How to Help Someone Who Has a Fetal Alcohol Spectrum Disorder

Because of the nature of their disability, individuals with Fetal Alcohol Spectrum Disorders (FASD) have very specific needs. CPI’s Nonviolent Crisis Intervention^® training program is relevant for those supporting individuals with FASD, and there are specific considerations and possible adaptations for making your training as applicable as possible to this very unique group.

Similar to individuals on the autism spectrum, people with FASD are affected by and respond to
anxiety differently than neurotypical individuals. FASD is also an invisible disability and comes with a collection of specific key issues related to intellectual functioning that can affect how to best respond when supporting individuals through a crisis.

Anxiety

Individuals with FASD can spend a large amount of time in a state of anxiety. As a result of the significant difficulties receiving, processing, and responding to information due to their brain damage, individuals with FASD can become anxious at even the most basic tasks or expectations. When they’re anxious, they may not respond in the typical ways that you would expect, so if you don’t have specific knowledge of their behavior or a close relationship with them, you may not recognize their specific signs of anxiety, and may miss the opportunity to intervene in a supportive manner.

“Flying off the Handle”

Additionally, as individuals with FASD spend large amounts of time in a state of anxiety, people around them can start to see this as the “norm” for them and not take advantage of the opportunities to intervene at the earliest possible time. In this way, if people get used to the anxious behavior of an individual with FASD as being the norm, when an individual escalates and moves into the second level of the CPI Crisis Development Model℠ (taught in Nonviolent Crisis Intervention^® training), it may be seen as if the individual “flies off the handle” quickly or without warning.

In fact, the warning was there in the form of the anxious behaviors, but those around the individual may just be used to this and therefore not respond in a timely manner.

FASD is an invisible disability

Since FASD is an invisible disability, people often have much higher expectations of the individual than are reasonable, given their actual intellectual abilities. The individual with FASD often looks “typical” and may have good or even above-average expressive communication abilities, which can convince others that they don’t have a disability at all. The reality is that often their receptive communication skills are very low and out of sync with their expressive skills. They can talk a good talk, but when it comes to really understanding what you are saying and knowing how to respond, they can be at a huge disadvantage.

Using verbal intervention strategies

This can be very confusing for people who support people with FASD. It can also have significant implications when you’re using verbal intervention strategies, as the strategies will not work in the same way as they would with a person who does not have FASD. If you’re part of a crisis intervention team for an individual with FASD, you should be sure to raise the issue of specific verbal intervention tips for that person and how they would fit into a crisis intervention plan.

Here are some strategies to help:

• Use as few words as possible.
• Always clearly state what you want to happen—the desired behavior.
• Don’t argue, debate, or negotiate.
• Being direct is good, but don’t become too authoritarian, or doors will close quickly.
• Don’t expect the person to be reasonable or to act their age.
• Go for a few “Yes” responses first. Use short questions you think the person will answer “Yes” to, just to get them out of being stuck in the “No” loop.
• Be nonjudgmental.
• Start with a clean slate. Don’t have any assumptions as to why the person is behaving the way they are. There is a good chance you may be incorrect.
• Don’t get frustrated that you just dealt with this same type of issue yesterday. It may seem like the same issue, but to the person it’s likely a completely unique and unrelated crisis. It’s not that they aren’t paying attention; it’s that their brain isn’t letting them make the connection.
• Be extra attentive to your nonverbal and paraverbal communication. The person with FASD may not understand all the words you’re using when they’re going through a crisis, but they are likely tuned in to your appearance and sound.
• Keep in mind the strong Precipitating Factors related to the person’s brain damage as a result of prenatal alcohol exposure. It can help you maintain your Rational Detachment in a tough situation.

Misinterpreting behavioral motivations and Precipitating Factors

The differences between a person’s “normal” appearance and their significant cognitive issues can make it appear to others that the person with FASD is actually manipulative, lazy, a con artist, or sneaky. In fact, most of this is directly related to their disability.

When people misunderstand the FASD individual’s behavior or jump to conclusions, they can have inappropriate responses to the FASD person’s behavior. There are some big implications here for support regarding possible Precipitating Factors related to the disability of FASD. For example, stealing may not be stealing when a person with FASD is involved. The behavior may be a direct result of the person’s disability and their inability to understand ownership and control impulses.

Here are some key issues that individuals with FASD often struggle with:

Structure

In many cases, the FASD individual is not capable of structuring their time or schedule or even a simple multi-step task. Even when not in a state of anxiety or defensiveness, the FASD person may be unable to structure their time appropriately. Being left alone or given free time can be disastrous for the person with FASD. This is a significant issue for the FASD person that should be considered in any crisis intervention plan.

Unfortunately, the reality is that this is part of the reason why so many people with FASD end up in prison and do reasonably well when there. They require a great part of their life to be very structured, and a Directive approach may be beneficial most of the time when interacting with them. When considering how you respond to an individual with FASD who’s at the Anxiety stage of the Crisis Development Model^SM, there is value in looking at how you can be supportive while maintaining directive communication techniques.

Sequences

FASD individuals often have significant challenges with understanding even a simple sequence of more than two steps. They will often end up getting into trouble because they will appear competent to complete a task and may even tell you that they’re able to complete the task with no problem, but they can’t actually get past the second step before becoming confused, distracted, or frustrated.

This will have significant implications when it comes to verbal interventions and how you give instruction or direction to people with FASD. Some helpful strategies include breaking tasks down into two-step units and doing more modeling in your instructions. Simple written or visual cues may also be helpful for some individuals with FASD.

Understanding cause-and-effect relationships

This relates in part to the issues with sequences mentioned previously. Not understanding cause-and-effect relationships can make it difficult for the FASD individual to learn from their mistakes or past behavior and consequences. The person may continue to make the same mistakes or bad decisions over and over, much to the confusion and frustration of those supporting them. This has big implications for the Therapeutic Rapport aspect of Nonviolent Crisis Intervention^® training. Negotiations during the CPI COPING Model^SM phase of intervention may not be able to occur in the same way with the person with FASD, or there may need to be additional supports put in place to help with this process.

One suggestion for support people is that certain parts of the COPING Model^SM may need to be conducted immediately following an incident, as long as it’s safe to do so, if we want the individual with FASD to understand the connection to their behavior. They likely won’t make the connection if this occurs hours or days later.

It’s also important for support people to pay close attention to the concept of Rational Detachment to help deal with the frustrations that can arise and ultimately affect the way we communicate with the individual and how effective that communication is.

Understanding abstracts and generalizations

This includes everything from understanding the concept of time to understanding other people’s feelings and emotions. People with FASD may appear to be very self-centered and to have a lack of compassion for other people. This could be directly related to their disability.

There may be implications here for those supporting individuals with FASD in the area of Rational Detachment. It can take some specific skills to realize and understand that their odd or out-of-sync behavior could be directly linked to their disability. If you truly realize and understand this, it can positively impact your ability to work well with people with FASD despite their behaviors. I think this is another area where individuals get into trouble with the courts, because they may not appear to show remorse for things they are alleged to have done, whereas in fact they may not understand the whole situation. This will likely have implications for every level of the Crisis Development Model^SM when it comes to how you communicate with an individual with FASD.

Ongoing relearning required

One particularly challenging aspect of FASD for those who support these individuals is the fact that due to the brain damage caused by fetal alcohol exposure, individuals may spend a considerable amount of time having to relearn tasks that are taught to them. This can be frustrating for those who support the individual with FASD. It can leave you wondering why the person could do something just fine one day and completely lose it the next day. It can also be frustrating to have to constantly re-teach the same skills. Individuals may never actually learn some things, despite frequent re-teaching, or something may stick for a while but then just disappear again. This can also have a significant impact on what consequences might be appropriate when dealing with issues of noncompetence due to brain damage versus willful noncompliance or disruptive behavior.

When supporting the unique needs and abilities of individuals with FASD, using and appropriately adapting Nonviolent Crisis Intervention^® concepts can help improve relationships and outcomes.

Some great resources on FASD

The National Organization on Fetal Alcohol Syndrome (USA) offers information on FASD, resources, contacts, and more.

Dr. Asante of The Asante Centre is a world expert in FASD and is from my little town in northern British Columbia.

The Provincial Outreach Program for FASD offers very good educational information.

Whitecrow Village is an amazing group that offers expertise and credibility in the area of FASD. I have worked with this group, including doing training for their staff in their LIFE programs and a short stint on their Board of Directors.

About the Author

Chris Arnold is a Behavioral Therapist, author, teacher, and public speaker. With a M.Sc. degree in psychology, he was one of the first Canadian Master Level Nonviolent Crisis Intervention^® Certified Instructors. He’s the Clinical Director of the Provincial Networking Group Inc., a psychology professor for Northwest Community College, and a contract faculty for Douglas College in their Disability & Community Studies department. He has been working in disability services for over 25 years. A great deal of his work has included working with children and adults with FASD in their homes, the community, and in employment.

This article was originally published in the Fall 2014 issue of the Journal of Safe Management of Disruptive and Assaultive Behavior.