​What if today’s distress is not defiance - but a brain and body trying to function after too little restorative sleep?

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Sleep debt can quietly reduce capacity long before adults recognise what is happening. In FASD, tiredness may affect regulation, memory, processing, sensory tolerance, transitions and emotional recovery - changing what a child or young person can manage today.

We invite you to look beyond behaviour, ask about sleep and recovery first…. to adjust support before increasing demand.

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In FASD, sleep difficulties can affect regulation, attention, memory, processing, sensory tolerance, impulse control and emotional recovery. A child, young person or adult may appear more reactive, avoidant, forgetful, distressed or unable to cope when their brain and body are carrying sleep debt.

Across the lifespan: These principles can apply to children, young people and adults. Support should reflect the person’s current functional capacity rather than their age or apparent independence.

Sleep debt can build quietly over days or weeks, especially when a child, young person or adult has broken sleep, late settling, early waking, nightmares, sensory discomfort, anxiety or difficulty switching off.

Recovery principle: Recovery from accumulated sleep debt may take time. Expectations should not automatically return to normal after one improved night.

This is not poor motivation, bad attitude or deliberate non-compliance. It is a brain-based and body-based support need.

Practical action: ask how sleep, fatigue and recovery are affecting capacity today before increasing demands, expecting emotional regulation or interpreting behaviour as intentional.

Morning example: A child, young person or adult who had broken sleep may need a slower start, reduced language, fewer choices and extra co-regulation before school, college, placement, work or daily expectations begin.

It’s okay to be late - understanding capacity matters more than keeping pace.

School example: A pupil may struggle more with attention, instructions, noise, transitions or frustration after poor sleep. Staff should reduce demand and increase visual and adult support rather than assuming refusal.

Transition example: Sleep debt can make moving from one activity to another much harder. The person may need earlier warning, a quieter route, fewer words and recovery time after the transition.

Home example: After several nights of poor sleep, the family may use a minimum-demand day with simple food, familiar routines, reduced outings and more regulation support.

Health signpost: Persistent or severe sleep difficulties should be discussed with an appropriate health professional. Seek advice particularly where there is loud snoring, pauses or difficulty in breathing, unusual movements during sleep, ongoing pain, medication concerns or significant daytime sleepiness. These signs should not be assumed to be part of FASD without further assessment.

Immediate-safety example: When sleep debt reduces alertness, memory, judgement or impulse control, additional support may be needed around travel and road safety, cooking, medication, machinery, practical placements and other safety-critical activities. A task may need to be paused, supervised or rescheduled rather than completed at the usual pace.

College or supported internship example: A young person arriving after broken or insufficient sleep may need a later or slower start, fewer instructions, reduced travel or placement demands, a quiet recovery space, additional job-coach support and flexibility to pause or reschedule higher-risk practical tasks. Tiredness-related reduced capacity should not be interpreted as poor motivation or lack of commitment.

​Meeting phrase: “Sleep debt is affecting capacity, regulation and tolerance. We need to adjust expectations and support recovery rather than treating tiredness-related dysregulation as behaviour.”

Assumptions and safeguarding risk: A likely mistaken assumption is that a person can function consistently despite sleep debt, rather than recognising that capacity may vary with sleep quality, fatigue, sensory load, stress, context and the support available.

If this need is misread, or support is withdrawn too soon, the person may be blamed, exposed to avoidable failure, or left unable to recognise, communicate or respond to risk.

Particular safeguarding attention may be needed around travel, road safety, cooking, medication, machinery, practical placements, personal care, eating, sleep and sensory overload. A calm, curious response should consider brain-based and body-based differences and unmet need, not presume wilful non-compliance.

Support must be based on evidenced functional need and reviewed collaboratively over time, rather than reduced because of age, fluent speech, apparent compliance, behaviour, one successful occasion or one better night’s sleep.

EHCP evidence prompt: Record patterns between sleep, fatigue, regulation, learning, attendance, transitions, sensory tolerance and after-school collapse, including what support helped on low-capacity days.

EHCP phrase: “[Child/young person] requires support that recognises the impact of sleep debt on regulation, attention, processing, memory, sensory tolerance and emotional recovery. Provision should include adjusted expectations, reduced verbal load, visual supports, co-regulation, recovery time and home-school communication about sleep and fatigue.”

EHCP objective: "By the end of the review period, [child/young person] will be supported through agreed sleep-debt adjustments so that staff consider sleep, fatigue and recovery before expecting full regulation, learning, transition tolerance or independent task completion."

EHCP outcome for college or supported internship: “By the end of the review period, [young person] will access college learning or their supported internship through an agreed 'sleep-debt plan'. College, placement and job-coach staff will check current fatigue and capacity, adjust start times, travel, verbal and practical demands, provide access to recovery space and additional adult support, and postpone safety-critical tasks where necessary. Progress will be evidenced through improved supported attendance and engagement, fewer fatigue-related incidents or unfinished tasks, and consistent recording of the adjustments that enabled safe participation.”

Measurable provision prompt: "Success will be measured by consistent recording of sleep and fatigue patterns where relevant; reduced escalation linked to tiredness and rushed demands; increased use of agreed low-capacity day supports; and evidence that expectations are adjusted when sleep debt is affecting capacity."

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What if the behaviour we notice is the body asking for help before the child can find the words?

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Somatic signals are internal body sensations and outward signs. The signals themselves are not necessarily “poor”; the difficulty may lie in noticing or processing them, interpreting what they mean, responding to them or communicating them to someone else.

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For some children and young people with FASD, recognition or communication of hunger, pain, tiredness, anxiety, sensory overload or another body need may be delayed, inconsistent or less reliable - particularly during stress, fatigue or overload.

Others may experience certain signals very strongly, notice them accurately but struggle to identify their cause, or be hypersensitive to particular internal or external sensations.

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A sudden change in behaviour may therefore be an important clue - not a reason for blame. Pause, get curious and check the body before increasing demand.

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Safeguarding risk in FASD: If a person cannot reliably recognise, interpret or communicate pain, illness, hunger, thirst, toileting needs, fear, sensory distress or bodily discomfort, they may be unable to seek help early or give a clear account of what has happened.

Signs of injury, infection, medication effects, constipation, neglect, exploitation or abuse may be mistaken for behaviour, anxiety or sensory overload.

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A person may also comply with unsafe touch, personal care or demands because they cannot identify discomfort, find the words to object or understand that the situation is unsafe.

Adults should notice changes from the person’s usual presentation, use calm and non-leading communication, record observations objectively, preserve the person’s dignity and consent, and follow health and safeguarding procedures whenever there is a new, concerning or unexplained change.

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Why this may happen: Prenatal alcohol exposure can affect development of the brain and other body systems. FASD is highly individual, and research specifically linking FASD with interoception and autonomic regulation is still developing.

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Brain-based differences in sensory processing, attention, memory, language and regulation may make it harder for some people to notice a body signal, work out what it means, respond to it or explain it to someone else.

Physical, sensory and emotional causes can also overlap: pain may increase anxiety and sensory sensitivity; constipation may affect sleep and regulation; and fatigue may reduce the ability to recognise or communicate another health need..

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Important medical-safety note: Somatic signals should prompt curiosity, but they must not be used to explain away every change.

New, unexplained, persistent, severe or worsening symptoms require timely assessment by an appropriate health professional. Breathing difficulty, altered consciousness, significant injury, severe pain, repeated vomiting, dehydration or unusual drowsiness require urgent medical help. FASD, anxiety, sensory processing or behaviour should not be assumed to be the cause until illness, injury, constipation, medication effects and other health concerns have been considered.

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How sensory processing may affect somatic signals: Sensory processing differences are reported in FASD, although the evidence base, particularly across the lifespan - is still developing.

Internal and external sensations may be experienced as stronger, weaker, confusing, difficult to organise or variable from one situation to another. Everyday input - such as clothing seams, touch, bright or flickering light, noise, smells, movement, heat, cold, hunger or sensations from the gut - may feel overwhelming, painful or hard to identify.

The person may show stomach ache, headache, nausea, agitation, pacing, escape, shutdown or sudden distress before they can explain the source.

At other times, pain, thirst, temperature or the need for the toilet may be noticed late. Adults should learn the individual person’s patterns, offer supported ways to communicate and reduce or change difficult sensory input, while still seeking appropriate health assessment for new, persistent, severe, worsening or unexplained symptoms rather than assuming they are sensory or part of FASD.

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Possible somatic signs: Signs vary between people and are not diagnostic of FASD. They may include nausea, dizziness, appetite or bowel changes, muscle tension, trembling, altered breathing or heartbeat, sweating, feeling unusually hot or cold, low energy, unusual sleepiness, guarding part of the body, changed posture or walking, removing clothing, lying down, seeking pressure or movement, becoming unusually quiet or talkative, clinging to a trusted adult or repeatedly asking to leave. Some people notice a need only when it becomes urgent; others communicate it clearly.

Compare any change with the person’s usual presentation, record what was observed and avoid assuming a single cause.

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In FASD, hunger, thirst, pain, tiredness, sensory overload, anxiety, illness, temperature or needing the toilet may show through behaviour before the child can name the need.

Somatic signals may look like agitation, shutdown, irritability, avoidance, pacing, stomach ache, headache, restlessness, refusal, tearfulness or sudden distress.

This is not automatically attention-seeking, overreacting or deliberate behaviour; it may be the body communicating an unmet need.

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Practical action: Before increasing demand, ask, “Could this be pain, hunger, thirst, tiredness, sensory overload, anxiety or another body need?”

A body check should be calm, private and proportionate. Use the person’s preferred communication, offer one possibility at a time, allow processing time and avoid repeatedly suggesting a symptom. Respect dignity, consent and the person’s health, communication and safeguarding plans.

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Somatic Signals: Examples for Parents, Carers and Professionals

Body-check example: Check drink, food, toilet, pain, temperature, tiredness, sensory load and whether anything has changed from the person’s usual presentation.

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School example: A child who suddenly refuses work may be overloaded by noise, pain, hunger or fatigue. Staff should check body needs, use accessible communication and reduce demand before assuming avoidance.

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Home example: A child who becomes distressed after school may need food, quiet, low light, comfort, movement or fewer questions before they can communicate what is wrong.

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Health and medication example: A change in behaviour, alertness, appetite, sleep, bowel pattern, movement or distress may be linked to illness, pain or medication effects. Adults should record the change and seek appropriate clinical advice rather than changing prescribed medication without the prescriber’s guidance.

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Pattern-recording example: Record the time, setting, recent sleep and food, bowel or toilet pattern, medication, sensory demands, observable signs, the person’s own communication, support offered and what happened next. Share recurring or concerning patterns with the appropriate health professional.

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Meeting phrase: “Before we interpret this as behaviour, we need to consider whether the body is signalling pain, fatigue, sensory overload, anxiety or another unmet need.”

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Examples of EHCP Outcomes for Somatic Signals, Sensory Needs and Safeguarding

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Evidence note: Outcomes should describe the difference expected for the child or young person; Section F should separately specify the provision required to achieve them. Where sensory differences affect access, participation, personal care, health communication or safety, assessment should be completed by an occupational therapist with relevant paediatric sensory-processing expertise. Ayres Sensory Integration® Occupational Theraphy should be considered, the therapist should also hold recognised post-registration training in that approach. Assessment and intervention should be occupation-focused, evidence-informed, linked to functional goals and reviewed using agreed measures. Currently NHS Occupational Therapist's are not necessary training in Sensory Integration OT so if needs are noted, this additional needs would need to be commissioned by the EHCP as a specialist non-universal service to support needs.  

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• Body-signal communication outcome: “By [date], when [child/young person] experiences or is observed to show possible pain, illness, hunger, thirst, toileting need, fear, sensory distress or bodily discomfort, they will be supported to communicate this by at least one reliable means - such as a photographic body map, object, gesture, symbol, written choice, or trusted-adult-supported response - in [agreed proportion] of recorded opportunities across education and care settings.”

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• Early-response outcome: “By [date], agreed adults will respond to [child/young person]’s individual early body-signal indicators using the body-needs and health-escalation plan before increasing demand. Records will show the signal observed, support offered, response and any health or safeguarding action in [agreed proportion] of relevant incidents.”

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• Sensory participation outcome: “By [date], [child/young person] will access identified learning, transitions, eating, personal-care and community activities using an individually assessed sensory and environmental plan, with improved safe participation and reduced distress or withdrawal compared with the agreed baseline.”

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• Personal-care, consent and safety outcome: “By [date], during personal care, health procedures or situations involving touch, [child/young person] will be offered an accessible explanation, a consistent way to indicate yes, no, stop, pain or discomfort, processing time and the support of agreed adults. Records will demonstrate that assent, refusal, changes in presentation and safeguarding concerns are recognised and acted upon.”

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• Health-reporting outcome: “By [date], [child/young person] will have an agreed health-communication profile available across relevant settings, setting out their usual presentation, possible indicators of pain or illness, reliable communication methods and escalation thresholds. New, unexplained, persistent, severe or worsening changes will be recorded and referred through the agreed health pathway without being attributed automatically to FASD, anxiety, sensory processing or behaviour.”

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• Safeguarding-account outcome: “By [date], where [child/young person] needs to describe an event, concern or bodily experience, staff will use calm, non-leading questions, accessible communication, processing time and objective recording. Progress will be evidenced by consistent adherence to the agreed protocol and timely referral of new or unexplained concerns.”

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• Staff-competence outcome: “By [date], all relevant education, transport, personal-care, residential and supply staff will have completed FASD training and demonstrated competent use of [child/young person]’s body-needs, sensory, communication, consent and escalation plans through observation, supervision or an agreed knowledge check.”

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Specialist occupational therapy commissioning and provision:

“Within [specified timescale], the local authority will commission and fund a functional assessment by an HCPC-registered occupational therapist with evidenced expertise in FASD, sensory processing, interoception and trauma-informed practice. The assessment will identify barriers across education and daily life, establish a functional baseline and recommend sensory, environmental, communication and adult-support strategies. For Ayres Sensory Integration®, the therapist must hold recognised post-registration training and specify the rationale, functional goals, consent, risks and outcome measures. A written programme will state who provides each intervention, its frequency, duration and setting, staff training, monitoring and review at least every [term/number of weeks]. Educational provision will be specified in Section F, with related health provision recorded in the appropriate section.”

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Measurable review prompt: “Review evidence will include the child or young person’s views; family observations; objective records of body signals, communication and adult responses; use of agreed adjustments; health and safeguarding referrals; incidents involving personal care, touch or unmet bodily need; and functional participation across settings. Provision will not be reduced because of age, fluent speech, apparent compliance or one successful occasion. Any reduction will be gradual, evidence-based and agreed through review.”

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Measurable EHCP outcome for college or supported internship: “By the end of the review period, [young person] will access college learning or their supported internship through an agreed somatic-signals and sensory-support plan. College, placement and job-coach staff will use scheduled and responsive body-needs checks, accessible non-leading communication, sensory and environmental adjustments, reduced demand and agreed health or safeguarding escalation pathways. Progress will be evidenced by the young person communicating pain, illness, hunger, thirst, toileting need, fear, sensory distress or bodily discomfort by an agreed reliable means in [agreed proportion] of recorded opportunities; staff responding to early indicators in [agreed proportion] of relevant incidents; fewer episodes of unmet bodily need disrupting attendance or safe participation; and objective records showing timely referral of every new, unexplained or concerning change.”

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EHCP evidence prompt: Record patterns between body needs and behaviour, including sleep, food, hydration, toileting, pain, sensory stress, temperature, illness, medication, transitions and recovery after overload. Record the person’s own communication, the support used and whether they returned to their usual presentation.

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EHCP phrase: “[Child/young person] requires support that recognises somatic signals as possible communication of distress, discomfort, pain, illness or overload. Provision will include regular and responsive body-needs checks; accessible and non-leading communication; reduced demand during suspected overload; sensory adjustments; adult co-regulation; objective recording; and clear health and safeguarding escalation pathways.”

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EHCP objective: “By the end of the review period, [child/young person] will be supported to recognise, communicate and respond to body-based signals using agreed communication methods, regular body-needs checks, adult observation and co-regulation, so that physical, sensory and emotional needs are considered before distress or avoidance is interpreted as intentional behaviour.”

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Measurable provision prompt: “Success will be measured by consistent use of agreed body-needs checks and communication supports; reduced escalation linked to missed body needs; objective recording of patterns and adult responses across settings; and timely use of agreed health or safeguarding escalation where a change is new, unexplained or concerning.”

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To stay informed please subscribe for updates further below.
 

Disclaimer: This information is for general education and FASD-informed support only. It is not a substitute for individual medical, occupational therapy, mental health, legal, safeguarding or EHCP advice, assessment or diagnosis. Needs and presentations vary, so support should be based on the person’s assessed functional needs and agreed with appropriately qualified professionals. Seek prompt professional advice for new, unexplained, persistent, severe or worsening symptoms, and follow local emergency and safeguarding procedures where there is immediate risk or concern.

© FASD Informed UK™  All rights reserved.

In FASD, raised voices, repeated instructions, urgency, public correction, emotional intensity or too many words can increase dysregulation. A low-arousal approach helps adults reduce the demands around the child so their brain and body have a better chance of returning to safety and regulation.

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Low arousal does not mean ignoring risk or removing boundaries. It means keeping adults calm, language minimal, choices limited, space safer and the next step smaller.

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This is not permissive, soft or inconsistent. It is a brain-based support approach.

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Practical action: lower your voice, reduce words, give space, remove unnecessary audience pressure and make the next step smaller before expecting reasoning, reflection or cooperation.

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Low Arousal: Examples for Parents, Carers and Professionals

Voice example: The adult lowers their voice, slows their pace and uses fewer words instead of repeating instructions more loudly.

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Language example: Instead of asking “Why did you do that?” in the moment, try “You are safe. We will make this smaller. First, come with me.”

Space example: A child who is overwhelmed is moved away from a busy corridor, crowd or audience before adults try to talk, teach or problem-solve.

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Demand example: A task is reduced from “finish the whole sheet” to the adult making the task smaller and says calmly, “There is a lot on this sheet. Your name goes at the top. I can sit with you while we look at the first question together.”

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Transition example: During a difficult transition, the adult uses a calm phrase, shows the next visual, walks alongside the child and avoids extra discussion until regulation has improved.

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School example: Staff agree a low-arousal plan so that when the child is escalating, adults reduce language, remove audience pressure, offer a calm space and delay consequences or reflection until later.

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Home example: When a child is close to overload, the adult stops explaining, lowers demand, offers a drink or sensory support and returns to the conversation when the child is calmer.

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Assumptions and safeguarding risk:

Low Arousal is a skill the person can use consistently whenever asked, rather than an ability that may vary with stress, fatigue, sensory load, context and the amount of external support available.

If this need is misread, or support is withdrawn too soon, the person may be blamed, exposed to avoidable failure, or left unable to recognise, communicate or respond to risk.

Particular safeguarding attention may be needed around busy environments, transport, personal care, eating, sleep and sensory overload.

A calm, curious response should consider brain-based differences and unmet need, not presume wilful non-compliance.

Support must be based on evidenced functional need and reviewed collaboratively over time, rather than reduced because of age, fluent speech, apparent compliance, behaviour, or one successful occasion.

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EHCP evidence prompt: Record whether the child responds more successfully when adults use low-arousal communication, reduced verbal load, calm tone, predictable scripts, safe space, delayed reflection and smaller next steps during stress or escalation.

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EHCP phrase: “[Child/young person] requires a consistent low-arousal approach to reduce threat, verbal load, emotional intensity and escalation. Provision should include calm adult tone, reduced language, predictable scripts, access to a low-arousal space, reduced audience pressure, smaller next steps, co-regulation and delayed reflection until the child is regulated enough to process information.”

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EHCP objective: "By the end of the review period, [child/young person] will be supported through an agreed low-arousal plan so that adults consistently reduce voice volume, verbal load, audience pressure and task demand during stress or escalation, and provide co-regulation, safe space and delayed reflection before expecting reasoning, repair or learning."

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Measurable provision prompt: "Success will be measured by reduced escalation linked to adult language, urgency or public correction; consistent use of agreed low-arousal scripts and spaces across settings; evidence that staff reduce demand before crisis; and records showing that reflection, repair or consequences are delayed until [child/young person] is regulated enough to process them."

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​

To stay informed please subscribe for updates further below. 

​

Would you like more information about an FASD Informed EHCP?

​

Visit our FASD-Informed EHCP guide for practical help identifying needs, gathering evidence, preparing for reviews and writing specific, measurable provision:

https://www.fasdinformed.co.uk/ehcp

​

For FASD Informed Professional Report Writing pop along to our new page linked here: 

https://www.fasdinformed.co.uk/reportwriting

​

For support with an EHCP consider 1:1 support from an FASD Advocate; find more details HERE

© FASD Informed UK™  All rights reserved.

In FASD, threshold can be reached more quickly when a child or young person is tired, hungry, anxious, overloaded, in pain, under pressure, transitioning, processing too much language or managing too many sensory demands. Once threshold is reached, reasoning, learning, flexible thinking and cooperation may no longer be available.

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Adults may only notice threshold when behaviour changes, but the build-up often starts much earlier.

Support works best when demand is reduced before the child is pushed past capacity.

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This is not overreacting, refusing or choosing to escalate. It is a brain-based and body-based support need.

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Practical action: reduce demand before the person is pushed past capacity. Ask, “What can we lower, remove, make visual, slow down or postpone before this becomes too much?”

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Threshold: Examples for Parents, Carers and Professionals

Early signs example: A child may become restless, louder, quieter, tearful, repetitive, silly, withdrawn or physically tense before reaching threshold.

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School example: A pupil may cope with the lesson but reach threshold when there is noise, a transition, a correction, a surprise change or too many instructions at once.

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Home example: After a demanding school day, a child may have no remaining capacity for questions, homework, chores or changes to routine. A lower-demand plan may prevent escalation.

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Transition example: A child may be near threshold before the transition begins. Earlier warning, fewer words, a calmer route and recovery time may prevent overload.

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Meeting phrase: “They are nearing or past capacity. We need to reduce demand and support regulation before expecting reasoning, learning, apology or cooperation.”

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Assumptions and safeguarding risk: 

Threshold is a skill the person can use consistently whenever asked, rather than an ability that may vary with stress, fatigue, sensory load, context and the amount of external support available.

If this need is misread, or support is withdrawn too soon, the person may be blamed, exposed to avoidable failure, or left unable to recognise, communicate or respond to risk.

Particular safeguarding attention may be needed around busy environments, transport, personal care, eating, sleep and sensory overload.

A calm, curious response should consider brain-based differences and unmet need, not presume wilful non-compliance.

Support must be based on evidenced functional need and reviewed collaboratively over time, rather than reduced because of age, fluent speech, apparent compliance, behaviour, or one successful occasion.

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EHCP evidence prompt: Record what happens before threshold is reached, including sleep, fatigue, hunger, sensory overload, transitions, adult language, unexpected change, pain, anxiety, social demand and recovery time.

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EHCP phrase: “[Child/young person] requires support that recognises threshold and capacity limits. Provision should include proactive reduction of demand, reduced verbal load, visual supports, predictable routines, sensory adjustments, co-regulation and recovery time before the child is pushed beyond capacity.”

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EHCP objective: "By the end of the review period, [child/young person] will be supported through agreed threshold-aware adjustments so that staff recognise early signs of overload, reduce demand before escalation and provide co-regulation, sensory support and recovery time before expecting reasoning, repair or learning."

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Measurable provision prompt: "Success will be measured by consistent recording of early threshold signs; reduced escalation linked to rushed demands, sensory overload or unexpected change; increased staff use of agreed demand-reduction strategies; and evidence that adults respond before [child/young person] is pushed past capacity."

​

To stay informed please subscribe for updates further below. 

​

Would you like more information about an FASD Informed EHCP?

​

Visit our FASD-Informed EHCP guide for practical help identifying needs, gathering evidence, preparing for reviews and writing specific, measurable provision:

https://www.fasdinformed.co.uk/ehcp

​

For FASD Informed Professional Report Writing pop along to our new page linked here: 

https://www.fasdinformed.co.uk/reportwriting

​

For support with an EHCP consider 1:1 support from an FASD Advocate; find more details HERE

© FASD Informed UK™  All rights reserved.

​

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In FASD, the environment can either reduce or increase demand.

Noise, lighting, seating, crowding, visual clutter, pace, adult language, transitions and unpredictability can all affect regulation, attention, processing, sensory tolerance and safety.

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Environmental accommodation means adjusting the setting before expecting the child or young person to work harder.

It asks, “What can we change around them so their brain has a better chance of succeeding?”

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This is not special treatment, lowering standards or giving in. It is a brain-based support need and a reasonable adjustment.

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Practical action: adjust noise, lighting, seating, pace, visual information, adult language or transitions before increasing pressure, giving consequences or assuming refusal.

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Environmental Accommodation: Examples for Parents, Carers and Professionals

Noise example: A child who struggles in a loud dinner hall may need a quieter eating space, ear defenders, a trusted adult, a shorter time in the hall or a planned exit route.

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Lighting example: Bright lights, flicker or glare may increase sensory stress. Adjusting seating, blinds, lamps or screen brightness can reduce overload.

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Seating example: A pupil may cope better when seated away from busy doors, high-traffic areas, strong smells, unpredictable peers or overwhelming displays.

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Visual clutter example: Too many posters, instructions, choices or objects can increase cognitive load. A clearer workspace, simple visual sequence or covered display may support attention and processing.

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Transition example: A child may need a quieter route, early warning, a visual cue, a familiar adult and recovery time when moving between rooms, playground, lunch hall or home and school.

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School example: Before responding to distress with behaviour sanctions, staff check whether noise, crowding, seating, lighting, pace, language or transition demands need adjusting.

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Home example: A family reduces after-school demands by keeping lighting low, offering food and quiet, limiting questions and using a predictable decompression routine.

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Assumptions and safeguarding risk:

Environmental Accommodation is a skill the person can use consistently whenever asked, rather than an ability that may vary with stress, fatigue, sensory load, context and the amount of external support available.

If this need is misread, or support is withdrawn too soon, the person may be blamed, exposed to avoidable failure, or left unable to recognise, communicate or respond to risk.

Particular safeguarding attention may be needed around busy environments, transport, personal care, eating, sleep and sensory overload. A calm, curious response should consider brain-based differences and unmet need, not presume wilful non-compliance.

Support must be based on evidenced functional need and reviewed collaboratively over time, rather than reduced because of age, fluent speech, apparent compliance, behaviour, or one successful occasion.

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EHCP evidence prompt: Record which environmental adjustments reduce distress and improve access: noise reduction, predictable seating, sensory tools, lighting changes, visual supports, reduced clutter, quiet spaces, transition planning, reduced verbal load and adult co-regulation.

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EHCP phrase: “[Child/young person] requires environmental accommodation to reduce sensory, cognitive and transition demands.

Provision should include agreed adjustments to noise, lighting, seating, visual information, pace, adult language, quiet spaces and transitions so that the environment is adapted before behaviour is interpreted as refusal or non-compliance.”

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EHCP objective: "By the end of the review period, [child/young person] will be supported through agreed environmental accommodations across learning, transitions, social times and regulation needs, so that adults reduce sensory, cognitive and environmental demands before increasing pressure, applying sanctions or expecting independent coping."

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Measurable provision prompt: "Success will be measured by consistent use of agreed environmental adjustments across settings; reduced distress, avoidance or escalation linked to noise, lighting, crowding, visual clutter or transitions; and evidence that staff review the environment before interpreting behaviour as intentional."

​

To stay informed please subscribe for updates further below. 

​

Would you like more information about an FASD Informed EHCP?

​

Visit our FASD-Informed EHCP guide for practical help identifying needs, gathering evidence, preparing for reviews and writing specific, measurable provision:

https://www.fasdinformed.co.uk/ehcp

​

For FASD Informed Professional Report Writing pop along to our new page linked here: 

https://www.fasdinformed.co.uk/reportwriting

​

For support with an EHCP consider 1:1 support from an FASD Advocate; find more details HERE

© FASD Informed UK™  All rights reserved.

When a person with FASD becomes genuinely stuck, the response around them can make the loop calmer - or much harder.

Perseveration is an important but often misunderstood consideration in FASD support.

This is a longer read, and we apologise for that, but we hope the examples and wording give you practical ideas to consider and use in conversations.

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Perseveration and FASD: A child, young person or adult with FASD may become genuinely stuck on a thought, feeling, question, topic or action and need support to move on.

This can reflect brain-based differences in inhibition, attention-shifting, working memory, flexibility and self-monitoring. Dysmaturity, anxiety, sensory overload, impulsivity, reduced adaptive functioning and social-cognition differences may make disengaging, considering consequences or recognising boundaries even harder.

Responding with curiosity and support is more helpful than assuming wilful defiance, manipulation or understanding of the focus.

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A 'fixation' is the topic, object, rule, feeling or activity holding attention strongly; perseveration is difficulty stopping or shifting a thought, response, strategy or action. They may occur together but are not interchangeable. Lower-risk interests should be distinguished from presentations involving safety, consent, boundaries, exploitation or significant misinterpretation, without inferring intent, understanding or motivation from the focus alone.

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Perseveration may be stuck-in-set, where the person remains with the same thought, emotion, activity, strategy or topic; recurrent, where a word, phrase, question or response continues after it no longer adds meaning; or continuous, where an action continues beyond its usefulness.

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This can include repeatedly returning to a question, argument, missed plan, perceived injustice, reassurance need or preferred interest, or persisting with an unsuccessful strategy or an internal standard.

Verbal or behavioural loops may become disruptive or unsafe when combined with impulsivity, reduced inhibition or limited social understanding. Interruption, reasoning or repeated correction may strengthen the loop, particularly during anxiety, emotional arousal or cognitive overload.

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Difficulty with change, routines or stopping a preferred activity may instead reflect cognitive rigidity, a need for sameness, anxiety, transition difficulty, restricted or repetitive behaviour, compulsivity or impaired ‘set-shifting’.

These processes can overlap, so careful clinical formulation should identify what repeats, its triggers, what happens when it is interrupted, the associated risk and the support required.

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Perseveration: Examples for Parents, Carers and Professionals

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‘Recurrent question’ example: A child repeatedly asks, “Who is collecting me?” moments after receiving the answer because working memory, uncertainty or anxiety prevents the answer from settling. One adult shows the same written or photographic answer, says, “The plan is here; Mum is collecting you at three,” and avoids adding new explanations.

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‘Emotional perseveration’ example: After a disagreement at break, a young person returns to the perceived unfairness throughout the lesson and cannot yet shift into learning. The adult acknowledges it once -“That still feels very unfair” - records that it will be revisited at an agreed time, then supports a regulating activity before offering one small next step.

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‘Stuck-in-set’ example: A child continues trying the same puzzle piece, calculation method or computer command even though it is not working, and repeats the action when prompted to try another way. The adult avoids repeated correction, places the alternative beside the first attempt and says, “That way is not getting us there. This is another step we can try together.”

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School topic-loop example: During a science lesson, a pupil repeatedly returns to a preferred topic about trains and is unable to take in the current task. The adult briefly acknowledges the interest, places it on a visual “later” card, and uses a concrete bridge: “The train thought is safe for later. First, we are labelling one part of this diagram together.”

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‘Continuous’ action example: At home, a child repeatedly checks that a door is closed or rearranges an object long after the task is complete and becomes distressed when asked to stop. The adult reduces language, shows a simple “finished” visual, completes one agreed final check alongside the child and supports a switch to a familiar regulating activity.

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Examples where perseveration may create increased risk: A person may repeatedly return to a plan to leave a safe place, travel to a particular location or find a named person despite weather, traffic, time of day or previous safety advice; remain fixed on contacting, following, meeting or giving personal information or money to someone, including an online contact, despite clear boundaries or signs of exploitation; repeatedly attempt to access medication, alcohol, chemicals, tools, machinery, vehicles, fire, water, heights or another restricted item or place; become stuck on correcting a perceived injustice or confronting another person and be unable to disengage as tension rises; repeatedly return to thoughts, statements or actions about harming themselves or another person; or persist with a practical task or route after conditions have changed and it is no longer safe.

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Repetition alone does not establish intent, understanding or motivation, and similar presentations may involve impulsivity, compulsivity, anxiety, trauma, memory difficulty or cognitive rigidity.

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Adults can try to pause the unsafe activity, use the agreed low-arousal script and visual plan, provide additional supervision, reduce access to immediate hazards and follow the person’s safeguarding, crisis or emergency procedures; recurrent or escalating episodes require timely FASD-informed clinical formulation.

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Assumptions and safeguarding risk: A likely mistaken assumption is that the person can stop perseverating or shift attention consistently whenever asked, rather than recognising that their ability to disengage may vary with stress, fatigue, sensory load, context and the amount of external support available. If this need is misread, or support is withdrawn too soon, the person may be blamed, exposed to avoidable failure, or left unable to recognise, communicate or respond to risk.

Particular safeguarding attention may be needed around busy environments, transport, personal care, eating, sleep and sensory overload. A calm, curious response should consider brain-based differences and unmet need, not presume wilful non-compliance.

Support must be based on evidenced functional need and reviewed collaboratively over time, rather than reduced because of age, fluent speech, apparent compliance, behaviour or one successful occasion.

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Meeting phrase: “This looks like perseveration. Can we pause everything and agree one repeatable script, one visual reassurance and a shared transition plan, so everyone in the team responds consistently without repeated debate or demand on the child/adult or pressure to just drop it?”

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EHCP evidence prompt: Record what the child becomes stuck on, what increases the loop, what helps them shift, and whether supports such as visual reassurance, predictable scripts, adult co-regulation, reduced verbal load, transition objects or recovery time reduce distress.

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The EHCP examples below are separated by setting. The first pair is written specifically for college or a supported internship and uses [young person], college, placement and job-coach language. The second pair is written for school and other relevant education settings and uses [child/young person], school staff, family and termly review language.

Each Section E outcome should describe the change sought for the learner; each corresponding Section F paragraph should specify the provision required to achieve it.

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EHCP Section F provision — College or supported internship: “[Young person] will have an individual written perseveration and supported-switching plan used consistently across college, travel training, work preparation and their supported-internship placement. A named college practitioner and job coach or placement mentor will coordinate the plan, ensure relevant staff have a concise version and review implementation every [six weeks/half term] with [young person] and the agreed team.”

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Section F implementation and review — College or supported internship: “Records will show that the agreed plan was available and used in [agreed proportion] of relevant situations across each setting; named staff completed FASD-informed training or coaching; and review evidence includes [young person]’s views, staff implementation and any agreed changes.”

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EHCP Section F provision — Regulation, switching and safe participation in college or a supported internship: “At early signs of perseveration, staff will acknowledge the concern once, reduce verbal load or any debate, use the agreed declarative script and visual reassurance, allow processing time and support one concrete next step.

A named adult will begin the step alongside [young person], pause or adapt non-essential demands and support a safe return to the task, an alternative task or recovery. Safety-critical tasks will be paused, adapted or directly supervised where attention, judgement or participation is affected. Repeated questioning, public correction, pressure to ‘move on’, placement withdrawal or behaviour sanctions will not be used as a first response.”

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EHCP Section E outcome — College or supported internship: “By the end of the review period, with the specified Section F provision in place, [young person] will use or accept an agreed reassurance or switching support to move towards a safe next step, adapted task or recovery activity in [agreed proportion] of recorded opportunities. Compared with baseline, records will show reduced frequency, duration or intensity of perseveration-related distress; fewer disruptions to safe attendance or participation; and improved supported re-engagement with college learning, travel training or supported-internship workplace routines.”

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EHCP Section F provision — School and other relevant education settings: “[Child/young person] will have a written perseveration and switching plan implemented consistently across relevant education settings. The plan will identify individual triggers, early signs, safe and unsafe forms of fixation, agreed visual supports, repeatable scripts, regulating activities, switching strategies, supervision requirements and recovery arrangements".

"At the first signs of becoming stuck, trained staff will acknowledge the concern once; lower voice, pace and verbal load; use calm declarative language; show one visual reassurance or written answer; make the next step concrete and manageable; and support a switch through an agreed movement, sensory activity, practical job, transition object or regulating interest. Staff will allow additional processing time, reduce non-essential demand and audience pressure, and provide co-regulation and access to an agreed low-arousal space."

"Repeated questioning, public correction, moralising language and punitive responses will not be used to force an immediate shift. Reflection, repair or teaching will take place only when [child/young person] is regulated enough to process it. A named member of staff will coordinate the plan; all staff working directly with [child/young person], including relevant supply, transport and lunchtime staff, will receive FASD-informed training and access to a concise version of the plan. Implementation and impact will be recorded and reviewed at least termly with [child/young person], family and relevant professionals.”

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EHCP Section E outcome — School and other relevant education settings: “By the end of the review period, with the specified Section F provision in place, when [child/young person] becomes stuck on an identified thought, question, feeling, topic, strategy or action, they will move towards a safer, more regulated activity using an agreed communication or switching support in [agreed proportion] of recorded opportunities across relevant education settings. Compared with the agreed baseline, there will be a measurable reduction in perseveration-related distress or escalation and in the time and adult support needed to re-engage safely with learning, transitions or daily routines.”

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Clinical and safety consideration: Perseverative episodes may need careful, coordinated support when a person is fixed on thoughts, plans or actions that may be unsafe. Adults should stay calm, reduce verbal pressure, follow an agreed safety or safeguarding plan, provide appropriate supervision and seek timely advice from a suitably qualified clinician rather than relying on repeated debate or expecting the person to simply let the thought go.

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Clinical support should be considered when episodes are frequent, escalating, causing significant distress, affecting daily functioning or involving risk to the person or others. Urgent local crisis, safeguarding or emergency procedures should be followed where there is immediate danger.

For clinical formulation and support, a specialist FASD-informed neuropsychological assessment may be helpful at any age, including for children and young people under 16. It may be undertaken with or without a mental capacity assessment, depending on the person’s age, the referral question and the decision involved. From age 16, where there is concern about a particular decision, a separate decision-specific and time-specific mental capacity assessment may also be required. Further information from Dr Cassie Jackson, Consultant Clinical Psychologist, explains specialist FASD-informed neuropsychological assessment and its relationship to mental capacity assessment: https://www.fasdinformed.co.uk/_files/ugd/29cd79_76a4c4f9d5ec46a085ee88fd333f565c.pdf

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To support perseveration and reduce assumptions: consider our courses for Schools, Colleges, Alternative Provision, Multi-disciplinary teams: https://www.fasdinformed.co.uk/training

Or perhaps use our FASD communication cards so the person, or a carer supporting a child, young person or adult, can discreetly indicate that they are stuck, need fewer words, want a pause, need reassurance or help to switch safely to the agreed next step. The cards can also support communication about body needs, discomfort, pain, consent and when more help is needed, without relying on repeated questions or verbal explanations during an episode. Adults should agree the meaning of each card in advance, respond calmly and consistently, and preserve the person’s dignity and choice. Details can be found here: https://www.fasdinformed.co.uk/category/all-products

Disclaimer: This information is for general education and FASD-informed support only. It is not a substitute for individual medical, sensory integration occupational therapy, mental health, legal, safeguarding or EHCP advice, assessment or diagnosis. Needs and presentations vary, so support should be based on the person’s assessed functional needs and agreed with appropriately qualified professionals. Seek prompt professional advice for new, unexplained, persistent, severe or worsening symptoms, and follow local emergency and safeguarding procedures where there is immediate risk or concern.

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