2013. Vol.4, No.3A, 325-334
Published Online March 2013 in SciRes (
Copyright © 2013 SciRes. 325
Assessment for Intervention of Children with Fetal Alcohol
Spectrum Disorders: Perspectives of Classroom Teachers,
Administrators, Caregivers, and Allied Professionals
Jacqueline Pei, Jenelle M. Job, Cheryl Poth, Erin Atkinson
Department of Educationa l P sychology, University of Alb e rta, Edmonton, Canada
Received December 21st, 20 12; revised January 21st, 2013; accepted February 17th, 2013
The present study begins to address the need for evidence-based approaches for guiding the psychological
assessment of children with Fetal Alcohol Spectrum Disorders (FASD). This project represents an impor-
tant step toward increasing links between research and practice in the communication and use of assess-
ment results for informing intervention decisions. Using a qualitative research approach, the current study
contributes to knowledge about concerns with current psychological assessment practices and offers sug-
gestions for optimization based on conversations with teachers, administrators, caregivers and allied pro-
fessionals. Thematic analysis of 11 focus groups and 3 interviews (N = 60) yielded 3 major findings: the
need to focus on the whole child, the necessity of an assessment process that is responsive, and building
capacity in the school. This study increases the links between research and practice as we move toward a
model of assessment for intervention. Such a model has a strong potential for optimizing assessment prac-
tices to better meet the needs of children with FASDs as it promotes a shift that focuses on successful
child outcomes regardless of diagnosis.
Keywords: Fetal Alcohol Spectrum Disorders; Assessment; Intervention; Supports and Resources;
Children; Focus Group
Fetal alcohol spectrum disorders (FASDs) are a serious
health and social concern (Chudley et al., 2005). FASDs are the
result of maternal alcohol consumption during pregnancy and
have significant implications for the affected person, mother,
family and community due to lifelong deficits in several do-
mains of brain function (Chudley et al., 2005). Although litera-
ture regarding the behavioral profile of individuals with FASDs
is relatively limited (Burd, Klug, Martsolf, & Kerbeshian,
2003), reported neuropsychological and social deficits include
cognitive delay, poor executive functioni ng, limited social aware-
ness, weak adaptive skills, and mental health issues (Burd et al.,
2003; Harris, MacKay, & Osborn, 1995; Kelly, Day, & Stre-
issguth, 2000; Pei, Denys, Hughes, & Rasmussen, 2011; Ras-
mussen, 2005; Steinhausen, Willms, Metzke, & Spohr, 2003).
These substantial impairments create daily challenges for indi-
viduals living with FASDs. These difficulties can be lessened
with appropriate interventions and supports that are especially
effective when implemented in a way that involves collabora-
tion among those involved in the child’s life across home and
The school experience is often significantly impacted for
children with FASDs given the frequent presence of specific
cognitive and academic difficulties (Howell et al., 2006) as well
as behavioral problems. Given the disorder’s diverse presenta-
tion, there is a strong potential for school personnel to misun-
derstand the affected child; thus, it is unsurprising that many
children do not receive the empathy or accommodations they
require and may become frustrated and contemplate leaving
school (Duquette, Stodel, Fullarton, & Hagglund, 2006a). None-
theless, promising research has shown that given the right en-
vironment and support, adolescents with FASDs can graduate
from high school (Duquette, Stodel, Fullarton, & Hagglund,
2006b) and go on to lead fulfilling and quality lives (Ackerman,
1998; Green, 2007; Ryan & Ferguson, 2006a, 2006b). There-
fore, the critical role of appropriate interventions and supports
for these children cannot be underestimated.
Assessment versus Intervention
Psychological assessment is often the first step in the devel-
opment and implementation of appropriate interventions for
children with a variety of psychological and educational needs,
including those with FASDs (Kalberg & Buckley, 2007). The
array of symptoms and deficits associated with FASDs lends
itself to the need for comprehensive assessments that identify
the affected child’s strengths as well as highlight weaknesses
requiring additional support. This information aids teachers and
allied professionals to implement suitable programming and
provide meaningful accommodations. Although often a helpful
and key part of the intervention process, current assessment
practices are not without their limitations. In fact, a general
dissatisfaction with current psychological assessment and report
writing practices has been noted for more than four decades,
although little has been done to improve practices and remedy
these concerns (Mastoras, Climie, McCrimmon, & Schwean,
2011). Teachers, parents, and other service providers involved
in working with children with a variety of special needs and
educational requirements continue to express concerns about
test administration, report writing, and communication of the
Foremost, psychological assessments have been criticized as
being disconnected from the interventions they are intended to
inform. Examining the usefulness of assessment reports, Kno-
etze and Vermoter (2007) conducted focus group interviews
with 10 remedial teachers in South Africa. These discussions
revealed 3 important findings related to the lack of collabora-
tive practice in current assessment practices. First, teachers re-
ported a gap between the psychologist’s assessment expertise
and his/ her practical knowledge of the classroom environment
including teaching strategies and interventions. Second, it was
shown that although teachers respect the skills psychologists
bring to the assessment process, they believe that they too pos-
sess expert knowledge on classroom interventions and should
be consulted with when making decisions about programming.
Lastly, teachers noted that their input is rarely sought when
recommendations are written, resulting in suggestions that have
already been attempted by the teacher or that are unrealistic for
the classroom. The disconnect between the potential usefulness
of assessment and the reality of current assessment practices
serve as an impetus for the present study.
Understand ing Reports
An essential precursor for educational strategies is that teach-
ers and parents have access to useful psychological reports
(Borghese & Cole, 1994). In particular, a report is useful when
it is easily understandable (e.g. Cheramie, Goodman, Santos, &
Webb, 2007), when information is sufficiently specific to drive
interventions (Ryan & Ferguson, 2006a), and when strength-
based language is used in addition to highlighting weaknesses.
Researchers have reported that the language used in reports
(e.g., technical jargon) and the time it takes to decipher recom-
mendations often frustrates teachers and parents (Cheramie et
al., 2007; Knoetze & Vermoter, 2007). Workload issues restrict
the time teachers have available to read and understand a psy-
chological report. For parents, limitations in education and
reading ability pose a challenge for genuine understanding
(Harvey, 1997), which can lead to feelings of detachment from
the assessment process and impede recommendation fol-
low-through and advocacy (Groth-Marnat, 2009). Despite nu-
merous suggestions for the improvement of psychological re-
ports, specialized reports full of complex language continue to
be produced (Harvey, 2006; Mastoras et al., 2011).
Even when report language is not a concern, teachers often
feel that the way in which reports are written is too general
(Ryan & Ferguson, 2006a), and does not focus enough attention
on the identified issue(s). Often teachers feel as though they
need to perform their own evaluations after receiving the report
to pinpoint specific areas needing support (Knoetze & Ver-
moter, 2007). Ultimately, the purpose of psychological assess-
ment is to aid in the planning and implementation of individu-
alized interventions focused on improving functioning and
achievement (Fletcher et al., 2002); however, if the reports
generated address concerns in too broad a manner then their
relevance and value are compromised.
Another concern is the continued dissatisfaction with deficit-
focused language used consistently in reports (Groth-Marnat,
2009). Assessments often focus on what the child cannot do
or what they struggle to do—rather than suggesting areas in
which they demonstrate strengths (Mastoras et al., 2011). And
yet, research has found that including personal and educational
strengths in a psychological report can have a significant thera-
peutic effect, and that focusing ability rather than solely dis-
ability ca n lead to more efficacious tr eatment recommenda tions
and long-term growth (Seligman, Linley, & Joseph, 2004). Pro-
viding teachers with information about the strengths a child
possesses and how these can be used to compensate for learning
and behavioral difficulties may help them to tailor and imple-
ment interventions that have the capacity to facilitate change.
This may serve to lessen the educational frustrations of the
affected child as well as relieve some pressures from teachers to
modify programming without appropriate understanding of
what will work best.
Assessment for Intervention
Taken together, the limitations associated with current as-
sessment practices often lead to confusion and frustration for
teachers and allied professionals working with children with
FASDs who present with varied psychological, behavioral, and
educational needs. Overall, these concerns are not unique to the
assessment of children with FASDs but exist for evaluations of
children across contexts, ability levels, and cultures (e.g., Kno-
etze & Vermoter, 2007), demonstrating global challenges with
psychological assessment and its usefulness for intervention
determination. While the implications of less-than-optimal as-
sessment practices are far-reaching and affect a number of peo-
ple, they are especially troubling for children who present with
involved psychological profiles such as those with FASDs.
Given this complexity, the problems created by inefficient and
inadequate diagnostic-driven assessment practices are magni-
fied. The tim e for a move to assessment for intervention ha s come.
Purpose and Objectives
The present study is part of a larger program of research fo-
cused on improving educational practices for children with
FASDs (see Job et al., 2013; Pei, Job, Poth, O’Brien-Langer, &
Tang, 2013; Poth, Pei, Job, & Wyper, 2013). This study ad-
dresses the call for increasing the voice of teachers, adminis-
trators, caregivers, and allied professionals (i.e. social workers,
counselors, and educational assistants) in research related to
school-based interventions and supports. In particular, our find-
ings report on the assessment experiences of key stake-holders
involved in the implementation of interventions and support
services for children with FASDs (Job et al., 2011).
With a goal to inform school psychology practice, this study
was guided by the following 3 objectives: a) examine the posi-
tive and negative assessment experiences and attitudes of teach-
ers, administrators, caregivers, and allied professionals working
with children with FASDs; b) determine whether the experi-
ences of these stakeholders are consistent with the general the-
mes of dissatisfaction identified in the assessment literature;
and c) propose solutions to current psychological assessment
approaches considering the suggestions of key stakeholders,
and linking them to emerging research and evidence-based
practice in the field.
A qualitative, phenomenological approach was appropriate
given the study’s purpose to generate a comprehensive under-
Copyright © 2013 SciRes.
standing of experiences to inform practical next steps (Creswell,
2013). Semi-structured focus groups were selected as the means
for data collection as this allowed researchers to capture indi-
vidual stakeholder perspectives as well provide a forum for
participants to meet others who had experienced similar strug-
gles in the pursuit of diagnostic testing and specialized supports.
This interaction also provided those who had faced consider-
able obstacles with hope when listening to others’ stories of
successful assessment and intervention. Data collection for this
study follows the call for an increased presence of stakeholders’
perspectives in educational research involving children with
FASDs (Duquette et al., 2006a), facilitating a deeper under-
standing of the issues in assessment and roles involved parties
play in navigating the process (e.g., facilitator of the assessment,
recipient of report results, and communicator of the information)
(Krueger & Casey, 2000). For stakeholders unable to attend
focus group times, interviews were conducted following the
same protocol. Trustworthiness and confidence in the data was
enhanced by the use of verbatim transcripts, member checking
of focus group and interview summaries, and multiple coders
(Merriam, 2009; Patton, 2002).
A total of 60 individuals participated in the present study in-
cluding 31 teachers, 7 administrators, 16 allied professionals,
and 6 caregivers. Teachers reported having a degree of expert-
ise in special education, a mean of 13.2 years of experience
(range 1 - 32 years), and representing all levels of instruction (7
identified as Kindergarten to grade 5 and 24 identified as grade
6 to 12). Administrators had a mean of 22 years of experience
(range 15-30 years) within various roles (2 principals, 4 assis-
tant principals, and 1 head of student services). Allied profes-
sionals reported a mean of 10.89 years of experience (range 1 -
25 years), with the majority (12) identifying their roles as edu-
cational assistants and the remaining as other (i.e., in-home
consultant, reading specialist, guidance counselor, and manager
of the school’s Academy of Reading & Math Programs). Care-
givers consisted of 2 maternal grandmothers, 3 foster mothers,
and 1 adoptive mother. Their mean years of experience ranged
from 6 to 43 with a mean of 17.83 years. The age range for
affected children with whom the stakeholders worked was 3 to
18 years.
Data Collection
Participant recruitment was ongoing from March 2009 to
May 2012, using snowball sampling through established clini-
cal networks via email and telephone. Allied professional and
caregiver participants were identified through their involvement
with local FASD networks and programs. Administrator and
teacher participants were identified based on FASD student po-
pulation. Criteria for participant selection included: a) experi-
ence with a child with an FASD; b) involvement in that child’s
psychological or neuropsychological assessment (e.g., complet-
ing forms, providing an interview, being provided with assess-
ment results, and/or implementing interventions based on report
recommendations); c) working with that child in the classroom
or having knowledge of his/her classroom experience; and d)
communicating w it h car eg ivers, admini strators, teachers, and/or
allied professionals in support of successful outcomes.
In total, 11 focus groups and 3 individual interviews by role
(i.e., teachers, caregivers) were held, each lasting approxi-
mately one hour and following a semi-structured protocol. Re-
gardless of whether stakeholders participated in focus group or
interview sessions, the same protocol and probes were em-
ployed, with minor adaptations to reflect role-specific experi-
ences. For example, the question, “What supports outside the
school system have you accessed to help your child?” was
asked solely of caregivers to provide information about com-
munity supports and resources. The number of focus group
participants ranged from 2 to 9 with a mean of 6. Two research
assistants (interviewer and note-taker) with advanced training
in qualitative research facilitated the sessions. The presence of a
note-taker allowed the interviewer to remain fo- cused on the
interview process. Discussions were audio recorded and tran-
scribed verbatim, and a preliminary analysis generated summa-
ries that were distributed to participants electronically as a
means of member checking (Creswell, 2012). Participant feed-
back and additional comments were incorporated as notes in the
transcriptions to ensure accuracy of the data and completeness
of participant response.
Data Analysis
Inductive analysis was undertaken in 3 phases: individual fo-
cus groups and interviews, across focus groups and interviews
involving the same roles, and finally a cross-analysis of focus
groups, interviews, and roles. The integration of data sources
was guided by a constant comparison approach (Glaser & Stra-
uss, 1967) wherein codes and categories across focus groups
were compared for both congruence and dissonance by two in-
dependent researchers. Researchers began by generating codes
for one transcript, and then adding on or modifying codes
across transcripts within the same roles. Codes were discussed
until consensus was reached with the aim of achieving inter-
rater reliability of 90%. Code definitions were informed after
reading all transcripts.
At the end of this process, codes were pared down and as-
signed to broader categories. Summaries were written for each
role and helpful during the cross-analysis, allowing researchers
to compare similarities within each role and highlight differ-
ences across roles. This allowed for further streamlining of the
code and category lists and allowed for the identification of
themes and subthemes (see Figure 1) with definitions. Com-
plete coding lists demonstrating the progression from codes to
themes were created for each role and then integrated as much
as possible into a master list across roles. Important data spe-
cific to one role were starred and discussed separately within
the findings.
Findings and Discussion
Thematic analysis yielded 3 major findings which focused on:
the whole child, the assessment process, and building school
capacity. Interestingly, findings revealed that concerns with and
goals for improved assessment processes were not limited to
the FASD population but rather all children. The high needs of
children with FASDs simply serve to draw attention to the im-
portance of such changes. The following section is organized
by theme illuminating key concepts and experiences.
The Whole Child
Increasing the scope of the assessment process, to reflect the
Copyright © 2013 SciRes. 327
Copyright © 2013 SciRes.
Figure 1.
An example of code and theme devel opment across roles.
whole child, emerged as a necessary initiative in the move to-
ward improving diagnosis and intervention. To do this, partici-
pants felt that the information gathered must be sufficiently
comprehensive to reflect the complex needs of this population.
The goal of psychological assessment for diagnosis was ques-
tioned, with the rationale that there is a role for diagnosis within
the assessment process to help initiate funding, but that the
process can consist of more than the diagnosis alone. In short,
two key ideas were detailed: seeking the big picture through a
more collaborative and thorough assessment process and con-
sidering the role of diagnosis as a vehicle for resources and
Seeking the big picture. The process of gathering informa-
tion from multiple sources was consistently noted as being
foundational to the validity of the assessment process across
caregiver, administrator, and allied professional roles. The need
for more comprehensive assessments involving multiple indi-
viduals and data sources was emphasized in contrast to making
a determination for diagnosis and intervention based on limited
information. Wynn, an administrator, discussed the process of
assessment at her school: “Our psychologist meets with us,
gathers the information, [and] observes the kids on two or three
days…” The advantages of such a process include a better un-
derstanding of the child’s strengths and weakness across set-
tings, which enhances the likelihood that the assessment will
inform meaningful and feasible interventions, rather than “…
just getting a one-hour snapshot”.
A disconnect within the process of integrating the assessment
data to inform intervention decisions and practices was viewed
as being a source of concern as was the quality of written psy-
chological reports. Currently, assessment seems to be focused
on the product (i.e. producing a psychological report) rather
than the process of collaborating and involving all individuals
who care for the child in order to understand his or her needs.
For high-needs populations such as children with FASDs, con-
sistency in assessment process and practice has been revealed
in the literature as being key to implementing well-suited inter-
ventions. Ensuring all individuals involved in caring for chil-
dren with FASDs have the same information and understanding,
and considering their suggestions and feedback in the assess-
ment and intervention processes is crucial (Blackburn, Carpen-
ter, & Egerton, 2010).
Similar to the call for the inclusion of multiple sources in as-
sessment, participants ac ross all four roles indicated a desire for
the incorporation of information useful to strengths-based pro-
gramming. Caregivers and allied professionals discussed the
hindrance of a deficit-model, which emphasizes areas of weak-
ness and perpetua tes stigma and stereotypes. The use of a defi-
cit-model proved common in the assessment experiences of
participants across roles with only one caregiver experiencing a
supportive and strengths-based evaluation: “…[the assessment
proved] very supportive…the girl from the psych report [ex-
plained] his areas of strength and weakness and learning
style…so that they could make accommodations for him” (Jes-
All participants agreed on the usefulness of information
about cognitive and academic strengths in developing appropri-
ate interventions, noting that having the complete learning pro-
file of a child with an FASD leads to greater success in pro-
gramming and achievement. Concentrating on deficits may en-
able school psychologists to diagnose disabilities but such prac-
tice does not inform intervention and treatment of difficulties
(Jimerson, Sharkey, Nyborg, & Furlong, 2004). Conversely, re-
searchers posit that identifying areas of strength (e.g., confi-
dence) may help to address underlying challenges rather than
simply managing observable behaviors (Terjesen, Jacofsky,
Froh, & DiGiuseppe, 2004). The use of a strength-based ap-
proach also allows school psychologists and educators to better
understand affected children and their resources, facilitating
more complete intervention planning (Rhee, Furlong, Turner, &
Harari, 2001).
Considering the role of diagnosis. When considering the
consequences of diagnosis for a child with an FASD, caregivers
discussed diagnosis as a vehicle for accessing resources. Care-
givers tended to view diagnosis as a strength allowing them
access to services and accommodations that were previously
unavailable rather than a label that would negatively affect their
“I felt it’s more important that the child gets help than
worry about a label…I gave the school copies of all the
reports that we had…in fact one of the teachers said to me,
‘I’m so grateful to you for communicating this with us.
You’d be surprised how many parents don’t want us to
know the children have some problem.’” (Jessica, Care-
Darlene, a caregiver, added that diagnosis provides support
in advocating for specialized programming and resources:
“some of the positive things about having a diagnosis is
you’ve got something to work with and you’ve got back
up. [If] you’ve got that piece of paper in your hand, then
you don’t have to back down from anyone”.
For school personnel, diagnosis was viewed as more of a
guide, affording children and families greater direction and
support. As Wynne, an administrator, explained:
“…quite often if the child has FAS, there’s a good chance
the [biological] family is. So, they don’t have the structure.
They don’t have the ability to come in and share their ex-
periences since schools have not been good…quite often
they avoid the school. They’re not coming in there advo-
cating…so, it’s helping them also.”
Caregivers may fear assessment and diagnosis for their child
believing that it can lead to differential treatment by teachers,
peers, and even other family members. However, receipt of a
diagnosis can have value, providing a way to identify the af-
fected child’s difficulties and abilities and plan for problems
that may arise in future educational endeavors (Temple Univer-
sity Institute on Disabilities [TUID], 2003). A diagnosis can
also be beneficial in linking children and families with funding
and specialized programs and affording them access to services
crucial to success and healthy child development (TUID).
One of the main concerns with either a lack of psychological
assessment or less-than-optimal assessment practices is that
affected children may be misunderstood, resulting in inadequate
or inappropriate educational support. Tom, an administrator,
explained this challenge: “…quite often we don’t know because
they haven’t been formally diagnosed and they’ve been going
through school for many years you know being seen as behav-
ior students…” However, receiving a diagnosis may not be
enough for improved understanding of FASD, especially con-
sidering the diverse presentation of the disorder in affected
children. As Chloe, a caregiver, so eloquently expressed: “…
regardless of whether it’s the same label, they are different
children…and that’s what…people have to look at. Just be-
cause everybody has the same label doesn’t mean everybody’s
the same person.” Therefore, the utility of assessment and di-
agnosis appears hedged in how well teachers, administrators
and allied professionals are prepared to work with children with
FASDs and how informed they are about the condition.
Despite efforts to differentiate between diagnostic labels and
better inform teachers of the disorder (Chudley et al., 2005),
such attempts do not necessarily translate into improved teacher
knowledge of what challenges he/she may see in the classroom
(Clark, 2012). This is why professional development and re-
sources specific to FASD are essential for school personnel and
allied professionals working with affected children. In instances
where the needs of the child with an FASD are well understood,
stakeholders can work collaboratively to provide necessary
services, as in the case of Laura, a caregiver:
“…we got [the assessment] nice and early…this is what
allowed us to have all this wonderful help...our grandson
was given two years in kindergarten and he had occupa-
tional therapists and physiotherapists. He had all sorts of
things coming into the room because he was eligible for
it…early on someone [was] coming to the house to work
with him at home…everything was really good but it was
all based on that diagnosis.”
Researchers have established the importance of accurate di-
agnosis in determining appropriate interventions and limiting
the effects of secondary conditions (Malisza et al., 2005). How-
ever, diagnosis necessitates a response that includes the devel-
opment of a network of support and program planning tailored
to the affected child’s specific needs (Public Health Agency of
Canada, 2011). Whereas caregivers can help with advocacy and
modeling, school psychologists and educators can have an in-
fluence through creating and following individualized program
plans, establishing smooth transitions, and collaborating with
caregivers and community members (Duquette et al., 2006a).
Findings from the present study would suggest that while we
are striving toward a more collaborative, supportive model of
diagnosis and intervention, there is still work to be done.
The Assessment Process
The assessment process itself also emerged as an area of
conversation with participants. Many of these discussions
seemed linked to the underlying philosophy that accompanies
psychological assessment. Assessments may often be seen as a
way to react to concerns by identifying the problems that are
present. However, what this perspective fails to do is provide
any proactive response options with consideration for both
deficits and strengths with a goal toward identifying what suc-
cess might look like rather than solely why there is failure (Klin,
Saulnier, Tsatsanis, & Volkmar, 2005). Consequently, two key
ideas emerged: responsiveness of the assessment to prevent the
occurrence of greater problems and finding success by ensuring
professionals are equipped to help affected students achieve
Responsiveness. Participants spoke about the logistical com-
ponents of the assessment process as they contribute to prac-
tices that are deficit-focused and reactive due to the boundaries
of process (e.g., delay in achievement must be demonstrated
before an assessment can be requested). Consequently, they
emphasized the need for the process to be responsive to chil-
dren, educators, and families in order to effectively address
learning and behavioral needs and concerns with an eye toward
success rather than simply reducing problems. Paramount to
this idea is offering assessment services that are timely and
accessible. For some participants, the assessment process was
smooth and allowed for timely receipt of diagnosis and recom-
mendations, as evidenced by one caregiver, Jessica’s account:
“…I requested [a psycho-educational assessment] for him
and they were more than willing [to do it] right away, no
Copyright © 2013 SciRes. 329
questions asked…I didn’t have to fight for it. I didn’t have
to justify why I wanted it. They were just willing to do
it…[and] they had the psych[ological] report done right
For others, the wait for an assessment across school and
community settings was long yet worthwhile. As Laura, a care-
giver noted, “…it takes a number of months to get in [for an
assessment]…but it was a very smooth process once we started
it. And then there’s a whole team of professionals that work
with these kids.” This experience was echoed by school per-
sonnel who reported lengthy waits for an assessment due to
psychologists’ full caseloads: “…even the assessments that do
get done at school…they are well done but they’re a very
lengthy process” (Nadia, Allied Professional).
Overall, stakeholders underscored the benefits of early as-
sessment by qualified professionals. One teacher specified that
a “good, accurate assessment would be really [helpful] to get all
the testing done quickly and…by the right people” (Jenna).
Working toward an assessment model that allows for early and
timely diagnosis and intervention information enables the child
with an FASD access to funding for programmatic changes and
resources, focusing on growth rather than struggle (Healthy
Child Manitoba, 2010).
Equally as detrimental as the wait time identified by teacher
and administrators was the wait-to-fail model wherein assess-
ments cannot be accessed until a consistent lack of achievement
is shown. Wynne, an administrator, described her view of this
system and ideas for improvement:
“…it’s kind of frustrating ‘cause they now have experi-
enced 3 years of failure because they have to be 2 years
behind before they actually get identified. If we can iden-
tify them earlier then the school can be set up so that
they’re helping…streamline them into a special education
program if they need or at least [let] the teachers adapt…”
Evidence of the benefits of early diagnosis (e.g., improved
care of primary deficits and decreased impact of secondary
disabilities) is well documented (Koren, Nulman, Chudley, &
Loocke, 2003; Streissguth & Kanter, 1997) as a useful way to
reduce later adverse outcomes. However, some children with
PAE meet developmental milestones at age-appropriate times
and thus, an assessment at one time point may not provide a
comprehensive picture of functioning. For instance, it is only
when neurobehavioral deficits arise, including impairment in
executive functioning, that information about independent func-
tioning can be gleaned (Koren et al., 2003; Rasmussen, 2005).
Therefore, it may be prudent to think of assessment as not sim-
ply a diagnostic task but rather a way of gathering ongoing in-
formation about a child at key points in their education (e.g.
transitional times) to facilitate interventions that adapt to the
affected child’s changing needs and abilities. It is apparent that
too much of a delay for treatment (i.e., the wait-to-fail model or
time lags) can lead to a population of students who fall farther
and farther behind their classmates (Fletcher et al., 1998).
Finding success. Finding success through psychological as-
sessment means gaining understanding about where a child is at
and what would help to address his/her individual needs in
order to work toward success. For school personnel, this re-
quires adaptation, flexibility, and knowing your students. As
one allied professional, Bob explained:
“…it really depends on the kid. If the kid’s capable
then…we push to achieve…but I think that I really try to
be what the kid needs…it’s trying to see what’s going on,
what are the motivations behind what he’s up to, and…
then trying to provide him what he needs…”
However, part of achieving this degree of flexibility is de-
pendent on the team that participates in the assessment process.
It is imperative that the psychologist in charge of the assess-
ment recognizes that it will require a team to develop compre-
hensive intervention strategies and that the process warrants
contribution at all stages. As one teacher noted, intervention
planning is best done in collaboration:
“…the support makes you stronger as a teacher too,
right?...I learn so much from a [speech language patholo-
gist] and an [occupational therapist] and you learn so
many tricks [about] how they modify [things]…they come
in and they add something new and it just gets better and
better and you get stronger that way and more confident in
[your teaching]” (Carla).
Participants stated that it is not enough just to have profes-
sionals and families communicate with one another regarding
needs and strategies, but that children with FASDs require ac-
tive collaboration to identify needs and strengths and establish
effective strategies. This is commensurate with previous re-
search that emphasizes caregiver involvement in school-based
interventions (e.g., Clark, 2012; Kalberg & Buckley, 2007).
Such an approach will help with skill building, the improve-
ment of cognitive and learning strategies, and the reinforcement
of positive behaviors as well as involve families in the process
of advocating for needed and warranted services for their chil-
dren and themselves. Assessments geared toward intervention
can provide the catalyst and guidance for this degree of col-
All participant groups called for increased support for teach-
ers and caregivers from administration and other professionals
(e.g., social workers, counselors, and mental health profession-
als) so as to enhance the understanding of children with FASDs
and increase the utility of assessment. A teamwork approach
was described as a necessity whereby the workload is distrib-
uted among different stakeholders to ensure that affected chil-
dren receive needed assessments in a timely manner and that
shared understandings are reached. To assist in the provision of
interventions for children with FASDs, it is essential that pro-
fessionals working with this population receive adequate train-
ing and information about FASD-related deficits and secondary
disabilities, including the condition’s diverse presentation and
best practices for assessment and intervention (Gahagan et al.,
2006; Green, 2007; Paley & O’Connor, 2009; Paley et al.,
Building School Capacity
If a psychological assessment is to draw nearer to improved
understanding geared toward creating success for the whole
child—within assessment activities as well as through the as-
sessment process—then it is crucial that the assessment not
stand-alone. Instead, strong links between stakeholders and
effective communication strategies are important. To this end,
stakeholders emphasized the importance of a third theme fo-
cused on building school capacity in which two related chal-
lenges of the assessment process are emphasized: 1) clarity of
written communication that fosters understanding and facili-
Copyright © 2013 SciRes.
tates the development of interventions; and 2) transferring as-
sessment information to key stakeholders in a way that enables
implementation of useful recommendations for increased learn-
ing a nd development .
Information sharing. The discussion about assessment re-
ports centered around two unique topics: ease of sharing as-
sessment results with school personnel and difficulty in under-
standing report content. With respect to the former, it appears
schools are quite willing to receive assessment results and bet-
ter understand the affected child’s strengths and weaknesses:
“Most of the time I haven’t had difficulty sharing the as-
sessment and diagnosis. I’m also a very strong advocate
for my son…if somebody is a little bit…apprehensive or
leery about it, it doesn’t matter to me because I can over-
come that and just talk about…the positive things and the
things that he can do and the supports we need to put in
place…” (Jessica, Caregiver)
However, for those unfamiliar with assessment, the process
can be quite intimidating, especially for caregivers who have
heard often the weaknesses of their child. As such, the debrief-
ing session is not always a smooth or desirable event: “the par-
ents…find it daunting if… you’re supposed to offer them a
meeting with the person who conducted the assessment…”
(Tom, Administrator). Becky, another administrator further
elaborated: “…they’re tired, they’re exhausted. They don’t
need another report saying what their kid can’t do…they don’t
necessarily want to come in and meet with the psychologist to
go over the same thing…”
Breaking down the barriers of intimidation to facilitate open
communication between school psychologists, teachers, and
caregivers is paramount to information sharing. As it stands,
psychologists and other allied professionals are restricted in
their time to share information and resources, which can lead to
a duplication of services or gaps in service delivery for children
with special needs (Reddy & Newman, 2009). This limited
sharing of information and resources can leave teachers and
caregivers with disjointed assessment results, leading to inap-
propriate planning and intervention (Reddy & Newman).
Unique to the allied professional group, participants spoke
about the need for new and improved teaching strategies as
outlined by psychologists within the assessment report: “A lot
of the strategies that are given are like ‘Duh’…we already tried
that…Some of the strategies are just really silly and stuff that
we would already know and…do. We want new and improved
strategies that may work [for these students]” (Catia). The
specificity of strategies seemed to be of primary concern—with
school personnel looking for strategies tailored specifically to
the educational needs of children with FASDs. It seems that
there is a concern that while the psychologist may be the expert
in assessment, he/she may not be an expert on what is happen-
ing in the classroom and thus, what interventions would work
well for that environment (Knoetze & Vermote r, 2007).
Meaningful understanding. Language used in the report
emerged as a key challenge of current assessment practices and
was highlighted across teacher, administrator, and allied pro-
fessional roles. Language that was vague, complex or inconsis-
tent had significant implications for translation of report rec-
ommendations into action because school personnel had tre-
mendous difficulty understanding assessment results. For ex-
ample, one teacher candidly noted that the lack of comprehen-
sible reports leads many teachers to disregard them altogether:
“…teachers don’t read reports…[except] maybe at [Individual-
ized Program Plan] time…” (Sandra). Given that the psycho-
logical report provides such critical information, it is imperative
when writing to consider the education level and assessment
knowledge of the teachers and caregivers responsible for re-
ceiving the information and carrying out suggested recommen-
dations (Anastasi & Urbina, 1997).
Another area of debate was whether reports should include
“soft” language (e.g. “delay” rather than “deficit”) in describing
functional and behavioral limitations. The majority of partici-
pants across roles agreed that the use of softer language leads to
unrealistic expectations for improvement and pressure on teach-
ers to help children make gains:
“They want us to do assessments every year and see that
growth and when they’re seeing that their child’s not
growing then there’s got to be blame somewhere…‘what
is the school doing because my kid is still…[not] pro-
gressing?’…[and this is because]…the vocabulary has
been very delicate in saying ‘there’s a delay” and that in-
fers that at some point, if you work hard enough…you
will catch up…” (Sara, Administrator).
Overall, participants spoke to the inaccessibility of report
content due to complexities in language and written presenta-
tion. This finding is immensely important as it speaks to the
continued disconnect between knowledge and action. If teach-
ers and allied professionals are struggling to understand as-
sessment results, the likelihood that related strategies will be
incorporated in the classroom is limited. Knoetze and Vermoter
(2007) suggest teachers gain familiarity with psychometric tests
and psychologists make themselves aware of the aspects of
behavioral and cognitive functioning that would be most useful
to report on for school personnel and caregivers and write their
reports accordingly. Assessment for intervention necessitates a
bridging of the gap between the knowledge and skills of school
psychologists and those of teachers and allied professionals in
terms of assessment so that each stakeholder has a more holistic
understanding of the assessment process (Knoetze & Vermoter,
2007) and its ultimate goal of informing intervention.
Implications and Future Directions
This study highlights important implications and serves as a
call to action for researchers, school psychologists, and school
personnel. In advocating a move toward assessment for inter-
vention, there are 3 main ideas to be emphasized: a) assessment
and diagnosis are only as useful as the accommodations and
supports that follow; b) the varied learning and behavioral
needs of children with FASDs require assessments that are
geared toward informing intervention practices in order to
achieve the best possible results; and c) support for and inclu-
sion of teachers in the assessment process is vital, recognizing
their expertise and value in decision-making for programming
and intervention.
The present paper emphasizes the need for a fundamental
change in the purpose of assessment. Mastoras and colleagues
(2011) report that concerns and complaints about assessment
have lingered for more than forty years, and that little progress
has been made to improve upon current practices. If school
psychologists and educators are to effectively meet the needs of
children affected by FASDs, a paradigm shift away from diag-
nostic and funding goals toward informed interventions must
Copyright © 2013 SciRes. 331
occur. It is in this way that processes can begin to evolve, al-
lowing for greater collaboration among key professionals, im-
proved recommendations, and monitoring of child outcomes.
Stakeholders echoed many of the general feelings of dissatis-
faction identified in the assessment literature, suggesting that
the full potential of assessment is not being realized within the
school system. To remedy this, participants suggest a much-
needed shift in perspective. Through examination of the as-
sessment experiences and attitudes of teachers, administrators,
caregivers, and allied professionals involved in working with
children with FASDs, it is clear that a responsive assessment
process that reflects the whole child can be a valuable catalyst
to effective intervention practices.
Assessment must be re-conceptualized as a process of initi-
ating intervention. By using this lens to view assessment, as-
sessment moves bey ond simply attaching a diagnosis to a child
toward understanding the whole child within their environment
in order to best match their needs to the resources available.
This perspective then opens the door to some of the needs for
teamwork, collaboration, clear communication, use of lay ter-
minology, and consideration of both strengths and deficits of
the child with an FASD. This provides the opportunity to ap-
proach assessment in a proactive way; thus, avoiding the “wait
to fail” model and moving toward a “planning for success”
model. An assessment may or may not result in diagnosis, and
yet many affected children require specialized services and
supports to succeed in school. The goal then should be to dis-
cover and remediate the affected child’s underlying difficulties,
using assessment information to inform evidence-based instruc-
tion and intervention (Fletcher et al., 2004).
All professionals working with the affected child must be in-
vited to contribute to the assessment at several points, provid-
ing understanding and seeking solutions and strategies. By
moving to an assessment for intervention framework, a fluid
process of informed responding is created that recognizes ex-
pertise comes from many places, including both home and
school, which may then lead to improved consistency in im-
plementation of recommendations. However, moving to this
approach also means that more time must be allotted to teachers
and allied professionals to collaborate and plan next steps. In-
creased recognition of the proactive potential of assessment is
also required so responses can be initiated prior to crisis. To
enable these changes, it is crucial that both service providers
and schools recognize this potential and allocate resources (i.e.,
time and money). Those involved with the education system
must insist on this level of integrated service if this proposed
shift is to take place and we are to move forward in assessment
and intervention.
Due to the special nature of research with FASD populations,
several limitations in methodology are noted. First, the use of
snowball sampling, while convenient, can produce community
bias. Participants are not randomly selected and thus, may af-
fect the representativeness of FASD stakeholders. Those identi-
fied have been vocal in the field and may present with more
extreme experiences than the average teacher or allied profes-
sional working with affected children. A second limitation is
the lack of geographical and cultural representativeness of par-
ticipants in this study since school personnel worked within a
single, public school district with children with FASDs of little
ethnic variability (e.g., Caucasian or Aboriginal). To address
these limitations, researchers tried to select participants from as
many different schools and neighborhoods as possible and or-
ganized focus group sessions mixing stakeholders to limit the
familiarity of participants within each group. Third, the use of
focus groups can lead to questions of validity in that partici-
pants may be influenced by the researcher and/or other partici-
pants, providing responses that will be viewed favorably rather
than true experiences (i.e., socially desirability effect). It is
believed that providing summaries to participants and allowing
them a second opportunity to add to or change their responses
helped to enhance the trustworthiness of the data.
Without the fundamental shift toward assessment for inter-
vention, the needs of children with FASDs will continue to
remain unmet. The inability to meet the varied needs of this
unique population often results in frustration and discourage-
ment for the children and their teachers, and can lead to an
alignment with marginalized groups and other disruptive school
experiences for the individuals affected by FASDs—all secon-
dary disabilities frequently reported for this population (e.g.,
Streissguth et al., 2004). Considering the importance of inter-
vention and support services for successful outcomes of chil-
dren with FASDs, it is imperative that current assessment prac-
tices specific to this population be detailed, highlighting key
strengths and challenges. The recognition of important strengths
and weaknesses in the assessment process helps in the identifi-
cation of avenues for change as we move toward assessment for
intervention with the goal of successful outcomes for affected
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