Assessments for students suspected of having FASD help to provide information about their strengths and challenges. Certain assessments can also assist with a culminating diagnosis. Please contact your local diagnostic team for more information if FASD is suspected. The following information will outline formal psycho-educational, neuropsychological and speech and language assessments which may be available in your board. In particular, having a good assessment of adaptive functioning is critical to understanding and planning for the needs of a student with FASD. The better a student is understood, the better we are able to accommodate that student.
Note: Different assessment measures may be available in different boards. Therefore, specific tests are not identified and one cannot recommend one over another.
Adaptive functioning is defined as the practical, everyday skills needed to function and meet the demands of one’s environment, including the skills necessary to effectively and independently take care of oneself and to interact with other people. The three domains of adaptive functioning typically assessed are the:
- conceptual domain which includes skills in language, reading, writing, math, reasoning, knowledge, and memory,
- social domain which refers to empathy, social judgment, interpersonal communication skills, the ability to make and retain friendships, and similar capacities,
- practical domain which centers on self-management in areas such as personal care, job responsibilities, money management, recreation, and organizing school and work tasks.
Adaptive functioning is typically assessed through information gathered from a questionnaire given to a parent, teacher or another adult who knows the individual. The most frequently used measures of adaptive functioning are the Vineland Adaptive Behavior Scales, which just released its third edition in 2016 (Vineland-3) and the Adaptive Behavior Assessment System, which released its third edition in 2015 (ABAS-3).
Neuropsychological vs. Psychological Assessment
A neuropsychological assessment is conducted by a neuropsychologist, who applies knowledge about brain-behaviour relationships to the assessment, diagnosis and treatment of individuals with known or suspected central nervous system dysfunction. Neuropsychological assessments use a wider range of specialized assessment tools, and as such, they usually take longer to administer. They investigate specific domains of cognitive functioning that are controlled by different regions of the brain, such as executive functioning, visual-perceptual abilities, information processing, attention and concentration, learning and memory, sensory perception, language, adaptive skills, and fine motor skills. By examining a child’s underlying neurocognitive processes in greater detail, this information is linked back to brain structures, to provide information regarding the impact of any identified areas of difficulty on a person’s day to day functioning. Neuropsychological testing may be necessary for persons with documented neurologic disease or injury (e.g., traumatic brain injury, stroke) when there is uncertainty about the degree of impairment, or when an organic deficit is present but information on anatomic location and extent of dysfunction is required. Organic deficits, such as those resulting from prenatal alcohol exposure, cause symptoms due to structural abnormalities in the brain, as opposed to functional deficits which are considered psychological or emotional in nature.
A psychological/psycho-educational assessment is conducted by a clinical or school psychologist. School and Clinical Psychologists apply knowledge about human behaviour and development to the assessment, diagnosis and/or treatment of individuals with disorders of learning, behaviour, emotions and thought. Psychological/psycho-educational assessments seek to understand a child’s learning profile generally, and then guide the development of classroom accommodations and supports from an educational perspective. These evaluations typically include formal assessments of a child’s intelligence and a child’s academic achievement as well the many of the same domains as a neuropsychological assessment (e.g., memory, grapho-motor control, executive functioning, etc.), however, psychological/psycho-educational assessments are typically not as specific as neuropsychological assessments in pinpointing neurological processes that are causing the symptoms, and they do not link them back to specific brain structures. This is because cognitive assessment results have a wide range of variability (e.g., developmental delay, giftedness), so specific strategies are not provided. Instead, reference is made to further resources (such as the Waterfall Chart) which can be used as a starting point for intervention and support.
Executive functioning is a set of cognitive, or brain processes, that have to do with managing ourselves and our resources (e.g., our thoughts, our actions, our emotions) in order to achieve a goal. These processes are interdependent and essential to purposeful goal directed behavior. Weaknesses in executive functioning can affect a person’s everyday life. Some of these processes include our ability to:
- control impulses and think before we act (inhibition). Examples of weakness in this area include interrupting when others are speaking, blurting out answers and/or engaging in risky behaviour,
- control our emotions so we can take criticism, regroup when something goes wrong, and not overreact or get stuck in an overreaction,
- think flexibly or roll with the punches and not ‘get stuck’. Skills in this area are needed to make transitions, tolerate change, and solve problems,
- self-monitor or keep track of what we are doing. In school, skills in this area are needed to evaluate our work and check for mistakes. In life, skills in this area are needed to recognize the effect that our behaviour is having on others,
- plan and organize things within our environment and what we want to say. In order to do this effectively, we need to recognize why some things should go together, a skill needed to clean our room or our desk. Skills also allow us to recognize the most important to consider and or provide. Without these skills, an individual could miss the point in a classroom lesson or conversation,
- initiate or begin a task without prompting. Individuals with weaknesses in this are may have no idea where to begin a task and as a result they do not get started which makes them appear to be unmotivated or lazy. They may have difficulty planning for and organizing their free time.
- working memory which is the ability to hold key information in mind and use it.
There are different ways to assess executive functioning including a test directly administered to the child individually by a psychologist, or a questionnaire given to a parent, teacher or other adult who knows the child. Tests of executive functioning can either be very narrow, targeting a specific executive function, such as thinking flexibility, or they can be a test battery that has subtests each measuring a variety of cognitive functions including those listed above. Questionnaires typically ask questions about a variety of executive functions. Executive functioning may be assessed in either a neuropsychological assessment or psycho-educational assessment. Typically, neuropsychological assessments will use a number of specific tests to test specific executive functions or use a test battery of executive functioning, whereas, psycho-educational assessments are more likely to use a questionnaire to assess executive functioning.
Communication – Speech and Language
Speech is the physical ability to produce the sounds of language and string sounds together in order to produce words and sentences. Some children substitute sounds (e.g., f for th), omit sounds (e.g., nake for snake) and/or add or change sounds (e.g., spasgetti for spagetti). Some of these errors are part of normal development and others suggest that the child is having difficulty in this area. By the age of 4 years, a typically developing individual who does not know the child well should be able to understand what he/she is saying. By the age of 8 years, a child should have mastered the adult speech model (i.e. no speech errors are present).
Language is the ability to understand what is heard or read (e.g., follow directions, comprehend stories) and to express feelings and thoughts verbally or in writing (e.g., select the right word, use appropriate grammar, provide explanations). Language is also required to problem solve and reason, recognize the most important information to consider and provide, and get along socially with others. These skills, along with the ability to recall what is heard or read, are critical for success in a learning environment.
Some symptoms of language weakness may include difficulty:
- listening when they are spoken to,
- following directions and classroom instruction,
- understanding stories and classroom conversations,
- understanding jokes, sarcasm, and abstract language,
- completing classroom work within normal time lines,
- ‘finding’ the right word (e.g., using non-specific words like thing or stuff),
- expressing ideas in an organized and concise manner,
- interacting with peers in a socially acceptable manner (e.g., they can be perceived as a behaviour problem).
Eighty one percent of individuals living with FASD will have a language disorder (Popova et al., 2016). If you are unsure about the speech and/or language abilities of a student, a referral to a Speech-Language Pathologist should be considered.
Auditory Processing Disorder (APD)
Auditory processing is what you do with what you hear. Individuals with APD often are able to hear, that is they have normal hearing acuity, but they have difficulty processing what they hear in a rapid and efficient manner. For example, it may take them longer to attach meaning to sound. They may have difficulty paying attention to, remembering and using the information that they hear. At times they may not ‘hear’ the word or words that were actually spoken.
The Audiologist is the professional who diagnoses APD but it is within the scope of practice of a Speech-Language Pathologist to identify associated language factors. Audiological testing involves a number of difficult listening tasks. Testing is not recommended for children under the age of seven because of the immaturity of the auditory system.
The following strategies may minimize the impact of APD for school aged children at home:
- Make sure that your child is well rested. The ability to compensate will deteriorate if s/he is sick or tired;
- Reduce background noise (turn off the TV). Provide a quiet place to study;
- Speak at a slightly slower rate with mildly increased loudness levels. Encourage them to look at the speaker;
- Do not provide too much information at once. Pause frequently to allow time to process what has been said.
- Teach your child how to be an effective listener. Encourage her/him to ask for repetition and/or clarification.
The following strategies may be effective at school:
- Allow preferential seating that is 6-8 feet from the speaker and away from noise sources (e.g. the door, window);
- Pair the visual with the auditory. Say it, show it. Use demonstration whenever possible. Write key words on the blackboard.
- Pace the presentation with occasional pauses between meaningful units to permit time for comprehension.
- Allow a 10-30 second delay between asking a question and accepting an answer.
- Gain students attention and highlight important information. Use statements such as, ‘This is important’, ‘This is what you need to know/do’, ‘I want you to remember this’.