Dealing with a child affected by foetal alcohol spectrum disorder (FASD) can have it's challenges and the effectiveness of any strategies you decide to try will depend on the individual. Never give up on your child, if a strategy isn't working, try something else.
Here are some overall suggestions:
Understand the affects of FASD and adjust your expectations
Understand and remember that the basis for most of the challenging behaviour is caused by brain damage and neurological dysfunction. Even actions that may appear as deliberate or manipulative are often beyond the control of the child. Your child may not always consistently function at a level concordant with their age, and may not do as well at school, act up in social situations or not fully understand the consequences of their actions. This isn't to say that bad behaviour should go without consequences, but you should bear in mind that the child may struggle to learn from their mistakes and repeat the behaviour. Adjust your expectations accordingly, by showing more understanding and support you can encourage healthy and respectful behaviour.
Dealing with bad behaviour
Consequences (as well as rewards) need to be immediate, predictable and unchanging – no 'just this once...' breaks in routine. Rules need to be simple, as do consequences, for example 'you hit = you sit'. An immediate and easily recognisable indicator of behaviour would be giving the child a thumbs up for good behaviour and a thumbs down for bad behaviour.
It is also a good idea to ensure the child has a safe place where they can vent their anger in a physical manner without getting penalised for it. Somewhere where they can't hurt themselves (or others) and a physical activity such as a punchbag or kicking a ball is ideal.
Likewise, in the midst of a tantrum the child may not understand how to stop it and calm down. Use specific instructions such as 'open your eyes' and 'close your mouth' and set up a 'comfort corner' that is safe, comforting and quiet and is used to help them calm down, not as a punishment.
Environment
Instead of trying to change the child, change the child's environment. Children with FASD can become easily overwhelmed and distracted so consider less stimulating environments. In the home, minimize chaotic physical surroundings and think 'less is more'. Visual cues are very helpful for children affected by FASD and increase understanding and assist with memory. Labels, particularly line drawings and better yet drawn by the child themselves, help the child understand what things are for, how to use them and where things go. For example, store things by type, such as all shoes together, all toy cars together, all DVDs together etc and use visual labels so the child can work out where to put things. This can also be used for helping them remember which is the hot and cold tap, which way to turn the door knob, how full to fill the bath etc.
When out and about try and choose less stimulating environments, or if you must go try and do it at a less busy time.
Communication
You need to adapt both what you say and your body language when communicating with a child with FASD. Eye contact is very important as are visual cues. For example, combine 'I don't know' with a big shoulder shrug to help them understand, or use a big cheesy grin when you are happy.
Always try and state what the should do, not what they shouldn't do. Keep instructions clear and to the point, and be specific – instead of 'clean your room' try 'put the clothes in the wash basket' and 'put the toy cars in the car box'. Breaking tasks down into smaller steps helps with understanding and memory.
Try and describe things in a visual way to help them picture it – instead of 'you are interrupting me' say 'your words are bumping into my words'.
Promote positivity and play
A healthy lifestyle including a good diet, regular exercise and fun is beneficial to everyone. Encourage enjoyable activities and play such as art or sports, just always ensure that they are supervised. Playing a team sport may help them in learning how to work with others, make new friends and have fun whilst also being able to displace their excess energy. Focus on the positive, laugh and smile lots, encourage them and reward good behaviour – emotional rewards such as hugs or high fives go a long way.
Routine
Structure, routine and consistency are key when managing a child with FASD. Create good routines for mealtimes and bedtimes and stick to them – no exceptions. Your child may not understand or respond to their body's cues for when they are tired or hungry. Routines anchors activities in time and allows them to predict what comes next.
Have a good support team
Every individual with FASD reacts differently and some techniques may work better than others. Try to ensure the people who your child interacts with understand the nature and challenges of FASD and adapt their behaviour accordingly. Teachers should know your reward and consequence system and stick with it – your child won't necessarily respond to the same punishments as other children. Your healthcare professionals such as your doctor need to understand FASD and the specific challenges it brings. You know your child better than anyone so it is your responsibility to find out what works and make sure it is implemented in all aspects of their life.
Here are some overall suggestions:
Understand the affects of FASD and adjust your expectations
Understand and remember that the basis for most of the challenging behaviour is caused by brain damage and neurological dysfunction. Even actions that may appear as deliberate or manipulative are often beyond the control of the child. Your child may not always consistently function at a level concordant with their age, and may not do as well at school, act up in social situations or not fully understand the consequences of their actions. This isn't to say that bad behaviour should go without consequences, but you should bear in mind that the child may struggle to learn from their mistakes and repeat the behaviour. Adjust your expectations accordingly, by showing more understanding and support you can encourage healthy and respectful behaviour.
Dealing with bad behaviour
Consequences (as well as rewards) need to be immediate, predictable and unchanging – no 'just this once...' breaks in routine. Rules need to be simple, as do consequences, for example 'you hit = you sit'. An immediate and easily recognisable indicator of behaviour would be giving the child a thumbs up for good behaviour and a thumbs down for bad behaviour.
It is also a good idea to ensure the child has a safe place where they can vent their anger in a physical manner without getting penalised for it. Somewhere where they can't hurt themselves (or others) and a physical activity such as a punchbag or kicking a ball is ideal.
Likewise, in the midst of a tantrum the child may not understand how to stop it and calm down. Use specific instructions such as 'open your eyes' and 'close your mouth' and set up a 'comfort corner' that is safe, comforting and quiet and is used to help them calm down, not as a punishment.
Environment
Instead of trying to change the child, change the child's environment. Children with FASD can become easily overwhelmed and distracted so consider less stimulating environments. In the home, minimize chaotic physical surroundings and think 'less is more'. Visual cues are very helpful for children affected by FASD and increase understanding and assist with memory. Labels, particularly line drawings and better yet drawn by the child themselves, help the child understand what things are for, how to use them and where things go. For example, store things by type, such as all shoes together, all toy cars together, all DVDs together etc and use visual labels so the child can work out where to put things. This can also be used for helping them remember which is the hot and cold tap, which way to turn the door knob, how full to fill the bath etc.
When out and about try and choose less stimulating environments, or if you must go try and do it at a less busy time.
Communication
You need to adapt both what you say and your body language when communicating with a child with FASD. Eye contact is very important as are visual cues. For example, combine 'I don't know' with a big shoulder shrug to help them understand, or use a big cheesy grin when you are happy.
Always try and state what the should do, not what they shouldn't do. Keep instructions clear and to the point, and be specific – instead of 'clean your room' try 'put the clothes in the wash basket' and 'put the toy cars in the car box'. Breaking tasks down into smaller steps helps with understanding and memory.
Try and describe things in a visual way to help them picture it – instead of 'you are interrupting me' say 'your words are bumping into my words'.
Promote positivity and play
A healthy lifestyle including a good diet, regular exercise and fun is beneficial to everyone. Encourage enjoyable activities and play such as art or sports, just always ensure that they are supervised. Playing a team sport may help them in learning how to work with others, make new friends and have fun whilst also being able to displace their excess energy. Focus on the positive, laugh and smile lots, encourage them and reward good behaviour – emotional rewards such as hugs or high fives go a long way.
Routine
Structure, routine and consistency are key when managing a child with FASD. Create good routines for mealtimes and bedtimes and stick to them – no exceptions. Your child may not understand or respond to their body's cues for when they are tired or hungry. Routines anchors activities in time and allows them to predict what comes next.
Have a good support team
Every individual with FASD reacts differently and some techniques may work better than others. Try to ensure the people who your child interacts with understand the nature and challenges of FASD and adapt their behaviour accordingly. Teachers should know your reward and consequence system and stick with it – your child won't necessarily respond to the same punishments as other children. Your healthcare professionals such as your doctor need to understand FASD and the specific challenges it brings. You know your child better than anyone so it is your responsibility to find out what works and make sure it is implemented in all aspects of their life.
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