How to Correct Behavior Related to FASD

by Dr. Lorin Bradbury

Question: Dr. Bradbury, I just read the ‘Assessing FASD’ piece you published. Thank you for helping to shed light on this important subject. We have adopted fraternal twins who were prenatally exposed to alcohol. Our son is quite intelligent and does well in kindergarten, however issues arise at home, where is almost constantly defiant and seems to always have an agenda. In these moments it is so hard to remember that he has brain damage because his behavior seems so intentional. Have you come across any behavioral modifications that help kids on the FASD spectrum to “throttle back” and understand that his persistent demands to have things his way are only causing a greater rift in our familial relationships? Any insight you can provide is greatly appreciated.
Even though your children are twins, the damage can be quite different to each child. Dr. Clarren, a pioneer in this field, used to use the analogy of bubbles, or holes, forming in Swiss cheese. No two are the same. Fetal development is so rapid that even twins can be impacted differently. Further, twins that have not been exposed to alcohol in utero can have very different dispositions and personalities. So I believe I would be aware of the possible effects of the alcohol exposure, but not focus on it too much. Instead, I would implement parenting techniques, such as Assertive Discipline.
Lee and Marlene Cantor developed the concept of Assertive Discipline for educators, but then modified it for the home. Though the book is now out of print, it is still available at Amazon. It is called Assertive Discipline for Parents. It’s an excellent book and it’s easy reading with very practical information. There are five basic steps that I will present below:
(1) Stop yelling. (I am not saying you are a screamer. I don’t know you.) Action, not yelling results in behavior change.
(2) Develop simple rules and expectations.
(3) Decide ahead of times what the consequences will be for violating those rules will be.
(4) Always follow through. Regardless of how cute the infraction was, or how tired you are, you must follow through. Defiance of authority must be confronted. You will find, and probably have already found that different children respond differently to the same consequence. However it is important to define the consequences and follow through.
(5) Catch him being good and reward him. Do not reward every time he is good. Random rewards are much more effective.
I hope this is of some help. I will write more about developing a Token Economy in the future.
Lorin L. Bradbury, Ph.D. is a licensed psychologist in private practice in Bethel. For appointments, he can be reached at 543-3266. If you have questions that you would like Dr. Bradbury to answer in the Delta Discovery, please send them to The Delta Discovery, P.O. Box 1028, Bethel, AK 99559, or e-mail them to [email protected]

6 Comments

  1. The neurobehavioral model is key for addressing the needs of individuals with an FASD (see Diane Malbin’s book Trying Differently Rather Than Harder; available on Amazon). It matches the neurodevelopmental profile of the child/adult with appropriate expectations and accommodations in the environment, to improve the “goodness of fit” for the individual with an FASD in their everyday activities. This model does not rely on consequences per se, as many individuals with an FASD do not learn from consequences. Typically this means that supervision and supports need to be modified or changed if issues arise. The goal is to meet the needs of the individual to improve outcomes, regardless of what standard non-FASD-informed parenting models tell you is the “right” thing to do.

  2. Parenting approaches that focus on stopping or correcting behaviors, using consequences, and encouraging parental inflexibility are not a good fit for families caring for children with FASD and attachment trauma related to adoption. I would encourage families to instead consider Diane Malbin’s Neurobehavioral model, Heather Forbes’ Beyond Consequences, Karyn Purvis’ Trust Based Relational Intervention- TRBI approach- and Howard Glasser’s Nurtured Heart Approach. I also highly recommend the book “Wounded Children, Healing Homes: How Traumatized Children Impact Adoptive and Foster Families”. While it does not include a lot of information specific to FASD, it does help foster & adoptive families better understand some of the behaviors that might otherwise be described as oppositional or defiant, and the importance of reframing, understanding your own triggers, and approaching behaviors differently.

  3. This sounds like really solid advice for kids who do not have challenges in behavior/learning due to alcohol. In fact, it is similar to the approach we took with our affected child. However, it DID NOT work.

    Understanding the brain of a child with FASD is key. For example, I know my child has slow processing of information, so when I make a request for her to do something, I leave it at that and give her time and space to process. She used to immediately tell me no and refuse no matter how consistent and calm I was, and no matter the consequence. Once we started to ignore the no and give her space, she almost always did what was asked. She was telling us no because she felt stressed and pressured to understand and reply right away.

  4. Respectfully, a good number of the approaches suggested here will likely be unsuccessful because they are mostly traditional, and traditional approaches do not work for the FASD brain. As an example, agreeing to a consequence for stealing does not help prevent the behavior *if* stealing is actually the result of *lack of impulse control* and not intentional misbehavior. If you apply a punishment to a person for a behavior out of their direct control, that creates stress, and it does not teach them the underlying skill deficits that ultimately led to the behavior. Children cannot “try harder” and improve their impulse control–it is a skill that must develop with successful practice, time, and brain development, not continued failure, stress, and punishment.

    Addressing behaviors in people with FASDs can be tough, mostly because it takes a complete re-interpretation and understanding of behavior. This is why people with FASDs are not adequately supported in *any* system: they are not understood, and thus they are not provided with services that work for their specific cognitive skills set. There is literally no system that is consistently equipped to effectively work with FASDs (mental health, justice system, schools, developmental disability programs, medical, etc.). This is despite FASDs being potentially 5% of the US population.

    The Neurobehavior approach mentioned by Emily above is an evidence-based model that is invaluable to any parent or professional supporting someone with an FASD. You may find the videos on my Youtube channel helpful as well. (www.youtube.com/OregonBehavior)

  5. Successful caregiver practices for FASD focus on neurobehavioural approaches and are trauma informed, especially for children who join the family through adoption. Rigid consequence based behaviour modification strategies and token systems take managing FASD back 30 years.

  6. I learned through both the neurobehavioral method and TBRI (trust based relational intervention) that trauma, even prenatal trauma can have an impact on our children. Parent—you say the child has persistent demands. It sounds like perseveration that I see in our kids with FASD. That can’t be modified. Their brain is literally stuck, missing connections. You can try to interrupt this symptom of their disability through redirection, distraction, or you may have to go back and work through the issue with them. I highly recommend researching other parenting models to meet your child’s needs. Behavior modification doesn’t even necessarily work for kids with other disabilities.

Comments are closed.