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Module 6: Diagnosis and Treatment of FASD

Guidelines for Working With Individuals With an FASD

A shift in how we understand children with an FASD may help those who work with children with an FASD. The table shows differences between how behavior is perceived and what actually is occurring6.

Perceived Behavior vs. Actual Situation in Persons With an FASD


Actual Situation


Can't understand or process verbal directions


Frustrated, defensive, challenged


Doesn't understand, doesn't remember


Fills in, has memory problems

Doesn't try

Exhausted, can't start, or afraid of failure

Mean, rude

Defensive, hurt, abused, unable to interpret social cues

Constantly late

Can't tell time, can't get organized, doesn't get the concept of time (for example, if you need to leave by 1:00 to get to a 2:00 appointment, that's an hour away)

Doesn't care

Cannot show feelings, is protecting himself or herself

Refuses to sit still

Overstimulated, needs to move while learning, doesn't know what he or she is expected to do

Fussy, demanding


Trying to make me mad

Can't remember

Trying to get attention

Needing contact, support


Doesn't understand social cues and rules


Doesn't understand ownership

Doesn't get the obvious

Needs many reteachings, doesn't understand, despite intelligence

Makes the same mistakes over and over

Can't link cause to effect, can't see similarities, has difficulty generalizing

Doesn't work independently

Has chronic memory problems, can't translate verbal directions into action

Is overly physical

Is hyper- or hyposensitive to touch, doesn't understand social cues regarding boundaries

Uses poor social judgment

Is not able to interpret social cues, needs help organizing

Source: Adapted from Malbin, D. 1993. Fetal Alcohol Syndrome, Fetal Alcohol Effects: Strategies for Professionals. Center City, MN: Hazelden.

The appendix includes more detailed suggestions to assist those living with or caring for individuals with an FASD 4. Although targeted to families and caregivers, some of the suggestions may be practical for teachers, health care providers, social service providers, and others who work with individuals with an FASD. Another helpful resource is the Fetal Alcohol Syndrome Handbook Exit Disclaimer Graphic  PDF Icon produced by the University of South Dakota 5 .

Perhaps the most important thing to remember is that people do not choose to have an FASD. They want to fit in, live independently, have jobs, and make friends. They do not deliberately try to alienate others. Their brains function differently, causing them to learn differently and behave in challenging ways. Adapting to the situation and looking for ways to meet their needs can help improve the quality of life of people with an FASD. The problem is the alcohol, not the person.

 People do not choose to have an FASD

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