactions.
The effects of prenatal exposure last into adulthood. . . . Aberrant behaviors in
children, adolescents, and adults can be caused by prenatal damage.” (Pages 66-67)
The four regions of the brain most frequently referred to when discussing the effects of
prenatal alcohol exposure are the basal ganglia, cerebellum, corpus callosum, and
hippocampus. Neuroimaging studies show that all four of these brain regions are decreased
in size in the brains of individuals who were exposed to alcohol prenatally. In the worst
cases, the corpus callosum may be absent.
The impact of this damage to the brain is most readily seen by the various functions that
each of these regions controls. It follows that damage to each of these regions would
adversely affect the function for which each is responsible.
According to Riley, et al.,
“The basil ganglia are involved in voluntary limb movement, eye movement, and
cognition. The caudate [a part of the basal ganglia] . . . appears to be involved in
cognition, particularly with executive functions, such as problem solving, concept
formation, and working memories.” (page 37).
The cerebellum is “thought to be involved primarily in movement but also in cognitive
processes, such as attention.” (Prenatal Exposure to Alcohol, page 33) Damage to the
cerebellum has also “been implicated in learning deficits as well as in balance and
coordination.” (Mattson, page 189)
The corpus callosum connects the two halves of the brain and allows them to communicate.
Damage to the corpus callosum has “been linked to deficits in attention, intellectual
functioning, reading, learning, verbal memory, and executive and psychosocial
functioning.” (Mattson, page 188)
The hippocampus is involved in the function of memory. “Although the precise function of
the hippocampus in specific aspects of memory is controversial, it probably plays a role in
the consolidation of memory.” (Mattson, page 189)
When any of these regions - the basal ganglia, cerebellum, corpus callosum or hippocampus
- is damaged by prenatal exposure to alcohol it can have devastating effects. Each unique
area of the brain, by itself and in connection with the rest of the brain, controls some
functions. The greater the damage to the brain, the greater the consequences. It is
important to remember that brain damage caused by prenatal alcohol exposure can be
present even in the absence of the classic facial features of Fetal Alcohol Spectrum
Disorders.
Bibliography - See page 60.
15
Executive Skills
Executive skills are those skills which are controlled by the frontal lobes of the brain. They
are high level cognitive functions which allow individuals to organize their behavior through
planning and organizing, sustaining attention, persisting to complete a task, managing emotions, and monitoring thoughts to work more efficiently. Executive skills have been defined
as the directive capacities of the mind which cue the use of other mental abilities. In broad
terms, executive skills help individuals regulate their behavior. Individuals with an FASD often exhibit executive dysfunction, indicating possible damage to that area of the brain due to
prenatal alcohol exposure. The following chart identifies several executive skills, provides a
description of the skills, and list possible signs or symptoms of a dysfunction with each skill.
Executive Skill
Possible Signs or Symptoms of
Dysfunction
Description
Planning and
Sequencing
The ability to develop steps to
reach a goal or complete a task,
identify materials needed, and set a
completion dat. The ability to
arrange steps in the proper order.
May start project without
necessary materials.
May not leave enough time to
complete the project.
May not make plans for the
weekend with peers.
May skip steps while completing
a multi-step task.
May have difficulty relating
stories chronologically.
May “jump the gun” socially.
Organizing
The ability to obtain and maintain
necessary materials and aids to
completing sequence and achieving
goals.
May lose important papers or
possessions.
May fail to turn in completed
work.
May create an unrealistic
schedule.
Time
The ability to estimate how much
Management and time one has, how to allocate the
Prioritizing
time, and how to stay within
timelines and deadlines. The ability
to establish ranking of needs or
tasks.
May waste time doing small
projects and fail to do big
projects.
May have difficulty identifying
what material to record when
taking notes.
Flexibility
May get stuck on one approach.
May not know how to access
appropriate resources.
May become easily frustrated
and exhibit temper tantrums.
The ability to revise plans in view of
mistakes. The ability to adapt to
changing conditions
16
Executive Skill
Possible Signs or Symptoms of
Dysfunction
Description
Working Memory
The ability to hold information in
your mind while performing
complex tasks. The ability to draw
on past learning or experience to
apply to the situation at hand or to
project problem solving strategies
into the future.
May not follow directions.
May not write down, complete or
hand in assignments or bring
appropriate materials.
May forget the process for
assignments (long division,
proper headings, etc.).
May not remember to perform
responsibilities.
May lose things.
Metacognition
The ability to take a “bird’s eye
view” of oneself in a situation. The
ability to observe or think about
how to solve a problem. These are
self-monitoring and self-evaluation
skills.
May not understand directions.
May make careless mistakes or
fail to check work.
May fail to check assignment to
make sure directions were
followed.
May fail to recognize there is a
problem and fail to ask for help.
May fail to evaluate their own
performance.
May fail to see how their
behavior affects the group, the
situation or themselves.
Inhibiting
The ability to stop oneself from
responding to distracters and think
before acting. The ability to resist
the urge to say or do something.
The ability to delay gratification in
service of more important, longterm goals.
May appear distractible and/or
impulsive.
May pick smaller, immediate
reward over larger delayed
reward.
Self-Regulating
Affect
The ability to manage emotions to
achieve goals. The ability to control
or direct behavior.
May exhibit inappropriate or
over-reactive response to
situations.
Initiating
The ability to begin a task without
undue procrastination and in a
timely fashion.
May have difficulty getting
started on tasks which may
appear as oppositional behavior.
Goal Directed
Persistence
The ability to reach self-set or other
-set goals and to not be put off by
distractions or competing interests
May start tasks but not finish
them.
17
Secondary Disabilities in
Fetal Alcohol Spectrum Disorders
Primary disabilities, when referring to Fetal Alcohol Spectrum Disorders, are those caused by
brain damage both structural and functional (see Primary Disabilities in Fetal Alcohol
Spectrum Disorders on page 14 of this handbook). Secondary disabilities “are disabilities
that an individual is not born with, but may be acquired as a result of the CNS [Central
Nervous System] deficits” associated with Fetal Alcohol Spectrum Disorders. (National Center
on Birth Defects and Developmental Disabilities) Not every individual with a Fetal Alcohol
Spectrum Disorder exhibits secondary disabilities. In fact, “higher rates of secondary
disabilities were observed for people who had FAE [Fetal Alcohol Effect now known as Partial
Fetal Alcohol Syndrome] rather than FAS [Fetal Alcohol Syndrome]. . . . and an IQ score
above rather than below 70.” (Streissguth, page 111) It is important to note that not all
individuals diagnosed with a Fetal Alcohol Spectrum Disorder will be affected by all the
secondary disabilities included in this article. The most commonly seen secondary
disabilities are mental health problems, disrupted school experience, alcohol or drug use,
legal problems, confinement, inappropriate sexual behavior, and dependent living.
Mental Health Problems
Anxiety Disorders
Attachment Disorder
Attention Deficit Disorder (ADD)
Attention Deficit Hyperactivity Disorder (ADHD)
Conduct Disorder
Depression
Eating Disorders
Hallucinations
Oppositional Defiance Disorder
Psychotic Episodes
Suicide Threats/Attempts
“More than 90% of the individuals in our [Streissguth, Barr, et al., 1996] study had mental
health problems, and more than 80% had had treatment for mental health problems. There
was no difference in the prevalence of mental health problems for children versus
adolescents and adults.” (Streissguth, page 109)
Disrupted Schooling
Dropping Out
Expulsions
Suspensions
Behaviors which may lead to the above school disruptions.
Being Repeatedly Disruptive in Class
18
Disobedience
Disrespect Toward Teachers
Learning Difficulties
Not Getting Along with Peers
Truancy
“More than 60% of the adolescents and adults [in the Streissguth, Barr, et al. 1996 study]
had a disrupted school experience and, surprisingly, so had 14% of the children.
Suspensions were the most frequent disrupted school experience among individuals of all
ages.” (Streissguth, page 109)
Alcohol or Drug Use
“Problems with alcohol and other drugs were reported for 35% of adolescents and adults [in
the Streissguth, Barr, et al. 1996 study] but were not reported as a problem for
children.” (Streissguth, page 109)
Legal Problems
Assault
Child Molestations
Crimes against Persons
Crimes against Property
Domestic Violence
Running Away
Shoplifting
Theft
“Sixty percent of the adolescents and adults [in the Streissguth, Bart, et al. 1996 study] and
even 14% of the children had trouble with the law. . . . Individuals who didn't have
disrupted school experiences were only 40% as likely to be in trouble with the
law.” (Streissguth, page 109)
Confinement
Incarceration (Jail)
In-Patient Alcohol Treatment
In-Patient Drug Treatment
In-Patient Mental Health Treatment
“Fifty percent of the adolescents and adults [in the Streissguth, Barr, et al. 1996 study] but
less than 10% of the children had been confined. Adolescents and adults were more likely
to have been incarcerated (32% and 42%, respectively) than to have been in either
inpatient mental health programs (20%-28%) or inpatient alcohol and other drug treatment
programs (12%-20%).” (Streissguth, page 109)
19
Inappropriate Sexual Behavior
Compulsions
Inappropriate Sexual Advances
Inappropriate Sexual Touching
Obscene Telephone Calls
Promiscuity
Voyeurism
“Forty-nine percent of the adolescents and adults [in the Streissguth, Barr, et al. 1996
study] and 39% of children had displayed inappropriate sexual behavior.” (Streissguth, page
110) Poor judgment, lack of impulse control and difficulty learning from experience can
contribute to inappropriate sexual behavior.
Dependent Living
The term dependent living could be used to characterize “about 80% of the sample [in the
Streissguth, Barr, et al. 1996 study] (21 and over).” (Streissguth and Kanter, page 34) “The
majority of FAS [Fetal Alcohol Syndrome] adults may always need to live in a supervised
setting. Group homes for FAS affected adults can be a nurturing and supportive
environment, providing a degree of independence within a safe haven (Alcohol Related Birth
Injury (FAS/FAE) Resource Site).”
Problems with Employment
Difficulty Getting a Job
Difficulty Holding a Job
Being Fired
Losing a Job Without Explanation
The term “problems with employment” could be used to characterize “about 80% of the
sample [in the Streissguth, Barr, et al. 1996 study] (21 and over). Only seven of the 90
adults in this sample live independently and without employment problems” (Streissguth and
Kanter, page 34).
None of these secondary disabilities exists in a vacuum. Legal problems can stem from
alcohol and drug use. Disrupted school experiences can result from learning disabilities and
impulse control. While it may seem that secondary disabilities would be difficult to prevent,
there are several so-called “protective factors” which are associated with lower rates of
secondary disabilities in individuals with a Fetal Alcohol Spectrum Disorder. The protective
factors are early diagnosis; receiving special education and/or social services; a stable,
nurturing home environment; and an absence of violence.
(The following text speaks specifically to Fetal Alcohol Syndrome (FAS) but these protective
factors are equally important in all Fetal Alcohol Spectrum Disorders (FASD).)
20
Protective Factors
Early Diagnosis
“Children with FAS (Fetal Alcohol Syndrome) who are identified early have an improved
prognosis. A child who is identified early in life can be placed in appropriate educational
classes and given access to social services that can help the child and his or her family. In
addition, early diagnosis helps families and school personnel understand why the child might
act or react differently from other children in some situations.” (National Center on Birth
Defects and Developmental Disabilities)
Involvement in Special Education and Social Services
“Children who receive special education geared towards their specific needs and learning
style are more likely to achieve their developmental and educational potential. Children with
FAS show a wide range of behaviors and severity of symptoms. Special education allows for
individualized educational programs. In addition, families of children with FAS who receive
social services, such as respite care or stress and behavioral management training, have
more positive outcomes than families who do not receive such services.” (National Center
on Birth Defects and Developmental Disabilities)
Loving, Nurturing and Stable Caretaking Environment
“While all children benefit from a loving and stable home life, children with FAS can be
particularly sensitive to disruptions, transient lifestyles, or harmful relationships compared to
children who do not have FAS. Community and family support are needed to prevent
secondary conditions in individuals with FAS.” (National Center on Birth Defects and
Developmental Disabilities)
Absence of Violence
“Individuals with FAS who live in stable or non-abuse households or who do not become
involved in youth violence are much less likely to develop secondary conditions than children
who have been exposed to violence in their lives. Children with FAS need to learn and be
taught other ways of showing their anger or frustration.” (National Center on Birth Defects
and Developmental Disabilities)
Secondary disabilities can be difficult for individuals with Fetal Alcohol Spectrum Disorders
and their families. However, the protective factors can help to eliminate or lessen this set of
secondary disabilities.
Bibliography - See page 60.
21
Prevention
Given that Fetal Alcohol Spectrum Disorders are 100% preventable, it may seem a given
that prevention would figure in any discussion of not only Fetal Alcohol Spectrum Disorders
but also of women’s health issues. However, it is sometimes a fine line that researchers
studying Fetal Alcohol Spectrum Disorders, physicians treating women, and public health
officials must walk. Alcohol is a legal drug and anyone, including women, who are legally of
age are allowed to use alcohol. “The use and abuse of alcohol have long been centered in
emotional and moral debate. Women who use alcohol or other substances are particularly
stigmatized” (Institute of Medicine, page 112). For this reason, it is helpful to establish a
model of prevention that focuses not only on the woman who is or may become pregnant,
but also on her spouse or significant other, her physician, her community, and her society.
Ann Streissguth, Ph.D., a noted researcher in the area of Fetal Alcohol Spectrum Disorders,
has developed what she terms the “Five P’s of Prevention.”
1. Public Education
4. Programs and Services
2. Professional Training
5. Parent and Citizen Activism
3. Public Policy
Stresissguth’s “Five P’s of Prevention” work together to affect not only women who are or
may become pregnant but also the society around them. (Sreissguth, page 250)
1. Public Education is focused on educating the public at large about the dangers of
drinking during and even before pregnancy. Public education can take many forms.
Posters, lectures, brochures and media coverage are all forms of public education.
2. Professional Training is focused on teaching healthcare and social service
professionals about Fetal Alcohol Spectrum Disorders. But beyond that, teaching them
how to discuss with women the effects drinking can have on a fetus. Professionals
should be given concrete suggestions for introducing the topic of drinking during
pregnancy and they should be familiarized with ways to help women stop drinking.
3. Public Policy refers to the way government on every level deals with the issue of
drinking during pregnancy. Public policy is seen in the United States Surgeon General’s
warning urging women to stop drinking while they are planning to become pregnant. It
is also seen in the laws in some states requiring individuals to report to the state women
they know to be drinking during pregnancy.
4. Programs and Services refers to programs which intervene - even briefly - with
women who are drinking during pregnancy and services which support the women during
and after their pregnancy.
5. Parent and Citizen Activism is simply what its name says. Parents and citizens taking
an active role in the prevention of Fetal Alcohol Spectrum Disorders.
Ann Stresissguth’s “Five P’s of Prevention” is only one of several popular models of
prevention. No matter which model of prevention is used. It is important to remember that
Fetal Alcohol Spectrum Disorders are 100% preventable.
Bibliography - See page 60.
22
Strategies for the Home
The following strategies may be helpful to parents, guardians or caregivers of individuals
with a Fetal Alcohol Spectrum Disorder. It is important to note that each individual with a
Fetal Alcohol Spectrum Disorder is unique. The strategies listed here may not work for
everyone.
It is important to remember that it is not what the individual with a Fetal Alcohol
Spectrum Disorder “won’t” do, but rather what they “can’t” do as a result of damage to
the brain caused by prenatal exposure to alcohol. (See “Primary Disabilities in Fetal
Alcohol Spectrum Disorders” on page 14 of this handbook to learn more.)
There are many overlapping behavioral characteristics and related mental health
diagnoses which is why a differential diagnosis is important.
Consider chronological age (calendar age) versus developmental age (the age equivalent
to the individual’s developmental stage) when choosing everyday activities and
strategies.
When creating strategies it is important to Use teachable moments rather than punishment.
REMAIN CALM.
Look at the individual’s unusual behavior and find the individual’s “logic” behind the
behavior.
Utilize the “Eight Magic Keys” which are strategies that can be effective in helping an
individual with a Fetal Alcohol Spectrum Disorder. The “Eight Magic Keys” are listed
below.
Concrete
Consistency
Repetition
Routine
Simplicity
Specific
Structure
Supervision
No matter what discipline method you choose, stick with it and be consistent.
23
To have/create effective strategies it is important to focus on behaviors caused by brain
dysfunction. The following list includes behaviors that result from brain dysfunction
followed by possible strategies.
Hyperactivity and Attention Deficits
Take a break, exercise and encourage movement, or talk with the
individual’s doctor about medications that may be appropriate.
Impulsivity
SAFE (Stay Away from Emergencies) role-play with the individual that when
they are out of routine to check-in with a designated person to find out what
to do.
Literal Thinking and Poor Social Skills
Teach routines or create a book of commonly misunderstood phrases to help
the individual work on issues with literal thinking.
Difficulty Making Transition
Provide redirection, warnings, and let the individual feel like they are
involved in decision making activities.
Poor or Distorted Memory
Establish routines, teach organizational skills, and have the individual checkin with a friend to compare memories.
Keep routines simple and instructions short.
Give advance warning to the individual before changing tasks.
Focus on daily living skills.
Praise positive behavior.
Set limits and stick to them.
Be patient.
Repeat, repeat, repeat.
Concentrate on strengths and talents.
Beneficial Tools for Parents, Guardians and Caregivers
Have a support network of family, friends and professionals.
Be informed and share information with others in the individual’s life.
Take care of your own health.
Find humor in everyday life.
Strategies That May Make Mealtime Easier
Never give or withhold food as a reward or punishment.
Have meals at the same time every day, even on weekends.
24
Use simple rules at mealtimes (for example - “eyes on your food” or “eat with your
fork”)
Avoid long mealtimes as this can be distracting.
Seat the individual with a Fetal Alcohol Spectrum Disorder next to the most tolerant
individual.
Assign the individual a specific seat and never change it.
If the individual has difficulty sitting for a long time, let them stand at the table.
Serve premeasured portions of food to the individual if they tend to overeat.
Individuals with a Fetal Alcohol Spectrum Disorder may chew and chew without
swallowing, remind the individual of the need to swallow.
25
Introduction to
Educational Techniques
The following pages of this handbook contain articles describing educational techniques that
may be helpful to teachers, parents, guardians, and caregivers of individuals with a Fetal
Alcohol Spectrum Disorder. The articles are Educational Techniques for Preschool Students,
Educational Techniques for Elementary School Students, and
Educational Techniques for Junior and Senior High School Students.
As was noted in “Secondary Disabilities in Fetal Alcohol Spectrum Disorders” article on page
18, disrupted schooling is one of the most common secondary disabilities encountered by
individuals with a Fetal Alcohol Spectrum Disorder. “Secondary Disabilities in Fetal Alcohol
Spectrum Disorders” discussed the behaviors which may lead to school disruption.
However, there may also be underlying causes for the behaviors that lead to school
disruption as well as other contributing factors. Some of the possible contributing factors to
school disruption may include the following primary disabilities caused by brain anomalies.
Arithmetic Disabilities
Attention deficits
Delayed Reaction Time - Students with a Fetal Alcohol Spectrum Disorder may
process information slower and less efficiently than their peers.
Difficulties with Abstraction - Often seen as a difficulty understanding
consequences.
Difficulties Transitioning Between Activities
Difficulties with Verbal Learning - Students with a Fetal Alcohol Spectrum Disorder
may learn fewer words.
Difficulties with Visual-Spatial Learning - Students with a Fetal Alcohol Spectrum
Disorder often have difficulty replacing objects in their original position.
Disorientation in Time and Space - Often seen as a difficulty perceiving social cues.
Impulsivity - Often seen as poor frustration tolerance.
Memory Impairments
Difficulties Generalizing
The following lists some of the focus areas teachers and caregivers might consider when
discussing the education of a student with a Fetal Alcohol Spectrum Disorder. Also listed
below are some basic recommendations for each of the areas.
Environment - Keep the environment free of distractions and as organized as
possible.
Transitional Periods - Establish and use clearly defined cues to begin and end the
transition period between activities.
Organizational Skills - Keep tasks short. Use brief, concrete directions.
Increasing Attention - Use eye contact and touch when giving directions. Have the
student repeat the directions.
26
Controlling Impulsivity - Model and rehearse social skills. Require the student to
wait for an established signal before beginning a task.
Discipline - Ignore negative behavior whenever possible. Use brief, immediate
consequences when necessary.
Overstimulated - Have a respite plan for when the student is overwhelmed.
Memory - Teach memory strategies and repeat information continuously.
Hyperactivity - Provide opportunities for frequent breaks and movement activities.
The articles on pages 28-45 of this handbook will provide further information on strategies
for helping students with Fetal Alcohol Spectrum Disorders. While every student with a Fetal
Alcohol Spectrum Disorder will not encounter every problem discussed in these articles, most
will experience at least some difficulties with school and/or learning. Not every student with
a Fetal Alcohol Spectrum Disorder will respond to every technique included in the following
articles, but the suggestions provided here may help the teacher or caregiver to better help
the student learn and succeed in school.
Five words to remember when teaching a student with a Fetal Alcohol Spectrum Disorder Structure,
Consistency,
Brevity,
Variety, and
Persistence.
The information in this article and the articles “Educational Techniques for Preschool
Students,” “Educational Techniques for Elementary School Students,” and “Educational
Techniques for Junior and Senior High School Students” which follow on the next page of
this handbook has been compiled over a number of years by staff of the Center for
Disabilities working in the field of Fetal Alcohol Spectrum Disorders.
27
Educational Techniques
for Preschool Students
Alphabet
Make letters with paper and glue objects whose names begin with that letter to the paper
letter.
Match letters.
Match words.
Use the sounds of letters repeatedly. For example - “J,” juice, jump, jacket, etc.
The teacher cuts the letter out of sandpaper and has the child trace the sandpaper letter
with his/her finger.
The teacher writes a letter on the blackboard and has the student trace the letter.
The teacher makes dots on a paper in the shape of the letter and has the student
connect the dots to make the letter. The teacher can gradually decrease the number of
dots used to make the letter.
Make letters out of jiggler jello.
When a student is learning to write his/her name, it may be easier for the student to use
all capital letters at the beginning.
Teach sign language to designate each letter of the alphabet.
Environment
Students with a Fetal Alcohol Spectrum Disorder usually need more one-on-one teaching.
Increased staff should be considered.
Calm and Quiet
Soft music may be calming.
Tone down classroom so rooms are not overly stimulating.
Keep a minimal number of objects hanging from the ceiling and on the walls.
Use calm colors of paint on the walls.
Reduce clutter.
Well-defined areas across environments.
Structure
Same rules are enforced the same way.
Transition from One Activity to Another
Tell the student what they will be doing. For example - “We’ll finish painting, then
we’ll eat a snack.”
The teacher may need to give the student an object needed for the next activity so
the child has an easier time making the transition. For example - give the student
his/her lunchbox when it is time to eat lunch.
The student could be allowed to carry the book to story time or carry the puppet to
the puppet theater.
Teach transition routines.
Use visual timers to show when the transition will occur. For example - egg timer,
kitchen timer or clock.
Use a transition buddy when moving from room to room.
28
Evaluations
The following evaluations may be helpful in learning more about the student’s
development and assist in planning the teachers activities.
Speech and Language
Psychological
Motor
Adaptive Behavior
Occupational Therapy
Physical Therapy
Academic
Eye-Hand Coordination Activities
Use puzzles with knobs on the pieces.
Lace Cards
The teacher may need to make a larger lace card from cardboard.
The lace for the lace card may need masking tape on the end to make it easier for
the child to lace the card.
Have the student squeeze clothes pins open and closed.
The teacher may need to show the student how to do the activity, then guide the child
through the activity, and finally encourage the student to do the activity on his/her own.
The teacher could pick up the puzzle piece for the student to put in the right place
in the puzzle.
The teacher could lace the first two holes of a lacing card.
Have the student put pegs in a peg board.
Have the student pound pegs into a peg board.
Language Development
Students who are not yet talking.
Begin with simple story books.
The teacher can touch an object and name the object for the table. For example The teacher touches a table and says to the student “table.”
Use real objects the student can see and touch when naming objects.
Students who are using single words.
If the student says “drink,” say to the student “more drink.” This stimulates the
student to use more vocabulary.
Expand the student’s vocabulary slowly. When the student starts using two words,
start encouraging the student to use three words. If the student says “more
drink,” say to the student “want more drink.”
Talk to the student at their level. Use short sentences. Avoid using long
sentences.
Students with poor articulation.
A speech therapist could be a good resources for both the student and the teacher.
The teacher needs to use proper pronunciation. A good role model is important.
Go around the classroom, touch objects and name the object. Have the student
do the same thing.
29
At mealtime, have the student say what he/she wants rather than just giving the
student what you think they want.
Music activities can help children learn vocabulary.
Good morning songs.
Song before eating.
Name songs.
Circle game songs - sit down, stand up, name games.
Use sign language.
Sign language may be helpful to teach students even when they do not have
a hearing loss.
Sign language is concrete and visible and can be used along with verbal
language.
Managing Hyperactivity
Keep the environment structured.
Make a picture calendar.
Make a board with hooks.
Laminate pictures of activities for the whole day.
For example - have a picture of a student taking off their jacket. Have a
picture of a student putting a puzzle together. Have a picture of a student
playing on the playground.
As the student completes each activity during the day, the student would turn the
picture over. The student knows that he/she has completed an activity when the
picture has been turned over.
Limit the student’s choices to 2 or 3 toys.
Give the student plenty of time to make a choice.
If the student seems to be having difficulty making a choice, watch the student to
see if he/she looks longer at a particular toy or make a movement toward a certain
toy.
Place each activity in two baskets.
Have two baskets for a puzzle, two baskets for a matching activity, two baskets for
lacing cards, etc.
Having one activity in a set of baskets will help keep the student’s attention on the
activity for a longer period of time.
Take the activity out of the “start” basket and when the student has finished the
activity, the student puts the activity into the “finish” basket.
Keep activities in a designated place. The student will know where to return the activity
when he/she is finished with the activity.
Students who are hyperactive should sit on a chair rather than the floor.
The chair keeps the child from leaning backward, forward and sideways.
The chair helps keep the child in a specific space.
The teacher may need to show the child how to sit in the chair.
Feet flat on the floor.
Hands on the side.
30
Sitting up straight.
Have an activity ready at the table for when the student is sitting properly. A
student with hyperactivity may not sit at the table very long waiting for an activity
to be brought to them.
Structure the day alternating quiet time, active time, quiet time, etc.
If the student does not need sleep at nap time, the student may benefit from having
active activities like riding a tricycle in the hall.
Managing Behavior
Tantrums.
Take the student to a different room. Lullaby music playing in the room may help
calm the student.
Hold the student.
The teacher’s body language should not get the student excited. Talk in a calm
voice, walk slowly. If the teacher is relaxed, this will help the child relax.
Determine what happed before the tantrum occurred.
Look for antecedents to the behavior.
Antecedents are the events/things that happen which help the student lose
his/her temper.
Another way of reducing the likelihood of the child having a tantrum is to teach the
student new ways of dealing with his/her stress. For example - teach the student
to say “I’m mad.”
The student’s diet could be a contributing factor for the behavior.
Observe the child for any health problems.
For example - a student may pull at his/her ears when they have an earache.
Ask the student to “show me where you hurt.”
Ignore negative behavior whenever possible. Avoid overreacting to negative behavior.
Build a positive reinforcement system.
As the student finishes each activity on the picture calendar, hug the child.
When the student does a good job on a project, let the student know he/she will
receive a positive reinforcement such as a hug.
Math
Memorized counting from one to ten does not mean that the student understands what
the numbers mean.
Teach the student what the number “one” means before any more numbers are taught
to the student.
Ask the student to hand you one crayon or draw one circle.
Cut the numbers out of paper, glue oatmeal, rice, glitter, etc. to the number. The child
can then see, hear and feel the number.
Touch and count objects.
Concrete Teaching Methods
Use as much sensory stimulation as possible to teach each concept.
31
For example - teaching the color “orange.”
Wear orange clothes.
Have the student paint with orange paint.
Use orange construction paper for projects.
Serve oranges for a snack.
Use objects as much as possible to teach concepts.
For example - teaching about “circles.”
Use a cookie cutter to cut circle sandwiches.
Cut circles from construction paper and glue on round cereal or circles of
paper.
Teaching activities must be “concrete.”
For example - teaching a student to stay in a specified area of the yard.
Use 4 large orange cones to designate an area.
Tell the student to stay inside the 4 cones.
When the student has learned to stay inside the cones, gradually expand the
area the student is allowed to play in.
For example - the question “what do you want?”
This question is very abstract.
Give the student choices he/she can see, feel, touch or hear.
Short Attention Span
Determine how long the student usually works on an activity.
Ask the student to do “one more.”
For example - if the student is drawing circles and the student stops, ask the
student to draw “one more” circle.
The teacher should never make the student do more something more than once
after they have said “one more.”
This approach should increase the student’s attention span over time.
Social Behavior
Show the student how to share toys. Use a timer to share the most popular toys.
Teach the student how to be a friend.
Teach the student how to sit with a friend at the table.
Pair students for a week so the student with a Fetal Alcohol Spectrum Disorder can
work/play with a variety of students.
Teach the student how to join a group.
32
Educational Techniques
for Elementary School Students
Environment
Students with a Fetal Alcohol Spectrum Disorder usually need more one-on-one teaching.
Increased staff should be a considered.
Calm and quiet.
Soft music may relax the environment during break.
Tone down classroom so rooms are not overly stimulating.
Keep a minimal number of objects hanging from the ceiling and on the walls.
Use calm colors of paint on the walls.
Reduce classroom clutter.
Use bulletin boards as teaching tools, use soft colors. (Bulletin boards could
be covered if they are not in use.)
Structure
Establish a few simple rules.
Same rules are enforced the same way.
Use the same language when enforcing the rules.
Transition from One Activity to Another
Give the student reminders for ending and beginning activities. Use tactile signals.
For example - touch the student’s shoulder or elbow and say “the bell will ring in
five minutes, you need to finish up” or “we will go to lunch when the bell rings.”
Use music to signal that a transition is coming up.
Begin by playing music for five minutes before the transition. Then gradually
decrease the length of time the music is played.
When the music stops, the student knows it is time to transition to the next
activity.
It is important for the student to have a fairly consistent routine that is followed
every day.
Provide notebooks for the students which have all their classroom activities in order
for the day.
This gives the student a concrete item with which to structure his/her day.
If possible, class periods should not exceed 20 minutes.
The student could be allowed to carry the book to the reading area or the puppet
to the puppet theater.
Students with a Fetal Alcohol Spectrum Disorder may need several breaks during
the day.
Students may need sleep during the day.
Students may need to get up and move around more frequently than other
students.
Plan activities to facilitate movement and creativity between seat work
assignments.
33
Evaluations
Students with a Fetal Alcohol Spectrum Disorder may need food snacks
during the day.
The following evaluations may be helpful in learning more about the student’s
development and assist in planning the teacher’s activities.
Speech and Language
Psychological
Motor
Adaptive Behavior
Occupational Therapy
Physical Therapy
Functional Assessment
Eye-Hand Coordination
Use puzzles with knobs on the pieces.
Lace Cards
The teacher may need to make a larger lace card from cardboard.
The lace for the lace card may need masking tape on the end to make it easier for
the child to lace the card.
Let the student help with tasks that require sorting, stapling, putting things in place, etc.
The teacher may need to show the student how to do the activity, then guide the child
through the activity, and finally encourage the student to do the activity on his/her own.
The teacher could pick up the puzzle piece for the student to put in the right place
in the puzzle.
The teacher could lace the first two holes of a lacing card.
Language Development
Talk with the student at the student’s level. Use short sentences. Avoid using long
sentences.
Students with Poor Articulation
A speech therapist would be a good resource for the student and the teacher.
The teacher should use proper pronunciation. A good role model is important.
Articulation errors are common, accept the student’s communications without
correcting them. The repeat their sounds correctly.
Music activities help children learn vocabulary.
Good morning songs.
Song before eating.
Name songs.
Circle game songs - sit down, stand up, name games.
Quantity versus Quality of Speech
Students with a Fetal Alcohol Spectrum Disorder often use a large quantity of
speech. Be aware that quantity does not indicate quality.
Listen for the number of words per sentence.
Listen for the number of new words that the student uses.
34
Stress concept development through concrete examples encouraging the
student to demonstrate understanding. For example - When discussing
temperature, the student should know what to wear on a hot day as
opposed to what to wear on a cold day.
Sign Language
Sign language may be helpful to teach children with Fetal Alcohol Spectrum
Disorders even when they do not have a hearing loss.
Sign language is concrete and visible which can be used along with verbal
language.
Managing Hyperactivity
Keep the environment structured.
Have as few rules as possible and enforce rules consistently.
Never make a rule you do not plan to enforce.
Avoid threats.
Make the rules specific. For example - “no hitting,” “no kicking,” or “raise your
hand and wait to be called on.”
Make a picture calendar.
Make a board with hooks.
Laminate pictures of activities for the whole day.
For example - have a picture of a student taking off their jacket. Have a
picture of a student putting a puzzle together. Have a picture of a student
playing on the playground.
As the student completes each activity during the day, the student would turn the
picture over. The student knows that he/she has completed an activity when the
picture has been turned over.
Make lists for the student to follow during the day.
For example - “Read story starting on page 30 in the Reading Book,” “Do
worksheet on page 10 in the Reading Workbook,” and “Read about rocks starting
on page 15 in the Science Book.”
Student may need to have the list taped to their desk.
Some students with Fetal Alcohol Spectrum Disorders may have difficulty relating
chalk board instructions to their own behavior.
Place each activity in two baskets.
Have two baskets for a puzzle, two baskets for a matching activity, two baskets for
lacing cards, etc.
Having one activity in a set of baskets will help keep the student’s attention on the
activity for a longer period of time.
Take the activity out of the “start” basket and when the student has finished the
activity, the student puts the activity into the “finish” basket.
Keep activities in a designated place. The student will know where to return the activity
when he/she is finished with the activity.
Shelves and bookcases should be enclosed if possible to eliminate visual distractions.
Use vivid colors to emphasize important concepts. Emphasize with sound and movement
35
the factors that complement the learning objects.
During organized activities, students with hyperactivity need structure.
Students need a sequence of activity.
Students need to know what behaviors will be acceptable.
For example - “During this activity we will stay in our chairs,” “There will not
be any talking,” “Keep your eyes on your own paper,” and “If you want help,
raise your hand and I will come to you.”
Expect all students to follow directions together.
Wait until everyone follows the first direction before giving further
directions.
For example - “put your finger on the picture of the dog on your
worksheet, so we are all looking at the same thing.”
Wait for everyone to follow the direction before moving forward.
Loosely structured activities must be balanced with highly structured activities to give the
student an opportunity to move about, visit, relax, etc.
Structure the day alternating quiet time, active time, quiet time, active time, etc.
Managing Behavior
Tantrums
Remain calm and quiet. The teacher’s body language should not get the student
excited. Talk in a calm voice and walk slowly. If the teacher is relaxed, this will
help the student relax.
Let the student know there is a protocol for loss of control.
Taking the student’s hand and holding it for a short time will give the
student a signal that the teacher thinks the student is losing control.
If restraint is necessary, the teacher needs to exercise care and control.
Talk to the student, telling him/her that you are help them control their
behavior.
For example - “I am going to hold onto you until you are calm,” “Are
you feeling better?” or “Let me know when you are ready for me to let
go.”
Take the student to a different room if necessary.
Soft music and soft colors in the room may help calm the student.
Talk to the student in a calm, soft voice.
Ask the student to tell the teacher when he/she is ready to go back to the
classroom.
Determine what happed before the tantrum occurred.
Look for antecedents to the behavior.
Antecedents are the events/things that happen which cause the student to
lose his/her temper.
Look at different ways to eliminate the chances of the student throwing a tantrum.
If the student has an extremely difficult time with loud noises and lots of
activity, the student should be taught in a relatively quiet and calm area.
Anther way of reducing the likelihood of the child having a tantrum is to teach the
36
student new ways of dealing with his/her stress. For example - teach the student
to say “I’m mad.”
The student’s diet could be a contributing factor for the behavior.
Observe the child for any health problems.
For example - a student may pull at his/her ears when they have an earache.
Ask the student to “show me where you hurt.”
Ignore negative behavior whenever possible. Avoid overreacting to negative behavior.
Build a positive reinforcement system.
As the student finishes each activity on the picture calendar, give the student
positive reinforcement for his/her efforts in completing the activity.
When the student does a good job on a project, tell the student what he/she did
right. For example - “I really like the way you wrote your k’s.”
Math
Memorized counting from one to ten does not mean that the student understands what
the numbers mean.
Teach the student what the number “one” means before any more numbers are taught
to the student.
Ask the student to hand you one crayon or draw one circle.
Cut the numbers out of paper, glue oatmeal, rice, glitter, etc. to the number. The child
can then see, hear and feel the number.
Touch and count objects.
Teach functional math. For example - money, time, addition, subtraction.
Teach strategies for problem solving versus the memorization of facts.
Using the student’s fingers or counting tools may assist with addition and subtraction. A
calculator may assist in teaching math to students with a Fetal Alcohol Spectrum
Disorder.
Using fingers or a calculator should not be the first choice. However, they should
not be ruled out if they can benefit the student’s ability to learn math.
A calculator may be necessary for the student to do multiplication and division.
Reading
Some students may have difficulty focusing their eyes on the left side of the page and
moving their eyes to the right.
A student who uses a piece of paper or ruler under the line they are reading may
have an easier time.
Use a green marker at the left side, changing to a red marker at the right side for
written work.
Use colored arrows to signal starting points and direction from left to right.
Use books with simple, plain pictures. Small detailed marks in a picture can distract the
student.
Use books on tape.
Provide the student with books that correspond to the student’s interest area and
independent reading levels. Independent reading level means then student can read
90% of the words in the book.
37
Read aloud to the students daily and provide daily uninterrupted silent reading periods.
Before the student begins reading, ask questions about the material for the student to
think about while they are reading.
Concrete Teaching Methods
Use as much sensory stimulation as possible to teach each concept.
For example - teaching the color “orange.”
Wear orange clothes.
Have the student paint with orange paint.
Use orange construction paper for projects.
Serve oranges for a snack.
Use objects as much as possible to teach concepts.
For example - teaching about “circles.”
Use a cookie cutter to cut circle sandwiches.
Cut circles from construction paper and glue on round cereal or circles of
paper.
Teaching activities must be “concrete.”
For example - teaching a student to stay in a specified area of the yard.
Use 4 large orange cones to designate an area.
Tell the student to stay inside the 4 cones.
When the student has learned to stay inside the cones, gradually expand the
area the student is allowed to play in.
For example - the question “what do you want?”
This question is very abstract.
Give the student choices he/she can see, feel, touch or hear.
Short Attention Span
Determine how long the student usually works on an activity.
Ask the student to do “one more.”
For example - if the student is drawing circles and the student stops, ask the
student to draw “one more” circle.
The teacher should never make the student do more something more than once
after they have said “one more.”
This approach should increase the student’s attention span over time.
Determine what activity the student can attend to the longest.
Determine what it is about that activity that allows the student to attend.
Try to generalize those features to other activities.
Use color to highlight important information.
Check on student at the beginning, middle and end of assignments to ensure the student
is understanding and following directions.
Use visual cues to signal start and stop.
Vary presentation style.
The teacher should change the tempo of their speech. For example - speed up
and slow down.
38
The teacher should vary the inflection, quality and volume of their speech.
Use cognitive cues. For example - “Now this is important” or “Point to the number 2 with
your finger.”
Use the student’s interests to “hook” them.
Start lessons by activating prior knowledge and experiences.
Use novelty items such as pictures, objects, costumes, etc.
Use non-invasive prompts.
Eye Contact
Tap on Desk or Book
Touch the Student
Give students with a Fetal Alcohol Spectrum Disorder an outline of the lesson to increase
listening and comprehension.
Social Behavior
Show the student how to share playground equipment. The teacher may need to use a
timer to share the most popular playground equipment.
Teach the student how to be a friend.
Use puppets or dolls to role play.
Emphasize the feelings of others.
Practice using manners, consideration statements and apologies.
Teach the student how to sit with a friend at the table.
Emphasize interaction, sharing, courtesy, etc.
Use peer tutoring.
Pair children for a week so the student with a Fetal Alcohol Spectrum Disorder can
learn from children who do not have a Fetal Alcohol Spectrum Disorder.
Allow students with a Fetal Alcohol Spectrum Disorder to help the other students.
For example - Have the student with a Fetal Alcohol Spectrum Disorder
collect finished papers or distribute worksheets.
Capitalize on academic strengths of the student with a Fetal Alcohol Spectrum
Disorder.
39
Educational Techniques
for Junior and High School Students
Environment
Students with a Fetal Alcohol Spectrum Disorder usually need more one-on-one teaching.
Increased staff should be a considered. Students with a Fetal Alcohol Spectrum Disorder
may need to have repetition of information presented during class.
Calm and Quiet
Soft music may relax the environment during breaks.
Tone down classrooms so they are not overly stimulating.
Keep the number of objects hanging from the ceiling and on the walls to a
minimum.
Use calm colors of paint on the walls.
Reduce classroom clutter.
Use bulletin boards as teaching tools, use soft colors. (Bulletin boards could be
covered if they are not in use.)
Students might benefit from being able to use headphones during quiet time.
Students with a Fetal Alcohol Spectrum Disorder may not always be able to block
out extra noises.
For example - The ticking of a clock or the teacher talking with other
students may distract students with a Fetal alcohol Spectrum Disorder.
Structure
Establish a few simple rules.
Same rules are enforced the same way.
Use the same language when enforcing the rules.
Transition from One Activity to Another
Give the student reminders for ending and beginning activities. Use tactile
signals. For example - touch the student’s shoulder or elbow and say “the
bell will ring in five minutes, you need to finish up” or “we will go to lunch
when the bell rings.”
It is important for the student to have a fairly consistent routine that is
followed every day.
Keep the class schedule posted and refer to it before each transition.
Teach classroom routines.
Use pictures in sequence when students have difficulty remembering
the routine.
For example - entering the classroom at the beginning of the day,
sharpening pencils, getting teachers attention, walking in the hallway,
handing in homework, or using the restroom.
Provide notebooks for the students which have all their classroom activities
in order for the day.
This gives the student a concrete item with which to structure his/her
day.
40
If possible, class periods should not exceed 20 minutes.
The student could be allowed to carry the book to the reading area.
Students with a Fetal Alcohol Spectrum Disorder may need several breaks
during the day.
Students may need sleep during the day.
Students may need to get up and move around more frequently than
other students.
Plan activities to facilitate movement and creativity between seat work
assignments.
Students with a Fetal Alcohol Spectrum Disorder may need food
snacks during the day.
Evaluations
The following evaluations may be helpful in learning more about the student’s
development and assist the teacher in planning the teacher’s activities.
Speech and Language
Psychological
Motor
Adaptive Behavior
Interest Inventories
Occupational Therapy
Physical Therapy
Functional Assessment.
Language Development
Recognize that students with a Fetal Alcohol Spectrum Disorder may have delayed
language development.
Use concrete basic language when giving instructions. Use simple sentences.
Avoid giving more than one instruction per sentence.
Check with the student to make sure he/she understands the given directions.
Refer the student to a speech pathologist if appropriate.
Sign Language
Sign language may be helpful to teach students with a Fetal Alcohol Spectrum
Disorder even when they do not have a hearing loss.
Sign language is concrete and visible and can be used along with verbal language.
Managing Hyperactivity
Provide structure and a predictable routine.
Implement as few rules as possible and only the rules you are willing to enforce.
Allow students to sit in their chairs as comfortably as possible. Rapidly growing students
are unable to maintain strict posture and enforcing it can be frustrating for both teachers
and students.
Limit time frames for one activity to no more than 30 minutes if possible.
Keep the environment structured.
41
Make a picture calendar.
Make a board with hooks.
Laminate pictures of activities for the whole day.
For example - have a picture of a student taking off their jacket. Have a
picture of the student in the classroom.
As the student completes each activity during the day, the student would turn the
picture over. The student knows that he/she has completed an activity when the
picture has been turned over.
Make lists for the student to follow during the day.
For example - “Read story starting on page 30 in the Reading Book,” “Do
worksheet on page 10 in the Reading Workbook,” and “Read about rocks starting
on page 15 in the Science Book.”
Student may need to have the list taped to their desk.
Some students with Fetal Alcohol Spectrum Disorders may have difficulty relating
dry erase board instructions to their own behavior.
Place each activity in two baskets.
Having one activity in a set of baskets will help keep the student’s attention on the
activity for a longer period of time.
Take the activity out of the “start” basket and when the student has finished the
activity, the student puts the activity into the “finish” basket.
Keep activities in a designated place. The student will know where to return the activity
when he/she is finished with the activity.
Shelves and bookcases should be enclosed if possible to eliminate visual distractions.
Use vivid colors to emphasize important concepts. Emphasize with sound and movement
the factors that complement the learning objects.
During organized activities, students with hyperactivity need structure.
Students need a sequence of activity.
Students need to know what behaviors will be acceptable.
For example - “During this activity we will stay in our chairs,” “There will not
be any talking,” “Keep your eyes on your own paper,” and “If you want help,
raiser your hand and I will come to you.”
Expect all students to follow directions together.
Wait until everyone follows the first direction before giving further
directions.
Loosely structured activities must be balanced with highly structured activities to give the
student an opportunity to move about, visit, relax, etc.
Structure the day alternating quiet time, active time, quiet time, active time, etc.
Managing Behavior
Negative Behaviors
Remain calm and quiet. The teacher’s body language should not get the student
excited. Talk in a calm voice and walk slowly. If the teacher is relaxed, this will
help the student relax.
Let the student know there is a protocol for loss of control.
42
Taking the student’s hand and holding it for a short time will give the
student a signal that the teacher things the student is losing control.
If restraint is necessary, the teacher needs to exercise care and control.
Talk to the student, telling him/her that you are there to help them control
their behavior.
For example - “I am going to hold onto you until you are calm,” “Are
you feeling better?” or “Let me know when you are ready for me to let
go.”
Take the student to a different room if necessary.
Soft music and soft colors in the room may help calm the student.
Talk to the student in a calm, soft voice.
Ask the student to tell the teacher when he/she is ready to go back to the
classroom.
Determine what happed before the tantrum occurred.
Look for antecedents to the behavior.
Antecedents are the events/things that happen which cause the student lose
his/her temper.
Look at different ways to eliminate the chances of the student throwing a tantrum.
If the student has an extremely difficult time with loud noises and lots of
activity, the should be taught in a relatively quiet and calm area.
Anther way of reducing the likelihood of the child having a tantrum is to teach the
student new ways of dealing with his/her stress. For example - teach the student
to say “I’m mad.”
The student’s diet could be a contributing factor for the behavior.
Observe the student for any health problems.
For example - a student may pull at his/her ears when they have an earache.
Ask the student to “show me where you hurt.”
Look for behaviors which may signify visual problems.
Abnormal Head Posturing
Squinting
Holding Paper Close to Face
Obvious Errors Made When Working from the Chalkboard
Ignore negative behavior whenever possible. Avoid overreacting to negative behavior.
Build a positive reinforcement system.
As the student finishes each activity on the picture calendar, give the student
positive reinforcement for his/her efforts in completing the activity.
When the student does a good job on a project, tell the student what he/she did
right. For example - “You read the whole story.”
Math
Math may be a difficult subject for students with a Fetal Alcohol Spectrum Disorder.
Memorizing the multiplication tables may be difficult for students with a Fetal Alcohol
Spectrum Disorder. By the same token, division may be a difficult concept.
Teach functional math. For example - money, time, addition, subtraction.
Using the student’s fingers or counting tools may assist with addition and subtraction. A
43
calculator may assist in teaching math to students with a Fetal Alcohol Spectrum
Disorder.
Using fingers or a calculator should not be the first choice. However, they should
not be ruled out if they can benefit the student’s ability to learn math.
A calculator may be necessary for the student to do multiplication and division.
Reading
Some students may have difficulty focusing their eyes on the left side of the page and
moving their eyes to the right.
A student who uses a piece of paper or ruler under the line they are reading may
have an easier time.
Use a green marker at the left side, changing to a red marker at the right side for
written work.
Use colored arrows to signal starting points and direction from left to right.
Use books with simple, plain pictures. Small detailed marks in a picture can distract the
student.
Use books on tape.
Provide the student with books that correspond to the student’s interest area and
independent reading levels. Independent reading level means then student can read
90% of the words in the book.
Encourage reading for enjoyment and developing independence.
Incorporate popular magazines, newspapers, school paper, etc. into the student’s
reading program.
Emphasize reading as a means to communications. For example - note writing,
letter writing, memos, posters, etc.
Concrete Teaching Methods
Use as much sensory stimulation as possible to teach each concept.
Teaching activities must be “concrete.”
Provide hands on materials whenever possible.
Take students to actual site to teach learning objectives.
Allow students to make concrete choices. For example - “Which of these two
things do you want?”
Avoid abstract questions. For example - “What do you want?”
Give students choices that they can see, feel, touch and hear.
Social Behavior
Teachers should consult with the school counselor. It is important that teachers work
with other professionals using complimentary techniques when addressing the following
areas.
Inappropriate Sexual Behavior
Isolation
Depression
Loneliness
44
Inappropriate Expectations for Work, School and/or Independence
Help students use their personal strengths in order to develop positive recognition and a
sense of their value to their school and home communities.
Be emphatic, firm and realistic about expectations and performance from students.
Treat students with a Fetal Alcohol Spectrum Disorder as valuable, worthwhile human
beings with gifts to share. All students see teachers and other school personnel as role
models and will follow the examples they set.
Teach social skills directly through demonstration, role play and practice in real life
situations.
Vocational Education
Continue practicing the basic skills necessary to live independently as adults.
Academics
Daily Living Skills
Survival Skills
Basic skills should be generalized to a variety of settings.
Use a variety of stimulus to elicit behavior.
Use a variety of settings.
Use a variety of personnel.
Curriculum should focus on assisting students to function as social human beings.
Understanding rules of social interaction.
Taking on responsibilities.
Making decisions and realizing their consequences.
Develop and practice independent living skills within a group setting - getting along with
others in the same living space, sharing responsibilities, cooking, personal hygiene, etc.
Curriculum should focus on assisting students to function in the world of work.
Identify individual interests and aptitudes.
Develop self scheduling skills and community mobility skills.
Develop and practice job related skills.
Job coaching should focus on teaching routines and educating employers about the
student’s characteristics and necessary modifications.
45
Websites
Adopting a Substance-Exposed Child (Adopting.org)
http://www.adopting.org/adoptions/adopting-a-substance-exposed-child.html
Al-Anon/Alateen
http://www.al-anonfamilygrounps.org
Alcohol Related Birth Injury (FAS/FAE) Resource Site
http://www.arbi.org
Alcoholics Anonymous
http://www.aa.org
American Association on Intellectual and Developmental Disabilities (AAIDD)
http://www.aaidd.org
The Arc
http://www.thearc.org
The Arium Foundation
http://www.arium.org
Better Endings New Beginnings
http://www.betterendings.org
Brain Connection
http://www.brainconnection.com
Center for Disabilities
http://www.usd.edu/cd
Center for Neuro Skills, TBI Resource Guide
http://www.neuroskills.com
Center for Substance Abuse Prevention (CSAP) at the Substance Abuse and Mental Health
Services Administration (SAMHSA)
http://prevetnion.samhsa.gov
Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov
46
Children’s Academy for Neurodevelopment & Learning
http://www.kidscanlearn.net
Edmonton, Canada; FASD Linking the Community Together
http://www.region6fasd.ca
Family Village
http://www.familyvillage.wisc.edu
FAS Alaska
http://www.fasalaska.com
FAS Stars
http://www.come-over.to/fasstar
FAS World
http://www.fasworld.com
Fetal Alcohol and Drug Unit at the University of Washington School of Medicine
http://depts.washington.edu/fadu
Fetal Alcohol Syndrome Community Resource Center
http://www.come-over.to/FASCRC
Fetal Alcohol Syndrome Diagnostic & Prevention Network (FAS DPN)
http://depts.washington.edu/fasdpn
Fetal Alcohol Syndrome Family Resource Institute
http://www.fetalalcoholsyndrome.org
Gentle Teaching
http://www.gentleteaching.nl
Health Canada
http://www.hc-sc.gc.ca/index-eng.php
Howard Hughes Medical Institute
http://www.hhmi.org
March of Dimes
http://www.modimes.org
Medline Plus from the National Library of Medicine - Fetal Alcohol Syndrome
http://www.nlm.nih.gov/medlineplus/fetalalcoholsyndrome.html
47
Minnesota Organization on Fetal Alcohol Syndrome (MOFAS)
http://www.mofas.org
National Center on Birth Defects and Developmental Disabilities (NCBDDD) at the Centers for
Disease Control and Prevention (CDC)
http://www.cdc.gov/ncbddd
National Center on Birth Defects and Developmental Disabilities (NCBDDD) Fetal Alcohol
Spectrum Disorders
http://www.cdc.gov/ncbddd/fas/default.htm
National Center for Education in Maternal and Child Health
http://www.ncemch.org
National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of
Health (NIH)
http://www.niaaa.nih.gov
National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH)
http://www.drugabuse.gov
National Organization on Fetal Alcohol Syndrome (NOFAS)
http://www.nofas.org
National Women’s Health Information Center, U.S. Department of Health and Human
Services
http://www.4woman.gov
PACER Center
http://www.pacer.org
Pregnancy and Alcohol.org - Includes the Family Empowerment Network (FEN)
http://pregnancyandalcohol.org
Society for Neuroscience
http://www.sfn.org
South Dakota Division of Alcohol and Drug Abuse, South Dakota Department of Human
Services
http://dhs.sd.gov/ada
South Dakota Special Education Programs, South Dakota Department of Education
http://doe.sd.gov/oess/specialed/index.asp
48
Substance Abuse and Mental Health Service Administration, U.S. Department of Health and
Human Services
http://www.samhsa.gov
Substance Abuse and Mental Health Service Administration - National Clearinghouse for
Alcohol and Drug Information (NCADI)
http://ncadi.samhsa.gov
Teaching Students with Fetal Alcohol Syndrome/Effects: A Resource Guide for Teachers
http://www.bced.gov.bc.ca/specialed/fas
Zero to Three
http://www.zerotothree.org
Please Note: Inclusion of websites in the Fetal Alcohol Spectrum Disorders Handbook does
not imply endorsement by the Center for Disabilities, the Department of Pediatrics, the
Sanford School of Medicine or The University of South Dakota. Content of the websites
listed in the Fetal Alcohol Spectrum Disorders Handbook is the sole responsibility of the
authors of each website.
49
Organizations
Al-Anon/Alateen
1600 Corporate Landing Parkway
Virginia, Beach VA 23454
Phone - (757) 563-1600
Meeting Information - 1-888-425-2666
Website - www.al-anon.alateen.org
“For over 50 years, Al-Anon (which includes Alateen
for younger members) has been offering hope and
help to families and friends of alcoholics. It is
estimated that each alcoholic affects the lives of at
least four other people . . . alcoholism is truly a
family disease.”
Alcoholics Anonymous (AA)
P.O. Box 459
New York, NY 10163
Phone - (212) 870-3400
Website - www.aa.org
“Alcoholics Anonymous (AA) is a fellowship of men
and women who share their experience, strength
and hope with each other that they may solve their
common problem and help others to recover from
alcoholism.”
American Association on Intellectual
and Developmental Disabilities (AAIDD)
444 North Capital Street, NW
Suite 846
Washington, DC 20001
Phone - 1-800-424-3688
Website - www.aaidd.org
The American Association on Intellectual and
Developmental Disabilities (AAIDD) “promotes
progressive policies, sound research, effective
practices and universal human rights for people
with intellectual and developmental disabilities.”
The Arc of the United States
1010 Wayne Avenue, Suite 650
Silver Spring, MD 20910
Phone - (301) 565-3842 or
1-800-433-5255
Website - www.thearc.org
“The Arc of the United States advocates for the
rights and full participation of all children and adults
with intellectual and developmental disabilities.
Together with our network of members and
affiliated chapters, we improve systems of supports
and services; connect families; inspire communities
and influence public policy.”
Canadian Centre on Substance Abuse
75 Albert Street, Suite 300
Ottawa, ON K1P 5E7
Phone - (613) 235-4048
“The Canadian Centre on Substance Abuse has a
legislated mandate to provide national leadership
and evidence-informed analysis and advice to
mobilize collaborative efforts to reduce alcohol- and
other drug-related harms.”
50
Center for Disabilities
Department of Pediatrics
Sanford School of Medicine of The
University of South Dakota
1400 West 22nd Street
Sioux Falls, SD 57105
Phone - (605) 357-1439 or
1-800-658-3080
Website - www.usd.edu/cd
The Center for Disabilities conducts diverse yet
integrated activities through academic training,
community service, information dissemination, and
research/evaluation, all reflecting state-of-the-art
knowledge and experiences in the area of
disabilities. The Center is home to many projects
including NOFAS South Dakota which seeks to
improve FASD prevention efforts, to improve FASD
identification efforts, and to improve the service
and supports provided to individuals affected by
FASD.
Family Empowerment Network (FEN)
University of Wisconsin School of
Medicine and Public Health
Department of Family Medicine
777 South Mills Street
Madison, WI 53715
Phone - (608) 262-6590 or
1-800-462-5254
Website - http://pregnancyand
alcohol.org
The Family Empowerment Network (FEN) is a
“resource, referral, support and research program
serving families affected by fetal alcohol spectrum
disorders (FASD) and the providers who serve
them. FEN’s mission is simple, to empower families
through education and support.”
Fetal Alcohol Syndrome Family
Resource Institute (FAS*FRI)
P.O. Box 2525
Lynnwood, WA 98036
Phone - (253) 531-2878 or
In Washington State - 1-800-999-3429
Website - www.fetalalcohol
syndrome.org
The mission of the Fetal Alcohol Syndrome Family
Resource Institute (FAS*FRI), “a non-profit
organization, is to identify, understand and care for
individuals disabled by prenatal alcohol exposure
and their families, and to prevent future
generations from having to live with this disability.”
Join Together
715 Albany Street, 580-3rd Floor
Boston, MA 02118
Phone - (617) 437-1500
Website - www.jointogether.org
“Join Together is a program of the Boston
University School of Public Health. Since 1991, it
has been the nation’s leading provider of
information, strategic planning assistance, and
leadership development for community-based
efforts to advance effective alcohol and drug policy,
prevention, and treatment.”
March of Dimes
1275 Mamaroneck Avenue
White Plains, NY 10605
Phone - (914) 997-4488
Website - www.modimes.org
The mission of the March of Dimes is to “improve
the health of babies by preventing birth defects,
premature birth, and infant mortality. We carry out
this mission through research, community services,
education and advocacy to save babies’ lives.”
51
National Center for Education in
Maternal and Child Health (NCEMCH)
Georgetown University
Box 571272
Washington, DC 20057
Phone - (202) 784-9770
Website - www.ncemch.org
“The National Center for Education in Maternal and
Child Health Provides national leadership to the
maternal and child health community in three key
areas - program development, education, and state
-of-the-art knowledge - to improve the health and
well-being of the nation’s children and families.”
National Clearinghouse for Alcohol and
Drug Information (NCADI)
P.O. Box 2345
Rockville, MD 20847
Phone - (240) 221-4019 or
1-800-729-6686
Website - http://ncadi.samhsa.gov
“[Substance Abuse and Mental Health Services
Administration’s] SAMHSA’s National Clearinghouse
for Alcohol and Drug Information (NCADI) is the
Nation’s one-stop resource for information about
substance abuse prevention and addiction
treatment.”
National Institute on Alcohol Abuse and “NIAAA provides leadership in the national effort to
reduce alcohol-related problems by: conducting and
Alcoholism (NIAAA)
supporting research in a wide range of scientific
5635 Fishers Lane, MSC 9304
areas including genetics, neuroscience,
Bethesda, MD 20892
epidemiology, health risks and benefits of alcohol
Phone - (301) 443-3860
consumption, prevention and treatment;
Website - www.niaaa.nih.gov
coordinating and collaborating with other research
institutes and Federal Programs on alcohol-related
issues; collaborating with international, national,
state, and local institutions, organizations, agencies,
and programs engaged in alcohol-related work; and
translating and disseminating research finding to
health care providers, researchers, policymakers,
and the public.”
National Organization on Fetal Alcohol
Syndrome (NOFAS)
900 17th Street, NW, Suite 910
Washington, DC 20006
Phone - (202) 785-4585 or
1-800-66-NOFAS (1-800-666-6327)
Website - www.nofas.org
“The National Organization on Fetal Alcohol
Syndrome is dedicated to eliminating birth defects
caused by alcohol consumption during pregnancy
and to improving the quality of life for those
affected individuals and families.”
52
National Organization on Fetal Alcohol
Syndrome - South Dakota (NOFAS-SD)
Center for Disabilities
Department of Pediatrics
Sanford School of Medicine of The
University of South Dakota
1400 West 22nd Street
Sioux Falls, SD 57105
Phone - (605) 357-1439 or
1-800-658-3080
Website - www.usd.edu/cd/nofassd
National Organization on Fetal Alcohol Syndrome South Dakota (NOFAS-SD) is a program of the
Center for Disabilities. NOFAS-SD focuses on
training, services and supports, information
dissemination, and research as they relate to Fetal
Alcohol Spectrum Disorders (FASD). NOFAS-SD
provides a home for all the current and future
efforts of the Center for Disabilities in the area of
FASD.
South Dakota Division of Alcohol and
Drug Abuse
Department of Human Services
3800 East Highway 34
Hillsview Properties Plaza
c/o 500 East Capitol Avenue
Phone - (605) 773-3123 or
1-800-265-3123
Website - http://dhs.sd.gov/ada
The mission of the Division of Alcohol and Drug
Abuse is “to reduce the prevalence of substance
abuse disorders through prevention and treatment
services.”
South Dakota Special Education
Programs
Department of Education
700 Governors Drive
Pierre, SD 57501
Phone - (605) 773-3134
Website - http://doe.sd.gov/oess/
specialed
“It is the mission of Special Education Programs to
assure that children with disabilities receive a free
and appropriate public education in the least
restrictive environment. Special Education
Programs accomplishes this mission through
professional development trainings, technical
assistance and monitoring of special education
services provided by public schools districts and
agencies.”
Please Note: Inclusion of organizations in the Fetal Alcohol Spectrum Disorders Handbook
does not imply endorsement by the Center for Disabilities, the Department of Pediatrics, the
Sanford School of Medicine or The University of South Dakota. Actions of the organizations
listed in the Fetal Alcohol Spectrum Disorders Handbook are the sole responsibility of the
organization and its employees.
53
Resources
The following resources are available from the Wegner Health Science Information Center
(Wegner Center). The Center for Disabilities is a partner in the Wegner Center. For
information on borrowing these resources, contact the Center for Disabilities at (605) 3571439 or 1-800-658-3080 (Voice/TTY), contact the Wegner Center at 1400 West 22nd Street
in Sioux Falls, South Dakota or by phone at 1-800-521-2987, or contact your local library.
Books
Alcohol, Tobacco, and Other Drugs May Harm the Unborn by Paddy Shannon Cook, Robert
C. Petersen, Dorothy Tuell Moore and edited by Tineke Bodde Hasse - 1990
Assessment & Resource Guide for FAS/FAE: Fetal Alcohol Syndrome/Fetal Alcohol Effect by
Mary Wegmann, et al - 1995
The Best I Can Be - Living with Fetal Alcohol Syndrome or Effects by Liz Kulp with Jodee
Kulp - 2000
The Blood Runs Like a River Through My Dreams: A Memoir by Nasdijj - 2000
Born Substance Exposed, Educationally Vulnerable by Lisbeth J. Vincent, et al - 1991
The Broken Cord by Michael Dorris with forward by Louise Erdrich - 1989
The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities edited by Ann
Streissguth and Jonathan Kanter with introduction by Michael Dorris - 1997
Cheers! Here’s to the Baby! by Linda Belle LaFever - 2000
Children of Alcoholics edited by Marc Galanter - 1991
Children, Families, and Substance Abuse: Challenges for Changing Education and Social
Outcomes by G. Harold Smith, et al - 1995
Children of Prenatal Substance Abuse by Shirley N. Sparks - 1993
The Difficult Child by Stanley Turecki with Leslie Tonner -2000
Families in Recovery: Coming Full Circle by Carolyn Seval Brooks and Kathleen Fitzgerald
Rice - 1997
54
Fantastic Antone Succeeds! Experiences in Educating Children with Fetal Alcohol Syndrome
edited by Judith S. Kleinfeld and Siobhan Wescott - 1993
FAS: Parent and Child by Barbara A. Morse and Lyn Weiner - 1993
Fetal Alcohol Syndrome by Ernest L. Abel - 1990
Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment by the
Committee to Study Fetal Alcohol Syndrome, Division of Biobehavioral Sciences and Mental
Disorders, Institute of Medicine - edited by Kathleen Stratton, Cynthia Howe and Fredrick
Battaglia - 1996
Fetal Alcohol Syndrome: A Guide for Families and Communities by Ann Streissguth with
forewords by Godfrey P. Oakley, Jr. and Kenneth R. Warren - 1997
Fetal Alcohol Syndrome: A Training Manual to Aid in Vocational Rehabilitation and Other Non
-Medical Services by Robin A. LaDue, et al - 1999
Fetal Alcohol Syndrome and Fetal Alcohol Effects: Strategies for Professionals by Diane
Malbin - 1993
A Healthy Baby - Your Decision: A Series of Stories and Activities on Decision Making, Drugs
and Prenatal Development for Ages 11-14 by Patricia S. Eckert for AHTDS-Midwest - 1985
Hearts Open & Hands On - An interactive Learning Tool for Educators, Parents, Caregivers &
others Supporting an Adolescent Diagnosed with Fetal Alcohol Syndrome/Fetal Alcohol
Effects by Minnesota Department of Children, Families & Learning - 2000
I Would Be Loved by Linda J. Falkner - 2002
Identification of At-Risk Drinking and Intervention with Women of Childbearing Age: A Guide
for Primary-Care Providers by National Institute on Alcohol Abuse and Alcoholism and Office
of Research on Minority Health - 1999
Identification and Care of Fetal Alcohol-Exposed Children: A Guide for Primary-Care
Providers by National Institute on Alcohol Abuse and Alcoholism and Office of Research on
Minority Health - 1995
Kids Explore the Gifts of Children with Special Needs by Westridge Young Writers Workshop
- 1994
Loosening the Grip: A Handbook of Alcohol Information by Jean Kinney and Gwen Leaton
with illustrations by Stuart Copans - 1995
55
A Manual on Adolescents and Adults with Fetal Alcohol Syndrome with Special Reference to
American Indians by Ann Streissguth, Robin A. LaDue and Sandra P. Randels - 1988
The Martian Child: A Novel About a Single Father Adopting a Son by David Gerrold - 2002
Our FAScinating Journey: The Best We Can Be - Keys to Brain Potential Along the Path of
Prenatal Brain Injury by Jodie Kulp, forward by Toni Hager, selections by Teresa Kellerman
and Nannette Munn and epilogue by Liz Kulp - 2002
Personal Steps to a Healthy Choice: A Woman’s Guide by National Institute on Alcohol Abuse
and Alcohol ism and Office of Research on Minority Health - 2000
Problem Drinking by Nick Heather and Ian Robertson - 1997
Program Strategies for Preventing Fetal Alcohol Syndrome and Alcohol-Related Birth Defects
by National Institute on Alcohol Abuse and Alcoholism - 1987
Resources Related to Children and Their Families Affected by Alcohol and Other Drugs by
Elisabeth Hargrove, et al - 1995
The Source for Syndromes by Gail J. Richard and Debra Reichert Hoge - 1999
Substance-Exposed Infants and Their Families: A Review of the Literature by Miriam Potocky
and Thomas P. McDonald - 1992
Summary of Findings from the 1999 Household Survey on Drug Abuse by Division of
Population Surveys, Office of Applied Studies, Substance Abuse and Mental Health Services
Administration, and the Research Triangle Institute - 2000
Teaching Children Affected by Prenatal Drug Exposure edited by Barbara J. Seitz de Martinez
- 1995
Toxic Substances and Mental Retardation: Neurobehavioral Toxicology and Teratology edited
by Stephen R. Schroeder - 1987
Understanding Fetal Alcohol Syndrome edited by Barbara J. Seitz de Martinez - 1995
Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol
Syndrome (FAS) and Fetal Alcohol Effects (FAE): Final Report by Ann Streissguth, et al 1996
Electronic Resources
Adolescence and the Future produced by Perennial Education - 1991
56
Alcohol and Other Drugs produced by Wisconsin Counseling Association - 1988
Alcohol and Pregnancy: Fetal Alcohol Syndrome and Fetal Alcohol Effects produced by John
Ralmon Productions - 1992
Alcohol and Pregnancy: Effects on the Unborn Child produced by University of Nebraska
Medical Center - 1990
Alcoholism produced by Time Life Medical - 1996
Assessment and the Early Years produced by Altschul Group - 1991
The Broken Cord produced by Catherine Tatge - 1994
Child Development produced by Films for the Humanities and Sciences - 1996
The Child With Special Needs produced by Contemporary Forms - 1998
Children with Alcoholics: From Generation to Generation produced by Kristen Schultz - 1996
The Clinical Diagnosis of Fetal Alcohol Syndrome produced by Flora & Company Multimedia
Productions - 1994
Drug Wars: Who Will Cry for Our Children? produced by David Gray - 2002
Dying High: Teens in the ER produced by Human Relations Media - 2003
The Fabulous F.A.S. Quiz Show produced by March of Dimes - 1993
Faces Yet to Come produced by American Institute, University of Oklahoma
F.A.S. Series: The Early Years produced by HMS Productions - 1997
Fetal Alcohol and Other Drug Effects: A Four-Part Training Series for Parents and
Professionals produced Fetal Alcohol Syndrome Consultation, Education and Training
Services (FASCETS) - 2003
Fetal Alcohol Syndrome (FAS): A Global Issue produced by Native American Community
Board - 1989
Fetal Alcohol Syndrome produced by Films for the Humanities - 1992
Fetal Alcohol Syndrome and Effects: What’s the Difference produced by Vision Video - 1991
57
Fetal Alcohol Syndrome: Prevention, Diagnosis, Treatment: A Clinical Guide for Obstetric and
Pediatric Providers produced by Vida Health Communications - 2000
Journey to Birth produced by March of Dimes - 1984
Last Call: The Sobering trugh About F.A.S., F.A.E. produced by David Grey and Tom Monson
- 2001
Let It Not Be In Vain: A Program for the Prevention of Suicide and Alcohol Abuse produced
by KNG Production - 1998
Parents’ Perspective: Living With a Child Who has FAS produced by Center for Disabilities,
South Dakota Department of Health and South Dakota Council on Developmental Disabilities
- 1996
A Pregnant Woman Never Drinks Alone produced by Bowman Gray School of Medicine,
Wake Forest University - 1987
Preventing FAS produced by Lena Productions - 1989
Sebastian: An Extraordinary Life produced by Child Welfare Training Project, California
Department of Health with Wynn Tabbert
Something to Celebrate produced by Seneca Productions and Tony Belcourt - 1984
Students Like Me: Teaching Children with FAS produced by Vida Health Communications
with Betsy Anderson - 2000
Training Tape: Living with F.A.S./F.A.E.: The Early Years Birth to 12 produced by Vision
Video Productions with Bob Blair - 1992
What is FAS? produced by Lena Productions - 1989
What’s Wrong with My Child? produced by Kate Wenner - 1990
Worth the Trip: Raising and Teaching Children with Fetal Alcohol Syndrome produced by
Vida Health Communications - 1996
Please Note: Inclusion of resources in the Fetal Alcohol Spectrum Disorders Handbook does
not imply endorsement by the Center for Disabilities, the Department of Pediatrics, the
Sanford School of Medicine or The University of South Dakota. Contents of the resources
listed in the Fetal Alcohol Spectrum Disorders Handbook are the sole responsibility of the
authors, editors, publisher or producers of the resource.
58
Bibliography
FASD FAQs
Hoyme, H. Eugene. “A Practical Clinical Approach to Diagnosis of Fetal Alcohol
Spectrum Disorders: Clarification of the 1996 Institute of Medicine Criteria.”
Pediatrics 115. (2005): 39-47.
Institute of Medicine (U.S.) Division of Biobehavioral Sciences and Mental Disorders,
Committee to Study Fetal Alcohol Syndrome. Fetal Alcohol Syndrome: Diagnosis,
Epidemiology, Prevention and Treatment. Washington, D.C. 1996.
National Organization on Fetal Alcohol Syndrome (NOFAS). “FASD: What Policy Makers
Should Know.” April 15, 2008. <http://www.nofas.org/MediaFiles/PDFs/factsheets/
policymakers.pdf>.
National Organization on Fetal Alcohol Syndrome (NOFAS). “FASD: What School
Systems Should Know About Affected Students.” April 15, 2008. <http://
www.nofas.org/MediaFiles/PDFs/factsheets/students%20school.pdf>.
Historical Overview of Fetal Alcohol Spectrum Disorders
Abel, Ernest L. Fetal Alcohol Syndrome. Oradell, New Jersey. 1990.
Streissguth, Ph.D., Ann. Fetal Alcohol Syndrome: A Guide for Families and
Communities. Baltimore. 1997.
Incidence and Prevalence
May, Ph.D., Philip A. and Gossage, Ph.D., J. Phillip. “Estimating the Prevalence of
Fetal Alcohol Syndrome: A Summary.” Alcohol Research & Health. 25.3 (2001):
159-167. Accessed electronically at <http://pubs.niaaa.nih.gov/publications/arh253/159-167.htm> on July 29, 2008.
Characteristics of Fetal Alcohol Spectrum Disorders
Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services
Administration, U.S. Department of Health and Human Services. “The Physical
Effects of Fetal Alcohol Spectrum Disorders.” July 29, 2009. <http://
www.fasdcenter.samhsa.gov/documents/WUNK_Physical_Effects.pdf>.
Streissguth, Ph.D., Ann. Fetal Alcohol Syndrome: A Guide for Families and
Communities. Baltimore. 1997.
Substance Abuse and Mental Health Services Administration, U.S. Department of
Health and Human Services. “Fetal Alcohol Spectrum Disorders: The Basics.” July
29, 2009. <http://www.fasdcenter.samhsa.gov/educationTraining/FASDBASICS/
FASDTheBasics.pdf>.
Current Diagnostic Criteria for Fetal Alcohol Spectrum Disorders
Hoyme, H. Eugene. “A Practical Clinical Approach to Diagnosis of Fetal Alcohol
Spectrum Disorders: Clarification of the 1996 Institute of Medicine Criteria.”
59
Pediatrics 115. (2005): 39-47.
Institute of Medicine (U.S.) Division of Biobehavioral Sciences and Mental Disorders,
Committee to Study Fetal Alcohol Syndrome. Fetal Alcohol Syndrome: Diagnosis,
Epidemiology, Prevention and Treatment. Washington, D.C. 1996.
Primary Disabilities in Fetal Alcohol Spectrum Disorders
Mattson, Ph.D., Sarah N., Schoenfeld, Amy M., and Riley, Ph.D., Edward P.
“Teratogenic Effects of Alcohol on Brain and Behavior.” Alcohol Research & Health.
25.3 (2001): 185-191.
Riley, Edward P., McGee, Christie L., and Sowell, Elizabeth R. “Teratogenic Effects of
Alcohol: A Decade of Brain Imaging.” American Journal of Medical Genetics. 127C
(2004): 35-41.
Streissguth, Ph.D., Ann. Fetal Alcohol Syndrome: A Guide for Families and
Communities. Baltimore. 1997.
Secondary Disabilities in Fetal Alcohol Spectrum Disorders
Alcohol Related Birth Injury (FAS/FAE) Resource Site. “Neurodevelopmental Defects Secondary Disabilities.” July 30, 2008. <http://www.arbi.org/prevention/
neuro_second.html>.
National Center on Birth Defects and Developmental Disabilities, Centers for Disease
Control and Prevention, U.S. Department of Health and Human Services. “Protective
Factors for Children with FAS.” July 31, 2008. <http://www.cdc.gov/ncbddd/fas/
protective.htm>.
Streissguth, Ph.D., Ann. Fetal Alcohol Syndrome: A Guide for Families and
Communities. Baltimore. 1997.
Stresissguth, Ann, and Kanter, Jonathan, eds. The Challenge of Fetal Alcohol
Syndrome: Overcoming Secondary Disabilities. Seattle. 1997.
Prevention
Streissguth, Ph.D., Ann. Fetal Alcohol Syndrome: A Guide for Families and
Communities. Baltimore. 1997.
60