Forums » Smalltalk » AMA: FASD Social Worker

Hello RPR!

I posted a similar topic last year, but as my journey continues in this line of work, my role slightly changes. I have worked in child protection, women's shelters, and an agency for child & youth mental health where I acted as a psychotherapist. Currently I am working with FASD - Fetal Alcohol Spectrum Disorder.

Here are some quick facts and statistics about FASD to get this started - please note that these are from Canadian research sources and are all accredited:
- FASD is one of the most leading neurodevelopmental disorders there is; it is more prevalent than autism spectrum disorder, cerebral palsy, down syndrome and Tourette's syndrome combined. It is even higher in other parts of the world
- It is one of the most stigmatized because it means the birthmother consumed alcohol while their unborn child was still in the womb. As a note, this may because of depression, addiction issues, isolation and more. 1 in 2 pregnancies are unplanned and there is a lot of misinformation about alcohol during pregnancy - we don't blame birth mothers.
- 80% of children and youth with FASD are not living with their biological parent (majority are in adoptive families, group homes, kinship care)
- 60% of individuals with FASD over the age of 12 have been convicted of a crime or or somehow involved in the criminal justice system.

You are welcome to ask me anything social work related on specifically about FASD. In other words, ask me anything!

What kind of challenges do people with this disorder commonly face in society? Do they have trouble connecting with other people the way ASD people do?

What are common behavioral symptoms? How early are they noticed?

Hopefully not unrelated, but how did you get into this line of work? I notice you have a lot of experience working with kids. Is that just really common with social work, or do you deliberately specialize?

Hi Aardbei!

I'll start off with this acronym for explaining what FASD is - ALARMS.
A: Adaptive Functioning - challenges with social skills, boundaries, social ques, dysmaturity (chronological age usually higher than developmental).
L: Language - slower processing speed, abilities of vocabulary out of sync with comprehension, concrete terms needed vs abstract
A: Attention - difficulties with the ability to pay attention
R: Reasoning - difficulty understanding cause/effect of ones or others actions, trouble with problem solving, understanding time, math, money, ownership of an item.
M: Memory - working memory (may only remember one instruction at a time), may not remember something from previous day and therefore a lot of repetition is needed for rules, routines, instructions, etc. May "lie" because they genuinely can't remember something and fill-in memory gaps with what they believe to be true.
S: Sensory - hyposensitive and/or hypersensitive to stimuli

Remember, this is a spectrum and may appear differently for every person diagnosed.

One of the most common things is that its often a hidden disability. Meaning, someone with FASD may present very well and it would be unknown that they have it -- which means, they are often seen as 'choosing not to pay attention' or 'choosing to act-out' or 'lying' when really its their FASD. This diagnosis often goes unnoticed. Unfortunately, often individuals with FASD may get into trouble for 'stealing' when it's really that ownership of an object is an abstract concept!

People with FASD tend to be extremely friendly, generous, giving, kind and helpful! They are often the kid that everyone likes but 'wonders why they don't get it or follow the rules.'

Behaviour is usually a result of overstimulation in the environment such as sounds, bright lights, strange or strong smells, etc. It is hard for someone with FASD to self-regulate and not act on impulses. Hence, why behaviours may manifest.

You're right that I often work with kids! It's not the only thing that social workers do. There are policy makers, researchers, teachers, case managers, welfare workers and more. For me, kids are these resilient wonderful little people who are learning about the world. I love how funny they are, open and honest they are and I adore seeing them learn and grow - kids tend to learn and adapt quickly!

Thanks Aardbei

Hi Cass and thank-you for the work you do with these kids.

As a teacher, I wonder how often these children are not diagnosed or misdiagnosed until their behaviour becomes what is termed as "problematic" and what can be done before hand to help them?

A special court opened where I live to accommodate people with FASD: smaller, quieter, lots of visual aids so those in the system (at 10x the rate of the general population, apparently) have an easier time understanding what's going on. Demand is sky-high, but it also seems like the kind of environment where one would have to take care not to oversimplify or overexplain at the expense of someone's dignity. Is that a concern in your work?

I adore it!

So one of the strategies right now we are doing for my community is reaching-out to as many school boards as we can, directly speaking to teachers, special education coordinators etc to offer education sessions about FASD. There's also a bill being read here in Canada (hopefully successful) to have FASD education to teachers and school faculty mandatory because of how significant it is. We also make recommendations for classrooms!

The best method is early diagnosis, an individual education plan - accommodations for curriculum as necessary. If a teacher's assistant is there to work with them one on one, amazing. Here in Canada it's hard to obtain an FASD diagnosis however. One, because prenatal alcohol exposure must be confirmed or the individual must have FASD 'facial features' (which is only 10%). Because most children with FASD are adopted in kinship, etc. It is heavily relied on birth history to provide this information of whether or not this substance use happened. If the data it is not collected (or birthmother doesn't want to say because of stigma), no facial features = no diagnosis. Here in Canada, you also need four professionals to diagnose - speech and language pathologist, medical, psychological and occupational therapy.

Long explanation short: early intervention with correct FASD strategies that focus on the disability as brain-based versus behavioural is really key. Supervision constantly, routine (same thing everyday) and repetition of rules and expectations is also very helpful.

It could be, sure! But honestly, visuals, diagrams, step-by-step instruction is crucial (typically) for those with FASD. Because of memory gaps, sometimes they can only remember one step at a time. Visuals help to understand visually and concrete versus abstract phrasing. With FASD, often the developmental age is much younger than the chronological age of the individual. So someone who is chronologically 25 might developmentally be 10. Dignity of people is always a priority, and because it is a spectrum, we have to take that into account at all times.

I'm so so so glad to hear of this court system in your area.