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Competency 3: Treatment Strategies for Working with Clients with an FASD

Adults

Chronological Age Compared to Developmental Age

As seen in the diagram, the emotional and social age of adults with an FASD is often younger than the chronological age. The table shows possible cognitive impairments that can lead to inappropriate behaviors. These behaviors can interfere with the person’s ability to participate in treatment. Understanding the reasons for the behaviors can help in adapting treatment to meet the person’s needs. Not all adults who have an FASD show the same pattern of strengths and deficits.



Cognitive Impairments That Lead to Inappropriate Behaviors
Impairment Inappropriate Behavior
Memory problems Saying things that are not accurate; perceived as lying
Failure to understand ownership Taking things that don't belong to them; perceived as stealing
Little understanding of value of objects Destructive behavior
Slow cognitive or auditory pace Defiance
Poor judgment Easily victimized
Attention deficits Unfocused/distractible; poor functioning in school or work environments
Arithmetic disability Difficulty handling money
Memory impairment Difficulty learning from experience
Difficulty abstracting Difficulty understanding consequences, conceptualizing past, present and future, understanding concept of days, weeks or months, and understanding ownership
Difficulty understanding concepts of time and space Late for appointments; in other people's "space"
Impulsivity Poor frustration tolerance, safety issues, issues with the law, and acting without considering the consequences
Impaired sensory thresholds Difficulty with concentration, frustration, rage; and occupational performance (i.e. school)
Impaired body boundary conceptualization Overly friendly, personal safety issues, and sexual victimization

Source:  Adapted from Streissguth, A. 1997. Fetal Alcohol Syndrome: A Guide for Families and Communities. Baltimore, MD: Paul H. Brookes Publishing Co., p. 106, 1997; and Leveille, R. (Producer/Director). No date. Fetal alcohol syndrome and effect: Stories of help and hope [Film]. Center City, MN: Hazelden Educational Materials.

Understanding the causes of inappropriate behaviors can help in establishing procedures to govern the conduct of clients with an FASD. Persons with an FASD are rarely cruel or hostile on purpose. What looks like lying may be an attempt to cover a memory lapse by making things up. Stealing may be an attempt to buy friends with nice things. Anger and frustration may result from sensory overload or difficulty processing information. Similarly, the person with an FASD may appear defiant and refusing to complete tasks. In reality, the person may be avoiding the task due to fear of failure or an inability to understand the instructions.

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