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Page URL: https://practice.orangatamariki.govt.nz/our-work/disability/practice-when-working-with-disabled-people/support-tamariki-and-rangatahi-with-fasd/
Printed: 26/04/2024
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Last updated: 23/05/2023

Support tamariki and rangatahi with FASD

Strengths and impairments vary from tamaiti to tamaiti but there are common traits and brain-based learning and support needs that we need to understand so we can successfully support tamariki and rangatahi.

Ko wai au? Who am I? Remember that FASD has changed how my brain functions. Get to know how my brain works and the areas where I need support. Teach me to trust you, so you can help me to get things right. 

Common strengths

  • Highly verbal
  • Creative – artistic, music, drama, poetry talents
  • Enjoys connecting to people one on one, friendly
  • Keen to please – may need help to follow through
  • Works hard when engaged in activities of interest
  • Likeable
  • Sense of humour and fun
  • Resilient
  • Determined

Common areas where te tamaiti or rangatahi may be challenged and need support

  • Difficulty with social communication, both verbal and non-verbal – may need help managing relationships with peers and others
  • Poor or inconsistent memory and recall – can’t rely on their memory for important decisions or events
  • Cognitive inflexibility – may need help to change direction or give in if they are overwhelmed
  • Impulsivity, distractibility, disorganisation – may need cues and support to keep on track
  • Range of emotion – we accept bigger than usual 'ups and downs' and once these are resolved, we support te tamaiti or rangatahi to move on, keeping those around them safe
  • Confabulation – te tamaiti or rangatahi may make up stories, give false answers or say what they think we want to hear, so we double check with adults
  • Cognitive limitations that impact learning and academic tasks – we provide sufficient time and support so te tamaiti or rangatahi can do their best
  • Skill development is not consistent with the chronological age of te tamaiti or rangatahi – we accept their different developmental ability
  • Poor reasoning and judgement – rather than trying to reason with te tamaiti or rangatahi, we assist them with decision-making at their developmental level
  • High levels of risk-taking as well as being vulnerable to being exploited by others – we supervise well, help te tamaiti or rangatahi develop their relationships with pro-social people, and build on their areas of strength
  • Difficulty regulating emotions – we help te tamaiti or rangatahi by co-regulating, and don't buy into drama
  • Difficulty linking actions to consequences – te tamaiti or rangatahi has limited insight into the impact of their behaviour on supportive loved ones

How we can help

When we understand this pattern of brain difference, we can focus on helping the person with FASD to understand their disability and foster a positive sense of who they are and their unique qualities and potential.

We also focus on helping the person with FASD to keep themselves calm, and we won't rely on them to be able to consistently activate their higher-level functions such as reasoning, judgement and organising. Instead, we support and accommodate these higher brain functions, so that the person can function well.

The right support is about keeping te tamaiti or rangatahi calm and helping them get on track with a pro-social routine. They will need repeated help to recover when they move away from the pro-social routine.

FASD characteristics across the lifespan | NOFASD Australia (PDF 60 KB)

1 Avoid standard behavioural management techniques

Due to brain architecture, FASD practice is not as simple as removing what looks like 'bad behaviour'. Standard behavioural techniques assume a person can relate action with consequence. However, a consequence-based approach is likely to increase 'bad behaviour' because the person with FASD doesn't understand and is likely to get upset when others try to get them to do something. Instead, they need our help to get things right.

Video – Nathan Ory: Why typical behavioural approaches may not work | Provincial Outreach Program for Fetal Alcohol Spectrum Disorder (Canada)

Video – Nathan Ory: Why kids steal | Provincial Outreach Program for Fetal Alcohol Spectrum Disorder (Canada)

Video – Nathan Ory: Dealing with stealing | Provincial Outreach Program for Fetal Alcohol Spectrum Disorder (Canada)

2 Focus on building relationships and trust

We want to help the person with FASD to repeatedly get things right, and this can only happen in environments where aroha and trust are clearly evident and well supported.

We show that we are willing to understand and support their brain challenges, and that we're prepared to help them build their routine, weather their storms with them and help them recover each time.

This type of relationship helps us, and others important to them, lead the person with FASD to practise and re-practise skills and routines, and to build confidence that trusting someone pro-social, when they’re stuck and don’t know what to do, will be helpful and useful to them.

3 Get the basics right

Pay attention to the basics, in particular a good sleep routine, exercise, good nutrition, and social support.

4 Re-frame behaviour – see FASD symptoms and not behaviour

If we, collectively, can see challenging behaviour as symptoms of the FASD brain impairment, it increases our ability to create supportive and responsive environments. It helps us to focus on building strengths and helping tamariki or rangatahi to get things right more often.

Instead of Think brain-based
Stop that bad behaviour! Whakamana – prevent problems, help te tamaiti or rangatahi get things right and build their strengths
Behaviour modification Whakamana – model what we want, help te tamaiti or rangatahi to get things right over and over again, and help them recover from bad situations over and over again
Change the person Whakamana, whanaungatanga – change and support their environment. Focus on changing us and our decisions and not te tamaiti or rangatahi
Inappropriate View behaviour as like a younger tamaiti who needs structure and support to operate pro-socially and build on strengths
They’re just attention seeking! Needs attention, support and aroha
They’re stealing! Impulsive – te tamaiti or rangatahi doesn’t get ownership rules. We give help, supervise and simplify according to developmental age
They just do it again and again!! Doesn’t get consequences – give te tamaiti or rangatahi support and supervision and whakamana, and build their trust

Video – Social work in action: launching FASD eyebite cards | Oranga Tamariki

FASD 5S template (PDF 643 KB) (PDF 640 KB) (help for kaimahi to work out what to do next, short term and long term)

5 Substance use, suicidality, harmful and sexual behaviour of concern, and therapy

These are areas of particular concern for people with FASD and related neurodiversity and need to be approached in a way that considers the brain functioning of te tamaiti or rangatahi.

In general, kaimahi and supporters around the person with FASD need to use simple, concrete language and be 'matter of fact' and calming. Repetition, consistency, structure and reminders all need to be incorporated into any work with someone with FASD. If therapy is needed, it should be provided by someone who understands neurodiversity and brain-based approaches.

Issue paper: FASD and suicidality | Canada FASD Research Network

Blogpost: Understanding FASD and sexual behaviour | Canada FASD Research Network

Issue paper: Psychotherapy for individuals with FASD | Canada FASD Research Network

Issue paper: Broad approaches to psychotherapy for individuals with FASD | Canada FASD Research Network

6 Learning from incidents

When incidents do occur, we consider and report on the observed behaviour of te tamaiti or rangatahi and the environmental context – what te tamaiti or rangatahi and others (I, us) were doing, thinking and feeling before, after and at the time. This will provide a better understanding of the incident and what happened from the perspective of te tamaiti or rangatahi and with a brain-based lens. This knowledge can help us adjust our practice to reduce further risk.

At all times, aroha and compassion are needed when supporting people living with FASD, and when supporting those caring for te tamaiti or rangatahi. It’s not easy for all involved, and the more open and caring the environment, the better the decisions that can be made, and the safer the support can be.