Foetal Alcohol Syndrome Disorder
Last week we witnessed another massacre of 17 American school children being gunned down by Nicholas Cruz an ex-student of the school. Early reports point to Cruz as being a ‘disturbed’ student who was in constant trouble while at school and had since dropped out. Now experts are suggesting that this boy suffers from a disorder called foetal alcohol syndrome.
Foetal alcohol syndrome disorder (FASD) is permanent brain damage that is a result of the mother consuming alcohol during pregnancy. The amount of damage is related to the amounts of alcohol, when it was consumed and the genetic disposition of the mother. As a result the severity of the damage is across a spectrum FASD ranging from mild to severe.
The speculation regarding the probability of Nicholas Cruz suffering from this disorder is most likely underpinned by the appearance of his face. Children who have this condition are generally short, have low body weight but the clinching factor is their small head with a low nasal bridge, small eyes and a thin upper lip.
Coincidental to this tragedy is the release of a study from Western Australia on children in detention. This study has just been published in the BMJ Open and reported in The Conversation (14th February 2018). The study pointed out that 90% of all children in custody suffered a mental illness but of these inmates one in three had FASD, a distinct form of disability. Unlike the other common disorders in the population that become incarcerated, FASD is not a developmental condition but a brain based condition, that is the brain is damaged on a continuum that is related to the environment in which the foetus matured. It is critical to understand that FASD cannot be cured; it is permanent brain damage. The best we can do is assist these children manage their impediment.
The frequency of FASD in the population is in dispute. One strong factor for this uncertainty is the reluctance of the medical profession to make this diagnosis. Doctors are aware that such a finding places the blame squarely on the mother and condemns them to a life of guilt. However, in the latest Journal of American Medical Association they found that one in twenty children suffered from FASD; they had suspected the number to be more like one in one hundred. They still suspect this figure underestimates the prevalence of the disorder.
In Australia using various data from states and territories, the estimations are of 0.01 to 1.7 per 1,000 births but when examining the indigenous population this rises to 0.15 to 4.70 per 1,000 births. One study has found very high rates of FASD in some remote communities with the number of cases diagnosed at 120 per 1000 for children born between 2002 and 2003. These figures are debatable because of the poor registration of this disease but for any school there is a high possibility that these students are present and provide a unique challenge. For schools in remote regions with a high indigenous population the challenge is immense.
The behaviour manifestation of FASD is directly related to the cognitive impediments and parallels the dysfunctional behaviour of other types of brain damage. In particular there is a loss of the functions in the prefrontal cortex, the so-called executive part of the brain. This results in a lack of impulse control, poor decision-making and inept socialization. Other areas of brain damage impair memory and language acquisition and low attention spans.
Just like the disorder the level of dysfunctional behaviour will be expressed on a continuum. Some children may appear to act like the class clown, they may be just naughty or lazy or they may appear to be totally out of control and impossible to manage. No matter how ‘bad’ their behaviour is it is important to keep in mind that these kids struggle to remember what is expected of them, to understand the presenting social context and make any decision other than that dictated by their impulsive nature.
All this information is of little help in managing these students in your classroom other than to give an understanding of the challenges both teacher and student face. And, as in most cases the availability of system support for these difficult students is dubious if not non-existent. So what is the practical advice?
A review of the available therapeutic interventions shows that the best chance for these kids is to be born in a stable loving home, not a likely prospect. What is apparent is the longer they do live in a caring, non-violent environment the more they can have a substantial life.
So it is important that the teacher provides a stable, predictable environment with strong positive relationships. This requires strong professional boundaries (see Newsletter - Teaching Practical Boundaries 31st July 2017) that allow you to stay calm and make a professional decision around the behaviour of these children. As always the other students’ rights must be equally dealt with. This requires a very structured and predictable set of expectations. This will, in many cases mean some sort of time out for the student (See Newsletter - Time Out – 17 July 2017.)
Because these students will never recover from their disability there is a strong case to introduce an independent behaviour program (See Newsletter – Independent Behaviour Programs – Contracting for Behaviour Gains - 23rd August 2017.) That is the student and the class understands that consequences for the FASD student are different. This difference must be explained to the class but not the reasons for them. In my experience, when kids are included in the purpose for this practice they become very comfortable providing they are protected from any impact of the inappropriate behaviour.
In 2002 Malbin reported on the incarceration of FASD sufferers in the Journal of Law Enforcement. He came to the conclusion that catering to the strengths helps in the care of these sufferers. From this work it can be assumed that music, be that singing, composing or learning an instrument seemed effective; this helped with their emotional stability. Studying very concrete activities helped. Predictable subjects such as spelling, mathematics allow them to enjoy success building a more positive outlook to school. The more ‘grey’ area such as literature is a struggle but story telling or if they can independently read this provides a non-threatening access to literary skills.
Finally physical activities are useful as long as they are non-threatening and very importantly have no level of interpersonal contact. Not only are FASD kids impulsive and likely to retaliate without thinking they are also 50% more likely to display inappropriate sexual expression and that includes touching.
Kids with FASD provide an extreme challenge to schools. Not only is their little or no support it remains a fact that these kids are not responsible for their brain damage and it is hard to hold them responsible unless we, society gives them the special support they need to become responsible. It is possible that in Florida we have seen the devastating outcomes that can occur if we turn a blind eye to these kids.