Students with Fetal Alcohol Syndrome: Updating Our Knowledge, Improving Their Programs
Miller, Darcy, Teaching Exceptional Children
Jack, a 10-year-old fourth-grade student with Fetal Alcohol Syndrome, lives with his adoptive parents, who began as foster parents when he was 3 years old. Jack is a talkative, active, and creative boy who struggles with academics, making friends, and anger management. It is difficult for him to understand the consequences of his behavior, so his decision making doesn't always result in positive outcomes. After negative peer interactions, Jack's teacher uses direct teaching of social skills, modeling, and guided practice. However, Jack tends to repeat the same negative decisions, and therefore has few friends. Jack also has a difficult time understanding social cues and interpreting others' communication, wants, or needs.
Jack receives special education services, as do many other students with Fetal Alcohol Syndrome (FAS; see box, "What is FAS?"). However, since FAS is not a formally recognized category under the Individuals with Disabilities Education Act (IDEA), students with FAS typically receive services by meeling the definition of other disabilities, such as emotional/behavioral disorders, mental retardation, learning disabilities, or health impairments (Gessner, Bischoff, Perham-Hester, Chandler, & Middaugh, 1998). FAS is usually subsumed under other IDEA categories, and is often discussed in texts and resources as a subset of other disabilities, so educators may not have had the opportunity to develop a knowledgeable base about FAS or become familiar with effective instructional strategies. Recent research has provided new information about FAS to consider when designing programs for these students. This article provides an overview of new developments in defining and characterizing FAS, as well as suggestions for effective intervention.
Weaving Student Characteristics and Programming Together
In the past, students with mild characteristics associated with fetal alcohol exposure were designated Fetal Alcohol Effects (FAE; Clarren & Smith, 1978). FAE is no longer considered a useful diagnostic label, as it is too vague to be of much help to educators or clinicians (Astley, 2004). FASD is now used to denote the full range of fetal alcohol spectrum disorders associated with prenatal alcohol exposure. Students with spectrum disorders may exhibit learning and behavior patterns that are similar to those with Fetal Alcohol Syndrome (FAS), even though they may not meet the specific criteria for a complete FAS diagnosis (see Astley & Clarren, 2000).
The characteristics associated with FAS range from mild to severe, and differentially impact language/communication, social/behavioral, academic/ cognitive, and adaptive functioning (Table 1). Research has reaffirmed many of the characteristics traditionally associated with FAS, but also has clarified some misconceptions (Table 2). This new understanding of FAS, along with well-established research findings, has implications for special education teams as they address the needs of students with FAS. Suggested interventions (Figure 1) should be evaluated in light of the relationship of characteristics across domains. For example, difficulty understanding abstract concepts will affect a student in all areas of functioning, not just the academic/cognitive domain. These suggestions have been synthesized from new research findings on FAS and from clinical practice (Miller, 2003, Miller, 2004, Miller & Emerson, 2004).
FAS Characteristics and Challenges
New findings regarding the language/ communication challenges faced by students with FAS have significantly contributed to our understanding of their communicative functioning. In the past it was assumed that if these students scored within normal limits on standardized speech/language measures, their communications skills were not impaired. But many students with FAS possess strengths in vocabulary and verbal fluency and score within normal limits on standardized measures, yet still experience communication problems (Streissguth, Barr, Kogan, & Bookstein, 1997). …