Fetal Alcohol Spectrum Disorder and Mental Health in Adolescence

Onset Age: Mental health challenges commonly emerge during adolescence, with the peak onset age around 14 years. Up to 75% of mental health conditions emerge before age 25.

Prevalence: Mental health conditions in young people are rising, potentially driven by the unique social and environmental factors that today’s young people face. National data indicates that 40% of young people (16-24 years) experienced a mental condition in the past 12 months. Since 2007, there has been a 50% increase in mental disorders among this age group, particularly in young women.

Common Conditions: Anxiety, attention deficit/hyperactivity disorder (ADHD), depression, and conduct disorders are most prevalent, however less-common conditions such as eating disorders, psychosis, and mood disorders also tend to emerge during adolescence.

Challenges: Poor mental health can impact a young person’s engagement with education which may present as increased absenteeism, reduced focus, and an increased likelihood of suspension, expulsion, or leaving school. Young people who are struggling with their mental health may also face challenges with interpersonal relationships, and behavioural issues such as risky substance use or sexual behaviours. Self-harm and suicide are also significant concerns during this period.

Wellbeing: Good mental health is associated with better interpersonal relationships, greater academic achievement and completion, better physical health and increased life expectancy. Evidence shows that early interventions can significantly reduce harms associated with mental health conditions over the course of a young person’s life. Strong relationships with peers and trusted adults, and being engaged in the school community have also been shown to encourage mental wellbeing in young people.

Approach behavioural concerns with empathy and FASD-informed lens:

• Young people who are struggling with their mental health may be more likely to act out. This is especially true for those with FASD who struggle with emotional regulation. Punishments (such as class exclusion) can have a negative impact on the mental health of a young person with FASD, as it can raise feelings of exclusion and being ‘othered’. Use positive reinforcement, and clear verbal communication to address behavioural concerns. Consequences are rarely a successful means of management.

Promote and teach emotional regulation:

• All adolescents will benefit from building skills to regulate their emotions. As young people with FASD often struggle with emotional regulation, having regulation strategies to rely upon can help to reduce negative emotions. For example, the STAR strategy (Stop and breathe, Think, Act and Reflect) is a useful tool to help a young person self-regulate.
• Enact quiet spaces for students to use if they are feeling overwhelmed. Adolescents with FASD often experience sensory processing difficulties, which can impact emotional regulation. It’s important students have the opportunity to move away from overwhelming sensory experiences which may help them self-regulate, calm down, and refocus. Other sensory strategies that may assist with emotional regulation include listening to music, body exercises or stretching, or a drawing/colouring activity.
• Mindfulness strategies, such as a “body scan” activity that guides a young person to focus their breath and attention on different parts of their body may also be useful to help adolescents with FASD practice emotional regulation.

Build a safe and FASD-informed school environment:

• For young people with FASD or other neurodevelopmental conditions, inclusion is a strong protective factor for good mental health. A safe, respectful and inclusive learning environment acknowledges the unique needs of all children and allows for a sense of belonging within the school environment. Many individuals with FASD struggle with planning, organisation, impulse control, and sensory sensitivities which can impact their ability to focus and regulate emotions. Providing visual schedules, quiet breakaway spaces or noise-cancelling headphones, breaking tasks into small steps, and offering regular check-ins can help students stay on track and enhance the learning environment.

Promote resilience:

• Bullying and social exclusion are common for young people with FASD, which can negatively impact their mental health. Educators can support resilience by encouraging social skills development, fostering peer-mentorships and encouraging collaborative activities.

Encourage, plan, and reinforce positive habits:

• These might include good sleep patterns, regular exercise, and learning to recognise and manage emotions. For students with FASD this may require repetition and clearly structured planning, such as visual schedules or habit trackers.

Be aware of the signs and symptoms of common mental health conditions:

• Positive Choices have developed a guide to common mental health conditions and their related symptoms, however it’s important to note that symptoms of common mental health conditions may present differently in adolescents with FASD due to social, emotional and cognitive differences.
• Beyond Blue have developed resources for teaching and support staff to monitor and promote students’ mental wellbeing. Their BETLS Observation Tool helps educators monitor the behaviour, emotions, thoughts, learning and social behaviours of students.

Recognise help-seeking behaviours and offer support:

• A young person might reach out for external support in direct or indirect ways. This is known as help-seeking behaviour. Responding to help-seeking is incredibly important and can significantly improve the outcomes for a student struggling with their mental health. Young people with FASD may benefit from a pre-planned framework that guides them on how to recognise they need help, who and when to ask, and what to say. This can be reinforced using visual aids or role-play scenarios. The framework might include a Who, What, When and How. For example:
  • Who: “When I am feeling ____ [sad, angry, scared, alone, worried, etc], I need to talk to [teacher or learning support person].”
  • What: Ask [teacher or learning support person] if you can talk to them privately. E.g. “Can I talk to you privately?”
  • When: Make sure that there are no distractions, and that [teacher or learning support person] has time to talk. This might be after class or during a break.
  • How: “I need to talk to you about how I have been feeling. Lately I often feel ________[sad, angry, scared, alone, worried, etc]. I need someone to ______ [listen, help, etc].”

Refer young people to appropriate supports:

• Foster an open channel of communication with parents and caregivers, and other community networks, to gain an understanding of existing support systems surrounding the young person.
• If a young person appears to be struggling, they may need extra support. Consider finding a quiet moment to talk and open the dialogue about connecting them with further support. Ask them how you can help them and follow up at a later date.
• Young people with a diagnosis of FASD may have an existing support team or mental wellbeing plan. If a FASD diagnosis hasn’t been made, educators can still engage with caregivers and the appropriate support staff to ensure the student receives the opportunity of a formal diagnosis and the specialist therapeutic interventions that can follow.

Develop and support achievable learning goals:

• Tailoring the learning plan of a young person with FASD (or other neurodevelopmental conditions) can help to ensure that they are setting and achieving goals that are relevant and achievable. For example, a student who has difficulty with mathematics might benefit from an individualised, strengths-based assessment plan that will motivate them to develop their skills, without provoking unnecessary distress over results. A strength-based approach recognises students’ strengths—whether in art, music, or hands-on learning— and can boost self-esteem and engagement. These, in turn, can improve mental health.