Behavior Management Plan for FASD

Written for:
10-year-old boy
Fetal alcohol effects
Self-contained special-education class
One-on-one aide
By Terri Mauro


Overview of Behavioral Issues Associated with Fetal Alcohol Effects

Specific Behavior Plan for [child]
I. Create rules that target specific behaviors.
II. Provide constant positive feedback when rules are not being broken.
III. Provide immediate, unemotional time-outs when a rule is broken.
IV. Adjust the environment to make it easy to follow rules.
V. Assess effectiveness of plan on a regular basis and make adjustments.

Overview of Behavioral Issues Associated with Fetal Alcohol Effects

In working with [child] and managing his behavior, it will be helpful to understand a few things about fetal alcohol affected brains:

• For most of us, the part of the brain that has impulses and the part that knows the rules are in constant easy communication. So we have an impulse to do something, we check it against what we know to be acceptable rules of behavior, and we make a conscious choice whether or not to break a rule. But in fetal alcohol affected brains, the connection between those two areas is faulty or missing. So the child has an impulse to do something, and by the time the part of the brain that knows the rules is even aware of the impulse, the action has already taken place, and most likely somebody is already yelling at the child about it. So you can have a kid who knows the rules, wants to follow the rules, is upset about breaking the rules, yet still breaks them. At the moment of action, he’s working purely on impulse.

• And since impulsive behavior is almost by definition without reason, asking a fetal alcohol affected child why he did something and not taking "I don't know" for an answer is pretty much insisting that he lie. They don't know why they do it. They may not even know what they did. So you'll either get gobs of denial and defensiveness, or you'll get a spontaneous excuse that defies credulity. Imagination and creativity are some of the positive attributes of people with FAE, but when they're used in service of getting out of trouble, they usually result in a tall tale that makes matters worse.

• Social and emotional development lags way, way, way behind in people with FAE. Teens and young adults with FAE often have an emotional developmental age of about 6. So with an elementary-school-aged child, you have to figure they may be working at a toddler stage at best. You have to adjust everything to that level -- expectations, supervision, privileges, rules, discipline. People with FAE tend to be verbal well beyond their level of understanding, and it may be tempting to assume that that clever and talkative child is able to understand social rules at a much more sophisticated level. It's a mistake.

• Stress makes things worse. A confusing thing with FAE kids is that sometimes they seem to be able to do things and sometimes they don't, and it's natural to assume that that indicates willfulness. But in fact their ability to control their behavior declines in proportion to the amount of stress they are experiencing. This can be obvious stress -- a noisy place, difficult schoolwork, disruptions of routine -- or less obvious, particularly in kids with sensory integration problems who react to things in the environment the rest of us wouldn't even notice. Sometimes the loss of control happens well after a stressful event -- if a child uses up a lot of resources getting through something hard early in the day, he may run out of control late in the day.

Because of these relatively unchangeable facts of an FAE child’s life, strategies that rely on self-control and presume willfulness; that require an advanced level of maturity and responsibility; or that increase the level of stress will be ineffective at best and may in fact escalate bad behavior. These may include:

• Negative consequences.
• Big positive consequences.
• Escalating consequences.
• Nagging to stop behavior.
• Pressure not to break rules.
• Abstract rules like “Be respectful.”
• A choice offered between compliance and negative consequence.
• Behavior modification

On the other hand, strategies that do not presume control; that don’t put undue weight on behavioral slip-ups; that are suited to the child’s level of emotional maturity; and that decrease the level of stress will be more effective, and at the least will not escalate bad behavior. These may include:

• Positive consequences, on a modest scale, delivered immediately.
• Distraction from misbehavior.
• Brief time-outs, delivered consistently and matter-of-factly.
• Changing of environment to make success more likely.
• Behavior analysis to assist in changing of environment.
• Constant positive feedback and encouragement.
• Specific rules like “No hitting.”
• Choices in which both options are acceptable to adult.
• Behavior management

Specific Behavior Plan for [Child]

I. Create rules that target specific behaviors.

• Translate abstract classroom rules into five or six specific directives targeted to [child]’s particular needs. For example:

NO pushing, poking, hitting, or grabbing.
NO hugging or kissing in school.
NO interrupting the teacher.
NO leaving desk without permission.
NO using mean words like “stupid” or “shut-up.”

• Post the rules where [child] can see them, possibly taping them to his desk.

• Only include items in rules that you will be willing to reinforce with a time-out whenever the rule is broken. Avoid things that are likely to recur with such frequency that he would be in time-out constantly, such as finger-sucking, jumping, messy writing or standing up at desk.

• You may want to include at least one rule that [child] has little trouble keeping, so that he has a constant experience of success and control.

II. Provide constant positive feedback when rules are not being broken.

• Using the rules above: If he passes anywhere near another student without touching them inappropriately, comment on how well he followed the rule. If he goes five minutes without interrupting, comment on it. If he stays seated for even a few minutes, announce that you like the way he’s sitting. Tell him you like the way he’s talking when he chooses words thoughtfully.

• If you see him about to break a rule, jump in and distract him with a positive comment like: “It’s really hard to sit still, isn’t it? I see that you’re really trying. It’s great that you’re trying your best.”

• Augment the positive feedback with neutral statements indicating that he’s being noticed in a non-negative way any time he is following the rules. Comment on the pencil he’s using, the clothes he’s wearing, the story he’s writing, the number of problems he’s done.

• Do not expect or require a verbal response from him for the positive statements. Improved behavior will be his response.

III. Provide immediate, unemotional time-outs when a rule is broken.

• Say something along the lines of, “Oops, you interrupted. Go sit, please.”

• No nagging before and no discussion after the time-out. He does his time and emerges with a clean slate.

• Keep the time-outs brief to reduce resistance. At home, as little as 20 seconds has been successful in changing behavior. In the classroom, a minute should be sufficient. It’s not a punishment so much as an acknowledgment that a rule has been broken, and a break in the action to get himself together.

IV. Adjust the environment to make it easy to follow rules.

• Children with FAE need an “external brain” to help them with judgments and adjustments they cannot make on their own. It is the job of adults who are working with [child] to constantly monitor his reactions and his environment and arrange ways for him to be successful and unstressed.

If inappropriate physical contact is a problem:

• Put [child] at the front or end of any line.
• Give him tasks to do in the classroom as other students are leaving (e.g., turning out lights) so that he will naturally be last in line.
• Try to steer him to areas of the classroom or other room that are not crowded.
• Provide physical barrier between him and other students if he seems to be struggling to keep his hands to himself.
• Offer distraction if he seems to be struggling to keep his hands to himself.

If staying in his seat is a problem:

• Allow him to stand up while doing work.
• Provide frequent movement breaks.
• Provide lots of distractions and motivations to keep him on task.
• Consider providing him with a larger working space at the back of the room so that he can move around without distracting other students.
• Consider alternative seating options such as an exercise ball.
• Consider allowing him to work on projects in a more hands-on way, with less seat work required.
• Use movement as a reward for completing small amounts of work.

If interrupting the teacher is a problem:

• Give him written information about what will be happening on a particular day so he can follow it without questioning.
• Allow him one question every five minutes, or when he’s completed an allotted portion of work.
• Have him write questions in his notebook and present them at an appropriate time.
• Provide distractions when he seems about to interrupt.
• If he’s compelled to interrupt in the disciplining of another student, use distractions or removal to another part of the room or school to keep him from noticing or becoming involved.

If completing work in a cooperative manner is a problem:

• Give him a checklist of work he must complete so that he can keep track visually.
• Consider putting all worksheets to be done that day in a folder and allow him to choose what to do.
• Provide motivating rewards for small increments of work completed.
• If work is completed quickly, allow him to move on to a more enjoyable activity like computer work, reading, even looking out the window.
• If the appearance of a worksheet is overwhelming, fold it or use a piece of paper to block out all but one or two questions. Give a reward after these are completed.
• Allow verbal answers instead of written if that keeps him going.
• Allow him to pick a new writing utensil before starting a new worksheet.
• Send home uncompleted work as homework rather than making an issue of it at school.

If misbehavior appears to be escalating:

• Do behavior analysis to try to determine what might be causing stress. Possibilities include: disruption of routine; substitute or absence of adult in classroom; assemblies or periods in mainstream classroom (Spanish, art, music); difficult work; lots of fine motor work; overstimulation at recess; noisiness; boredom; lack of movement.
• If the circumstance that is causing the stress can’t be changed, strengthen all other supports, increase the number of positive or neutral statements, break work into smaller units for rewards, and lower academic and behavioral expectations for the day.
• Keep track of what seems to cause problems and prepare in advance for future occurrences. If possible, send word home in advance of schedule changes or absences so that [child] can be prepared.
• Talk to [child] about what you think may be causing him to lose control. “You seem to be having a hard time this afternoon. I think maybe you used up all your control sitting still at the assembly this morning. Let’s try to pull you back together.”

Maintain a “bag of tricks” to be used as motivation, reward, or distraction from misbehavior.

• Have as many high interest or highly distracting items or ideas as possible so you can keep trying until something works. Some things that can be used to motivate and/or distract [child] when necessary are:
Car magazines (freebies from supermarket)
Shopping cards
Writing or drawing in notebook
Toy cars
Hard candy
Game where you join dots to make squares
Different pens
Looking out window
Asking a question
A surprising or silly statement
Whispering a secret in his ear
Taking a walk
Getting a drink
Pushing hard against his hands
Reading a book
Choosing what to do next

• Keep adding ideas to the list as you find things that work (or as [child] asks to do things -- use those as rewards/distractions).

V. Work with parents to assess effectiveness of plan on a regular basis and make adjustments.

• Send daily behavior report home (parent will provide form).

• Parents will include school behavior in daily “credit review,” in which [child] can earn points for privileges.

• Share with parents what seems to be working, and seek advice for what doesn’t.

• Include on report any stress-inducing occurrences that may have affected behavior.

• Meet with parent regularly to discuss behavior that is causing a problem in the classroom and develop management strategies.

• Re-evaluate the rules from time to time and adjust them to reflect [child]’s changing behavioral challenges and triumphs.

• Take advantage of materials on Fetal Alcohol Effects and other behavioral resources available from the parents. These include:

Fetal Alcohol Syndrome, Fetal Alcohol Effects: Strategies for Professionals by Diane Malbin

Fetal Alcohol Syndrome by Anne Streissguth

“Teaching Students with Fetal Alcohol Syndrome/Effects” from the British Columbia Ministry of Education

Transforming the Difficult Child: The Nurtured Heart Approach by Howard Glasser and Jennifer Easley

Steps to Independence by Bruce L. Baker and Alan J. Brightman

The Challenging Child by Stanley Greenspan

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