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Focusing on the Perception Piece of the FASD Puzzle Faced by Schools: Making a Difference for Students

Debra L. Evensen, MA, Fetal Alcohol Consultation & Training Services

Summary: This article focuses on the misfit between the abilities of students with a history of prenatal exposure to alcohol and the expectations of the education system; the importance of medical diagnosis of a FASD; and how techniques fit for developmental age can lead to success.

Behaviors Throughout US Schools (that we least like to admit)

Learning and behavioral challenges associated with FASD often go unnoticed until children enter school, then become more disabling as students progress through grade levels. This trend stems from the ineffective way a brain with FASD is able to process information (Coggins et al., 2007). A strong predictor of success for students prenatally exposed to alcohol is proper medical diagnosis of one disability (Streissguth et al., 1991, 1996) within the spectrum of FASD.

The Real Classroom—Observation and Empowered Teachers Make the Difference

Without medical diagnoses to accurately interpret unexpected learning and behavioral responses, simple naiveté and misunderstanding come into play. Students are frequently mislabeled (e.g., oppositional, conduct-disordered or sociopathic) and treated (e.g., discipline programs or inappropriate psychiatric medication). Because such treatments attend to secondary characteristics only (Evensen, 2000; Kvigne et al., 2003) the situations in schools worsen.

Successful programs and outcomes are based on a student’s social and adaptive skills, summarized effectively by Developmental Age score (Thomas et al., 1998). FASD-related scores are typically half a student’s chronological age!  

Individuals with FASD respond like younger children.

As students continue through schools, the misfit between their abilities and expectations from teachers widens (Alton & Evensen, 2006; Crocker et al., 2009). The following examples illustrate how FASD brain-based differences often lead to misinterpretation of students.

Early Childhood Summary. During early years students with FASD likely perform the best they will ever perform in the education system.

  • Joan, Who Liked Hens
    This girl got into trouble for being out of her seat and not paying attention to the story the first grade teacher was reading, Hen in the Pen. Moments earlier she had run to the teacher’s desk, grabbed a pen and was searching for the hen inside of it.
  • Collin, a Stealing Third Grader
    This boy repeatedly took items that didn’t belong to him. Despite lectures and punishments, the problem persisted until teachers and parents marked every single item of his with a “personalized name brand.” This taught Collin he can only take things marked by his brand. Stealing stopped immediately.

Students with FASD learn from literal language.

  • Sadie, a Quiet Fourth Grader
    She talked normally at recess and lunch but refused to speak altogether during class. When called upon the girl kept her lips pressed firmly together and stubbornly stared straight ahead. After losing privileges and being lectured in the principal’s office, a parent conference revealed her father had tried to encourage positive behavior with “Remember Sadie: never, ever talk out in class”.

Habit Patterns Direct Behaviors of Those with FASD

Children with FASD routinely miss the insight that directs appropriate behavior (Streissguth, 1997; Evensen, 2000). Instead, like a younger child, they respond with learned “habit patterns” and superficial understanding.

Elementary School Summary. By the time students reach grade 3, learning and behavioral challenges show. Astute teachers suspect ADD (Coles, 2001; also see O’Malley, 2007) or wonder about parenting issues—in light of off-task behavior. After all, naiveté and memory issues look like oppositional noncompliance.

Think of adolescents with FASD as “stretch toddlers.”

Wybrecht (1996) proposed the biggest challenge students with FASD encounter is our own bias toward age-appropriate behavior. Her practical tool, to regard such students as “stretch toddlers,” speaks volumes of the perception piece of the FASD puzzle faced inside schools.

Middle School Summary. The jump to middle school demands a child deal firstly with many transitions daily and secondly with understanding and following through on (abstract) directions. Students with FASD lose their way in this transitory environment. Here, behaviors surface that appear maladaptive.

  • Elle, a Distressed Seventh Grader
    Lectured by her teacher about a classroom assignment, Elle yelled, “I want to kill you.” She was escorted to the principal’s office. When asked if she wants to harm, Elle shyly whispered “No, I didn’t know what else to say.” When asked if she wanted help learning how to talk when she was frustrated, Elle answered, “Yes, please.”

A Cautionary Note

Naïveté, poor problem solving skills and inability to think clearly under pressure put students with FASD at high risk for (1) manipulation, bullying and isolation, and (2) maladaptive or explosive response (Crowe, 2008). Paying attention to the brain differences of students with FASD, then providing appropriate learning environments, is essential for effectively reducing violence.

High School Summary. Many students with FASD fail to graduate high school (Alton & Evensen, 2006). Districts attempting to lower dropout rates should consider addressing the proverbial “elephant in the room,” i.e., FASD. It takes these students longer to reach cognitive maturity. The benchmark of 18 years is reached by mid-20s instead.

FASD students are terribly misunderstood.

Yet with observation, appropriate diagnosis, classroom strategies, and expectations consistent with their developmental age, students with FASD can reach adulthood with a more positive outcome.

Author biography:

Deb Evensen, MA, an outspoken advocate for those living with FASD, is a master teacher and behavior specialist with more than 35 years’ experience teaching children, adolescents and adults. She has been a pioneer in discovering practical solutions that work for individuals with fetal alcohol spectrum disorders. She brings the unique perspective of one who has spent thousands of hours helping to find solutions within communities across North America facing FASD.


Alton H & Evensen DL (2006) Making a Difference: Working with Students who have Fetal Alcohol Spectrum Disorders. Gov. of Yukon, Dept. of Education (Whitehorse), 101 p.

Coggins TE, Timler GR, & Olswang LB (2007) Identifying and treating social communication deficits in school-age children with Fetal Alcohol Spectrum Disorders. In (Ed. KD O’Malley) ADHD and Fetal Alcohol Spectrum Disorders. Nova Science Publishers Inc., 161-178.

Coles C (2001) Fetal alcohol exposure and attention: Moving beyond ADHD. Alcohol Research and Health, 25, 199-203.

Crocker N, Vaurio L, Riley EP, & Mattson SN (2009) Comparison of adaptive behavior in children with heavy prenatal alcohol exposure or Attention-Deficit/Hyperactivity Disorder. Alcoholism: Clinical and Experimental Research, 2015-2023.

Crowe JA (2008) The Fatal Link: The Connection Between School Shooters and the Brain Damage from Prenatal Exposure to Alcohol. Outskirts Press, 224 p.

Evensen DL (2000) Working with adolescents in high school: techniques that help. In (Eds., J Kleinfeld, B Morse & S Westcott) Fantastic Antone Grows Up. University of Alaska Press (Fairbanks), 139-147.

Kvigne V, Leondardson G, Borzelleca J, Brock E, Neff-Smith M, & Welty T (2003). Characteristics of mothers who have children with fetal alcohol syndrome or some characteristics of fetal alcohol syndrome. Journal of the American Board of Family Practice, 16, 296-303.

O’Malley KD (2007) Fetal Alcohol Spectrum Disorders: an overview. In (O’Malley, KD, Ed.) ADHD and Fetal Alcohol Spectrum Disorders. NOVA Science Publishers, 1-23.

Streissguth, AP (1997) Fetal Alcohol Syndrome: A Guide for Families and Communities. Hall H Brooks Publishing Co., 306 p.

Streissguth AP, Aase JM, Clarren SK, Randels SP, LaDue RA & Smith DF (1991) Fetal alcohol syndrome in adolescents and adults. Journal of American Medical Association, 265 (15), 1961-1967.

Streissguth AP, Barr H, Kogan J, & Bookstein F (1996) Understanding the occurrence of secondary disabilities in clients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE). Final Report to the Centers for Disease Control and Prevention (CDC), University of Washington (Seattle), Tech. Rep. No. 96-06.

Thomas SE, Kelly SJ, Mattson SN, & Riley,EP (1998) Comparison of social abilities of children with Fetal Alcohol Syndrome to those of children with similar IQ Scores and normal controls. Alcoholism: Clinical and Experimental Research, 528-533.
Wybrecht B (1996) “FAS and the Judicial System”. Overcoming Secondary Disabilities in Children with FAS; Conference, Seattle, WA. Unpublished oral presentation.


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