FASD-Informed Clinical Reports

A Practical Guide to Clinical Formulation, Functional Evidence and EHCP-Ready Professional Recommendations

Who this guide is for and why clinical and professional wording matters

For paediatricians, psychiatrists, clinical psychologists, neuropsychologists, speech and language therapists, occupational therapists, nurses, allied health professionals, SENCO's, social workers and multidisciplinary teams.

A clinical or professional report can do more than record diagnosis or test performance. It can explain how a child or young person functions in everyday life and be transferrable to give education, health and care professionals evidence that can be translated into Sections B, E, F and, where relevant, I of an Education, Health and Care Plan (EHCP).

“A clinically accurate report becomes educationally useful when it explains the functional impact, the contexts in which difficulty occurs and the support required.”

Suggested structure for an FASD-informed clinical or professional report that can be interpreted into a measurable EHCP

Reason for referral and questions to be answered.
Sources of information: Separate records, informant reports, observation and direct assessment.
Developmental, medical, family, social and educational history: Record prenatal alcohol exposure status sensitively and identify gaps.
Assessment conditions and validity: Note regulation, fatigue, rapport, repetition, breaks, visual support and scaffolding.
Profile of strengths and needs: Cover relevant neurodevelopmental and adaptive domains, including variability.
Integrated formulation: Explain how findings fit together and what may underlie the child’s presentation.
Functional implications for education and daily life: Describe access, participation, relationships, independence and safety.
Safeguarding, vulnerability and protective support: The report should analyse safeguarding as a direct part of the neurodevelopmental formulation, not as a separate list of incidents or a judgement about “poor choices”. It should set out any disability-related vulnerability, including suggestibility, apparent compliance, confabulation, developmental mismatch, weak risk appraisal, difficulty recognising hidden motives, coercion, grooming or exploitation risk, online and financial safety, unsafe peer influence, missing risk and failure to generalise safety learning. Clinicians should distinguish known incidents and near misses from foreseeable risk; explain how communication, memory, executive functioning, adaptive functioning, sensory overload, fatigue and the wish to please may affect disclosure, consent and real-world judgement; and identify protective factors as well as the supervision, communication adjustments, trusted-adult routes, environmental safeguards, information-sharing and escalation arrangements required across home, education and community settings. Recommendations should specify who will provide support, in which situations, at what level and how risk will be reviewed, including after new relationships, transitions, placement changes, missing episodes or any reduction in formal or family support. Where consent or mental capacity is relevant, the report should state the limits of the clinical evidence and whether specialist, decision-specific assessment is required.
Recommendations: Specify what is needed, by whom, how often, where, with what expertise and how impact will be reviewed.
Diagnostic statement and limits of certainty: Use current diagnostic guidance and avoid implying certainty beyond the evidence.

Recording prenatal alcohol exposure

All professionals and expert witnesses can record prenatal alcohol exposure sensitively, factually and only to the level supported by evidence. Identify the source of information, whether exposure is confirmed, probable, suspected, unknown or not documented, and any limitations in the history.

Avoid blame, moral judgement or speculation. Where exposure cannot be confirmed, do not treat absence of documentation as proof that exposure did not occur; instead, state the uncertainty and continue to describe the child’s neurodevelopmental profile and clinical needs.

Professional importance and early referral: Current UK clinical guidance for alcohol in pregnancy and perinatal care strengthens the need for non-judgemental enquiry, accurate recording, information sharing and coordinated support when prenatal alcohol exposure is known or possible.

Where prenatal alcohol exposure is known and a child has significant developmental, physical, behavioural or neurodevelopmental difficulties, clinicians should actively “rule in” FASD as a differential formulation and refer promptly to the appropriate local or regional neurodevelopmental/FASD pathway.

Referral should not be delayed until facial features are identified, exposure can be precisely quantified, difficulties become severe, or education and family arrangements reach crisis.

Early referral allows the multidisciplinary team to clarify diagnosis, assess the full neurodevelopmental and adaptive profile, identify safeguarding vulnerability, coordinate intervention and provide evidence for educational planning while assessment is ongoing. If a dedicated pathway is not available, the clinician should identify the most appropriate paediatric or neurodevelopmental service, document the rationale for referral and specify interim FASD-informed support. If there are no pathways for FASD in the locality then a 'Right to Choose' referral can be made by the GP or consulting clinician.

Practice resources: Clinical guidance for alcohol: early-intervention terminology and direct NHS FASD referral pathway. See also the Department of Health and Social Care’s Clinical guidelines for alcohol treatment: pregnancy and perinatal care.

Suggested wording: “Prenatal alcohol exposure is reported by [source] and is recorded as [confirmed/probable/suspected]. Available information does not permit reliable quantification of timing or dose. This uncertainty does not alter the need to assess and respond to the child’s identified neurodevelopmental and functional difficulties.”

“When prenatal alcohol exposure and significant developmental need are known, uncertainty should shape careful assessment

— not delay referral, support or safeguarding.”

Core FASD-informed reporting principles

Describe the brain-based difficulty before the behaviour. Explain whether distress, avoidance, impulsivity, apparent non-compliance or risk-taking may reflect memory, language, processing, executive, sensory, adaptive or social-cognitive impairment.
Report function, not scores alone. State what assessment findings mean for learning, communication, daily routines, relationships, safety and participation.
Look for developmental mismatch. Record where chronological age, verbal presentation, attainment and adaptive functioning differ.
Make variability clinically meaningful. Explain the effects of fatigue, sensory load, novelty, stress, language demand, transitions and adult scaffolding.
Do not treat verbal fluency as proof of understanding. Describe receptive language, processing time, retention, use and weighing of information, and real-world application.
Use caregiver and school evidence as functional data. Repeated accounts of inconsistency, vulnerability, failed generalisation or post-school exhaustion may clarify what a clinic-based assessment cannot show.
Separate primary and secondary needs. Identify neurodevelopmental impairment and distinguish it from additional anxiety, trauma-related responses, low mood or distress arising from repeated mismatch and failure.
State what adults and environments must do. Recommendations should not place the whole burden of change on the child.

“The report should explain the brain-based need, not simply rename the behaviour.”

From clinical finding to EHCP-ready evidence

Finding: name the assessed or observed neurodevelopmental difficulty and its evidential basis.
Functional impact: explain what the child cannot do reliably, independently, safely or across settings because of that difficulty.
Context: identify the demands and environments that increase or reduce the difficulty, including fatigue, sensory load, language complexity, transitions and adult support.
Required response: state the adjustments, intervention, supervision, expertise, frequency and review needed.

“Finding, impact, context and required response create the bridge from assessment to provision.”

Writing recommendations that can become Section F provision

Recommendations should identify the intervention or adjustment, responsible practitioner or appropriately trained adult, minimum frequency or occasions of use, relevant settings, level of oversight and review arrangements. Avoid unsupported phrases such as “access to”, “as required”, “regular opportunities” or “staff to be aware”. Where exact frequency depends on further professional assessment, state who will complete that assessment and the interim support required.

“If a recommendation does not say who will do what, when and how often, the EHCP writer is left to guess.”

Example — working memory and processing: Assessment indicates marked difficulty holding and manipulating verbal information. In class, the child is likely to lose multi-step instructions, begin only part of a task and appear avoidant when the demand exceeds working-memory capacity. Performance is likely to reduce further when tired, anxious or in noisy settings and to improve with visual structure and individual prompting. Adults should therefore give one concrete step at a time, provide a visual record, allow additional processing time, check understanding through demonstration rather than repetition, and revisit learning through planned overlearning.

Transferable Section F wording: “During every lesson, transition and practical activity, all staff will give no more than one concrete instruction at a time, supported by a written, photographic or symbol prompt. Staff will allow at least 10 seconds’ processing time before repeating or rephrasing and will check understanding by asking [name] to show or identify the next step. New learning will be revisited through a minimum of three planned rehearsal opportunities across the week and practised with more than one adult and in more than one setting. The SENCO will sample implementation fortnightly for the first term and at least half-termly thereafter; effectiveness will be reviewed termly using evidence of task initiation, completion, retained learning and level of prompting.”

Example — task initiation: Assessment indicates that [name] may understand a task after explanation but cannot reliably identify the starting point, organise action or begin without external prompting. Delay or apparent avoidance should not be interpreted as refusal. Transferable Section F wording: “At the start of every lesson, independent-work period and practical routine, a named trained adult will gain [name]’s attention, present a visual first step, model that step where required and remain available until [name] has begun. If initiation has not occurred within [number] minutes, the adult will reduce the task, repeat the visual cue and start the first action alongside [name]. Staff will record latency to start and level of prompting for one agreed task daily; the SENCO will review the data half-termly.”

Example — planning and sequencing: [Name] has difficulty generating, ordering and retaining the steps needed to complete unfamiliar or multi-stage work. Transferable Section F wording: “Before every task containing more than one step, an FASD-trained adult will provide a numbered visual sequence containing no more than [number] steps at one time. The adult will explicitly model the sequence, prompt [name] to mark each completed step and check progress after each stage. Extended tasks will be divided into sections of no more than [duration] minutes, with planned review between sections. The sequence will remain visible throughout and will be used across classroom, personal-care, community and vocational routines where relevant.”

Example — organisation of materials and routines: Executive-function impairment affects [name]’s ability to remember equipment, organise belongings, locate information and prepare for the next activity. Transferable Section F wording: “A named adult will complete a visual equipment and timetable check with [name] at arrival, before each change of lesson and before departure. Materials will be stored in consistently labelled and colour-coded locations, and duplicate essential equipment will be available in [specified settings]. [Name] will not lose learning time or receive a sanction for disability-related forgetting. Staff will record the number of routines completed with each level of prompting and review the system termly with [name] and the family.”

Example — cognitive flexibility and change: [Name] has difficulty shifting attention, changing an established plan and generating an alternative response when circumstances alter. Unexpected change may lead to freezing, repeated questioning, distress or leaving the activity. Transferable Section F wording: “All foreseeable changes will be shown on [name]’s visual timetable and explained using simple concrete language at least [timeframe] in advance. A trained adult will rehearse the original plan, the changed plan and what will stay the same. For unavoidable changes, the adult will provide a visual ‘change’ cue, two safe limited options and co-regulation before movement. [Name] will have [duration] additional transition time and will not be expected to shift immediately following verbal instruction alone.”

Example — inhibition and impulse control: [Name] may act before holding the rule, consequence or safety information in mind. This reflects reduced inhibitory control and should not be framed solely as wilful risk-taking. Transferable Section F wording: “During identified high-risk activities, transitions and unstructured times, one of the named trained adults will remain within [specified proximity] and provide proactive visual stop–check–act prompts before action is required. Adults will reduce waiting and queuing, limit access to identified hazards and offer an immediate safe alternative. Following an incident, staff will use brief supported repair and rehearsal when [name] is regulated; sanctions or delayed consequences will not replace preventive supervision and teaching.”

Example — time awareness and pace: [Name] cannot reliably estimate duration, monitor the passage of time or adjust pace to meet a deadline. Transferable Section F wording: “For every timed task and transition, staff will use a visual timer and a now–next sequence. A trained adult will give prompts at [specified intervals], identify the amount of work expected rather than saying ‘finish soon’, and allow [number] minutes’ additional transition time. Deadlines will be divided into dated interim steps and reviewed with [name] [frequency]. Progress will be measured by supported completion of each stage, not independent time estimation.”

Example — self-monitoring and checking work: [Name] has difficulty noticing omissions, recognising when a strategy is not working and asking for help before failure or distress. Transferable Section F wording: “For [number] identified learning or daily-living tasks each day, a trained adult will use a three-part visual check: ‘What am I doing? What is the next step? Do I need help?’ The adult will model the check, review work with [name] at each agreed stopping point and give specific corrective feedback without requiring independent error detection. The specialist teacher will review the checklist and level of prompting at least termly.”

Example — supported problem-solving and generalisation: [Name] may learn one response in a familiar context but cannot reliably identify when or how to use it with a different adult, task, peer or setting. Transferable Section F wording: “Each explicitly taught strategy will be practised on at least [number] occasions, with at least [number] adults and in at least [number] settings. Staff will use the same visual prompt and script, then support [name] to choose between no more than two previously taught options. Generalisation will be assessed through observed supported use in the target setting; verbal explanation of the strategy will not be treated as evidence that it can be applied independently.”

Example — executive-function coaching embedded across the day: A brief isolated intervention is unlikely to meet needs that affect all routines and environments. Transferable Section F wording: “A qualified teacher or psychologist with relevant FASD and executive-function expertise will prepare an individual executive-support programme within [number] weeks. The professional will observe [name] in at least [specified contexts], train all regular staff for a minimum of [duration], model the strategies in practice and provide [frequency] consultation. A named key adult will coordinate daily implementation across lessons, transitions and unstructured periods. The programme will be reviewed at least termly with the SENCO, family and relevant professionals.”

Example — measurable executive-function outcomes: “By [review date], with the specified visual and adult scaffolding, [name] will begin an agreed familiar task within [number] minutes on [proportion] of observed occasions, complete a [number]-step routine with no more than [defined level] prompts, and use the agreed help-seeking cue in [proportion] of identified difficulty situations. Baseline, latency, completion and prompt-level data will be sampled [frequency] across more than one setting. Progress will not be measured by removal of support alone; any reduction in scaffolding will be gradual, evidence-led and reversed if participation or safety deteriorates.”

Example — small teaching group: Assessment and observation indicate that competing speech, movement and social demand substantially reduce [name]’s ability to process instruction, regulate arousal and remain engaged. In groups larger than [evidenced threshold], [name] requires repeated adult redirection and is unable to demonstrate learning reliably. Performance improves in a calm group with predictable routines, low language load and immediate clarification. Transferable Section F wording: “For direct teaching of new or conceptually demanding material, [name] will be taught in a consistent group of no more than [number] pupils, by a qualified teacher with support from an FASD-trained adult, for [number] sessions of [duration] each school day/week. The group will use a low-arousal room with minimal visual and auditory distraction. Whole-class participation will occur only where the same processing, regulation and supervision requirements can be maintained. The school will record engagement, distress signs, task completion and adult prompts and review the group size termly with the SENCO and relevant clinician.” A recommendation for class or group size should be based on evidence of the child’s response to group demand; “small class” alone is not sufficiently specific.

Example — access to an outdoor, low-arousal environment: Occupational and clinical evidence indicates that sensory overload and cognitive fatigue build across the school day and reduce attention, language processing and emotional regulation. [Name] returns to learning more successfully after predictable movement and access to a calm outdoor environment; this is a regulation and learning provision, not a reward or a response available only after crisis.

Transferable Section F wording: “[Name] will have planned access to a quiet outdoor or nature-based regulation space for at least [duration] at [specified times, for example before morning lessons, before lunch and mid-afternoon], with additional access at the first agreed signs of overload. A trained adult will accompany and co-regulate, using the individual sensory plan, and will support a predictable return to learning. Outdoor access will not be withdrawn as a sanction. Staff will record use, recovery time and successful return to learning; the occupational therapist or appropriately qualified practitioner will review the plan at least termly.”

Example — individual sensory-regulation plan: Assessment identifies a pattern of sensory over-responsivity, under-responsivity and/or sensory seeking that affects attention, participation, emotional regulation and safety across the school day. Transferable Section F wording: “A registered occupational therapist will complete an individual, participation-focused sensory assessment within [number] weeks and produce a written sensory-regulation plan specifying [name]’s early signs of dysregulation, known sensory triggers, helpful environmental adjustments, proactive activities, adult responses, contraindications and a step-by-step return-to-learning routine. The plan will be available to all relevant staff and used across lessons, transitions, break, lunch, transport and off-site activities. It will be reviewed by the occupational therapist after [number] weeks and at least termly thereafter, using agreed functional outcomes.”

Example — proactive movement and regulation breaks: [Name]’s attention and regulation reduce after sustained sitting, listening or visually demanding work. Movement is required before overload develops and should not depend on the child independently recognising or requesting it. Transferable Section F wording: “[Name] will receive a planned [duration]-minute movement or regulation break after no more than [number] minutes of seated or high-demand activity, and before identified high-demand transitions. A trained adult will prompt, supervise and follow the occupational therapist’s written programme. The break will use agreed activities linked to regulation and participation, will not be withdrawn as a sanction, and will be followed by a visual return-to-task sequence. Staff will record whether [name] returned to learning, the time taken and the level of prompting required.”

Example — auditory and visual environmental adjustments: Background speech, sudden noise, crowding and visually busy spaces reduce [name]’s ability to distinguish relevant information and maintain regulation. Transferable Section F wording: “[Name] will be seated in a low-distraction position agreed with the occupational therapist and will be taught in a room where avoidable background noise and visual clutter are reduced. Staff will provide advance warning of predictable loud events, access to an agreed quiet workspace within [time] of early overload signs, and any assessed hearing-protection option in accordance with professional advice. The setting will identify and adjust known high-load environments, including assemblies, dining areas, corridors, changing rooms and transport. Effectiveness will be reviewed half-termly through participation, recovery and distress data.”

Example — interoception, body-state awareness and adult checking: [Name] does not consistently recognise or interpret internal signals such as hunger, thirst, temperature, pain, toileting need, fatigue or escalating arousal. Transferable Section F wording: “At [specified times] and before transitions, a trained adult will complete a brief visual body-state check with [name], offer limited concrete choices and support the agreed response, including food, drink, toileting, clothing adjustment, rest or regulation. Staff will not rely on [name] independently identifying or reporting need. The occupational therapist or relevant clinician will provide the visual framework, train staff and review implementation termly. Progress will be measured by supported recognition and timely adult response, not independent self-management alone.”

Example — low-arousal recovery following overload: Once sensory and emotional overload occurs, verbal reasoning, questioning and rapid return demands prolong dysregulation. Transferable Section F wording: “At the first agreed signs of overload, a named trained adult will reduce spoken language, remove non-essential demands, guide [name] to the identified low-arousal space and provide co-regulation for as long as clinically required. The adult will not question, sanction or require restorative discussion until [name] has returned to their recognised regulated baseline. A visual recovery sequence and graded return will then be used. Staff will record antecedent sensory demands, support provided, recovery time and any change required to the preventive plan; incidents will trigger review rather than loss of sensory provision.”

Example — transitions and unstructured sensory load: Corridors, arrival, departure, break and lunch combine unpredictable movement, noise, proximity and social demand and are therefore predictable points of sensory and regulatory risk. Transferable Section F wording: “[Name] will transition [number] minutes before or after the main pupil group, accompanied by one of the named trained adults. Arrival, break, lunch and departure will follow a visual sequence and include access to the agreed low-arousal space or outdoor area. Queuing will be avoided. Any unavoidable change will be prepared using visual information and rehearsal at least [timeframe] in advance where possible. The SENCO will review transition records half-termly and after any significant incident.”

Example — sensory equipment and safe use: Any specialist equipment should be individually assessed, linked to a functional purpose and monitored; a generic list of sensory objects is not adequate provision. Transferable Section F wording: “Only equipment and activities identified in the occupational therapist’s written plan will be used. The plan will state their purpose, timing, duration, level of supervision, safety precautions and criteria for stopping or changing use. The occupational therapist will demonstrate safe use to named staff, check implementation within [number] weeks and review effectiveness at least termly. Equipment will remain available when required for access and regulation and will not be contingent on behaviour.”

Example — occupational-therapy delivery and staff coaching: Sensory recommendations are unlikely to be effective if limited to an isolated assessment or therapy session. Transferable Section F wording: “A registered occupational therapist with relevant paediatric sensory and neurodevelopmental expertise will provide [number] minutes of direct assessment/intervention and [number] minutes of indirect consultation each [week/month/term]. The therapist will observe [name] in at least [specified contexts], write and update the sensory plan, train all regular staff within [timeframe], model strategies in context and review implementation with the SENCO and family at least termly. A named member of staff will oversee daily delivery and maintain the agreed monitoring record.”

Example — measurable sensory-regulation outcomes: “By [review date], with the specified adult and environmental support, [name] will return to an agreed learning activity within [number] minutes after [proportion] of planned regulation breaks, participate in [identified activity] for [duration], and experience a reduction from [baseline] to [target] in episodes requiring removal from learning because of sensory overload. Progress will be reviewed using duration, recovery, participation and level-of-prompting data alongside the child and family’s account; absence of crisis alone will not be treated as proof that sensory need has reduced.”

Example — specialist FASD-informed teaching: The profile shows persistent difficulty with executive functioning, receptive language, adaptive learning and generalisation. Ordinary differentiation alone is unlikely to be sufficient because [name] requires teaching designed around neurodevelopmental impairment and repeated across people, places and routines.

Transferable Section F wording: “[Name] will receive a minimum of [number] hours per week of direct teaching from a qualified teacher with evidenced training and experience in FASD or closely related complex neurodevelopmental presentations. Teaching will use concrete and declarative language, visual sequencing, reduced cognitive load, explicit modelling, error-reduced practice, overlearning and supported generalisation. The specialist teacher will provide staff coaching for at least [duration/frequency], observe implementation at least [frequency], and produce a written programme updated termly. All staff working regularly with [name] will complete specified FASD-informed training within [timeframe], followed by supervised practice. Progress will be measured through supported functional performance across classroom, unstructured and community contexts, not independent verbal recall alone.”

Example — sensory integration occupational therapy assessment and ongoing timetable provision: Where clinical and functional evidence indicates that sensory-processing differences substantially restrict [name]’s participation, regulation, motor planning, learning or safety, generic sensory advice is insufficient. A registered occupational therapist should complete a thorough occupation- and participation-focused assessment and determine whether Ayres Sensory Integration® therapy, sensory-based intervention, environmental adaptation, staff coaching or a combination is clinically indicated.

Transferable Section F wording: “Within [number] weeks of the final EHCP, [name] will receive a comprehensive sensory integration and occupational performance assessment from a registered occupational therapist with evidenced postgraduate training and current competence in paediatric sensory integration, FASD and complex neurodevelopmental presentations. The assessment will include standardised and functional measures where appropriate; observation across classroom learning, transitions, break, lunch, physical activity and self-care; consultation with [name], family and education staff; and analysis of sensory modulation, discrimination, praxis, postural control, interoception, motor planning, fatigue, environmental demand and participation. The occupational therapist will issue a written report and individual programme within [number] working days, identifying the clinical rationale, goals, intervention method, frequency, duration, setting, equipment, safety precautions, responsible adults, review measures and any contraindications.

Where direct sensory integration therapy is clinically indicated, the occupational therapist will provide [number] sessions of [duration] each week for an initial block of [number] weeks in an appropriately equipped space, followed by formal review against agreed participation outcomes. Sessions will be protected in [name]’s timetable and will not be cancelled for routine staffing or curriculum reasons, used as a reward, or withdrawn as a sanction. Missed clinically planned sessions will be rearranged within [timeframe].

The occupational therapist will also design participation-focused sensory strategies to be embedded daily into [name]’s timetable rather than confined to therapy sessions. The timetable will show the exact planned regulation periods, for example [duration] on arrival, before each identified high-demand lesson, before lunch, after lunch and before homeward transition, with additional supported access at the first agreed signs of overload. A named trained adult will prepare the space and equipment, prompt and supervise each activity, record the response and support a predictable return to learning. Strategies will also be incorporated into ordinary classroom, outdoor, movement, self-care and transition routines wherever indicated.

The occupational therapist will train all regular staff for a minimum of [duration] within [number] weeks, model the programme in school, observe implementation at least [frequency], and provide [number] minutes of consultation each [week/month/term]. A named member of staff will coordinate daily delivery and maintain a provision record showing scheduled and delivered sessions, activities used, regulation before and after, return-to-learning time, participation and any adverse response. Equipment and activities will be used only as specified by the occupational therapist and in accordance with documented risk assessment.

The occupational therapist, SENCO, family and key staff will review the programme after [number] weeks and at least termly thereafter. Review will use validated measures where appropriate and functional evidence of engagement, recovery, access to learning, motor planning, self-care, distress, attendance and level of adult prompting. Provision will be adjusted according to evidence; absence of incidents or verbal reports that [name] ‘enjoys’ an activity will not, by itself, demonstrate effectiveness or justify withdrawal.”

Good-practice rule: Clinical advice should explain why each feature is required by this child’s assessed needs. EHCP wording should then specify the maximum group size or ratio, the purpose and minimum frequency of outdoor access, the qualifications and FASD expertise of the teacher, the methods, executive-function and sensory provision, responsible practitioner, staff training, monitoring and review.

Executive-function support should externalise planning, sequencing, time, monitoring and inhibition where these cannot yet be managed reliably by the child. Sensory interventions should be individually assessed, participation-focused and linked to defined outcomes. Placement type should follow from the total provision required; it should not be used as a substitute for specifying that provision.

FASD-informed communication support

Why professional recommendations matter: Communication support should not be left to general advice such as “use simple language” or “seek speech and language therapy input”.

The clinical report should state whether [Name] requires an FASD-informed speech and language assessment and should identify the specialist support needed in school. Recommendations should explain the effect of receptive-language difficulty, auditory processing, working memory, narrative organisation, inference, abstract language, social communication, suggestibility and the gap between verbal fluency and functional understanding.

The EHCP should also specify who will assess and support [Name], how frequently, in which school contexts, how staff will be trained and coached, and how functional impact will be reviewed. NICE QS204 emphasises an individualised management plan addressing immediate and long-term needs and coordinated across health, education and social care; SIGN 156 includes speech and language therapists within multidisciplinary assessment, management and follow-up for children and young people affected by prenatal alcohol exposure.

Example professional recommendation — FASD-informed speech and language assessment: “[Name] requires a comprehensive assessment by a registered speech and language therapist with demonstrable knowledge and experience of FASD and complex neurodevelopmental communication profiles. The assessment should examine receptive and expressive language, auditory processing, response time, working-memory demands, understanding of abstract and implied language, inference, narrative organisation, social communication, functional understanding, suggestibility and the reliability of apparent agreement.

Assessment should include observation in school across direct teaching, transitions and less structured activity; consultation with family and education staff; and comparison of performance in a supported one-to-one setting with real-world communication. The therapist should identify the communication methods, visual supports, processing time and adult scaffolding required and provide a written report that can inform Sections B, E and F of the EHCP.”

Example Section F wording — ongoing specialist speech and language support in school: “A registered speech and language therapist with evidenced FASD and neurodevelopmental communication expertise will provide [number] minutes of direct specialist work and [number] minutes of indirect consultation each [week/month/term].

The therapist will observe [Name] in at least [specified school contexts], prepare and update an individual written FASD-informed communication programme, and model the agreed approaches to the named key adults. All regular staff will receive initial training of at least [duration], followed by coached practice and implementation review at least [frequency].

A named trained adult will embed the programme daily across lessons, transitions, unstructured periods and safety-related conversations, including short declarative language, one idea at a time, photographic now-and-next support, extended processing time and checks of functional understanding.

The therapist will review [Name]’s progress with the SENCO, family and key staff at least termly and after any material change in presentation, placement or communication need. Review will use observation of participation, understanding, generalisation, distress, help-seeking and level of adult prompting; verbal fluency or performance in an isolated therapy session will not be treated as evidence that specialist support is no longer required.”

Interim provision: Where a full FASD-informed speech and language assessment has not yet been completed, the clinical report should still describe the evidenced communication needs and recommend an interim protocol. Assessment should refine provision, not postpone it. The photographic now-and-next system, reduced verbal load, declarative language, consistent wording, extended processing time and adult checks of real-world understanding should be implemented while specialist assessment and school-based support are arranged.

“A quick answer may show a wish to respond; it does not necessarily show understanding, retention or safe application.”

Clinical formulation: [Name]’s communication profile is consistent with FASD-related difficulty processing, retaining and responding to spoken language, particularly when [Name] is tired, stressed, dysregulated or presented with several ideas at once. Looking away, becoming quiet or appearing distracted may indicate continuing processing rather than disengagement. Rapid repetition, rephrasing or additional questions may increase cognitive load because changed wording can be experienced as new information. [Name] therefore requires short, predictable language, one idea at a time, extended processing time, a photographic visual now-and-next prompt and calm FASD-informed declarative communication across the school day.

Example Section B wording — communication and processing need: “[Name] has significant difficulty processing, retaining and responding to spoken language at ordinary conversational pace. [Name] may understand only part of a longer message and cannot reliably process multiple instructions or questions together. [Name]’s response may be delayed by up to 20 seconds, and looking away, becoming quiet or appearing distracted may indicate that [Name] is still processing. Rephrasing a question too quickly can be experienced as an additional question and may leave [Name] stuck trying to process several versions. [Name] requires short, concrete and predictable wording, one idea at a time, visual support and checks of functional understanding. Verbal fluency, apparent agreement or a quick answer should not be treated as reliable evidence that [Name] has understood, retained or can apply the information.”

Example Section E outcome — supported communication access: “By the next annual review, [Name] will access spoken information and everyday routines more consistently because adults will use short, predictable FASD-informed declarative language, allow sufficient processing time and support each step with a photographic visual now-and-next prompt. Progress will be evidenced by [Name] completing familiar routines with reduced distress and an agreed level of adult prompting; it will not be measured by rapid verbal response or independent recall alone.”

Example Section F wording — FASD-informed communication protocol: “Throughout lessons, transitions, unstructured periods, personal-care routines, off-site activities and discussions involving safety or change, all adults working with [Name] will follow [Name]’s written FASD-informed communication protocol. Adults will use only a few short sentences at any one time, according to what [Name] needs in that moment; say one idea or instruction at a time; use calm, concrete and declarative language rather than repeated demands; and use the same agreed wording wherever possible.

Adults will allow up to 20 seconds for [Name] to process and reply. If [Name] does not answer, the adult will repeat the question once only, using exactly the same words, and wait again. The adult will not add a second question, immediately break the question into new wording or fill the silence. After one repetition, the adult will pause and use a photographic visual, written word, picture, gesture or limited choice prompt instead of adding more spoken language. Looking away, becoming quiet or seeming distracted will be treated as possible signs of continued processing. Staff will check understanding through supported action, demonstration or selection of the next step, rather than asking only whether [Name] understands.”

Example Section F wording — photographic visual now and next: “A named trained adult will prepare and maintain an individual photographic ‘Now and Next’ board using clear photographs of [Name]’s actual people, places, activities and regulation spaces. The board will display no more than the current activity and the immediately following activity, with finished items visibly removed or marked complete. It will be shown and referred to at arrival, before every lesson or activity change, before break and lunch, before departure and whenever an unexpected change occurs.

The adult will pair the photographs with the same brief agreed wording, for example, ‘Now maths. Next garden,’ and will avoid adding unnecessary explanation. Foreseeable changes will be photographed or represented in advance and rehearsed with [Name]. The board will travel with [Name] between relevant settings and will not be withdrawn as a sanction or made dependent on behaviour. A named key adult will review photographs at least weekly and update them whenever people, rooms, transport, routines or activities change.”

FASD Communication Box: Key Adult Guidance

Choose only a few sentences at any one time, depending on what [Name] needs in that moment. The phrase bank below includes anchoring phrases, which bring [Name] back to the agreed plan, and calming phrases, which support [Name]’s body and brain to feel safer.

Keep sentences short and simple.
Use calm, FASD-informed declarative language rather than demands.
Say one idea at a time.
Use the same words each time wherever possible.
Allow up to 20 seconds for [Name] to reply or ask a question.
If a question is asked, wait up to 20 seconds.
If [Name] does not answer, repeat the question once only and in exactly the same words.
Do not immediately break the question into different wording.
Do not add a second question while [Name] is still processing the first.
Remember that changed wording may be experienced by [Name]’s brain as a new question, leaving [Name] stuck trying to process several questions.
After repeating once, pause and use a photographic visual, written word, picture, gesture or limited choice prompt instead of adding more language.
If [Name] looks away, becomes quiet or seems distracted, [Name] may still be processing.
Do not rush to fill the silence.

Anchoring phrases: “Now this. Next that.” “The plan is still the same.” “First this step. Then we will look again.” “I’ll show you the next part.” “The photograph shows what is happening now.”

Calming phrases: “I’m going to slow things down.” “I’m here with you.” “There is time.” “We can use the picture.” “This looks difficult right now.” “Your body may need a pause.”

Practice message: Short, repeated and predictable wording helps [Name] feel safer and gives [Name]’s brain more opportunity to understand. The protocol should be used proactively, not only after distress has escalated.

Safeguarding, consent and decision-making

Apparent consent or compliance: agreement, silence, friendliness or willingness to please may not demonstrate understanding, free choice or appreciation of consequences.
Suggestibility and coercion: the person may accept another person’s account, change their answer under pressure, seek approval or be directed into unsafe activity.
Grooming and exploitation: social naivety, desire for belonging, concrete thinking and difficulty recognising hidden motives may increase vulnerability to criminal, sexual, financial, online or peer exploitation.
Memory and evidence: fragmented recall, inconsistent sequencing or delayed disclosure should not automatically be interpreted as dishonesty. Questioning should be simple, non-leading and adapted to communication need.
Generalisation: verbal knowledge of a safety rule may not transfer to a new person, platform, place or emotionally charged situation.
Developmental mismatch: social and adaptive functioning may be substantially younger than chronological age, even when speech, appearance or attainment suggest greater maturity.
Online and financial vulnerability: impulsivity, difficulty judging authenticity and weak future thinking may affect messaging, image sharing, gaming, purchases, contracts, debt and scams.
Peer environment: risk can arise through imitation, unsafe alliances, scapegoating, pressure to carry items or messages, or association with people whose intentions are not understood.
Transitions and unstructured time: transport, corridors, breaks, community access, placement changes, discharge and movement into adult services may reduce oversight precisely when risk increases.
Multiple or hidden harms: self-neglect, homelessness, substance misuse, domestic abuse, missing episodes, exploitation and contact with criminal justice services may overlap and require coordinated analysis rather than separate responses.

“Safety planning must account for the person’s actual judgement under pressure, not only the rules they can repeat when calm.”

What proactive safeguarding should specify

A named lead professional and a small, consistent network of trusted adults.
The times, places, relationships and online contexts in which supervision or checking is required.
Concrete, repeated and developmentally matched teaching, including rehearsed scripts for leaving, refusing, checking and seeking help.
Communication adjustments for disclosure, interviews, consent discussions and risk assessment.
How professionals will verify real-world understanding rather than rely on verbal recall or apparent agreement.
Clear information-sharing arrangements across agencies, with consent and confidentiality considered alongside the need to protect the person.
A response to perpetrators, coercive contexts and unsafe environments, rather than locating responsibility solely with the vulnerable person.
Contingency plans for missing episodes, online contact, unsafe peers, transport, money, medication, community access and changes in routine.
Review triggers, including incidents, new relationships, placement or staff changes, bereavement, exclusion, transition, reduced family support or evidence of escalating influence.

Measurable safeguarding recommendations

Example — individual safeguarding formulation and baseline: “Within [number] weeks, a clinician with FASD and safeguarding expertise will complete a written formulation integrating developmental level, communication, executive functioning, adaptive functioning, suggestibility, confabulation, social cognition, online behaviour, missing risk, peer influence, community access and family evidence.

The report will define [Name]’s priority risk contexts, early indicators, protective factors, required level of supervision and at least [number] observable baseline measures, such as missing or near-missing episodes, unsafe contacts, unplanned online contact, use of the trusted-adult route, time to disclose, level of prompting and recovery following an incident. The formulation will distinguish disability-related vulnerability from deliberate risk-taking and will be reviewed at least termly and within [number] working days of a significant incident or material change.”

Example — proactive supervision and trusted-adult response: “During arrival, departure, break, lunch, transport, off-site activity, online access and identified peer contact, one of [number] named adults trained in FASD and safeguarding will maintain [line-of-sight/within specified distance/direct] supervision. [Name] will have a visual trusted-adult card and will rehearse one consistent leave–check–tell routine at least [frequency] in real or simulated contexts. Staff will record each supported use, whether help was sought before or after adult prompting, the context and the response time. The safeguarding lead will review the record every [week/fortnight] and adjust supervision where risk, distress or prompting increases.”

Example — explicit safeguarding teaching and generalisation: “[Name] will receive [number] sessions of [duration] each week using concrete language, photographs, visual scripts, modelling and rehearsal relating to coercion, grooming, exploitation, unsafe secrecy, gifts, threats, money, online contact, travel, boundaries and help-seeking. Each priority skill will be practised with at least [number] adults and in at least [number] relevant settings. Progress will be measured by observed supported action in realistic scenarios, not verbal recall alone, using an agreed prompt scale and a target of [defined level] support on [proportion] of opportunities by [review date].”

Example — incident and near-miss review: “Every safeguarding incident, near miss, missing episode, material change in peer relationship or unsafe online contact will be reported to the designated safeguarding lead on the same working day and reviewed with the named lead professional within [number] working days. Review will record antecedent demands, communication used, supervision available, possible coercion or suggestion, [Name]’s functioning at the time, protective actions and the required change to the plan. Conclusions will not rely solely on consistency of recall. The updated action and responsible person will be circulated to the agreed Team Around the Family within [number] working days.”

Example — early preparation for adulthood and supported living: “Early preparation for adulthood will begin by [age/year group] and no later than Year 9. A named transition lead will maintain a staged plan covering education or employment, health, relationships, money, benefits, travel, community participation, housing, supported living, digital safety, advocacy and decision support. [Name] will receive at least [number] hours each week of developmentally matched teaching and supported practice in real settings. By [date], adult social care, relevant health services and potential supported-living providers will receive the agreed functional and safeguarding profile, communication protocol, supervision requirements and contingency plan. Readiness will be reviewed at least termly through observed performance with recorded prompt levels; verbal explanation or a single successful trial will not be treated as evidence of safe independence. Any proposed reduction in support will require evidence across at least [number] settings and [number] weeks and will be reversed if safety or participation deteriorates.”

Example — FASD-informed neuropsychological assessment: “Within [number] weeks, [Name] will receive a comprehensive assessment from a registered clinical neuropsychologist or appropriately qualified psychologist with demonstrable FASD expertise. The assessment will examine attention, processing speed, learning and memory, language, executive functioning, social cognition, adaptive functioning, suggestibility, decision-making, risk appraisal and the effects of fatigue, stress and scaffolding. It will include record review, direct assessment, caregiver and education or care-provider evidence, and observation or functional sampling across at least [number] real-world contexts. The report will state test limitations, profile scatter, the difference between structured performance and everyday functioning, functional developmental levels across domains, safeguarding implications and specified recommendations for education, health, social care and preparation for adulthood. A written report will be issued within [number] working days and reviewed with the Team Around the Family within [number] weeks.”

Example — FASD-informed Stage 4 multidisciplinary training: “All professionals and paid carers with regular responsibility for [Name] across education, health, social care, transport, respite and supported living will complete an identified FASD-informed Stage 4 programme within [number] weeks. Training will cover neurodevelopmental formulation, communication, executive and adaptive functioning, sensory and emotional regulation, confabulation and suggestibility, exploitation and missing risk, decision support, mental capacity, preparation for adulthood, supported-living practice and multidisciplinary implementation. New staff will complete training before working independently with [Name]. Attendance and competency checks will be recorded; at least [proportion] of the regular workforce will complete scenario-based assessment at the agreed pass standard. The trainer or clinical lead will provide [frequency] coached practice, observe implementation in at least [number] settings and repeat competency review at least annually and after serious incidents or major transitions.”

Example — Team Around the Family coordination: “A named lead professional will convene the Team Around the Family at least every [4–6] weeks during assessment, transition or heightened risk and at least termly when stable. Membership will include [Name] with accessible participation support, family or carers, education, health, social care, safeguarding, relevant therapists, and supported-living or transition representatives where applicable. The team will review safeguarding measures, neuropsychological and therapy recommendations, training completion, delivery records, incidents and near misses, family sustainability and preparation-for-adulthood actions. Minutes will identify each action, named owner and deadline and will be circulated within [number] working days. Failure to deliver an agreed action or any significant increase in risk will trigger escalation to [named role or pathway] within [number] working days.”

“Protective support should address the coercive person and unsafe environment, not place responsibility solely on the vulnerable individual.”

Transitions, adulthood and continuity

Transition planning should begin early and should not assume that eligibility thresholds, a change of service or reaching age 18 removes the underlying vulnerability.

Plans should identify who will coordinate support, what information must transfer, how the person will be supported to understand changes, and what safeguards are required in further education, employment, housing, relationships, money management, healthcare, transport and community life. Where needs remain, the clinical report should state that withdrawal of scaffolding may increase risk even if the person can describe safety rules or has periods of successful functioning.

Family and carer impact

Families often provide the continuous memory, planning, co-regulation, supervision and advocacy that services assume the individual can supply independently. This may include managing appointments, school communication, crises, online safety, money, transport, medication, relationships, sleep and repeated reteaching. The work is frequently invisible because it prevents incidents rather than producing easily counted interventions.

The cumulative impact may include disrupted employment, financial strain, sleep loss, social isolation, reduced access to ordinary family activities, repeated professional meetings, concern for siblings, and anxiety about who will provide support in adulthood.

Carer exhaustion or difficulty maintaining supervision should prompt practical help and renewed multi-agency planning, not blame.

Services should avoid interpreting a family’s detailed account of risk as overprotection where it reflects repeated experience of hidden vulnerability, failed generalisation or harm narrowly avoided.

Clinical reports should also recognise varied family circumstances. Birth parents may experience stigma or fear when prenatal alcohol exposure is discussed; adoptive, foster, kinship and special guardianship families may be managing incomplete histories, attachment disruption, service fragmentation or uncertainty about future responsibility.

Enquiry should be respectful, non-judgemental and focused on what the person and family need now.

Family support strategies

Family support should reduce avoidable strain, strengthen safety and make caring sustainable across the lifespan. It should be proactive, coordinated and matched to the family’s actual responsibilities, rather than offered only after crisis or placement breakdown. NICE QS204 recognises that an FASD management plan should address immediate and long-term needs, signpost families to resources and services, coordinate health, education and social care, and be reviewed at transition points.

A named coordinator or key professional: one reliable contact to organise communication, clarify responsibilities, track actions and prevent the family repeatedly retelling its history.
An individualised family support plan: record the person’s profile, successful strategies, risks, family priorities, agreed services, responsible professionals, review dates and contingency arrangements.
FASD-informed training and coaching: provide practical guidance on brain-based behaviour, developmental mismatch, communication, memory, co-regulation, sensory need, safeguarding and realistic expectations; include extended family and paid carers where appropriate.
Practical help at pressure points: identify support needed with mornings, bedtime, appointments, transport, school attendance, homework, medication, meals, finances, online activity and community access.
Short breaks and reliable respite: offer planned, flexible provision delivered by adults who understand the person’s communication, regulation and safeguarding profile; include emergency backup where ordinary arrangements fail.
Emotional and therapeutic support for carers: facilitate access to non-judgemental counselling, trauma-informed support, peer networks and opportunities to process grief, uncertainty, stigma and chronic stress.
Support for siblings: provide age-appropriate information, protected time with caregivers, opportunities to discuss worries and assurance that siblings are not expected to become substitute carers.
Strengths-based family consultation: treat family knowledge of triggers, near misses and effective strategies as evidence; involve carers in planning while also hearing the child or young person directly using accessible methods.
Home–education consistency: agree a small set of shared communication, regulation and safety approaches, with simple written or visual tools that travel between settings.
Safeguarding and crisis planning: specify trusted contacts, escalation routes and responses to missing episodes, coercion, unsafe relationships, online harm, aggression, self-neglect or carer exhaustion.
Financial, benefits and employment advice: signpost families to welfare-rights advice, disability-related benefits, grants, direct payments, flexible-working information and help with the additional costs of care.
Advocacy and navigation: support families to understand referral routes, assessments, the Local Offer, SENDIASS, social-care processes, complaints and review rights; provide independent advocacy where required.
Health and wellbeing support: help carers protect sleep, physical health and access to their own healthcare; care planning should not depend on one exhausted adult remaining constantly available.
Planned transition and future-care work: begin early, identify who will assume coordination and decision support, transfer essential risk information, and plan for further education, employment, housing, adult social care and community safety.
Regular review and rapid re-entry: review support after incidents, bereavement, relationship changes, exclusion, placement change, reduced informal help or transition; families should not have to restart the entire referral process when previously recognised need escalates.

“Safeguarding must follow the person across settings and across the lifespan; support should not disappear when vulnerability remains.”

How professionals can evidence family support

The family’s account of strengths, daily functioning, near misses, successful strategies and unmet need.
The level of supervision, prompting, coordination and advocacy currently provided, including overnight and out-of-setting demands.
The effect on carers and siblings, without attributing the child’s disability-related presentation to parenting.
Training and accessible information needed by parents, carers and the wider support network.
Practical support, short breaks, crisis planning, parent-carer assessment or family help that may be required.
Training, accessible information and ongoing coaching needed by parents, carers and the wider support network in FASD-informed therapeutic parenting: a calm, relational, developmentally matched approach that uses co-regulation, connection before correction, predictable routines, low-arousal responses, concrete communication, repetition, repair and environmental adaptation. Reports should make clear that this is disability-informed caregiving, not evidence of parenting deficit, and that carers may need regular reflective consultation to sustain it consistently.
A named route for advice when risk changes and a clear process for escalating concerns.
Plans for future care, advocacy and decision support so that responsibility does not fall indefinitely on one family member.
Regular review at transition points and after any reduction in formal or informal support.

Suggested wording: “The family currently provides a high level of anticipatory supervision, repetition, co-regulation and coordination that substantially reduces observable risk. This includes FASD-informed therapeutic parenting: calm, relational and developmentally matched caregiving based on connection before correction, predictable routines, low-arousal responses, concrete communication, repetition, supported repair and adaptation of the environment.

This support should not be mistaken for absence of need or treated as evidence that parents or carers should manage without specialist input. If it were reduced without an equivalent formal plan, [name] would be at increased risk of [identified harms].

The FASD management plan should therefore include practical training and ongoing coaching in FASD-informed therapeutic parenting for parents, carers and the wider support network; reflective consultation and planned respite to sustain the approach; shared multi-agency responsibility; contingency arrangements where indicated; and continuity into adulthood.”

Example professional wording — assessed short breaks: “[Name]’s FASD-related needs require sustained supervision, co-regulation, repetition, support with transitions and active safeguarding across home and community settings. The family currently provides this at a level that is not sustainable without regular planned support. I recommend a social-care assessment for short breaks that considers both [Name]’s developmental and functional needs and the impact of caring on the wider family.

Provision should be predictable and delivered by carers trained in FASD, [Name]’s communication protocol, sensory regulation, suggestibility, coercion and exploitation risk. The assessment should specify the form of break, minimum frequency and duration, location, staffing ratio, transport, introductions, emergency cover and review arrangements. Short breaks should provide a positive, safe and developmentally matched experience for [Name], while enabling parents or carers to rest, attend to siblings and sustain care. A generic activity offer should not be treated as sufficient where [Name] requires individual scaffolding or supervision.”

Example professional wording — Children with Disabilities Team assessment for a personal assistant or enabler: “[Name] requires an assessment by the local authority Children with Disabilities Team to determine the level of social-care support needed for safe community access, leisure participation, development of functional skills and reduced reliance on family members. Because FASD affects [executive functioning, memory, communication, adaptive functioning, sensory regulation, judgement and/or suggestibility], [Name] cannot reliably plan journeys, recognise risk, resist pressure, manage money, communicate need or generalise safety teaching without individual support.

The assessment should consider provision of a consistent personal assistant or enabler, including through a direct payment where appropriate, for at least [number] hours each week and additional hours during school holidays, subject to assessed need. The worker should have specified FASD and safeguarding training, use [Name]’s communication and regulation plans, provide [one-to-one/defined] supervision in identified contexts, support participation rather than substitute for it, and maintain agreed records of activities, prompting, incidents and outcomes. The plan should include recruitment support, DBS and employment arrangements where applicable, contingency cover, travel time, expenses, review frequency and a named social-care lead. Apparent verbal competence or isolated successful outings should not be used to infer safe independent community access.”

Example professional wording — HAF, holiday clubs and after-school clubs: “[Name] should be enabled to access suitable Holiday Activities and Food (HAF) provision, holiday schemes and after-school clubs on an equal and safe basis. Standard open-access provision is unlikely to be accessible without additional support because [Name] is affected by [sensory overload, difficulty with unfamiliar routines, communication and processing needs, developmental immaturity, impulsivity, suggestibility and/or vulnerability in peer groups].

Before attendance, the commissioning or providing service should complete an individual access and safeguarding assessment with [Name], the family and relevant professionals. The plan should specify a maximum group size of [number], [one-to-one/defined ratio] support from a consistent FASD-trained adult, visual preparation and visits before the first session, an individual communication and regulation plan, access to a quiet or outdoor low-arousal space, supported transitions, safe collection and transport arrangements, food and health requirements, online and peer-safeguarding measures, and a named contact for the family.

[Name] should receive at least [number] supported sessions of [duration] during each identified holiday period and/or [number] after-school sessions each week, subject to assessed need and programme availability. Attendance, participation, distress, recovery, incidents and level of prompting should be reviewed after the first [number] sessions and at least termly. If a universal club cannot deliver the assessed adjustments safely, the local authority should consider a specialist place, additional commissioned staffing, a personal assistant/enabler or a direct-payment arrangement rather than concluding that [Name] cannot participate.”

Planning note: Short breaks, personal-assistant support and community or holiday provision may be secured through children’s social care, direct payments, HAF commissioning or other local arrangements rather than solely through Section F.

The professional report should still describe the assessed need, required safeguards and measurable support clearly. The EHCP should record relevant social-care provision in the appropriate section and coordinate it with educational provision, particularly where support affects attendance, preparation for adulthood, community participation, family sustainability or safe access to learning.

For professional reports and EHCP advice: recommendations should state which family support is required, who will provide it, the minimum frequency or availability, how it will be coordinated and reviewed, and what interim or contingency support will apply.

“When family support prevents crisis, its success can make the underlying level of need less visible.”

Specialist mental capacity assessment for likely or confirmed FASD

For a young person aged 16 or over.

In a complex case involving likely or confirmed FASD, a general assessment may be insufficient if the assessor does not understand the effects of receptive-language difficulty, slow processing, working-memory impairment, executive dysfunction, confabulation, developmental mismatch, concrete thinking, acquiescence and high suggestibility. A person may repeat information, appear agreeable or give a fluent answer without being able to apply the information, resist pressure, compare consequences or make the decision safely in real life. Leading questions, repeated questioning, authority dynamics or a wish to please may alter the answer and create a false impression of informed agreement.

The Mental Capacity Act Code of Practice should therefore guide both the method and the choice of assessor. The decision-maker remains responsible for ensuring that the assessment is adequate, but should seek specialist input where the decision is complex, the consequences are serious, the presentation is disputed, or neurodevelopmental and communication difficulties fall outside the assessor’s expertise. This protects the young person or adult from unsafe assumptions and protects the social worker or other decision-maker from being expected to reach conclusions beyond their training.

Where indicated, a specialist assessment can be commissioned from an appropriately qualified professional with demonstrable FASD and Mental Capacity Act expertise, such as an FASD-informed clinical psychologist. Depending on the question, the assessment may also require speech and language, occupational therapy, psychiatric, neuropsychological or other multidisciplinary evidence. The specialist should advise on accessible presentation of information, susceptibility to influence, the reliability of apparent consent or refusal, and whether understanding demonstrated in a structured interview transfers to the actual decision and setting.

A specialist opinion must not replace the statutory presumption of capacity or turn FASD into a blanket finding of incapacity. Conclusions must remain decision- and time-specific, distinguish an unwise decision from inability to decide, document practicable support, and identify when reassessment is required. Where capacity is lacking, subsequent action must follow the Mental Capacity Act 2005, including best-interests and least-restrictive principles and any applicable advocacy or safeguarding duties.

“Capacity cannot be read from fluent speech, confidence or compliance; it must be evidenced for the particular decision with the right support in place.”

Examples of professional recommendations

Specialist referral: “Where capacity is disputed, the decision is complex or high risk, or ordinary assessment cannot accommodate [Name]’s neurodevelopmental profile, commission an assessment from an appropriately qualified practitioner with demonstrable expertise in both FASD and the Mental Capacity Act 2005.”
Define the decision: “The referral must identify the exact decision, why it is required now, the reasonably foreseeable consequences of each available option and the date by which a decision is needed. A global assessment of ‘capacity’ is not appropriate.”
Accessible preparation: “Before assessment, the practitioner should establish [Name]’s communication profile, preferred supports, processing time, recognised signs of overload, optimal time of day and the people whose presence helps or inhibits communication.”
Supported presentation of information: “Relevant information should be presented in short, concrete units using visual, written or practical materials. [Name] should be given extended processing time, planned breaks and more than one opportunity to consider the decision where urgency permits.”
Neutral questioning: “Questions should be non-leading, use consistent wording and avoid forced agreement. The assessor should record whether answers change after repetition, rephrasing, praise, challenge or suggestion, and should not interpret acquiescence as informed consent.”
Functional testing: “The assessment should examine whether [Name] can understand, retain, use or weigh the relevant information and communicate a choice. Evidence should include application to realistic scenarios, not repetition of facts alone.”
Real-world transfer: “Where the decision concerns money, relationships, online activity, travel, accommodation, healthcare or safety, assess whether understanding demonstrated in interview transfers to the actual environment and remains available under stress, fatigue, social pressure or reduced support.”
Suggestibility and coercion: “The assessor should consider [Name]’s susceptibility to authority, peers, grooming, coercion and a wish to please. Where influence is suspected, obtain the person’s views in a safe setting and consider whether advocacy or safeguarding action is required.”
Multidisciplinary evidence: “Obtain speech and language, neuropsychological, occupational therapy, psychiatric or other evidence where communication, executive functioning, sensory regulation, adaptive functioning or mental health materially affects the decision.”
Informant evidence: “With appropriate consent or lawful authority, consult people who know [Name] well about functional decision-making, previous supported choices, vulnerability and the conditions under which understanding improves or deteriorates. Their evidence should inform, but not replace, direct engagement with [Name].”
Documentation: “The report should record the impairment or disturbance relied upon, the precise decision, relevant information, practicable supports attempted, [Name]’s responses, evidence for each element of the functional test, possible influence or coercion, the conclusion and its limits.”
Review: “State when capacity should be reassessed, including after recovery from acute distress, medication change, improved communication support, a material change in circumstances or before a substantially different decision.”
If capacity is present: “Record the support required for [Name] to exercise the decision safely and communicate it consistently. Capacity should not be used as a reason to withdraw disability support, safeguarding measures or reasonable adjustments.”
If capacity is lacking: “Identify the next lawful process, including best-interests decision-making, the least restrictive practicable option, accessible participation, consultation and any entitlement to independent advocacy. Safeguarding and contingency measures should be specified while the decision is resolved.”

Example combined recommendation: “[Name] requires a specialist, decision-specific mental capacity assessment concerning [decision], undertaken by an appropriately qualified FASD-informed clinician with Mental Capacity Act expertise. The assessment should be completed at [Name]’s optimal time of day, over more than one session if required, using short concrete language, visual support, extended processing time and non-leading questions.

It should test understanding, retention, use or weighing of information and communication of a decision, including application in a realistic context and under any relevant social pressure. The clinician should review available speech and language, executive-function, adaptive-functioning and safeguarding evidence; consult [identified people] with appropriate authority; document all practicable support; and advise when reassessment is required. Pending completion, [interim decision-support and safeguarding arrangements] should remain in place.”

“A specialist opinion should challenge unsafe assumptions based on diagnosis, fluent speech, confidence or compliance; it should improve access to supported decision-making, not turn FASD into a blanket finding of incapacity.”

Further wording examples across support areas

The examples below show how additional clinical findings can be translated into specific Section F provision. Bracketed details must be completed from the individual evidence.

Provision should describe the support required to achieve an outcome; diagnosis or placement type alone is not provision.

Example — retention, recall and overlearning: Assessment indicates that [name] may appear to learn information during a supported session but cannot reliably retain or retrieve it later. Transferable Section F wording: “New priority learning will be taught in units of no more than [number] steps and revisited for at least [number] brief sessions across each week. A trained adult will use the same visual cue and wording, provide error-reduced rehearsal, and practise the learning with at least [number] adults and in [number] relevant settings. Staff will complete a weekly retention check after [interval] without treating unsupported recall as the only measure of progress. The specialist teacher will review the teaching sequence and retention data at least half-termly.”

Example — adaptive functioning and daily routines: [Name]’s practical functioning is below that suggested by chronological age or verbal ability and requires external structure for safe completion. Transferable Section F wording: “A named trained adult will teach [specified routine] through a consistent photographic sequence, direct modelling and supported practice on at least [number] occasions each week. The adult will prompt each stage, supervise any safety-critical element and record the highest step completed with the agreed level of support. Practice will occur in the real setting in which the skill is required. Support will not be withdrawn solely because [name] can describe the routine verbally; reduction will follow functional evidence across at least [number] consecutive weeks.”

Example — emotional regulation and co-regulation: When demands exceed processing, sensory or adaptive capacity, [name] cannot reliably down-regulate through verbal reasoning or independent strategies. Transferable Section F wording: “A small team of named FASD-trained adults will provide proactive co-regulation at arrival, before and after high-demand lessons, during transitions and at the first agreed signs of escalating arousal. Adults will reduce language and demand, use the individual visual regulation sequence and remain available until [name] returns to their recognised baseline. Restorative discussion will occur only when regulated and will last no more than [duration]. Staff will record triggers, support used and recovery time; the plan will be reviewed at least half-termly and after any significant escalation.”

Example — fatigue, attendance and access to the school day: Clinical evidence indicates that cognitive and sensory fatigue accumulates across the day and contributes to reduced functioning, distress or non-attendance. Transferable Section F wording: “For [specified period], [name] will follow an individual access plan including [adjusted start/finish, protected low-demand period or reduced transition load] and a quiet regulation space available within [number] minutes. Missed teaching will be prioritised and retaught individually or in a group of no more than [number] pupils for [duration/frequency], without requiring [name] to complete an additional full workload at home. Attendance, recovery time, engagement and post-school impact will be reviewed every [number] weeks with the family and relevant clinician. Any proposed increase in demand will be gradual and evidence-led.”

Example — social understanding and safer peer participation: [Name] has difficulty interpreting intention, boundaries, humour, persuasion and hidden social rules and may imitate or comply to gain acceptance. Transferable Section F wording: “A trained adult will provide [number] individual or small-group sessions of [duration] each week using concrete scenarios, visual mapping, modelling and rehearsal of boundaries, pressure, help-seeking and repair. The same adult will prepare and support [name] before identified peer activities and review the interaction afterwards. Unstructured peer contact will occur within the agreed supervision plan. Progress will be measured by observed supported use of the agreed scripts and routes to help, not verbal knowledge alone.”

Example — safeguarding supervision and trusted-adult system: Clinical evidence identifies high suggestibility, reduced risk appraisal and unreliable transfer of safety learning. Transferable Section F wording: “One of [number] named adults trained in FASD, communication need and safeguarding will provide direct supervision during arrival, departure, break, lunch, transport, off-site activity, online learning and identified peer contact. The adult will remain within [defined distance/line of sight] in specified high-risk contexts. [Name] will carry a visual trusted-adult card and rehearse the same leave–check–tell script at least [frequency]. Any incident, missing episode, unsafe contact or material change in peer group will trigger risk-plan review within [number] working days with education, family and relevant safeguarding professionals.”

Example — sleep, medication and health-related access: Sleep disturbance, pain, medication effects or other health needs reduce alertness, attendance or safe participation. Transferable Section F wording: “A named staff member will complete a brief health and readiness check with [name] and family at [specified frequency], following the agreed health plan and information-sharing arrangements. On identified low-readiness days, staff will reduce non-essential cognitive demand, provide the specified rest and regulation opportunities and prioritise core learning. Medication or clinical procedures will be supported only by trained staff in accordance with the healthcare plan. Education, health and family representatives will review the impact on access at least termly and after any treatment change.”

Example — motor coordination, handwriting and recording: Motor planning, coordination or graphomotor difficulty significantly increases effort and prevents written output from reflecting knowledge. Transferable Section F wording: “For all tasks requiring more than [amount] of handwriting, [name] will use [assessed method, such as keyboard, scribe or speech-to-text] and will not be required to copy extended text from a board. A trained adult will provide [frequency] practice in the agreed access method, and the occupational therapist will assess seating, equipment and task demands, train staff and review within [number] weeks and at least termly. Progress will be measured through access, accuracy, fatigue and ability to demonstrate curriculum knowledge, not handwriting volume alone.”

Example — therapy integrated into daily education: Speech and language or occupational-therapy needs affect access throughout the day and cannot be met by isolated clinic sessions alone. Transferable Section F wording: “The registered [speech and language therapist/occupational therapist] will provide [number] minutes of direct work and [number] minutes of consultation each [week/month/term], observe [name] in at least [contexts], produce a written programme and model each strategy to named staff. A trained education adult will deliver the programme for [duration/frequency] across ordinary routines and maintain the agreed record. The therapist, SENCO, family and key staff will review functional impact at least termly and revise the programme.”

Example — preparation for adulthood and supported independence: [Name] requires repeated, concrete teaching and adult scaffolding to use practical skills safely beyond the classroom. Transferable Section F wording: “From Year 9, [name] will receive at least [number] hours each week of developmentally matched teaching and supported practice linked to employment, independent living, community inclusion and health. Priority routines will include [travel, money, appointments, food, work tasks or help-seeking] and will be practised in real settings with a trained adult. Risk assessment and supervision will be specified for each activity. Progress will be measured by functional performance with an agreed level of support; independence will not be inferred from verbal explanation or a single successful occasion.”

Example — multidisciplinary coordination and review: The child’s needs span education, health, therapy, safeguarding and family support and require one coherent plan. Transferable Section F wording: “A named EHCP coordinator will convene a multidisciplinary implementation review at least once each term, attended by [specified professionals], the family and [name] with accessible participation support. The meeting will review delivery records, outcomes, incidents, fatigue, attendance, family impact and emerging risks; assign each action to a named person with a deadline; and issue an updated written implementation plan within [number] working days. Any significant placement, health, safeguarding or family change will trigger an additional review within [number] working days.”

Clinical domains to report in functional terms

Attention and executive functioning: initiation, inhibition, planning, sequencing, organisation, shifting, self-monitoring and completion.
Learning and memory: encoding, working memory, retrieval, retention, overlearning and transfer to new people, places or tasks.
Language and communication: receptive and expressive language, auditory processing, abstract language, inference, narrative, response time and the gap between fluent speech and functional comprehension.
Adaptive functioning: practical daily living, time, money, routines, self-care, independence, judgement and the degree of prompting or supervision required.
Sensory and motor functioning: sensory seeking or avoidance, overload, interoception, coordination, motor planning and the effect on access and regulation.
Emotional regulation: arousal, recovery after stress, co-regulation, fatigue and whether emotional or behavioural escalation follows neurodevelopmental overload.
Social cognition and safeguarding: developmental maturity, boundaries, suggestibility, imitation, cause-and-effect reasoning, risk appraisal, coercion, grooming and exploitation vulnerability.
Physical and medical factors: sleep, growth, neurological findings, pain, medication, hearing, vision and other health needs affecting education.

Professional report quality check

Have I stated the evidential basis and degree of certainty for each important conclusion?
Have I explained functional impact across clinic, home, education and community settings?
Have I described developmental mismatch, adaptive functioning and the possibility that verbal skill masks need?
Have I explained variability and the effect of fatigue, sensory load, language demand, stress and scaffolding?
Have I distinguished primary neurodevelopmental impairment from secondary distress or separate mental health needs?
Have I identified strengths without using them to minimise disability?
Have I described safeguarding vulnerability, suggestibility and real-world risk where relevant?
Can each recommendation answer: what, who, how often, where, with what expertise and how reviewed?
Could an EHCP writer lift the functional needs into Section B and translate the recommendations into Section F without guessing?
Have I included the child or young person’s and family’s perspectives, including evidence of what helps and what increases difficulty?

Key professional and SEND anchors

NICE Quality Standard QS204 covers assessment and diagnosis of FASD in children and young people and identifies priority areas including recording fetal alcohol exposure, referral where probable exposure is accompanied by significant difficulty, neurodevelopmental assessment where indicated, and an individualised management plan following diagnosis. SIGN 156 addresses identification, medical and neurodevelopmental assessment, multidisciplinary diagnosis, management and follow-up for children and young people exposed prenatally to alcohol.

In England, the SEND Code of Practice and the government guide for health professionals emphasise coordinated education, health and care assessment and outcomes. Current UK clinical guidance on alcohol treatment in pregnancy and perinatal care also stresses non-judgemental information, clear recording, multi-agency planning and support.

Use this page with the FASD-Informed EHCP guide

This page supports the clinical report that enters the statutory process; the companion FASD-Informed Education, Health and Care Plan page supports the professionals who convert that evidence into accurate needs, outcomes, provision, safeguarding analysis and placement decisions. Used together, the two pages create a clear chain from assessment finding, to functional need, to specified support.

In-text citation examples

Use one citation style consistently throughout the page. The examples below use an author–date approach and can be adapted to the organisation’s preferred house style. Add a quality-statement, paragraph, section or page locator where a precise proposition depends on a particular part of a source.

Narrative citation — NICE: “NICE Quality Standard QS204 (NICE, 2022) identifies recording prenatal alcohol exposure, referral, neurodevelopmental assessment and individualised management planning as priority areas.”
Parenthetical citation — NICE: “Known prenatal alcohol exposure alongside significant developmental difficulty should prompt timely referral and assessment rather than delay until crisis (NICE, 2022).”
Narrative citation — SIGN: “SIGN 156 (Scottish Intercollegiate Guidelines Network, 2019) describes multidisciplinary identification, assessment, diagnosis, management and follow-up for children and young people exposed prenatally to alcohol.”
Parenthetical citation — SEND: “Special educational provision should be detailed, specific and normally quantified, including the type, hours, frequency and level of expertise required (Department for Education and Department of Health, 2015, paras. 9.69 and 9.73).”
Narrative citation — UK clinical guidance: “The Department of Health and Social Care (2025, updated 2026) emphasises non-judgemental enquiry, clear recording, information sharing and coordinated support in pregnancy and perinatal care.”
Parenthetical citation — management planning: “A management plan should address immediate and long-term needs and coordinate support across health, education and social care (NICE, 2022, Quality statement 5).”
Narrative citation — mental capacity: “The Mental Capacity Act Code of Practice (Department for Constitutional Affairs, 2007) requires capacity to be assessed for the specific decision and after practicable support has been provided.”
Parenthetical citation — specialist capacity input: “Specialist professional input should be sought where communication or neurodevelopmental complexity falls outside the assessor’s expertise (Department for Constitutional Affairs, 2007).”
Several sources supporting one statement: “FASD-informed practice requires a multidisciplinary formulation linked to functional need, coordinated support and review across transitions (NICE, 2022; Scottish Intercollegiate Guidelines Network, 2019).”
Direct quotation: Use quotation marks and add the most precise locator available, for example: “quoted wording” (Organisation, year, p. [page]) or (Organisation, year, para. [paragraph]). Verify the wording and locator against the original source before publication.

Good practice: Cite the source immediately after the claim it supports. Do not attach a citation to locally developed example wording in a way that implies the source uses those exact words. Introduce model EHCP or clinical wording as an interpretation or practice example based on the cited guidance, and retain the full matching entry in the reference list.

Stuck or complex cases:

Where assessment, safeguarding, EHCP provision, placement, transition, supported living or multi-agency planning has become stuck, disputed or difficult to coordinate, contact FASD Informed UK for specialist support. We can provide FASD-informed professional supervision, one-to-one consultation, or multidisciplinary support to help the Team Around the Family clarify the neurodevelopmental formulation, identify unmet need and risk, agree practical next steps, and translate clinical evidence into coordinated education, health and social-care planning. This support complements, but does not replace, statutory safeguarding action, local procedures, formal assessment or legal advice.

References and further reading

NICE. Fetal alcohol spectrum disorder: Quality standard QS204. Published 16 March 2022.
Scottish Intercollegiate Guidelines Network. SIGN 156: Children and young people exposed prenatally to alcohol. 2019.
Department for Education and Department of Health and Social Care. SEND code of practice: 0 to 25 years.
Department for Education and Department of Health and Social Care. 0 to 25 SEND code of practice: a guide for health professionals.
Department of Health and Social Care. Clinical guidelines for alcohol treatment: pregnancy and perinatal care. Published 2025; updated 2026.
Department for Constitutional Affairs. Mental Capacity Act 2005 Code of Practice. The Stationery Office, 2007. ISBN 978-0-11-703746-5.
Mental Capacity Act 2005.
FASD Informed UK. Clinical guidance for alcohol: early-intervention terminology and direct NHS FASD referral pathway. Practice resource.
Department for Education. Working together to safeguard children 2026: a guide to multi-agency working to help, protect and promote the welfare of children. Statutory guidance, March 2026.
Department for Education. Keeping children safe in education 2025. Statutory guidance in force until 31 August 2026; see also Keeping children safe in education 2026, which comes into force on 1 September 2026.
Children Act 1989, including section 17 and Schedule 2, paragraph 6: services for children in need, disabled children and breaks from caring.
Adoption and Children Act 2002, including section 1: the child’s welfare throughout life; and sections 3 and 4: adoption services and assessment of need for adoption support services.
The Breaks for Carers of Disabled Children Regulations 2011, SI 2011/707.
Department for Education. Short breaks: safeguarding the welfare of disabled children. Statutory guidance, 2010.
Department for Education. Short breaks for carers of disabled children. Departmental advice for local authorities, March 2011.
Children and Families Act 2014 and the Special Educational Needs and Disability Regulations 2014: statutory framework for EHC needs assessments and EHC plans.
The Special Educational Needs (Personal Budgets) Regulations 2014: personal budgets and direct payments in relation to EHC plans.
Department for Education. Holiday activities and food programme 2026 to 2027 financial year. Guidance for local authorities, updated 19 August 2026.
Royal College of Occupational Therapists. Using sensory integration therapy, sensory-based interventions and sensory approaches with children and young people. RCOT Informed View, March 2026.
Payne, S. Why the language we use around sensory interventions matters. Royal College of Occupational Therapists, 17 March 2026.

© FASD Informed UK™. This page is provided for information and professional learning. It does not replace individual clinical judgement, applicable diagnostic guidance or legal advice. Please reference FASD Informed UK™ when sharing or quoting from this page.

Email us

How reports can dovetail with the EHCP

The companion FASD Informed EHCP page begins with educational need and shows how Sections B, E, F and I should describe and meet that need. This clinical page starts one step earlier. It helps clinicians convert assessment evidence into a clear neurodevelopmental formulation, describe day-to-day impact across settings, distinguish primary impairment from secondary distress, and state recommendations in terms that education teams can use without changing their clinical meaning.

A report should retain appropriate clinical caution. It should distinguish confirmed findings, reported history, direct observation and reasonable clinical inference. Where diagnosis is incomplete, clinicians can still describe the evidenced functional profile and recommended support. Educational planning does not require clinicians to overstate diagnostic certainty; it requires them to be clear about impact and need.