Video: Psychological Issues in Children and Adults with FASD

Psychological issues affecting children and adults with FASD are presented. Ways to improve safety and meet psychological needs are given.

About this video

Production date: May 29, 2009
Length: 1 hour, 58 minutes
Presenter: Brenda Knight
Download slide notes for this video (PDF, 16 pages)

Brenda Knight is a practicing psychologist with a private practice in Vancouver, British Columbia. Over the past 38 years her work has included the assessment and treatment of individuals with FASD and their families, as well as individuals with developmental disabilities and mental health issues. Brenda was nominated for the YWCA Woman of Distinction Award for her groundbreaking work in the area of Deafness and FASD. She is an adoptive parent of a child with FASD (who’s now a married mother of 2).


This video will help you understand:

  • the psychological issues that affect a child’s capacity to cope
  • how to maximize the emotional safety of the child and increase resilience
  • ways of meeting psychological needs


  1. Basic assumptions (6:55)
  2. Factors contributing to emotional and behavioural characteristics (9:04)
  3. FASD and the effect on coping (26:53)
  4. Treatment considerations (54:58)
  5. Communication enhancers and closing remarks (20:16)

Basic assumptions

  • each person with FASD is unique
  • living successfully with FASD has many forms
  • the ultimate goal is not necessarily independent living
  • supporting the family of a person with FASD is just as important as treating the person

Factors contributing to emotional and behavioural characteristics

  • genetic history including family history of mental health disorders
  • pre and post-natal care and environment
  • parent-child relationship
  • adverse experiences
  • skill of caregivers
  • children born with FASD are predisposed to psychiatric disorders
  • 95% have been physically or sexually abused in their lives (included institutional abuse)
  • 79% reported having a birth parent with an alcohol problem

Health related issues

A person with FASD may experience issues with:

  • immune system
  • severe allergy problems
  • cardiovascular
  • urinary tract
  • skeletal growth
  • nervous system
  • eating difficulties or disorders

What may be observed as a psychological problem may actually be a physiological problem. In cases of adoption, the child’s history isn’t always disclosed or known.

FASD and the effect on coping

  • impact of alcohol on brain can affect language, motor skills, memory and executive functioning (judgement, decision-making, impulse control)
  • often other factors also at play
  • children who have been abandoned, neglected or have not had safe parenting situations can have difficulty attaching
  • may have difficulty learning from consequences
  • poor social skills
  • take on personality of whoever they are around
  • if they’re grouped in with behaviour disordered children, they are easily influenced
  • difficulty generalizing directives from one situation to another (for example, not shoplifting in London Drugs to shoplifting at Shoppers Drug Mart)
  • difficulty with social judgment
  • failure to learn from experience due to impact of impaired memory and poor abstract thinking

Difficulty with regulation of emotions

  • American Sign Language (ASL) has proven useful to help them understand emotions
  • signs help to clarify and express each emotion
  • shows levels of anger visually
  • ASL can be useful as a tool for parents to visually regulate their child’s behaviour without humiliating child

Treatment considerations

  • children with FASD can come to new living situations with unknown history
  • their reactions to sight, sound, time of year may be related to earlier unknown trauma
  • treatment provider must listen to parents and people in a supporting role (as they have valuable insight)
  • need to take into account that treatment and support interventions are frequently time-limited and may contribute to feelings of abandonment
  • minimize change in service providers to avoid re-traumatization
  • find a way for client to transfer meaningful history to next caregiver and or therapist

Approaches to treatment

  • diagnosis is an important means to help:
    • anticipate long term care needs
    • make sense of behaviours that were not understood
    • the individual understand their condition
    • eligibility for specific programs and funding (in some cases)
  • supportive counselling is needed for caregivers
  • psychiatric assessment and consultation may be useful for children struggling with treatable secondary disabilities
  • individual psychotherapy (therapist must be trained in working with FASD)
  • peer support groups such as recreational support
  • drug and alcohol treatment; specific programs for FASD are needed
  • recreational programs can be very important to provide self-esteem and purpose in activities
  • internet can be dangerous
  • the spiritual life is important

Anchor person

An anchor person or life interpreter is a safe person that the child can trust because:

  • they know the person well and child trusts that the person has their best interests in mind
  • they are available 24-7 to provide on the spot support
  • they interprets things in simple terms that can be easily understood

Goals of therapy

  • freedom enhancement with structure and safety in mind
  • help child with FASD develop an understanding of FASD at a developmentally appropriate level (such as changes in their body)
  • learn to advocate for self, even at a basic level (for example providing a medic alert bracelet or card explaining their condition)
  • protect self in situations when support isn’t there
  • identify strengths and work within limitations
  • help reconstruct their definition of self
  • help them understand their behaviour and their brain

Reality based planning

  • develop a relationship with a good pharmacist that can help set up a good plan if medications are involved
  • include financial planning
  • develop understanding of siblings so they can support each other in the future
  • provide education on alcohol and drugs to help them understand their limitations

Communication enhancers and closing remarks

When communicating with a person with FASD:

  • create contrasts with your speaking patterns and voice to maintain engagement
  • increase comprehension by including non-vocal cues such as facial expressions, gestures, body movements, drawings and notes
  • for comprehension, allow time between topics and subjects, but not so much time as to lose engagement
  • use short sentences and don’t use idioms (expressions like “go fly a kite”)
  • listen carefully to what languages the person uses and use it back to them
  • repeat important points
  • define the purpose of the communication
  • speak with normal flow with pauses, watching for comprehension
  • if it appears they don’t understand, suggest that you have not explained it well and try again in a different way
  • provide something to fidget with
  • to signify a change of subject, state that the subject is finished and the subject is being changed
  • change body position and tone of voice
  • insert transitional distractions between topics (for example, play or exercise)
  • use humour to reduce anxiety, develop a rapport and motivate return visits
  • demonstrate a healthy approach to dealing with stress
Modified: 2015-09-09
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