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Fetal Alcohol Spectrum Disorder and social and emotional development during adolescence

Secondary School Resources

The purpose of this factsheet

This factsheet will assist secondary school teaching and support staff to better understand social and emotional development in adolescents with Fetal Alcohol Spectrum Disorder (FASD). It also aims to provide strategies to assist educators to support the social and emotional development and wellbeing of young people with FASD in the school environment.

Every young person with FASD is different, often in significant ways and will have their own strengths and challenges. These strategies may not be effective every time and maintaining flexibility is crucial when supporting young people with FASD. It’s important to note that 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 information in this factsheet will be useful for all students with social and emotional difficulties, even if a young person does not have a formal FASD diagnosis. As the pathway to a FASD diagnosis can be lengthy, it’s important that support strategies are implemented as soon as possible.

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1 Social and emotional development during adolescence

In addition to the significant biological changes that occur during adolescence, such as brain development, physical maturation, and hormonal changes, it is also a time of intense social and emotional development. Key areas of social change or development include:

  • The increased importance and influence of peer relationships. Adolescents spend an increasing amount of time with friends and peers, especially in the school environment. The need for peer acceptance, the desire for respect by peers, and the fear of social rejection can be a significant influence for many adolescents.
  • The development of self and identity. Adolescents begin to explore the person they are and want to be, the roles they want to occupy in adulthood, and their place in society.
  • The development of sexual identity and formation of romantic relationships.
  • The experience of independence, changing social roles and responsibilities, and greater autonomy.

There are also significant emotional changes and development that occur during this period. Adolescence is a time when young people must develop and utilise a broad range of emotional skills and competencies to successfully move through this developmental period. These include (but are not limited to):

  • Learning how to express emotions in accordance with one’s own goals and the social context.
  • The ability to recognise and interpret the emotions of others, including the understanding that different desires and beliefs can engender different emotions from people, and that emotions can be hidden.
  • Developing a greater understanding of more complex emotional experiences, for example, that emotions may be mixed or multiple.

Social and emotional development and competence has been directly linked to academic achievement and success in the school environment. Adolescents who experience difficulties in social and emotional functioning are at greater risk of falling behind in school, and have greater chances of behavioural, emotional, academic and social developmental problems.

2 FASD and social and emotional development

FASD has significant implications for social and emotional development. It is thought that social and emotional challenges may be the result of a combination of the cognitive impairments associated with FASD, such as challenges with executive functioning, social cognition, language, and sensory processing. These cognitive variables likely interact with environmental factors in the secondary school environment (e.g., more complex peer relationships, larger class sizes with more transitions and less supervision) to make it a particularly challenging area for young people with FASD. These difficulties typically emerge in childhood, but persist into adolescence, and become more pronounced with age. The social and emotional deficits experienced by adolescents with FASD have significant implications for their success in the school environment. Adolescents with FASD who present with social skills deficits are at a greater risk of negative behavioural outcomes, mental health issues, social withdrawal, and school avoidance. Adolescents with FASD often have difficulties with:

  • Peer relationships: Adolescents with FASD can be inappropriately friendly, and struggle with socially appropriate reactions and social boundaries, leading to being overly trusting or vulnerable to manipulation. As a result, they may experience peer rejection, teasing, and bullying, which in turn, can contribute to difficulties with self-esteem, aggression, mental health, and school.
  • Emotional understanding: For example, understanding that multiple emotions can be experienced simultaneously, that all emotions are ok to experience, and emotions can be hidden. Additionally, adolescents with FASD often have trouble recognising others’ emotions. These difficulties with social and emotional functioning may make adolescents with FASD more vulnerable to peer pressure, exploitation, or being taken advantage of by others.
  • Dysmaturity:  Adolescents with FASD will typically show a pattern of dysmaturity. This means that their emotional, social, or cognitive development does not align with what is typical for their chronological age. They will often be unable to meet aged-based expectations for social and emotional functioning. For example, a 15-year-old adolescent with FASD may have the emotional understanding equivalent to a 12-year-old, but the social skills of a 10-year-old. Dysmaturity is particularly important to consider when adolescents with FASD are developing their own sexual identity and engaging in relationships with others. As their developmental maturity may not align with their chronological age, this may impact on their ability to keep themselves safe – or it may lead to socially inappropriate behaviour.
  • Many young people with FASD will also struggle with impulse control, sensory regulation, frustration tolerance, and emotional outbursts.

3 Strategies to support social and emotional development in adolescents with FASD

Whilst there are few evidence-based interventions targeting social and emotional development for children and adolescents with FASD, there are some principles that have been enacted with good success in many schools. One strategy with promising preliminary evidence is to explicitly teach social and emotional skills. The Provincial Outreach Program for Fetal Alcohol Spectrum Disorder (POPFASD), a Canadian organisation funded by the British Columbia Ministry of Education has developed a framework for working with secondary school age children with FASD to help them acquire the social and emotional skills needed to live and engage in their day-to-day life in secondary school.

The framework focuses on explicitly teaching social and emotional skills to adolescents with FASD using small student groups with similar social and emotional challenges. To view an in-depth explanation of the framework, please see this short (15 minute) video produced by POPFASD.   The framework includes the below steps and is a useful guide to building social and emotional skills in a manner that is tailored to the needs of specific student groups.

There are also general principles that are best practice in supporting young people with FASD. These include things like routine, repetition and consistency, and you can read about them on our What is FASD page. These principles should always underpin approaches to working with students with FASD and be applied in conjunction with the specific strategies below to build social and emotional skills.

  1. Decide what needs to be taught

    Every adolescent with FASD will have different strengths and needs. It can be helpful to complete an assessment of a student’s current social and emotional skills to determine what areas need to be focused on. This can be done via observation, informal interviews, or using validated tools such as the Social Skills Rating System. If it’s appropriate, include the student in this decision-making process.

  2. Organise and plan

    Create small groups of students with similar social and emotional skill challenges. Decide on when, where, and how often to meet. Adolescents with FASD will benefit from repetition and reinforcement, so short and frequent meetings may improve the effectiveness of the sessions.

  3. Introduce the skill

    Begin with an easy-to-learn skill (e.g., joining a group activity). Introduce the topic and brainstorm successful actions with the group. It can be helpful to gather the ideas into a selection of instructions or rules.

  4. Model the skill

    The staff member leading the group should then model the skill or behaviour for the students. During the demonstration, it may be helpful to point out what kind of decisions are being made that are appropriate for the situation.

  5. Practice the skill (role-playing)

    Practice the skill through role-playing. Ensure there are opportunities for feedback. Adolescents with FASD may learn best with lots of encouragement and reinforcement about what behaviours are considered appropriate and inappropriate.

  6. Practice in a real-life setting

    It’s important to practice the skills in a real-life setting, as students with FASD usually find it challenging when transferring learned skills to real-life situations and will often have difficulty generalising information from one setting (e.g., role-play) to another (e.g., the classroom). It may be helpful to share the planned skill with other teaching and support staff, so the student can be supported appropriately by all relevant staff, reinforcing learned skills in different classes, lunchtime settings, or extracurricular activities.

  7. Review, give feedback, practice again (if needed)

    Identify if the student needs additional support. Providing immediate positive feedback in a natural setting may increase the student’s success and ensure that the student can practice again as needed to reinforce learning. As poor memory is a common FASD deficit, regular reinforcement of skills will always be necessary.

References

Aviles, A. M., Anderson, T. R., & Davila, E. R. (2006). Child and adolescent social-emotional development within the context of school. Child and Adolescent Mental Health, 11(1), 32–39. https://doi.org/10.1111/j.1475-3588.2005.00365.x

Branje, S., De Moor, E. L., Spitzer, J., & Becht, A. I. (2021). Dynamics of identity development in adolescence: A decade in review. Journal of Research on Adolescence, 31(4), 908-927.

Denham, S.A. (2019). Emotional Competence During Childhood and Adolescence. In V. LoBue, K. Pérez-Edgar, & K.A. Buss (Eds.), Handbook of Emotional Development (pp. 492-541). Springer, Cham. https://doi.org/10.1007/978-3-030-17332-6_20

Jansen, K., & Kiefer, S. M. (2020). Understanding brain development: Investing in young adolescents’ cognitive and social-emotional development. Middle School Journal, 51(4), 18–25. https://doi.org/10.1080/00940771.2020.1787749

Kerns, K. A., Siklos, S., Baker, L., & Müller, U. (2015). Emotion recognition in children with Fetal Alcohol Spectrum Disorders. Child Neuropsychology, 22(3), 255–275. https://doi.org/10.1080/09297049.2014.993310

Kully-Martens, K., Denys, K., Treit, S., Tamana, S., & Rasmussen, C. (2012). A Review of Social Skills Deficits in Individuals with Fetal Alcohol Spectrum Disorders and Prenatal Alcohol Exposure: Profiles, Mechanisms, and Interventions. Alcoholism, Clinical and Experimental Research, 36(4), 568–576. https://doi.org/10.1111/j.1530-0277.2011.01661.x

Petrenko, C. L. M., Pandolfino, M. E., Quamma, J., & Carmichael Olson, H. (2017). Emotional understanding in school-aged children with Fetal Alcohol Spectrum Disorders: A promising target for intervention. Journal of Population Therapeutics and Clinical Pharmacology, 24(2), e21–e31. https://doi.org/10.22374/1710-6222.24.2.5

Rosenblum, G. D., Lewis, M., Adams, G. R., & Berzonsky, M. D. (2006). Emotional Development in Adolescence. In G.R. Adams, & M.D. Berzonsky (Eds.), Blackwell Handbook of Adolescence (pp. 269–289). Blackwell Publishing Ltd. https://doi.org/10.1002/9780470756607.ch13

Scott, S. K. & Saginak, K. A. (2016). Adolescence: Emotional and Social Development. In M.D. Stauffer, & D. Capuzzi (Eds.), Human Growth and Development Across the Lifespan (pp. 347–386). John Wiley & Sons, Inc. https://doi.org/10.1002/9781394258925.ch12