FAS/E and Impulse Control
(Teresa Kellerman's reply to a parent's question)
"Why can't they control their impulses?
That is the part I don't understand. If they can understand, why can't
control it? I don't understand."
Fact: John understands the rules
Fact: John understands the consequences.
Fact: John goes ahead and does it anyway (AGAIN).
Fact: John can later relate the exact rules and consequences.
Fact: Mom emits a long sigh.
Fact: John still cannot control his behaviors most of the time.
Remember hearing about how the prenatal exposure to alcohol affects
the corpus callosum? That's the membrane between the left brain and
the right brain that passes information between the two hemispheres of
the brain. The corpus callosum of kids with FAS/FAE is damaged, and
in some cases it is absent.
The left brain is the one that handles facts, rules, order, thoughts,
language and logic. The right brain is the one that handles music,
intuition, creativity, and impulses. Is it beginning to become clear yet?
The "do's and don'ts" are sitting there in the left brain, but when that
hits the right brain, a child with FAS acts first, and processes the
later, information that is there but cannot be accessed in time to prevent
This is very similar to what happens when a "normal" person drinks
alcohol. After a few drinks, alcohol shuts down the left brain, which
kind of falls asleep and no longer functions the way it should. So the
person is now acting on the right brain only, feeling, acting on impulse,
A person with FAS is kind of like an inebriated person. You all know
how a person who has had one too many might try to drive home, even
if he knows he shouldn't, or a person might say things impulsively that
she wouldn't dare say when she's sober. A man and woman are more
likely to have unprotected sex when they have been drinking.
You all know what I'm talking about. I have heard this behavior described
for FAS and alcoholics as "F--k it" syndrome, because a person does
something anyway, even when they know it is likely to cause trouble.
Impulse control has NOTHING to do with knowing the rules or understanding
the consequences when rules are broken. Impulse control is a neurological
function of the frontal lobe, which is damaged by prenatal exposure to
The frontal lobe, when it functions properly, controls inhibitions and
When the frontal lobe has connections that are not wired properly or when it
has holes in it, well, it just is not going to function well. It is NOT a
Giving John cues and reminders helps him to control his impulses because
it interrupts the process between impulse and action long enough for the
information to get where it needs to go.
Medication seems to sober John up... really! And when his meds wear off,
its just like watching him get drunk. He turns into Mr. Silly, immature,
of attention, pain in the butt. With meds, he's almost human! :-)
I have explained this to John enough times that I actually think he
the concept pretty well. As a matter of fact, when John does something
stupid, I never ask him "Why did you do that?" because he just might explain
it to me.