 Welcome to Module 2. In today's session, we will be highlighting the differences between brain structure and brain function while emphasizing a process approach to understanding the behaviors of individuals with an FASD. Our objective is to explain that the effects of prenatal alcohol exposure on the developing brain may not result in structural differences, meaning that the brain may look as expected, but that does not mean that the brain functions as expected. As we discussed briefly in Module 1, the brain functioning of an individual with a fetal alcohol spectrum disorder can vary widely both within and between individuals. As a result, we suggest that it is helpful to move from the idea of listing problem behaviors and instead focus on building an understanding of the function or contributing causes behind individual behaviors. In this module, we would like to emphasize that the brain structure, that is, the physical makeup of the brain of an individual with an FASD, may be similar to the brain structure of an individual who has not been prenatally exposed to alcohol. We briefly touched on this in Module 1 when we discussed that injury caused by prenatal exposure of alcohol to the developing brain can be diverse and varied and is primarily related to brain function and not structure, which makes predicting the impact on behavior difficult. Although predicting challenging behavior can be difficult, we still have ways to make sense of the behavior we see that also allows us to become active and effective problem solvers when working with individuals with an FASD. In order to be active and effective problem solvers, we need to start with a tenant that all behavior is functional. What do we mean when we say that all behavior is functional? Well, it means that the actions we take serve a purpose. Regardless of what it may look like to an outsider, all behavior is goal-oriented, meaning that our behavior is meant to get us from point A to point B. The difficulty for the outsider is to determine what point B or the desired outcome may be, as well as what may be obscuring or blocking the path between A and B. One way to describe how all behavior is goal-oriented is to use an analogy. Let's assume our goal is to move a package in Alberta from Edmonton to Calgary. If all is well on the roads, we will likely drive that package taking Highway 2, the most direct road that supports the most efficient transport. Highway 2 between Edmonton and Calgary is the most traveled stretch of divided highway in the province and has a speed limit of 110 km per hour. Now, let's say our friend Johnny wants to move the same package between Edmonton and Calgary, but in his world, Highway 2 is a single lane gravel road with frequently changing speed limits. Johnny may still choose to use his version of Highway 2, but it will take him much longer to deliver the package from Edmonton to Calgary. In our example, Johnny may or may not be aware that everyone else can take the efficient road to achieve the delivery goal much more rapidly than he can, but regardless, he may become frustrated by his pace. If you were an outside observer who did not know that Johnny's route was a single lane gravel road, you may assume that it's Johnny's fault that he's not arrived with the package in the same amount of time as other people. Assuming that maybe he's running late because he's been slow to leave or has stopped along the way, maybe you thought that Johnny's goal was to stop and get a burger in route rather than delivering the package quickly, and this assumption could lead to thinking that the delivery is not important to him or that he does not care about it. Misinterpreting his behavior as an outside observer could leave Johnny further frustrated and angry as he may be working harder to attain the goal of delivering the package despite not being understood by others. So Johnny may be working harder to achieve the same goal as other delivery drivers because the route he has available to him functions differently than the route other typical delivery drivers can take. Let's take this analogy a step further and imagine that something has happened and that Johnny's preferred route, Highway 2, is actually closed. Since he still wants to make the delivery, he may choose to take another route from Edmonton to Calgary or maybe he'll choose to go to another city. In this case, Johnny is still seeking to attain the same result deliver the package as best he can, even if it arrives in a different city. Again, this leaves Johnny even more open to misinterpretation by outside observers as we may perceive his actions as oppositional or resistant to the original goal of getting the package from Edmonton to Calgary. An outside observer may think that Johnny's goal was to frustrate us rather than make a delivery because if he delivers the package to the wrong city, he is definitely frustrating anyone expecting the package in Calgary. As an observer, if we draw the conclusion that Johnny was deliberately and intentionally trying to be oppositional or defiant, we only add to his frustration because we have misunderstood his goal. Being misunderstood may consequently result in Johnny becoming angry, sad, or withdrawn, essentially making it harder for any future goal to be achieved. The result of misunderstanding a failed goal as intentional sabotage may also lead to Johnny setting a new goal to avoid future embarrassment and reject any new deliveries as it is better to reject the task than to look incapable of completion or to be misunderstood as oppositional and defiant when, in fact, Johnny tried the best he could given the routes that were available to him. So let's consider the analogy of roadways we've been discussing while returning to what we're learning about the brain. The brain is essentially comprised of approximately 80 to 100 billion neurons. Neurons have cell bodies that, in our analogy, represent cities and axons that represent the roadways that transport information between the cell bodies and around our brain. Information that ultimately presents as our behavior. One impact that alcohol has on the developing brain is to change the ability of our brain to move information around efficiently. So, applying our analogy, this means that some pathways in the brain that should be fast and direct, or paved, are slow and indirect, or gravel, for individuals with an FASD. The challenge is that we just don't know which roads are paved and which are gravel, so we can't predict what behaviors will be impacted. Because we don't know which pathways are affected, we need to rely on behavioral cues to tell us if there is difficulty. Importantly, rather than assuming that an individual is behaving in oppositional or resistant ways, we need to try to determine what their goal was and what might be obstructing their path. For example, is there roadway gravel instead of pavement, so we can provide support like giving them clearer directions and more time to achieve their goal? Let's add one more factor to our analogy, weather. Consider the impact of a snowstorm on our ability to make the trip from Edmonton to Calgary. We will likely be slower. Now, consider the impact of a snowstorm if your route is a gravel road. It may be so hazardous that you may not be able to make the trip. So what does a snowstorm translate to in terms of the brain? Remember that all behavior is functional. Can you recall a time when you felt you were off all day? Maybe you were dropping things, forgetting things, having difficulties finding the right word, simply wishing you had not gotten out of bed? Many factors can contribute to why we have snowstorm days like lack of sleep, poor nutrition or skipping a meal, dehydration, hormonal variation, among many other environmental and complex neurobiological reasons. Regardless of the cause, we all have snowstorm days and when something is slowing down how the information gets around our brain. In contrast, think about what an off day for an individual with an FASD might be like. Consider that individuals with an FASD often have gravel roads and traveling these roads requires hard work, even on sunny days. When we add the snow, individuals with an FASD might be greatly impacted, possibly unable to function at all, leading to higher frustration and resulting in a much greater sensitivity to failure. Snowstorm days can account for why sometimes individuals with an FASD experience greater difficulties. It's not that they won't do a task that they have previously been able to complete, like tying their shoes, but as a result of the snowstorm, they simply can't do the task. In our role as problem solvers supporting individuals with an FASD, questions to ask ourselves when we observe a challenge emerge include what is their goal or destination, what might be obstructing the road on route to that goal, and how can we facilitate the achievement of their goal so that they can experience more successes and fewer frustrations. In Module 2, we have emphasized that the effect of prenatal alcohol exposure on the developing brain may not result in structural differences, meaning that the brain may look as expected, but that does not mean that the brain functions as expected. Therefore, instead of listing potential problem behaviors, it is more helpful to focus on building an understanding of the functions or contributing causes behind individual behaviors. Taking a process approach to behavior provides us an opportunity to become active and effective problem solvers. To apply this approach, we need to first understand that all behavior is functional regardless of what it may look like to an outsider. All behavior is goal-oriented, meaning that our behavior is meant to get us from point A to point B. We explored this functional or goal-oriented behavior through the analogy of delivering a package from Edmonton to Calgary and made further comparisons to how the brain functions. In particular, the brain is comprised of neurons which have cell bodies that, in our analogy, represent cities and axons that represent the roadways that transport information between the cell bodies and around our brain, information that ultimately presents as our behavior. One impact that alcohol has on the developing brain is to change the ability of our brain to move information around efficiently. So, applying our analogy, this means that some pathways in the brain that should be fast and direct or paved are slow and indirect or gravel for individuals with an FASD. The challenge is that we just don't know which roads are paved and which are gravel, and we don't know when a snowstorm might come along. So we can't predict what behaviors will be impacted when. As a result, individuals with an FASD exhibit a pattern of challenging behavior that can be best described as following a consistent pattern of inconsistencies. It is therefore important to remember that it might not be that they won't do what is asked of them but that they can't do what is asked of them as a result of a snowstorm day. In our role as problem solvers supporting individuals with an FASD, we should ask ourselves how we could support individuals to achieve their goals, thus facilitating their experience of more successes and fewer frustrations. In the next module, we will explore brain functions further, specifically with regards to emotional regulation and the impact prenatal alcohol exposure has on the developing hypothalamic pituitary adrenal axis.