We’ve covered a majority of the primary symptoms of Fetal Alcohol Spectrum Disorder over our last ten blog posts. Today, we’ll dive deeper into another characteristic of FASD—difficulty with Executive Function.
According to the Cleveland Clinic, “executive function refers to skills you use to manage everyday tasks like making plans, solving problems and adapting to new situations.”
Executive function, also referred to as the “Boss of the Brain” by Dr. Jerrod Brown, Ph.D., involves the prefrontal cortex—a part of the brain often impacted by prenatal exposure to alcohol. Dr. Brown and I spent an entire episode discussing executive dysfunction on my Adoption & Foster Care Journey Podcast. You can find that episode HERE
Executive Function Brain Tasks
Executive function is responsible for many important brain tasks. Let’s take a closer look and consider how prenatal exposure (and childhood trauma) can negatively impact each one.
Planning & Organizing
Impulse Control
Goal Setting
Attention/focus/multi-tasking
Short-term Memory
Transitioning tasks
Self-regulation
Planning and Organizing
When a person has challenges with organizing and planning even seemingly simple tasks like cleaning a bedroom can be difficult. Knowing where to start, next steps, order of steps, and when the job is considered complete can be overwhelming.
My daughter, who came to us through a kinship placement, always struggled with cleaning her room. I’d assign her the task and she’d willing go. An hour later she would be found sitting on the floor in the midst of the mess with her nose in a book. I’d launch into a lecture and issue a consequence which triggered a meltdown.
These room cleaning battles were not due to defiance or laziness. After decades of learning about trauma and FASD, I now understand that my daughter’s brain works differently. To clean a room anyone’s brain has to plan, organize, remember, make decisions, and stay focused—all difficult tasks for a person with executive function
challenges.
Rather than vague verbal imperatives like “clean your room,” parents should provide specific one-step directions such as “put dirty closes in this basket.” Age appropriate charts or lists can be helpful if reviewed and practiced. Co-cleaning with your child will help them learn the steps, stay on task, and help build connection. As mentioned in the blog post about dysmaturity, always take a child’s developmental level of functioning into consideration. By adjusting our expectations to their present level of cognitive ability we can often decrease frustration and avoid meltdowns.
Goal Setting
Setting goals involves executing a plan to achieve the goal. This requires planning and time management skills—also challenging for individuals with brain-based conditions such as FASD.
Mowing our multi-acre lawn was an expectation we had for one of our teenage sons. Even though Slava could operate a zero-turn, ride-on mower and would get paid for the job, he refused every time we told him to mow. One might say he was a lazy teenager, but let’s consider his executive function challenges.
For anyone to mow a lawn their brain has to know where to start, how to break the lawn up into sections, stay focused, complete each section, and know when the job is finished. Starting and executing the steps to meet the goal of mowing the lawn requires executive function skills.
Instead of fighting with Slava, we recognized he needed support. My husband sectioned
off our lawn and showed him where to start. He also stayed nearby to direct him to each
section. Father guided son through the sections and followed the same pattern each
time. Over time, Slava’s brain learned to follow this routine. Sometimes, though, he still
needs guidance to remember the steps and stay on task to complete the goal.
Short-Term Memory
Short-term memory is another executive function brain task impacted by parental exposure to alcohol. Poor short-term memory impairs a child’s ability to follow directions, multi-task, remember rules, and make good decisions. They often lose items, have difficulty remembering next steps, miss assignments or appointments, and perform inconsistently.
Because FASD is an invisible disability those affected are misunderstood as lazy, oppositional, or apathetic. Kids struggling with short-term memory problems are often frustrated, exhibit frequent meltdowns, have low self esteem and experience fatigue.
Parents, teachers and other professionals should provide accommodations to help
support children with memory difficulties. Giving one-step directions, using less words,
and providing frequent reminders are helpful. Visual aids are great resources when they
are taught and practiced. Teaching new material, practicing, reteaching, practicing
again, and frequently reviewing are often necessary.
Self-Regulation
Self-regulation is the ability to understand and manage one’s own behavior and reactions to feelings and environmental stimuli. This brain task helps a person adjust their reactions and behaviors to maintain appropriate social responses.
The ability to self-regulate helps a person to:
Respond appropriately to big emotions such as frustration, anger or even excitement
Calm down after excitement
Maintain focus
Control impulses
Behave in socially appropriate ways to maintain friendships
Make good decisions
Learn at school
Both childhood trauma and prenatal alcohol exposure can impair an individual’s ability to self-regulate. Parents and professionals should provide accommodations to help a child struggling with self-regulation. These supports can include:
Sensory breaks to manage sensory overload
Weighted blanket and/or heavy work
Notice triggers & avoid them when possible
Give choices
Replace “no” with “not now”
Pay attention to sleep—tired children have more difficulty regulating
Provide snacks/water—hungry/thirsty children have more difficulty regulating
Decrease frustrations—reduce workload, less/no homework
Impulse Control
The ability to resist an impulse or temptation is another executive function task altered by prenatal exposure to alcohol. Lack of impulse control often gets our children into trouble.
One young adult with an FASD described how she’d see a chocolate bar on the kitchen table and take it. She didn’t stop to think about who it belonged to or ask permission. Later, when her mom inquired about the missing candy, the girl would deny taking it—and be accused of stealing and lying. But, due to poor short-term memory, she genuinely didn’t remember eating it.
Lack of impulse control and poor short-term memory can lead to big problems and dangerous situations. How can we keep our kids safe and out of trouble when they lack the ability to control their impulses? Admittedly, this is a daunting task for parents. For starters, I recommend the 3 P’s: Prepare, Plan, and Practice.
Anticipate problems and prepare for them. Staying ten steps ahead of our kids is exhausting but necessary to keep them safe when they cannot keep themselves safe.
My eighteen year-old son is never left home alone for more than an hour for his safety and our peace of mind.
Plan ahead for any possible temptations and remove them. My boys are extremely limited when it comes to online activity. The internet is a dangerous place for all kids—especially those with brain differences. Our youngest and most vulnerable teen has no social media, no access to YouTube without supervision, only has a cell phone with restricted apps and no access to our smart TV remote without supervision.
Teach and practice safety routines to build your child’s muscle memory. Wearing a bike helmet, crossing the street, memorizing parent phone numbers and home address are essentials to practice. Playing stop and think games or using curriculum or flash cards can be helpful.
Prepare, plan, practice—but remember impulsivity is not driven by a bad kid but by a brain that works differently.
Attention/Focus/Multi-Tasking
Due to disruptive and impulsive behaviors, many prenatally exposed children are
diagnosed with attention deficit hyperactivity disorder (ADHD)*. The region of the brain
called the prefrontal cortex is the control center for most cognitive functions including
attention and focus—both executive function tasks.
*National Library of Medicine
Children with FASD often have difficulty focusing on school work. During the years we homeschooled, my teenage son would get distracted if the dog barked, a package was delivered, or my cell phone rang. Returning his focus back to school seemed to take forever.
Once I understood distractibility was due to a brain that was harmed by prenatal alcohol exposure, I learned to accommodate my son’s brain difference. Eliminating as many distractions as possible helped. For example, I’d silence my cell phone and not answer calls during school time. If there was an interruption I couldn’t control, like someone ringing our doorbell, I’d extend grace and allow my son time to refocus. Some days however, the interruption would put a stop to school entirely—I knew trying to reengage my son would be fruitless.
It’s important to note that some children can become hyper-focused on a topic or thought—this is called perseveration—and is quite common in people with FASD. For example, when I ordered something online for one of my boys, it was the only thing they could think or talk about. Daily we had to track the package and, on delivery day, they would wait by our mailbox. I learned to relax my homeschool expectations that day—no learning would occur with their brain stuck in perseveration mode.
We live in a fast-paced world where many of us take pride in our ability to multi-task. Multi-tasking requires attention and memory. According to the National Library of Medicine, we pay a price for the stress caused by this demand on our brains. Imagine how taxing the demand is on the brain of a child with FASD?
In a typical high school classroom a student is expected to listen as a teacher presents material, take notes (this involves writing, reading and memory—tasks which use different parts of the brain), filter out distractions, remember what was said, and stay focused. For a student with FASD, this multi-tasking can cause high levels of anxiety. An accommodation, such as providing printed notes, can reduce the student’s stress level thus allowing them to actually learn the material.
Difficulty with Transitions
Many children with FASD have difficulty transitioning from one task to the next. Being told to put away a video game and start homework or turn off the TV and get ready for bed can trigger a meltdown. This reaction is actually less about disobedience and more about a child’s brain difference.
The demand to shift from one activity to the next causes stress on a brain that was prenatally exposed to alcohol. One of my sons struggles with fire drills at school. The sudden interruption of the alarm and required immediate reaction to stop a task and file out of the building caused him significant anxiety.
Whenever possible, give advance notice for transitions. This may reduce stress and avoid meltdowns. My son’s class is now alerted about fire drills in advance and his teacher gives reminders throughout the day. This has helped decrease his anxiety somewhat.
Support Not Shame
Executive function is responsible for important brain tasks such as planning, organizing, goal setting, memory, self-regulation, impulse control, attention, multi-tasking, and transitioning. The brain’s ability to perform these cognitive skills is negatively impacted by prenatal alcohol exposure as well as childhood trauma.
It is vital for parents, caregivers, teachers and other adults in a child’s world to understand that executive dysfunction is due to a brain difference not willful disobedience or laziness. We must provide appropriate support and not shame a person because their brain works differently. Providing accommodations, as we would for anyone with a disability, is the best way to success.
Comments