Fetal Alcohol Syndrome / Fetal Alcohol Effects (FAS/FAE)
ASSESSMENT CONSIDERATIONS FOR OLDER CHILDREN

Children who have been exposed to drugs and alcohol in utero are often left with residual problems. These problems follow them throughout their childhood and adversely affect their educational progress. Therefore, it often becomes necessary for the school district to determine if and when a child with this history needs special education support. Since many of these problems are related to behaviour and social attributes, standard intellectual assessments often do not provide an accurate picture of the child's functional impairments. The following list describes the major characteristics often exhibited by these children and suggests behavioral correlates for assessment:

• 1. Exhibits behavioral extremes - very loving to very hostile, very cooperative to very oppositional with little evidence of intermediary behaviours:
• 2. Low tolerance for stress - might manifest through bedwetting, increase incidence of quarrels/fights:
• 3. Difficulty organizing own play - can't stay with one activity or long, play lacks purpose, cannot complete play activity without adult intervention:
• 4. Limited attention to task - easily distracted from task by external and internal stimuli, even when motivated:
• 5. Decreased adaptive task persistence - poor trial and error problem solving, impaired ability to carry out self-help skills:
• 6. Difficulty reading social clues - is not alert to and does not recognize correlates of mood or mood changes in others (eg. facial expressions):
• 7. Impulsive behaviour - acts without thinking, disregards consequences of behaviour:
• 8. Difficulty in peer relationships - a longer, frequently fights, doesn't seem to able to adjust behaviour to circumstances of ongoing interaction:
• 9. Easily overstimulated - becomes confused, agitated and disorganized when options (task choices, relationships) are presented:
• 10. Sporadic mastery of spatial-motor tasks - although able to complete some age appropriate eye-hand coordination tasks is lacking lower level developmental skills (eg. can write in cursive but doesn't print):
• 11. Inconsistent use of problem solving strategies - can't see alternatives or compromises, plans poorly for future events, difficulties making choices:
• 12. Difficulty handling changes in routine - upset and agitated with change; often perseveres on previous activity or routine:
• 13. Word retrieval difficulties - can describe function, purpose and attributes but can't produce appropriate name or word:
• 14. Poor attachment / sense of self - decreased or inappropriate use of adults for solace, object attainment, and conflict resolution; indiscriminate attachment to strangers; does hot find social interactions positively reinforcing; decreased or inappropriate response to verbal direction; regressive behaviour (acts younger than age when upset or frustrated):
• 15. Delays in language development - below age level receptive and expressive language.
• 16. Delays in development of play skills - delays in development of imitation and representational play, - play skills are immature.

Given the broad spectrum of these problems a standard battery of intellectual and personality instruments may not give an accurate picture of the child. The structure inherent in an individually administered battery often masks these problems. It is therefore important that an equal or greater emphasis be given to clinical observations of the child. Observations would include: parent/child interactions, as well as play and organizational skills within various settings, the classroom, with peers in unstructured play, or alone. Use of adaptive or behavioral scales may also be helpful.

Taken from "Identification and Intervention Strategies for Professionals working with Children and Families Affected by Polysubstance Abuse"

Written by: Follow Along Subcommittee of The Perinatal and Addiction Task Force of The Children's Hospital of Buffalo and New York State Division of Substance Abuse Services November, 1990