Video: Cognitive Interventions for Individuals with FASD

This video discusses cognitive intervention research, service providers and practices for those affected by FASD.

About this video

Production date: March 9, 2011
Length: 1 hour, 48 minutes
Presenters: Carmen Rasmussen and Jacqueline Pei
Download slide notes for this video (PDF, 23 pages)

Dr. Carmen Rasmussen, PhD is an Assistant Professor in the Department of Pediatrics and a Member of the Centre for Neuroscience at the University of Alberta. She is also a research affiliate at the Glenrose Rehabilitation Hospital in Edmonton, Alberta.

Dr. Jacqueline Pei, R. Psych., PhD is a psychologist specializing in neuropsychological assessment. She is also an Assistant Professor in Educational Psychology at the University of Alberta and a member of the FASD diagnostic team at the Glenrose Rehabilitation Hospital in Edmonton, Alberta.


This video will help you to understand:

  • research related to cognitive interventions
  • links between research, service provider and practice
  • impacts for persons with FASD


  1. Introduction (2:55)
  2. FASD and cognitive interventions: math, language and memory (28:02)
  3. Executive functioning interventions (14:14)
  4. Using computer-based interventions (28:53)
  5. Executive functioning training in children with FASD in Alberta (17:17)
  6. Questions (17:00)


FASD refers to the physical, mental, behavioural and learning problems that happen to a baby exposed to alcohol while in the womb. This is called prenatal alcohol exposure (PAE).

PAE produces a range of effects including:

  • Fetal Alcohol Syndrome (FAS)
  • Fetal Alcohol Effect (FAE)

The most common and major impact is on cognitive function. This means that language, math and memory are hindered. Math problems tend to align with the amount of alcohol exposure.

FASD rate and cost:

  • approximately 1 in 100 children has FASD
  • it’s one of the most common causes of intellectual disability
  • huge social cost
  • projected lifetime cost for one person with FASD is $1.1 million in Alberta

FASD and cognitive interventions: math, language, and memory

There are 2 schools of thought in traumatic brain injury and recovery research literature:

1. Traditional

  • focus on primary damage
  • goal is to heal cognitive function (such as memory)
  • approach includes use of compensatory strategies to support interventions across areas of functioning
  • often done outside the functional contexts or environments of person (such as in a clinical setting)

2. Context sensitive

  • focus is on understanding how primary damage impacts functional actions in everyday life (such as school)
  • flexible mixture of cognitive exercises, task-specific training of relevant everyday skills
  • intervention for strategic thinking and compensatory behaviour in functional contexts
  • environmental modifications are key, including changing the support behaviours of people in the person’s natural environments (home or classroom)

Math intervention study: Math Interactive Learning Experience (MILE) (Kable et al. (2007)

  • randomized control trial with children 3-10 years with FASD
  • math intervention group: 6 weeks of individualized tutoring in math
  • focusing on cognitive deficits that contribute to math difficulties
  • contrast group: standard psychoeducational/, neurodevelopmental evaluation, individual education plan
  • all parents received parental instruction on FASD
  • the math intervention group was focused on math – contrast group was focused on standard education
  • children were assessed on behaviour and math before and after


  • children in math group showed more advances in math than the contrast group
  • parents in both groups reported improvements in behaviour
  • 6 month follow-up: math group still had higher math scores than contrast group
  • both groups still showed improvements in behaviour

Language intervention study: Language and Literacy Training (LLT) program (Adams et al. 2007)

  • randomized control trial in South Africa with 40 children 9 years of age with FASD, and 25 non-exposed children of same age
  • LLT children worked with a speech language therapist twice a week for 9 months
    • they focused on phonological awareness and other literacy skills in reading and spelling


  • the LLT group showed significantly more improvements on measures of language and literacy
  • all groups showed similar changes in general scholastic success

Memory intervention study: Loomes, Rasmussen and Pei et al. (2008)

  • examined whether teaching a verbal rehearsal strategy to children with FASD increased their memory span
  • ‘rehearsing’ as a memory strategy develops at about 7-years-old in children with normal development
  • 33 children, ages 4-11 years, diagnosed with FASD formed an experimental group (n=17) who received rehearsal training and a control group (n=16) who received no training


The experimental group improved greatly over 3 sessions, whereas the control group showed no improvement over 3 sessions.

  • age wasn’t correlated with improvements
  • therefore teaching rehearsal strategies could be beneficial to children of all ages
  • older children were more able to express that they were using rehearsal

The study resolved that rehearsal training is effective in improving memory for numbers among young children with FASD.

Executive functioning interventions

Executive functioning (EF) refers to higher order cognitive processes such as planning, organizing, and decision making.

Because EF is controlled by the brain’s frontal lobe, and PAE negatively affects the prefrontal cortex, children and adults with FASD and PAE are impaired on a variety of EF tasks.

EF is a vital factor in academic achievement. It’s linked to problems with social functioning and mental health.

Diamond et al. (2007) assessed the EF intervention program ‘Tools of the Mind’

Based on the theory of scaffolding (Vygotsky 2007). It uses real external aids (including buddy reading, visual aids and clean up songs).

  • 147 preschoolers in low-income urban preschools (not FASD)
  • 85 randomly assigned to “tools” group and 62 to “contrast” group (supports academics but not EF)
  • classroom-based program
  • children completed EF tests after program that measured inhibition, rules, switching attention
  • teachers were trained to include EF training in everyday classroom activities


  • children in “tools” performed much better than “contrast” group on measures of EF
  • more demanding EF tasks showed largest effects and linked most with academic measures
  • EF can be improved in young children attending regular classrooms
  • long term effects still unknown

Using computer-based interventions

Using computer-based interventions has resulted in positive outcomes, when used with meta-cognitive and behavioural interventions.

Computer-based interventions may not restore or remedy cognitive function fully. However, they may improve functioning enough to allow children to engage more in learning or other compensatory strategies.

Participants experience increased self-esteem which can lead to improved benefit for other interventions and therapies.

‘Cognitive Carnival’ (Dr. Kearns University of Victoria – a work in progress)

Combines working memory, inhibition control and attention training.

Consists of 3 games: “Liftoff,” “Wheel,” and “Platform”

  1. Liftoff: works on auditory and visual spatial working memory.
  2. Wheel: measure of sustained attention.
  3. Platform: measure of auditory and visual working memory.

About the games:

  • requires use of metacognitive skills, self-regulation and scaffolding (given support)
  • children are inspired to make errors and learn from them
  • children are urged to try other strategies when performance is weak

Metacognition: reflecting on our own process of doing things (monitoring cognition). Using metaknowledge to regulate information processing and behaviour (controlling cognition).

Metacognition is necessary for self-regulation, as it helps purposely control one’s thoughts and actions.

Scaffolding (Vygotsky)

  • used to assist learning along with metacognitive strategies
  • support is personalized to child and context
  • support is calibrated – it’s dynamic and provided at specific level
  • support fades: provided as essential and reduced over time as competence grows


  • rehearsal strategies: “try repeating numbers as you hear them”
  • visualization strategies: “picture the shapes in your mind”
  • reducing speed: “take some time to memorize the items before starting the level”

Executive function training in children with FASD in Alberta: Pei and Rasmussen

  • 2010 pilot study using Cognitive Carnival with children diagnosed with FASD
  • randomized clinical control trial with 18 students in Edmonton Public Schools (ages 7-13, mean = 9.5 years)
  • 24 half-hour sessions over a 12 week span
  • control condition: equal amount of time with interventionist using computer education resources
    • for example: animals, geography and strategy games
  • number of pre and post-measures completed by research assistants blind to condition
  • majority of participants also received pre and post DTI scans (for a DTI study on brain function)


  • improvement in both groups but more so in the intervention group
  • clinically but not statistically important
  • math scores close to significance, memory, visual spatial skills, visumotor precision, auditory attention also improved due to increased attention to detail


  • results not conclusive
  • measures not sensitive enough
  • difficulty getting post scores

Important to note

  • control group still got an educational computer intervention
  • personal component (coaching) is crucial and the control group still got this
  • results may be due to positive effect that one-on-one time and coaching have for students with FASD
  • 2011 intervention based on results of pilot
  • involved an increased age range with 24 students (ages 6-16, mean of 11.8 years)
  • using a delayed-treatment control approach
  • trying to increase power of study and tease out more information for factors impacting performance
  • made changes in measures to increase sensitivity and look at functional outcomes


What were the selection criteria for participants?

  • started with schools offering to participate
  • they went through their files and recognized children with FASD diagnosis
  • built in a lot of support
  • takes a lot of resources to support training piece in school system

What kind of training did interventionists have?

  • all had minimum bachelor degree
  • interventionists were set up with strategies and weekly debrief sessions

Did they have co-occurring conditions?

  • where we could, we went back to look for these
  • more likely to capture things like ADHD than anxiety, for example, from looking at school records
  • got consent to access medical records in 2011

Where can games be purchased?

  • Cognitive Carnival isn’t yet available because its effectiveness needs to have good evidence to support its use

Are test results better because you are “teaching to the test”?

  • tests give insight into function, and that improvement will improve function
  • some tests were quite separate

What kind of pupil-teacher ratio and physical classroom supports would support these kids?

  • one-on-one would be best so lowest ratio is best
  • reduce distractions in the classrooms
  • ensure play is built into the day
  • having kids work in pairs
  • not enough research has been done in these areas to make a lot of suggestions


Usually the most important consequence of FASD is affected cognitive function. This means that language, math and memory are often impaired.

Interventions have shown that cognitive function can be improved in both the clinical and classroom setting using many different methods.

Interventions using computer-based resources need to be used together with metacognitive and behavioural interventions.

Modified: 2015-09-09
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