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Supporting our Most Vulnerable: The Complexities and Importance of Focusing on

the Positives of Students with FASD

Shelby Job

Department of Education, University of Lethbridge

EDUC 4709: Issues in Special Education: Behavior Disorders

Dr. Terra Leggat

June, 15. 2022

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A few months ago, I got a phone call from a principal of an elementary school who

sounded desperate. He was looking for an educational assistant for a boy in grade three who was

diagnosed with FASD, ADHD, and other sensory processing deficits. He described the boy as

“very tricky at times, explosive, can be aggressive but also enduring and caring”. I was surprised

to be offered the position because I am university education student who had at that time had

never worked as an EA before. Nervously but excitedly, I accepted the position wondering what

I had gotten myself into. After ending the call with him my nerves began to build as I realized

that I knew almost nothing about FASD. I knew it was caused from prenatal alcohol exposure

but was clueless about how FASD individuals are impacted or the challenges they face. It turns

out that I was not the only one. Research has indicated that as many as 77% of Canadian teachers

feel they are ill-informed and/or have misconceptions about FASD (Poth et al.,2014). This is

problematic because FASD is the most common developmental disability in Canada effecting at

least 4% of the population with some research predicting this number to be much higher. This is

more than autism, cerebral palsy, down syndrome, and tourette syndrome combined (CanFASD,

2021) . The Canadian FASD network defines FASD (Fetal Alcohol Spectrum Disorder) as a

“lifelong disability that affects the brains and bodies of people who are exposed to alcohol in the

womb. Each person with FASD has both strengths and challenges and will need special supports

to help them succeed with many parts of their daily lives” (CanFASD, 2021). Children with

FASD usually struggle greatly in school with at least 60% of students with FASD experiencing

some disruption to their education in the form of suspensions, expulsions or drop outs (Poth et

al.,2014). This means that it is vital that teachers are informed about FASD and how it may

impact the learning and behavior of their students.

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FASD is a complex condition that affects aspects of student’s cognitive, behavioral,

emotional and social abilities. Having a basic understand of FASD and how it impacts the

learning and behaviors of students is a crucial first step for becoming more informed and able to

support students. FASD is a highly complex condition because the root is from prenatal alcohol

exposure but those with FASD face a number of other interrelated and compounding issues

including: high level of environmental adversity, compounding stigma, intergenerational

impacts, social determinants of health, unique caregiver and family experiences, and co-

occurring health conditions (Green, 2007). Understanding the complexity of the challenges

students with FASD face helps us to develop a more compassionate and holistic understanding of

student’s with FASD experience. Children with FASD often exhibit deficits in cognitive

functioning. This means they may have difficulty with planning, organization, attention, learning

from consequences (both natural and imposed), memory deficits, speech and language delays

and limited visuospatial functioning and memory (Green, 2007). Individuals with FASD can

often demonstrate a lack of inhibition, impulsivity, poor judgement, and lack of cognitive

flexibility resulting in the inability to generalize rules and challenges in social interactions

(Green, 2007). These are just some of the common characteristics of FASD but it is important to

remember each student with FASD will be unique. They may express a combination of these

traits or even different traits completely however, it is still beneficial to have a basic understand

of the challenges that students with FASD may be experiencing. The complexity of FASD is

compounded with the common co-occurrence of other conditions.

There is a high comorbidity rate between FASD and other mental health conditions. In

comparison with the general population individuals with FASD are ten times more likely to have

ADHD, twenty times more likely to have substance abuse problems, and twenty five times more
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likely to be diagnosed with a psychiatric disorder (Flannigan et al., 2022). Mental health

challenges are also prevalent in those with FASD and occur along side complex biopsychosocial

vulnerabilities which makes it very difficult to understand the underlying needs of students and

the cause of challenging behaviors they many present (Flannigan et al., 2022). Having an

accurate diagnosis of the compounding conditions of students with FASD is beneficial for

applying effective supports and interventions but certainly still remains a challenging task.

Adding to the diagnostic challenges of children with FASD is a variety of other psychological

symptoms including hyperactivity, emotional disorders, sleep disorders, aggression,

inappropriate sexual behavior, self-injury, and social skill challenges (Green, 2007). Students

with FASD many also endure low self-esteem and social isolation (Green, 2007). It is critical

that teachers understand the complexity of FASD and how children’s symptoms and behaviors

can stem from a variety of characteristics associated with FASD. These co-occurring conditions

can manifest and compound the challenges students with FASD are already facing. For example,

a recent study as found that children with FASD experience significantly higher sleep

disturbances than typically developing children and are over 70% more likely to have nightmares

(Mughal et al., 2021). This means that a student with FASD is likely to be experiencing

symptoms of sleep deprivation on top of the challenges of FASD and other co-occurring

conditions. Being aware of the complexity of conditions that students with FASD are

experiencing will help teachers understand where learning and behavior challenges stem from

and how to best support these students.

Perhaps the most important aspect of understanding FASD and how to help support

students with FASD is through trauma informed teaching practise. Individuals with FASD

experience disproportionally higher rates of prenatal and postnatal adversity and are thus often
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exposed to high levels of trauma (Flannigan et al., 2022). Trauma and FASD are often

intrinsically linked through intergenerational trauma. Beginning early in life, children with

FASD are exposed to higher rates of adverse experiences such as caregiver disruption, death of

parents, abuse and neglect, and familial substance abuse (Flannigan et al.,2022). Trauma affects

the brains in many ways but one of the most important considerations for us as educators is that

trauma can disconnect children from the ability to attach to others in positive and trusting ways

(Weston & Thomas, 2018). It is crucial to make efforts to build strong relationships with our

students with FASD even if it is challenging at times. It is also important to remember that the

trauma our students with FASD have will affect them in a variety of ways that manifest into

‘behaviors’ at school. Remembering to remain compassionate and focused on relationships and

skill development is key.

This was a major consideration for the student I worked with who, through the foster care

system, had experienced trauma alongside his FASD. His trauma manifested into intense

abandonment fears. Understanding these fears and how to support him through them became a

major aspect of working with him. We initially had built a strong relationship and a couple

weeks after beginning to work with him things were going quite smoothly at school. We were

keeping him regulated most of time, he was developing skills both academically and socially,

and I felt we had a positive relationship. However, after about a month after I started working

with him his behavior became increasingly more challenging. I was perplexed because it seemed

to be directly associated with me. Whenever I was working with him, it seemed he would ‘flip

his lid’ a lot more frequently. His aggression towards me also increased substantially. It became

quite frustrating because I couldn’t figure what had changed or what I was doing wrong. A

meeting with a FASD specialist for southern Alberta changed my perspective completely. The
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specialist explained that due to having FASD and the trauma that he endured caused him to have

strong subconscious abandonment fears. The specialist explained that his increased ‘behaviors’

and acts of aggression towards me were his trauma brain’s method of protecting him. His brain

was essentially trying to push me away to see if I would leave him. After this explanation it

became easier to remain compassionate and patient with him and emphasized the importance of a

strong relationship. It also meant that when my time working with was over, we had to support

him through this in a way that would hopefully not perpetuate his trauma and reinforce his

abandonment fears. While it was still very challenging and upsetting for him when I left, the

most effect method for supporting him through the transition was making sure he understood that

I was leaving because of circumstance and not leaving him specifically. He was also comforted

knowing that there was potential for contact in the future, whether it was me visiting him at

school or setting up virtual Teams meetings when he missed me. Although this is a specific

example, I think what can be learned from it is how important it is for educators to recognize that

students with FASD usually have additional trauma and this may affect them in a variety of

ways. As educators it becomes imperative that we make efforts to build strong relationships with

students with FASD and be aware of how trauma may be impacting them in order to support our

students the best we can.

Due to the complexity of their condition and the many struggles they face it is really easy

to focus on the negative with individuals with FASD, however their condition is defined by both

strengths and challenges. Focusing on strengths of students with FASD is vital for building a

more positive perspective of them both with others and themselves. There is a significant lack of

research into the strengths of individuals with FASD and this can perpetuate a sense of shame,

suffering, victimization, and contribute to the stigma associated with FASD (Flannigan et al.,
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2018). Research has indicated that both the challenges and capabilities of those FASD need to

be considered when determining a holistic understanding of their condition and how to best meet

their needs (Flannigan et al., 2018). Individuals with FASD are frequently reported to have a

number of positive qualities including, but not limited too: friendly, likeable, affectionate,

helpful, generous, outgoing, good story tellers, insightful, exceptionally bright in some areas,

artistic and musical, mechanical, athletic, determined, hard working, willing, forgiving, non-

judgemental, caring, good with children and animals, and strong hands on learners (Flannigan et

al., 2018). This list is extensive and demonstrates the extent to which the positive qualities of

students with FASD may be over looked. I know this was certainly true of the boy I worked

with who was almost all these things! Teachers and administration who participated in a

qualitive study about the most effective classroom strategies for students with FASD found that

recognizing the positive characteristics and assets instead of focusing on the negative

characteristics was one of the most important aspects of supporting students with FASD (Poth et

al., 2014). The group also noted that the academic and behavioral challenges of students with

FASD can be so profound that it can sometimes be challenging to recognize strengths and

encourage positive behaviors but this makes it all the more crucial to recognize and celebrate the

positive assets of student with FASD and promote health identity development (Poth et al.,

2014). This becomes even more important when we consider that students with FASD often

struggle from low- self esteem and negative self-image. This was one of the most heartbreaking

but important things when it came to the student I worked with.

The student I worked with suffered from low-self esteem and often engaged in very

negative self talk; recognizing his strengths and promoting a positive self image became one of

the most important elements of working with him. When he was upset and or unregulated, he
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would often scream things like: “I hate myself!”, “You hate me!”, “I am the worst!” or “Nobody

likes me!”. This was truly heart retching to listen to and I became almost desperate to try to

improve his perspective of himself and to stop engaging in such vile self talk. When he is

unregulated is when he engaged in the worst self talk but in these moments, he was not receptive

to reassurance or support. His positive self-image had to build in times when he was regulated. I

made an effort to take note of his strengths and positive characteristics and made sure to

celebrate them, even in small ways. Being recognized for his strengths made this student so

proud! He would light up whenever I complemented him on a skill or thanked him for a positive

behavior. Over time I think his self esteem did begin to improve.

There was an incident with him that will probably stand out to me for the rest of my

teaching career and demonstrates how critical it that we celebrate the positive traits of students

with FASD. One day when this student had became unregulated and had a big blow up, he

screamed an endless stream of negative self talk. In the room we were in there was a poster that

had 15 or so positive affirmations such as “I am kind” or “I am brilliant” etc.. As he was

beginning to calm down and re-regulate, he looked at that poster and yelled, “ I am none of those

things!”. It broke my heart to hear that he didn’t believe he was any of these positive things so I

told him, “You are all of those things”. When I said this, he gave me a look of complete anguish

and said I lying to him. I told him I was not and believed whole heartedly that he was all of

those things. I proceeded to tell him a story or give an example of when he demonstrated all of

those positive traits. About half through he began to sob uncontrollably so I asked him if he

wanted me to stop and he shook his head no. By the time I had finished the last of words, he was

standing in front of me with his hand on my knee. Comparatively, when I started he had been

curled up in a ball in the corner of the room as far away as he could get. With tears streaming
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down his face, he looked me in eyes and in the most sincere voice I have ever heard he thanked

me. Later he told me that no one had ever done that for him before. Although we still had many

ups and downs after this incident and he did still continue to engage in negative self talk, it was a

distinct turning point in our relationship and I believe he did have a more positive self-image

afterwards. This was probably the most impactful moment I have experienced working with

students so far and cements how important it that we recognize the strengths of our students and

help them develop a positive self-image.

FASD is the most common neurodevelopment condition in Canada yet one that many

teachers are ill-informed about. It is important that educators understand how immense the

complexities of FASD are and how it impacts the cognitive, social and emotional capabilities of

students. FASD and traumatic experiences are intrinsically linked and one of the most important

things educators can do to support students with FASD is to be trauma informed. Students with

FASD will benefit immensely from positive relationships with school staff who are

understanding and compassionate towards the trauma they have endured. Our role as educators is

to prepare our students for a successful future to the best of our abilities and for student’s with

FASD a crucial element of this is developing a positive self image and esteem. This can be

achieved by focusing on the strengths and assets of our students. Although FASD is a permanent

condition, there are many ways that we can support these students and help prepare them for a

positive future.
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References

Flannigan, K., Reid, D., & Harding, K. & the Family Advisory Committee. (2018). Strengths
among individuals with FASD. CanFASD. Retrieved June 11, 2022, from
https://canfasd.ca/wp-content/uploads/publications/Strengths-Among-Individuals-with
FASD.pdf

Flannigan K, Pei J, McLachlan K, Harding K, Mela M, Cook J, Badry D. & McFarlane. A.

(2022). Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder.
Frontiers in Psychology, 12(778471), 1-8, Doi: 10.3389/fpsyg.2021.778471
Green, J. H. (2014). Fetal Alcohol Spectrum Disorder: Understanding the Effects of Prenatal
Alcohol Exposure and Supporting Students. The Journal of School Health, 77(3), 103
108. https://doi-org.ezproxy.uleth.ca/10.1111/j.1746-1561.2007.00178.x
Mughal, R., Wong, S. S., Dimitriou, D., & Halstead, E. (2021). Nightmares in Children with
Fetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically
Developing Peers. Clocks & Sleep, 3 (33), 465-481.
https://doi.org/10.3390/clockssleep3030033
Poth, C., PEI, J., Job, J.M., & Wyper, K. (2014). Toward Intentional, Reflective, and
Assimilative Classroom Practises with Students with FASD, The Teacher Educator,
49(1), 247-264. DOI: 10.1080/08878730.2014.933642

What is FASD? CanFASD. (2021, April 20). Retrieved June 10, 2022, from
https://canfasd.ca/what-is-fasd/

Weston, J. & Thomas, S. (2018). Fetal alcohol spectrum disorder (FASD) and complex trauma:
A resource for educators. Marinwarntikura Women’s Resource Centre.
https://edmontonfetalalcoholnetwork.files.wordpress.com/2018/12/fasd_2nd_ed-2018.pdf