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Primary Symptoms of FASD—Language & Communication

You can leave the scene of an accident and not get in trouble,” declared my volunteer fire fighter son after a late night fire call. 

He explained how two guys had driven their truck off the road, sideswiped a shed, and fled into the woods. They weren’t found until the next morning. By then, drinking and driving couldn’t be proved, so the pair were only ticketed for leaving the scene. 

My twenty-year old son with Fetal Alcohol Syndrome concluded that he could get into an accident, leave the scene and not get into trouble. As alarm bells rang in my head I explained the only reason the guys left the scene was because they’d been drinking. A DWI is big trouble compared to leaving the scene.

Our conversation went round and round for thirty minutes. My son, convinced he’d discovered some big secret, didn’t understand the serious consequences at stake. I kept reiterating that he should never leave the scene of an accident—for any reason. He agreed, yet kept coming back to the fact that, if he did, he’d only get a ticket for leaving the scene.

Why did he keep missing the point? Language and communication difficulties are common primary symptoms of brain-based conditions like Fetal Alcohol Spectrum Disorder (FASD). 

Language and Communication Difficulties

Children with FASD often have difficulty with language and communication which affects social skills and academic learning. These challenges can present in the following ways:

  • Talks better than understands

  • Confabulation

  • Difficulty putting feelings into words

  • Doesn’t seem to get it

  • Difficulty answering verbal questions

  • Difficulty reading body language

Can’t Walk the Talk

As in the above example, kids with FASD may appear engaged and even repeat what is said to them but might not really understand. Often, they have difficulty with receptive and expressive language skills.

Receptive language is the ability to comprehend spoken language such as listening to directions and then following them. Expressive language is the ability to accurately express wants and needs in a way that makes sense.

My son is able to do lots of helpful things at the scene of an accident. However, he couldn’t accurately process what he witnessed or heard other emergency personnel discussing.


According to the National Library of Medicine confabulation is defined as a neuropsychiatric disorder wherein a patient generates a false memory without the intention of deceit. Confabulation sounds like lying but the person believes they are telling the truth.

For example, one of my adult adopted daughters often inaccurately shares childhood memories. She will joyfully say, “Remember when?” And go on and on about a funny family story. I smile and laugh along knowing only part of what she’s saying is accurate. 

My daughter is not lying or purposefully making up stories. Due to prenatal exposure and childhood trauma, her brain fills in the gaps with inaccurate details. Confabulation can be harmless when retelling family memories but could get an individual into serious trouble when it comes to legal matters.

Difficulty Naming Feelings

Children with FASD often have difficulty putting their own feelings into words as well as understanding the feelings of others. 

When my boys were younger they didn’t know how to express feelings. They never used words like happy, sad, scared or excited. They also didn’t seem to notice the feelings of family members or other people. 

We began intentionally talking about feelings—naming them as we experienced them. Feelings flash cards were helpful teaching aids as well. 

Even so, one of my boys still only recognizes extremes—everything is either terrible or wonderful. He mostly zeros in on the terrible. He doesn’t seem to understand the spectrum of feelings. A person can be frustrated, irritated, or critical but that doesn’t mean they’re mad or hateful.

Alexithymia—the inability to recognize or describe one’s own emotions is common in individuals who have experienced childhood trauma and prenatal exposure. Listen to my conversation with Dr. Jerrod Brown on the topic of Alexthymia on The Adoption & Foster Care Journey podcast HERE.

Understanding the feelings of others, Theory of Mind, is also difficult for children with childhood trauma and/or FASD. I dedicated an entire podcast episode with Dr. Brown to this subject which you can access HERE.

Doesn’t Get It

We live in the country on several acres of land. To engage our teenage son in chores, we purchased a small zero-turn lawnmower. He was very excited about this. It’s easy for him to maneuver and we’re paying him to mow. 

There’s just one problem—maybe three if you count the two times he broke the throttle cable by excessive revving. Instead of mowing, our son often just drives up and down the paved driveway. 

Even after explaining that mowing the lawn actually means cutting the grass, he keeps cruising up and down the pavement. It’s like he doesn’t understand that driving the mower is not the same as mowing the lawn.

Difficulty Answering Verbal Questions

Kids with FASD, trauma or other brain-based conditions often have difficulty responding to verbal questions. They might answer with “I don’t know” or not answer at all. This could be due to slower processing pace—another primary symptom of FASD. See my blog post about Slower Processing Pace for more details.

One mom, after learning about slow processing, tested it out. When her daughter came home from the first day of high school, mom knew there would be papers to sign. She asked her daughter if there was anything she needed to see. Her daughter promptly answered, “No.” Mom kept quiet. Five minutes later her daughter said, “Actually, I do have something for you to sign.” 

Difficulty Reading Body Language

While my son picks up on tone of voice—often misreading it as anger—he’s oblivious to body language and facial expressions.

When my biological kids were little I could give them that look and they knew mom meant business. My adopted boys with FASD don’t get the message. Giving them the “hairy eyeball”, touching their arm, or shaking my head doesn’t work. 

Not picking up on body language can appear disrespectful, disobedient, or worse. However, many of our kids with adverse childhood experiences like prenatal exposure and trauma, miss body language cues. Unfortunately, this could get them into trouble as they get older and unknowingly violate personal boundaries. 

Helpful Tools

Language and communication difficulties are common primary characteristics of FASD and other neurobehavioral conditions. Here are some suggestions to help you accommodate and support your child:

  • Keep in mind their brain works differently 

  • Set expectations to their developmental age which is often much younger than their biological age

  • Use fewer words when speaking to them

  • Give only 1-3 step directions at a time

  • Always check for understanding BUT just because they can repeat what you say does NOT mean they really do understand or can follow through

  • Don’t shame them for confabulation

  • Discuss/teach feelings using an emotions chart and/or feelings flashcards

  • Give extra time for them to answer questions

  • Teach body language & facial expressions

  • Practice & repeat

Just because our kid is successful once or twice does not guarantee he will remember it tomorrow or next week. Keep practicing. 

As parents and caregivers, it’s imperative we remember trauma and prenatal exposure to alcohol or other drugs changes the way the brain works. Therefore, we must change the way we parent by utilizing brain-based parenting tools and strategies.

If you would like to listen to The Adoption & Foster Care Journey podcast  episode on Primary Symptoms of FASD—Language & Communication you can find it HERE.

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