Living with Foetal Alcohol Spectrum Disorder

Decision-making. The process of making decisions is very complicated for children with FASD. The decisions they have to make on a daily basis can pose a problem that interferes with their everyday life. Because their brains process information in a different way, these children may have difficulty understanding the consequences of their actions. In most cases, they will need extensive external support to improve in this area.

Friendships. Social relationships can be very difficult for children and adolescents with FASD. 
People with FASD often have poorer social skills than expected for their age group. They need to focus all their energy in order to cope with everyday tasks, which leaves them with fewer resources available to concentrate on social aspects. For example, they may not know how to take turns when speaking, or they may find it difficult to respect the physical space of others. This may lead to them experiencing situations of exclusion in social groups, which makes them feel very lonely and frustrated. It also puts them at a disadvantage compared to others, which can lead to bullying.  
 

Impulse control. People with FASD find it difficult to control their behaviour in certain situations due to deficits in their brain function. The people around children and adolescents with FASD need to remember that they do not act this way to be defiant, nor do they do it intentionally. Instead, they are trying their best to feel equal to other people their age. If inappropriate behaviours are observed, the following should be assessed: the physical environment (any changes in temperature, lighting, decoration, smell, etc.); basic personal needs (hunger, thirst, tiredness, etc.); the social context (feeling lonely or overstimulated by others, feeling under pressure, etc.). Adults need to understand that the brain connectivity of these children has been altered, and this means everything becomes more complicated in certain situations and/or on certain days.

Managing money. This topic can be very frustrating for adolescents with FASD. The concept of money and value is very difficult to understand without the necessary skills. For them, a pair of shoes may seem to have the same value as a chocolate bar. Money is an abstract concept, which means that while money is real and we can touch it, the value it has forms part of a broader idea. Adolescents with FASD often act impulsively. This means that when they want something, they don’t consider past mistakes or understand that their actions may affect their future. It is important to be patient and repeatedly explain to them the correct way to manage money.

The difference between fantasy and reality. Children already see the world differently to adults, but children with FASD have difficulty understanding the difference between fantasy and reality. They may lie continuously, but it is not done intentionally. They have difficulties with short-term memory and sometimes fill in the gaps with other information they remember. They may try to please the person they are talking to by saying things they think they want to hear, or they may have trouble thinking in a logical way. Due to the way their brains work, they may eventually start to believe their own fantasies.

Sensory adaptation. Many children with FASD are very sensitive to touch, movement, lighting and/or sound. Because of the way their brains work, they may be very focused on what they feel, see or perceive, instead of directing their attention towards other things. When they are hypersensitive to stimuli they may need to disconnect, or they may engage in inappropriate behaviour in an attempt to stop whatever it is that is bothering them. These behaviours can be very difficult for the family to cope with, especially when they occur in public. It is important to remember that their senses are not well regulated. Sometimes it may be difficult for them to know when they are hot or cold, or they may have trouble feeling pain. The support of an occupational therapist is essential in the case of children with sensory difficulties. 
 
 

Sense of ownership/property. Children and adolescents with FASD have difficulties understanding what the concepts of ownership and property mean. There are several reasons for this. Firstly, they tend to ‘live in the moment’ and, therefore, when they see something they want and it is available, they simply take it. Secondly, difficulties with short-term memory mean they do not remember whether they have taken it or if someone has given it to them. 

They may lie, either because they don't really remember that they have taken the item, or because they are afraid of getting into trouble. People with FASD may not remember past mistakes, and therefore do not remember other occasions where they have ‘stolen’ with resulting negative consequences. 

It is difficult to know what to do when a person with FASD steals something. Personal judgement must be used in each situation to assess what the cause was. They must also be repeatedly taught what stealing means. 
 

Changes. Life is full of changes. Adults handle the changes in children and adolescents’ lives. 
Moving house, starting school, changing class and teacher, or changes to family life are all common situations. For people with FASD, it can be very difficult to accept change. As well as these major changes, they also have difficulty coping with small changes in their daily routines, for example stopping playtime to go and eat. 
 

Participating in activities. Most children are interested in participating in extracurricular activities with other children. For some children and adolescents with FASD, the skills that these activities require, such as the ability to work in a team, follow instructions, develop skills quickly and compete, cause them more stress than enjoyment.

Structure. Children with FASD may experience a lot of stress if they do not have a very structured life. When people structure their daily lives, they do so in an order that makes sense to them. A person with FASD needs structure to help them orientate themselves in everyday life. The use of reminders helps to give structure. They can be used as a sort of ‘external brain’. Visual timetables, timers and diaries can also be used.

Routine. Routine is important for everyone. Understanding that we do the same things at the same times allows us to keep organised. Children and adolescents with FASD have trouble organising themselves. The family can help them create routines and learn appropriate habits. Although a person with FASD may not understand why they need to brush their teeth every day, it is important that they develop a solid hygiene routine.

Routines in visual format (pictures, bullet points) are very useful. Routines broken down into sequences with all the steps to be followed facilitate autonomy.