Introduction to [Child]

Written for:
9-year-old boy
Fetal alcohol effects
Self-contained special-ed class
One-on-one aide
Start of school year
By Terri Mauro

[Child] has been diagnosed with Fetal Alcohol Effect (FAE). Since he spent the first 21 months of his life in a Russian orphanage with very little therapy or stimulation, his development in many areas is particularly delayed. FAE may look in many ways like ADHD -- hyperactivity, distractibility and impulsivity are the most common effects -- but behavior modification that works with ADHD kids is generally ineffective for children with FAE, since the brain damage caused by prenatal alcohol exposure can keep them from being able to learn, adjust, and change their behavior. What is recommended for children with FAE is to focus on changing the environment rather than the behavior. This sometimes involves changing our attitudes and expectations as well. Here are a few specific things to be aware of when working with [child]:

[Child] may appear high-functioning in many areas, but there are others in which he is significantly delayed. Although his expressive language is close to age-appropriate and he is good at his academic work, his emotional development is closer to a four- or five-year-old level. You may not be able to expect more of him in terms of sitting-and-being-quiet, taking turns, and interacting with other children than you would of a kindergartner. We can talk to him all we want about being a "big boy," but his coping mechanisms are not anywhere near "big boy" level, and there's nothing he can do about it. We need to adjust our expectations accordingly.

Fine motor work is particularly trying. Because [child] has low muscle tone, he has trouble holding a pencil and controlling its movements, and becomes easily fatigued. It is very hard for him to maintain focus when doing something frustrating and difficult (as, indeed, it is for all of us), and as indicated above, his capacity for tolerating frustration is that of a much younger child. Please be sensitive to this. You can sometimes keep his mind on the work if you remove the fine-motor component; at the very least, break fine-motor work into small segments and give him breaks and rewards in between.

[Child] needs movement to stay alert. Because of sensory integration problems related to his reception of vestibular and proprioceptive input, [child] needs a certain amount of movement to be able to pay attention. If you can get him to sit still and be quiet, you may notice that he becomes sleepy and inattentive. Conversely, many have noted that [child] can be moving around the room and seeming not to be listening, but still be able to tell you exactly what you said. Movement helps him stay alert. While you may not be able to let him roam around, *please* plan many movement breaks for him throughout the day, and don't be to stern about fidgeting. If you don't plan movement breaks, he may request them himself by asking to go to the bathroom. A lot.

Rewards work better than punishments. He can't remember either when he's feeling impulsive, but the less stress in the environment, the more he's able to control himself, and rewards create less stress than punishments. Things that work well as rewards/motivators for him are: looking at someone's keys; car magazines (the freebies from the supermarket); getting to take a walk; jumping; looking out the window; going to the therapy room and putting his hands in rice; and basically anything he's asked to do that you've had to say no to. Time-outs can be effective with him, but you might try phrasing it as a positive: "I can see by the way you're acting that you need a time out."

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