Strategies to support executive functioning in primary school aged children with FASD

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The purpose of this factsheet

This factsheet has been developed to assist primary school teaching and support staff to understand the impact of Fetal Alcohol Spectrum Disorder (FASD) on executive functioning, and to adapt teaching and learning strategies to meet the needs of children with FASD. The strategies in this factsheet are designed to support children with FASD, however, due to the overlap between FASD and other neurodevelopmental disorders they may be useful for other children experiencing executive functioning challenges. It’s important to be aware that every individual with FASD is different, each will have their own strengths and challenges. As such, these strategies may not be effective every time or may require ongoing reinforcement.

Additionally, it’s important to note FASD is so prevalent, many educators may not realise they are interacting daily with students who have undiagnosed FASD or FASD that has been misdiagnosed as another neurodevelopmental disorder. The strategies in this factsheet are designed to support children with FASD, however, due to the overlap between FASD and other neurodevelopmental disorders they may be useful for other children experiencing executive functioning challenges. As the pathway to a FASD diagnosis can be lengthy, it’s important that support strategies are implemented as soon as possible, even if a young person does not have a formal FASD diagnosis.

What is Executive Functioning?

Executive functioning is the term used to describe the set of mental processes that are essential for behaviours requiring planning and concentration. These mental processes allow us to organise our thoughts, set and plan goals, stay focused on tasks and connect ideas in our minds.

Executive functioning underlies daily behaviours such as decision making, time management and social interactions by helping the brain organise and prioritise incoming information to plan and execute actions effectively. Without strong executive functioning, individuals are more prone to impulsive behaviours as they may struggle to process and regulate their thoughts and actions. Executive functioning skills are important for success in school and daily life. In the classroom, challenges with executive functioning can affect a student’s ability to learn, stay organised, manage emotions and complete tasks.

It is understood that there are three core executive functions. From these core functions, many higher-order cognitive functions evolve, such as planning, organisation, abstract thinking and concept formation. These are essential in the learning process as they allow us to apply knowledge to form solutions, and to connect different ideas together.

Core executive functions

Inhibition

Control over attention, behaviour, thoughts and emotions to overcome impulses and resist distractions. For example:

The ability to resist impulsive urges, such as talking at inappropriate times, pushing in line, or grabbing something that does not belong to them.
A tendency to respond immediately, rather than thinking through an answer

Working memory

Being able to hold and manipulate information mentally. Working memory allows us to connect information from earlier to what we are working on now. For example:

Following complex or multi-step instructions to complete a task on the go
Updating or adapting to a change of instructions during a task
Solving a maths problem in your head
Following complex sentences or storylines when reading a book. For example, a sentence with multiple clauses

Cognitive flexibility

The ability to switch between different thoughts or actions, adjust to new situations or demands, or to think creatively. For example:

Connecting different concepts together to form broad understandings
Being able to imagine something from someone else’s perspective
Noticing that one way of solving a problem isn’t working, and trying a new strategy

Executive Functioning & FASD

Executive functioning is one of the nine neurodevelopmental domains that can be affected by FASD (see our resource Understanding FASD in a school environment for more information). Executive functioning challenges can manifest in the classroom as difficulties in following instructions, completing assignments, transitioning between activities, and managing emotions and behaviour. Teaching and support staff may observe students with FASD experiencing frustration, anxiety or withdrawal in response to these difficulties, which can further impact their ability to learn and participate in classroom activities. Maintaining patience and understanding can help the student feel safe and supported as they navigate these challenges. The below table lists examples of common executive functioning difficulties that may be experienced by a child with FASD, and provides suggestions to help educators adapt their teaching and learning strategies to better meet the needs of children with FASD.

Some strategies focus on environmental modifications, such as reducing distractions, adjusting class plans, or altering routines. Other focus on direct interventions that help the student develop their own routines and systems. Implementing environmental interventions is important, but supporting long-term executive functioning skills can also help a child with FASD succeed beyond the classroom environment.

Inhibition

Example of challenge	Strategy
May act with some impulsivity (e.g., speaking up at an inappropriate time)	Seat the student closer to the teacher to allow for closer supervision and modelling of appropriate times to talk Provide positive reinforcement when the child demonstrates self-control
May give the first answer that comes to mind, rather than taking time to retrieve the correct answer	Allow extra time to answer questions Encourage a 5-second pause before answering
May get restless or distracted during long periods requiring sustained attention	Establish regular routines that balance focused work with short movement breaks Try check-in periods during independent work to help monitor progress
May have difficulty having conversations with classmates	Encourage taking turns and asking questions in conversation Use social role-play to demonstrate good conversational skills

Planning

Example of challenge	Strategy
May not know where to begin a task, or in which order to do things	Break down tasks into small, manageable steps Scaffold assignments with smaller milestones and more frequent review points
May have trouble with spacing when writing (e.g., starting a sentence without the room to finish it)	Encourage nonwritten ways of presenting ideas (e.g., mind maps or drawings) Use templates or examples of what the work should look like to provide a scaffold for the student
May not consider what books or tools are needed when packing their backpack	Keep extra sets of books or tools for home or school Utilise digital tools to keep homework readily available online Use a visual checklist to help when packing their bag

Organisation

Example of challenge	Strategy
Difficulty keeping their desk or personal space tidy	Group similar items to help the child easily identify where something should go, and where to find it later Set aside a regular time to clean and organise

Emotional Control

Example of challenge	Strategy
May have heightened emotions and react disproportionately to a situation	Ensure a quiet space is available to help cool down or unwind Encourage deep breathing, or counting to ten
May find it difficult to express their thoughts and emotions	Allow extra time for processing and replying, especially in a situation that may be emotionally heightened (e.g., a disagreement or disciplinary situation)

Working Memory

Example of challenge	Strategy
May struggle to hold information about what they are currently working on, or what you have asked them to do	Keep instructions short, clear and direct Use mnemonics (e.g., an acronym, sentence or song) to help group information easily Use instructions that can easily be referred back to during a task Keep visual aids handy, such as a process checklist or timeline
May struggle to do mathematics in their head	Use visual tools, such as dice or blocks to represent numbers
May struggle to prioritise tasks when given a list of things to do	Write down tasks and provide visual cues Break tasks into shorter steps

Cognitive flexibility

Example of challenge	Strategy
May struggle to connect separate concepts May have trouble finding different ways to reach a similar conclusion	Use summaries before and after lessons to help connect ideas together Employ mind-mapping tools or programs to help create a visual concept map
Might have difficulty seeing things from another person’s perspective, for instance in a disagreement with another child	Use social stories or role-playing to create understanding of other points of view

Example of challenge

Strategy

May struggle to connect separate concepts

May have trouble finding different ways to reach a similar conclusion

Use summaries before and after lessons to help connect ideas together
Employ mind-mapping tools or programs to help create a visual concept map

Might have difficulty seeing things from another person’s perspective, for instance in a disagreement with another child

Use social stories or role-playing to create understanding of other points of view

Set Shifting

Example of challenge	Strategy
May take longer to transition between tasks or topics (e.g., moving from a maths lesson to reading time) May have difficulty stopping an action when asked to do so, or appear defiant when asked to shift to calm state	Establish a consistent, structured routine Use visual schedules or sequence planners to refer back to Give warnings to communicate upcoming transitions

Example of challenge

Strategy

May take longer to transition between tasks or topics (e.g., moving from a maths lesson to reading time)

May have difficulty stopping an action when asked to do so, or appear defiant when asked to shift to calm state

Establish a consistent, structured routine
Use visual schedules or sequence planners to refer back to
Give warnings to communicate upcoming transitions

Abstract Thinking

Example of challenge	Strategy
May not understand ambiguous terminology, such as words with multiple meanings	Playing word games and discussing the meanings behind puns or phrases Encourage them to stop and write down words that they may not understand during reading

Concept Formation

Example of challenge	Strategy
May have difficulty understanding or explaining new concepts	Give students written lesson outlines to help consolidate information and link to previous lessons Highlight key words or ideas on worksheets Use sorting activities or graphic organisers to help physically categorise and connect information Pair with a peer to help consolidate information and fill knowledge gaps (e.g., take turns explaining their understanding to each other)
May not learn from past experiences or have a good understanding of consequences	Use real-world examples to help reinforce learning Ensure consequences are a positive tool used to correct a behaviour, rather than as a punishment Be patient if a student does not seem to learn from past consequences, as this is likely due to executive functioning challenges rather than intentional defiance or bad behaviour

References

Betts, J. L., Eggins, E., Chandler‐Mather, N., Shelton, D., Till, H., Harnett, P., & Dawe, S. (2022). Interventions for improving executive functions in children with foetal alcohol spectrum disorder (FASD): A systematic review. Campbell Systematic Reviews, 18(4). https://doi.org/10.1002/cl2.1258

Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64(1), 135–168. https://doi.org/10.1146/annurev-psych-113011-143750

Goldstein, S., & Naglieri, J. A. (2014). Handbook of Executive Functioning. In Springer eBooks. https://doi.org/10.1007/978-1-4614-8106-5

Guy, P. (2018). Brain development and school. In Routledge eBooks. https://doi.org/10.4324/9781351025263

Kingdon, D., Cardoso, C., & McGrath, J. J. (2015). Research Review: Executive function deficits in fetal alcohol spectrum disorders and attention‐deficit/hyperactivity disorder – a meta‐analysis. Journal of Child Psychology and Psychiatry, 57(2), 116–131. https://doi.org/10.1111/jcpp.12451

Lezak, M. D. (1982). The problem of assessing executive functions. International Journal of Psychology, 17(1–4), 281–297. https://doi.org/10.1080/00207598208247445

Mattson, S. N., Bernes, G. A., & Doyle, L. R. (2019). Fetal Alcohol Spectrum Disorders: A review of the neurobehavioral deficits associated with prenatal alcohol exposure. Alcoholism Clinical and Experimental Research, 43(6), 1046–1062. https://doi.org/10.1111/acer.14040

McLean, S., Child Family Community Australia, & Australian Institute of Family Studies. (2018). Developmental differences in children who have experienced adversity: Difficulty with executive functioning. In Child Family Community Australia | Information Exchange [CFCA PRACTICE GUIDE]. Child Family Community Australia. https://aifs.gov.au/sites/default/files/publication-documents/cfca_developmental_differences_executive-functioning_practice-guide_0.pdf (Original work published 2018)

Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “Frontal lobe” tasks: a latent variable analysis. Cognitive Psychology, 41(1), 49–100. https://doi.org/10.1006/cogp.1999.0734

Rasmussen, C. (2005). Executive functioning and working memory in Fetal Alcohol Spectrum Disorder. Alcoholism Clinical and Experimental Research, 29(8), 1359–1367. https://doi.org/10.1097/01.alc.0000175040.91007.d0