Students with FASD- Missing the Diagnosis

“Class, I want everyone to open up your desks, take out your math books, turn to page 49 and work on problems 1-10.”

The previous set of instructions, or similar, has no doubt been spoken in classrooms all over Ionia County, and indeed the state, if not the U.S. Also, undoubtedly, most children were able to complete those instructions. Some kids struggled to find their math book, then asked their neighbors which problems they were to do, but remembered the essence of the instructions.

Some children, like Tracy, however, heard, “Open your desk.” Captivated by the other items in their desk, it was only when they noticed others working, when peers were again laughing at them, or, most likely, when the teacher stormed over, frustrated, that they realized (again) that they must have done something wrong, but have no idea what. Sent to the principal’s office (again), forced to come up with an explanation of why she was in trouble, Tracy explained, “I hit Emily.” (She never hit anyone.) Expelled for hitting, Tracy was sent home.

Tracy used something called “confabulation,” common in persons with a Fetal Alcohol Spectrum Disorder (FASD), a form of brain damage that occurs when the mom drinks alcohol during pregnancy. Confabulation is filling in with what seems logical, because you can’t remember what actually occurred. Some call this “lying,” but it is very, very different.

Lying is done to get yourself out of trouble; you know what occurred but deliberately tell a different story. Confabulation is often seen in people with dementia who tell you they had oatmeal for breakfast when in fact they had eggs and toast. There is no benefit in “lying”; they simply can’t remember and want to “save face” by coming up with what seems like a reasonable answer. In Tracy’s case, she doesn’t have dementia, but she does have definite brain-based challenges. That day in school, she opened her desk and the next thing she knew, she was sent to the principal’s office. Asked to come up with a reason, she gave one. To her benefit, though, she did get out of school, a place she has learned to hate.

What is the purpose of education? This seems a silly question, but it really is not. Tracy has been expelled for typing up a beautiful six-page report on spiders. Her fine motor skills are poor and her Individual Education Plan (IEP) allows for typing instead of writing. Her teacher, however, forgot the IEP, and failed the paper when it wasn’t handwritten. Tracy, frustrated, screamed, then was expelled.

Some of the most important steps in working with persons with an FASD are to always remember to make requests (not demands) in one-step directions. Then, put a series of one-step directions together. People can learn series of one-steps. Have you ever noticed that you can complete an action and not even realize you’ve done it, such as drive down the road, wash dishes, etc.? This is often the result of “procedural memory.” That is, you do an act over and over again so many times that you can do it from memory.

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Disclaimer:  The views and opinions in this article are those of the authors and do not necessarily represent the views of Edmonton and Area Fetal Alcohol Spectrum Disorder Network.


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