WHAT IS ADAPTIVE FUNCTIONING?
According to Mental Health Net adaptive functioning is affected by three basic skill sets:
This includes reading, numbers, money, time, and communication skills.
These skills help us to get along well with others. These skills include understanding and following social rules and customs; obeying laws, and detecting the motivations of others in order to avoid victimization and deception.
Practical Life Skills
These are the skills needed to perform the activities of daily living. This includes feeding, bathing, dressing, occupational skills, and navigational skills.
HOW DOES FASD AFFECT ADAPTIVE FUNCTIONING?
According to a website run by University of Alberta (Canada) called Know FASD common adaptive functioning difficulties include:
• Poor self-care/hygiene
• Difficulty considering consequences
• Lack of ability to make decisions and take initiative
• Unresponsiveness to subtle social cues
• Lack of healthy friendships
• Poor concentration/attention
• Social withdrawal
• Crying/laughing too easily
• High Anxiety
• Lying, cheating, stealing, lack of consideration
• Exhibiting excessive happiness
WHAT MIGHT HAPPEN WITHOUT THE RIGHT INTERVENTION?
As the individual ages, expectations in these areas are increased, which might lead to increased problems in adolescence and adulthood.
Adolescents and adults with FASD have been found to have the average adaptive functioning of a seven-year old. They will be expected to function as a typically developing adult, which is often not possible for these adults.
When these individuals do not meet expectations, there is increased dissatisfaction towards them. This can have a negative effect on social functioning and mental health.
One of the most significant deficits among individuals with FASD is adaptive functioning, which refers to the personal and social skills needed to live independently. Poor adaptive functioning likely contributes to the high rates of secondary disabilities and associated adverse life outcomes.
For instance, Streissguth et al found that among adolescents and adults with FAS/FAE (mean age 17 years), adaptive functioning skills were at the level of a seven-year-old, with deficits being most pronounced on socialization skills.
Streissguth et al identified adaptive behaviours as one of the most striking deficits in children with FASD.
In another study on adaptive functioning, Whaley et al found that socialization decreased with age (relative to the norm) among children two to 10 years of age with PAE. This study was not longitudinal and, thus, causal interpretations could not be made; however, it may be that some adaptive deficits in FASD become more pronounced with age.
Furthermore, in Germany, Spohr et al found that individuals with FASD had significant difficulty with employment and independent living.
A more recent study in the UK Behaviour and Adaptive Functioning in Children and young people with fetal alcohol spectrum disorders revealed:
Data of 106 participants registered from 2005 to 2015 were extracted from a clinic database. In total, 99 individuals with confirmed prenatal alcohol exposure (PAE), aged from 5 to 25 years, were analysed using scaled scores of the Vineland Adaptive Behavior Scales-Second Edition (VABS-II), and the Developmental Behaviour Checklist-Primary Carer Version (DBC-P) and Teacher Version (DBC-T). Differences due to age, gender, IQ and family structure (adopted/living with birth parents) were also explored.
The mean composite adaptive behaviour score on the VABS-II was classified as “low” at 68.2 (SD=8.5), with the socialisation domain being the most impaired.
Significantly lower VABS-II composite scores were found in individuals with lower IQ’s, older ages and in males.
Disruptive behaviours were the most commonly observed on the DBCs, whereas primary carers scored significantly higher than teachers across all subscales.
IQ, age and gender were not associated with the total percentile scores of both DBCs.
Adoption made no differences compared to living with birth parents.
Yet another report: Adaptive behaviour in children and adolescents with foetal alcohol spectrum disorders: a comparison with specific learning disability and typical development came to the following conclusions:
In conclusion, children and adolescents with FASD are often exposed to a double burden in life, as their neurological sequelae are accompanied by adverse living surroundings exposing them to further environmental risk.
In addition, they remain remarkably underdiagnosed by the health care system.
The results of this study show that the adaptive abilities of children and adolescents growing up with FASD are significantly compromised compared to both typically developing peers and IQ-matched children with SLD.
On a societal level, more efforts and resources should be focused on recognizing and diagnosing FASD and supporting communication skills, daily living skills and most of all social skills across diagnostic groups within FASD.
Without adequate intervention, adolescents and young adults with FASD run a great risk of marginalization and social maladjustment, costly not only to society but also to the lives of the many young people with FASD.
There is an intervention program in testing to help with adaptive functioning :
GoFAR: An Intervention for Affective and Metacognitive Control in FASD
The GoFar program focuses on a core area of deficit identified in FASD; that is, on disorders of affective and cognitive control that are central to behavioral and adaptive disorders from infancy through young adulthood.
By school age, such problems often present as attentional problems, deficits in executive functioning and disorders in conduct and behavior. GoFAR develops methods to address these problems in young children by bringing together computer game technology and behavioral techniques for affective and cognitive control.
The methodology is based on previous work that suggests that a metacognitive technique (FAR: “F” Focus/Plan, “A” Act, “R” Reflect) is helpful in improving behavioral and educational outcomes in FASD. An important element is the GoFAR computer game, a “serious game” that supports the understanding and development of metacognitive control techniques and reinforces its use by clinically-referred children, ages 5 to 10 years.
This game is incorporated into a 10 week, manualized intervention program which focuses on improving adaptive functioning and behavior.
We carried out a clinic trial of a pilot group of 30 alcohol-affected children and their caregivers. Outcome measures included both standardized assessments suitable for a clinical setting and measurement of changes in physiological response. Pre and post testing allowed a preliminary understanding of the usefulness of the program elements, including the GoFAR game, as well as the suitability of the outcome measures selected.
More comprehensive evaluation of the efficacy of this methodology in treating the neurodevelopmental disorders associated with FASD is planned.
Quick Facts about GoFAR
- GoFAR includes a computer game that teaches children to control impulsive and problematic behavior.
- Parents and Caregivers are an important part of the GoFAR program.
- The program lasts 10 weeks with each session lasting 60 minutes.
- We are still enrolling volunteer families to participate in the program.
- Evaluation of the child’s behavior and emotional responding
- Computer games
- Learning parenting strategies to improve child behavior
- Outcome testing to evaluate results
So as with other areas, early intervention is key. And while many of our children may not reach full independence, we strive for inter-dependence. And that is not a bad thing. Really, as a society, unless you are a survivalist, we are interdependent on each other. We just have to redefine what our family will look like long term.
Come back tomorrow for more FASD specific information on characteristics, behaviours and challenges.