Fetal alcohol effects
Self-contained special-education class
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BEHAVIOR MANAGEMENT PLAN FOR [CHILD]
of Behavioral Issues Associated with Fetal Alcohol Effects
Specific Behavior Plan
I. Create rules that target specific behaviors.
II. Provide constant positive feedback when rules are not being
III. Provide immediate, unemotional time-outs when a rule is broken.
IV. Adjust the environment to make it easy to follow rules.
V. Assess effectiveness of plan on a regular basis and make adjustments.
Overview of Behavioral
Issues Associated with Fetal Alcohol Effects
In working with [child]
and managing his behavior, it will be helpful to understand a few
things about fetal alcohol affected brains:
For most of us, the
part of the brain that has impulses and the part that knows the
rules are in constant easy communication. So we have an impulse
to do something, we check it against what we know to be acceptable
rules of behavior, and we make a conscious choice whether or not
to break a rule. But in fetal alcohol affected brains, the connection
between those two areas is faulty or missing. So the child has an
impulse to do something, and by the time the part of the brain that
knows the rules is even aware of the impulse, the action has already
taken place, and most likely somebody is already yelling at the
child about it. So you can have a kid who knows the rules, wants
to follow the rules, is upset about breaking the rules, yet still
breaks them. At the moment of action, he’s working purely
And since impulsive
behavior is almost by definition without reason, asking a fetal
alcohol affected child why he did something and not taking "I
don't know" for an answer is pretty much insisting that he
lie. They don't know why they do it. They may not even know what
they did. So you'll either get gobs of denial and defensiveness,
or you'll get a spontaneous excuse that defies credulity. Imagination
and creativity are some of the positive attributes of people with
FAE, but when they're used in service of getting out of trouble,
they usually result in a tall tale that makes matters worse.
Social and emotional
development lags way, way, way behind in people with FAE. Teens
and young adults with FAE often have an emotional developmental
age of about 6. So with an elementary-school-aged child, you have
to figure they may be working at a toddler stage at best. You have
to adjust everything to that level -- expectations, supervision,
privileges, rules, discipline. People with FAE tend to be verbal
well beyond their level of understanding, and it may be tempting
to assume that that clever and talkative child is able to understand
social rules at a much more sophisticated level. It's a mistake.
Stress makes things
worse. A confusing thing with FAE kids is that sometimes they seem
to be able to do things and sometimes they don't, and it's natural
to assume that that indicates willfulness. But in fact their ability
to control their behavior declines in proportion to the amount of
stress they are experiencing. This can be obvious stress -- a noisy
place, difficult schoolwork, disruptions of routine -- or less obvious,
particularly in kids with sensory integration problems who react
to things in the environment the rest of us wouldn't even notice.
Sometimes the loss of control happens well after a stressful event
-- if a child uses up a lot of resources getting through something
hard early in the day, he may run out of control late in the day.
Because of these relatively
unchangeable facts of an FAE child’s life, strategies that
rely on self-control and presume willfulness; that require an advanced
level of maturity and responsibility; or that increase the level
of stress will be ineffective at best and may in fact escalate bad
behavior. These may include:
Big positive consequences.
Nagging to stop behavior.
Pressure not to break rules.
Abstract rules like “Be respectful.”
A choice offered between compliance and negative consequence.
On the other hand, strategies
that do not presume control; that don’t put undue weight on
behavioral slip-ups; that are suited to the child’s level
of emotional maturity; and that decrease the level of stress will
be more effective, and at the least will not escalate bad behavior.
These may include:
on a modest scale, delivered immediately.
Distraction from misbehavior.
Brief time-outs, delivered consistently and matter-of-factly.
Changing of environment to make success more likely.
Behavior analysis to assist in changing of environment.
Constant positive feedback and encouragement.
Specific rules like “No hitting.”
Choices in which both options are acceptable to adult.
Plan for [Child]
I. Create rules that
target specific behaviors.
Translate abstract classroom
rules into five or six specific directives targeted to [child]’s
particular needs. For example:
NO pushing, poking, hitting,
NO hugging or kissing in school.
NO interrupting the teacher.
NO leaving desk without permission.
NO using mean words like “stupid” or “shut-up.”
Post the rules where
[child] can see them, possibly taping them to his desk.
Only include items in
rules that you will be willing to reinforce with a time-out whenever
the rule is broken. Avoid things that are likely to recur with such
frequency that he would be in time-out constantly, such as finger-sucking,
jumping, messy writing or standing up at desk.
You may want to include
at least one rule that [child] has little trouble keeping, so that
he has a constant experience of success and control.
II. Provide constant
positive feedback when rules are not being broken.
Using the rules above:
If he passes anywhere near another student without touching them
inappropriately, comment on how well he followed the rule. If he
goes five minutes without interrupting, comment on it. If he stays
seated for even a few minutes, announce that you like the way he’s
sitting. Tell him you like the way he’s talking when he chooses
If you see him about
to break a rule, jump in and distract him with a positive comment
like: “It’s really hard to sit still, isn’t it?
I see that you’re really trying. It’s great that you’re
trying your best.”
Augment the positive
feedback with neutral statements indicating that he’s being
noticed in a non-negative way any time he is following the rules.
Comment on the pencil he’s using, the clothes he’s wearing,
the story he’s writing, the number of problems he’s
Do not expect or require
a verbal response from him for the positive statements. Improved
behavior will be his response.
III. Provide immediate,
unemotional time-outs when a rule is broken.
Say something along
the lines of, “Oops, you interrupted. Go sit, please.”
No nagging before and
no discussion after the time-out. He does his time and emerges with
a clean slate.
Keep the time-outs brief
to reduce resistance. At home, as little as 20 seconds has been
successful in changing behavior. In the classroom, a minute should
be sufficient. It’s not a punishment so much as an acknowledgment
that a rule has been broken, and a break in the action to get himself
IV. Adjust the environment
to make it easy to follow rules.
Children with FAE need
an “external brain” to help them with judgments and
adjustments they cannot make on their own. It is the job of adults
who are working with [child] to constantly monitor his reactions
and his environment and arrange ways for him to be successful and
physical contact is a problem:
Put [child] at the front
or end of any line.
Give him tasks to do in the classroom as other students are leaving
(e.g., turning out lights) so that he will naturally be last in
Try to steer him to areas of the classroom or other room that are
Provide physical barrier between him and other students if he seems
to be struggling to keep his hands to himself.
Offer distraction if he seems to be struggling to keep his hands
If staying in
his seat is a problem:
Allow him to stand up
while doing work.
Provide frequent movement breaks.
Provide lots of distractions and motivations to keep him on task.
Consider providing him with a larger working space at the back of
the room so that he can move around without distracting other students.
Consider alternative seating options such as an exercise ball.
Consider allowing him to work on projects in a more hands-on way,
with less seat work required.
Use movement as a reward for completing small amounts of work.
the teacher is a problem:
Give him written information
about what will be happening on a particular day so he can follow
it without questioning.
Allow him one question every five minutes, or when he’s completed
an allotted portion of work.
Have him write questions in his notebook and present them at an
Provide distractions when he seems about to interrupt.
If he’s compelled to interrupt in the disciplining of another
student, use distractions or removal to another part of the room
or school to keep him from noticing or becoming involved.
work in a cooperative manner is a problem:
Give him a checklist
of work he must complete so that he can keep track visually.
Consider putting all worksheets to be done that day in a folder
and allow him to choose what to do.
Provide motivating rewards for small increments of work completed.
If work is completed quickly, allow him to move on to a more enjoyable
activity like computer work, reading, even looking out the window.
If the appearance of a worksheet is overwhelming, fold it or use
a piece of paper to block out all but one or two questions. Give
a reward after these are completed.
Allow verbal answers instead of written if that keeps him going.
Allow him to pick a new writing utensil before starting a new worksheet.
Send home uncompleted work as homework rather than making an issue
of it at school.
appears to be escalating:
Do behavior analysis
to try to determine what might be causing stress. Possibilities
include: disruption of routine; substitute or absence of adult in
classroom; assemblies or periods in mainstream classroom (Spanish,
art, music); difficult work; lots of fine motor work; overstimulation
at recess; noisiness; boredom; lack of movement.
If the circumstance that is causing the stress can’t be changed,
strengthen all other supports, increase the number of positive or
neutral statements, break work into smaller units for rewards, and
lower academic and behavioral expectations for the day.
Keep track of what seems to cause problems and prepare in advance
for future occurrences. If possible, send word home in advance of
schedule changes or absences so that [child] can be prepared.
Talk to [child] about what you think may be causing him to lose
control. “You seem to be having a hard time this afternoon.
I think maybe you used up all your control sitting still at the
assembly this morning. Let’s try to pull you back together.”
Maintain a “bag
of tricks” to be used as motivation, reward, or distraction
Have as many high interest
or highly distracting items or ideas as possible so you can keep
trying until something works. Some things that can be used to motivate
and/or distract [child] when necessary are:
Car magazines (freebies from supermarket)
Writing or drawing in notebook
Game where you join dots to make squares
Looking out window
Asking a question
A surprising or silly statement
Whispering a secret in his ear
Taking a walk
Getting a drink
Pushing hard against his hands
Reading a book
Choosing what to do next
Keep adding ideas to
the list as you find things that work (or as [child] asks to do
things -- use those as rewards/distractions).
V. Work with parents
to assess effectiveness of plan on a regular basis and make adjustments.
Send daily behavior
report home (parent will provide form).
Parents will include
school behavior in daily “credit review,” in which [child]
can earn points for privileges.
Share with parents what
seems to be working, and seek advice for what doesn’t.
Include on report any
stress-inducing occurrences that may have affected behavior.
Meet with parent regularly
to discuss behavior that is causing a problem in the classroom and
develop management strategies.
Re-evaluate the rules
from time to time and adjust them to reflect [child]’s changing
behavioral challenges and triumphs.
Take advantage of materials
on Fetal Alcohol Effects and other behavioral resources available
from the parents. These include:
Syndrome, Fetal Alcohol Effects: Strategies for Professionals”
by Diane Malbin
Syndrome” by Anne Streissguth
with Fetal Alcohol Syndrome/Effects” from the British Columbia
Ministry of Education
Difficult Child: The Nurtured Heart Approach” by Howard Glasser
and Jennifer Easley
“Steps to Independence”
by Bruce L. Baker and Alan J. Brightman
Child” by Stanley Greenspan
copyright (c) 2003 by
Overview of Behavioral Issues Associated with Post-Institutionalized