ON THE ORGANICITY OF FAS/FAE
SECONDARY SYMPTOMS WHICH MAY DEVELOP OVER TIME:
Sources: Morse, Rathbun, Malbin
one thing we can say about FAS/FAE is that no two are the same."
(Randels) Because of the wide variability of the nature of the impairment,
degree of effect, their manifestation and presence of confounding
variables (secondary symptoms) there is no "cookbook"
approach to working with individuals who are effected. The following
are a few general indicators of organicity and how they may present
themselves. They are organized loosely around the theoretical construct
presented by Dr. Barbara Morse.
translating from one modality to another (hearing into action,
talking into action, words onto emotions)
cognitive pace: Time lag from input to understanding to action
(trouble with seeing a movie, taking notes)
reinforcement: Spotty learning, retention (need constant reminders,
memory: Their own memory is unreliable for them.
that they're not doing something right, but can't figure out
what it is" (Morse)) Learn on Monday, forget on Wednesday
processing, vision processing problems
IN GENERAL ARE DIFFICULT:
LANGUAGE IS BETTER THAN RECEPTIVE LANGUAGE:
Recommend: Observe patterns, re-frame perception of problem. Depersonalize.
Provide structure rather than control, invite individual to participate
in developing goals and structure. Articulate goals, expectations
and timelines; modify as appropriate. Provide simple, one step cues,
check to assure comprehension. Introduce information in as many
modalities as possible. Modify the environment as appropriate, either
increasing or reducing stimuli.
difficulty forming links, ie., between behaviour and consequence,
cause and effect.
predictive skills: Prediction is based on ability to reflect,
integrate, relate events, synthesize, compare and contrast,
and project abstractly into the future.
Impulse control is based on prediction.
social skills; may miss nuances, meaning of social cues.
in traditional problem solving skills, planning
not make associations, ie between clothing and weather, etc.
not generalize behaviours from day to day, ie, "Don't hit"
then hits the next day, 'Don't ride in the street', rides in
Recommend: Observe. Depersonalize. Teach links. Walk through process
of deduction and prediction. Specifically teach social skills. Model
appropriate behaviours, conflict resolution, identification of feelings,
concerns. Provide structure rather than control. Understand learning
curve, issues of organicity in planning teaching strategies.
SEEING SIMILARITIES AND DIFFERENCES:
difficulty filtering and prioritizing external stimuli
motion may reflect overstimulation
difficulty seeing patterns, sequencing and tracking
have difficulty distinguishing fantasy from real life (especially
where protective mechanisms are in place.)
Recommend: Observe. Provide visual, multimodality cues. Simply articulate/demonstrate
similarities and differences. Provide concrete, life-skills related
opportunities to explore similarities and differences. Assure 90%,
check for retention periodically.
be related to slow cognitive pace, need for time and closure
relate to resistance to change (to the relative unknown)
relate to rigidity which reflects attempt to control and make
sense of their environment (If one can't anticipate, predict,
change may be frightening.)
on keeping on", have difficulty initiating stopping of
a behaviour, whether a project, teasing, interrupting.
Recommend: Observe. Identify need, modify timelines as appropriate.
Prepare for transitions: Forewarn, anticipate, state, act.
effect of chronic frustration, global defense mechanism.
have difficulty accessing, processing and relieving stress and
frustration. Accurate association of words and internal state
may not be readily available; internal discomfort may not be
may be flat, responses to painful stimuli may be blunted
down may alternate with explosive episodes with little provocation
appear as withdrawn, passive, resistant, lying, aggressive,
resist school, act out among peers.
driven"; many behaviours at home may reflect rigidity and
perseveration around affilliative needs and behaviours intended
to create or preserve peer relationships
down, defiance/non-compliance appears common for adolescents
where there is a perceived threat to peer relationships; not
uncommon for adolescents in general - the degree to which behaviours
occur and their resolution are reflective of organicity
Recommend: Observe. Reframe. Identify shut down cues, areas of chronic
frustration. Identify strengths, integrate into environment. Modify
expectations to be congruent with actual level of ability. Refer
as appropriate for specific support for psycho- social issues related
** Note ** Resolving secondary symptoms may pose a challenge. Since
the organicity often impacts individuals' ability to effectively
use words to communicate distress, traditional psychotherapy may
be ineffective. Perseveration, rigidity, and learned behaviours
which are developed as a function of living in an alcoholic/dysfunctional
home further dictate the need for realistic expectations for timelines
for resolution of these issues.