Language and Communication Problems

Persons affected by prenatal alcohol exposure typically have communications problems, even when they do not have a low IQ. They can have problems with learning language, as well as with expressive language and receptive language.

One common problem that affects language and communication among persons affected by FASD is reaction time; i.e., prenatal alcohol exposure is associated with slower, less efficient information processing speed.

It takes the alcohol-damaged brain longer than the non-damaged brain to interpret communication it receives from the environment, including spoken and non-verbal messages (facial expressions, tone of voice, etc.). Problems with logical thinking, abstract reasoning, and working memory can also make expressing themselves difficult for persons with FASD.

I’ve always been quiet. My brain is not! If I could say what I think, I would never shut up.. I find myself in situations where everyone is talking and I seriously cannot connect my brain with my mouth so I appear quiet or shy…I know that my brain is not cooperating. It can be embarrassing to have a room full of people waiting for me to put my sentence together…

I think one of my biggest frustrations is communication. I could walk around with a pencil and paper and communicate all day, but that is not how the world does it. We (people with FASD) are expected to do what the rest of the world does. What if we all walked around with different forms of communication. Not just speech. A lot of my frustrations are simply because I am not able to communicate what I want or need to.

Annied (Ann Kagarise), Blogger, Living with FASD

Expressive language challenges in individuals with FASD can include:

  • Remembering or retrieving commonly-used words quickly when needed.
  • Creating grammatically correct sentences. For example, using the wrong verb form in a sentence.
  • Using fluent speech, but without meaningful or appropriate content (also known as “cocktail party” conversation). For example, having with appropriate responses in a conversation, or starting a conversation with someone else.

Receptive language challenges in individuals with FASD can include problems with:

  • Memory.  For example, a child with problems with receptive language may not be able to remember what the teacher said.
  • Sequencing
  • Discrimination between words
  • Comprehension,
  • Selective attention
  • Word association (associating a word with an idea)
  • Generalization.(Using a word associated with a specific task or setting to more global uses).

The National Institute on Alcohol Abuse and Alcoholism notes that children with FASD have issues with encoding in verbal memory — the processing of information to then recall later — which can result with a receptive language development delay.

Children with FASD may be diagnosed with problems with speech production. They may have significant issues with voice quality, forming words, fluency and pronunciation.

Language development difficulties caused by FASD can impact a academic performance as well as social interaction.  For example, the individual may have problems drawing conclusions, following verbal instructions, reporting events accurately or even truthfully. When participating in group discussions, the person may go off-topic. He may perseverate and have difficulty transitioning to a new subject. He or she may have trouble communicating calmly, taking turns, listening, and responding effectively, which can affect interaction with others.

Parents, teachers, supervisors, probation officers, or others can use different interventions to help individuals with FASD. These include:

  • Language development checklists (to determine what specific problem(s) the person is having
  • Combining visual representation with words. Depending on the age of the person, these may include pictures, puppets, hand cues, musical cues, specific objects, etc.
  • For readers, a tape recorded version of the material to listen to at the same time.
  • Picture dictionaries
  • Visual instructions
  • Sight word cards for required vocabulary 
  • Art projects can make abstract concepts more concrete for a student.
  • Assistive technology, such as smartphones (for text messages, storing photos, etc.), calculators, and electronic spell checkers, may help the individual in the classroom and in the community
  • Ask the person to draw pictures of what happened (during a specific incident, event, activity, or to describe a feeling or problem); help him or her to caption the pictures, and sequence them. Then talk together about the sequence of images.
Here are additional rules of thumb:
  • Concrete communication is important when communicating with an individual who has FASD.
  • Keeping instructions short, and allowing time between instructions to allow time for the person to process one before hearing the next one, is important.
  • Minimizing the use of similes (“We’re like two peas in a pod”) and metaphors (“That guy is bad news”), and any other language that could be interpreted in multiple ways, is important.
  • Asking the person to restate, in his own words, what he understood is helpful along the way to make sure that what he understands is what was intended.