This is Me is designed to increase understanding of and facilitate support for individuals with FASD and others who are part of their support system or environment. This is Me creates a visual context to assist individuals to learn, understand and explore some of the brain-based behaviours, strategies and strengths associated with FASD.

• Help others make a shift to understand an individual’s experience and that their challenges and learning difficulties are brain based.
• Encourage discussion about the value and effect of making accommodations (changes), modifying environments and belief systems— “Okay, so now, how do we change our environment and our expectations to help an individual with FASD (specifically my child, family member, student, employee, etc.) have a more positive life experience with a better chance for success?
• Develop empathy (understanding) for Me, as this empathy can help engage others in problem solving, identifying strategies and making modifications to the environment more suited to Me.

This is Me is based on the concept of brain domains, which are used to describe brain function (purpose and job). This concept recognizes that alcohol can impact the developing brain at a structural (physical level), cellular, and neuro-chemical level (brain chemicals). This directly impacts brain functioning, which is often seen in an individual’s development and behaviour.

Fetal Alcohol Spectrum Disorder (FASD) is a medical diagnosis which describes the effects caused by alcohol use during pregnancy. Most often there are no obvious physical signs to show a person has FASD, but the brain can still be impacted. Prenatal alcohol exposure may impact multiple areas (“domains”) of brain functioning. The new Canadian Diagnostic guidelines require (need) major differences in at least 3 different areas, resulting from prenatal alcohol exposure. Individuals who meet these conditions may be diagnosed with:

FASD with facial features

short palpebral fissures (small eyes), smooth philtrum (smooth skin between nose and upper lip) and thin upper lip
OR

FASD without facial features

The Manitoba FASD Diagnostic team continues to measure and consider the Sensory Domain as an important factor in understanding an individual’s capacity.

The new Canadian Guidelines for FASD diagnosis (Cook et el “Fetal Alcohol Spectrum Disorder: A guideline for diagnosis across the lifespan,” CMAJ 2015. This illustration has been adapted from a diagram contained in the “Every Day is an Adventure: What Parents and Caregivers Need to Know About FASD”, Healthy Child Manitoba.

Academic Achievement: A person may have difficulty in school, which translates to reading, math, spelling, and comprehension (understanding). The ability to do well in school depends on multiple areas of brain function working together and the opportunity to have a school setting that provides the necessary resources for learning. Unfortunately, individuals with FASD are often labelled as “not motivated” or “not trying”. Therefore, understanding these learning challenges as a reflection of brain differences and adapting (changing) the environment to provide a good fit for the person with FASD can result in a more positive learning experience and greater success.

Attention: Individuals with FASD can be easily distracted, have difficulty paying attention and sitting still. They may be overstimulated by both visual (what they see) and auditory (what they hear) information. Behavioural challenges may include being “off task”, inattentive, and appearing hyperactive.

Thinking and Reasoning (Cognition): This means challenges with processing speeds (take in and use information), reasoning, planning, solving problems and comprehending (understanding) complex ideas. Often individuals with FASD can show a wide range of IQ scores. Persons with extremely Low scores in IQ may qualify for life long disability services.

Language (Receptive: understanding what is said and Expressive: putting thoughts into words): Persons with FASD often show a delay in language development, difficulty understanding lengthy conversations and instructions, as a result can be incorrectly accused of “not listening”. With age, individuals may appear to speak well, but may be unable to fully grasp the meaning. For example, they may be able to repeat instructions or rules, but may not be able to follow through. It’s important to remember, although an individual with FASD may be talkative, their language may still be developmentally lower than their peers. Difficulties with communication especially affect social interactions and academic achievement.

Memory: This can mean difficulty with long-term, short-term and/or working memory. An individual may have trouble with memorizing, may seem forgetful, and experience difficulty with accessing, selecting and organizing information when needed (for example-remembering what they were just told to do). In other instances, an individual may seem as though they are lying, or storytelling, but in fact they are filling in the blanks when unable to remember.

Executive Functioning: Individuals with FASD often have trouble with planning, sequencing (placing items in order), problem solving and organizing. A person with challenges in executive functioning may also be impulsive and/or hyperactive with difficulty managing emotions. Sometimes they can become stuck on a specific thought or idea. A person may have difficulty understanding cause and effect and controlling behaviour, sometimes leading to repeated mistakes. Challenges with transitions and change are common, as well as difficulty with concepts, abstract ideas, consequences and managing time. Problems in this area impact most every aspect of day to day life.

Living and Social Skills (Adaptive Behaviour, Social Skills and Social Communication): In this area an individual with FASD may not understand personal boundaries and have difficulty reading social cues. They can be socially vulnerable and easily taken advantage of, in addition to having difficulty seeing things from another’s perspective. They can present as being socially and emotionally immature and may behave younger than their actual age, even into adulthood. Challenges with addressing hygiene (self-care) needs, understanding money, time and managing healthy coping skills are often impacted.

Brain structure and Function (Neuroanatomy/Neurophysiology): An individual with FASD, may have a smaller head, brain size, and/or a seizure disorder, and in some circumstances abnormal results on a scan (e.g. MRI or EEG) consistent with prenatal alcohol exposure.

Motor Skills: Individuals with FASD may have difficulty with gross motor skills, such as balance, strength, endurance, coordination, reflexes and muscles tone, as well as challenges with fine motor skills, such as using a pencil for writing, scissor use, doing up buttons and zippers and other fine motor manipulation. Another area of challenge may be visual-motor integration, which is the ability to use visual skills (e.g. correctly recognize a form/shape) together with motor skills (e.g. to replicate or copy shapes). This skill is important when individuals are learning how to copy shapes or print letters.

Affect Regulation (Ability to Control and Adjust Emotions): An individual with FASD may experience challenges in the areas of mental health, such as: anxiety, depression, and mood imbalance in the severe range. This means a mental health diagnosis in this area needs to be made before Affect Regulation can be counted as a brain domain impacted by FASD.

Sensory: Individuals with Sensory processing challenges may be over or under sensitive (or both) to different sensory events, for example: movement and body awareness, smell, touch, taste, visual (what is seen), and auditory (what is heard). This may present as:

• Easily overwhelmed by bright lights, people, and noisy, crowded, overstimulating environments.
• Easily startled by loud sudden noises or unexpected touch
• Avoids touching people of hugging others. Refuses to wear certain clothing or touch certain textures
• Plays roughly and takes physical risks
• Can Invade other people’s personal space
• High or low tolerance to pain and temperature
• Clumsy and uncoordinated
• Difficulty with self-regulation (just right level of energy needed to respond to sensory events)
• Overwhelming sensory experiences may trigger a fight, flight or fright response.

This is Me is an imaginative, powerful tool that can create empathy and build understanding for caregivers, service providers, professionals and individuals with FASD. It assists individuals to better understand challenges that result from brain differences related to FASD. The goal is to help people think in new ways about FASD, ask questions, and envision (see) new possibilities. This is Me is made up of animated scenarios grouped into three sections: My Strengths, My Challenges and Strategies for Me. These portray (show) situations and behaviour reactions that can be common to individuals with FASD, along with illustrations of ways to interact and respond, leading to more successful outcomes, relationships and supportive environments.

This is Me can be used:

• One to one with an individual with FASD
• With families or caregivers living with an individual with FASD
• As an educational resource for service providers, clinicians and small or large groups