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prefrontal cortex, insular, premotor cortex, cerebellum, basal ganglia- striatum- caudate nucleus, amygdala, and thalamus, neurotransmitter systems, precuneus, hippocampus, corpus callosum. The development of all the parts of the brain and networks that provide these functions is affected by prenatal alcohol exposure: the normal process of perseverance is interfered with, and an appropriate shift of focus is not possible. The process then becomes one of Perseveration; executive and adaptive functioning are compromised. It is under these circumstances that the behavior of those affected by prenatal alcohol exposure is seen as an affront to society that is willful in nature, and not the manifestation of abnormal neurological development that it truly is. PERSEVERATION The word perseveration was introduced in the early 20th century in the context of psychology, psychiatry and brain function : since then its usage has developed in the context of interference with the normal process of perseverance. Perseveration is a normal phenomena in early childhood. Normal development requires elimination of childhood perseveration. For those with FASD this elimination does not occur. Interruption of perseveration, by the will of others or circumstances beyond their control, is an extremely uncomfortable process for those with FASD- so they react: reactions usually referred to as Transition Reactions, with misinterpretations by the observer. Our early concept of perseveration as a construct of the mind was clarified as a pathological neurological proces with the identification of the involved areas of the brain. In 1914 William S. Foster wrote a review “On the Perseverative Tendency”. He covered the use of the word perseveration over the preceding fourteen years. The review dealt with observations and theories of normal perseverance and alluded to perseveration. While he did not specifically distinguish between the two, Foster did acknowledge that the perseverative tendency included a number of functions that arose from the brain; similar to the Stuck-In-Set Perseveration described today. It was recognized early on that perseveration existed in different types with different behavioral patterns. The three types usually referred to were first proposed in 1984 by Sandson and Albert. The clarification and defining of these types and their behavioral patterns continues. Repetition of words or movements is most referred to when describing perseveration. Such cases are related to more discrete pathology involving the neuroanatomy of the impaired function.
The Stuck-in-set perseveration relates to more intellectual behavioral issues involving inability to shift the focus of activity in spite of previous experience. There is a consensus that the frontal lobes and their associated white-matter pathways play a prominent role in perseveration. However, there is evidence that damage to other areas of the brain contributes to stuck-in-set perseveration. Stuck-in-Set Perseveration is associated with more diffuse neurological impairment involving a number of brain areas. [ PFC, Basal ganglia- striatum, Dopamine Systems, tuberoinfundibular pathway, ventral tegmental area.amygdala.hippocampus, cingulate gyrus,olfactory bulb] All the areas of the brain referred to, their development, their function and their neurotransmitter systems, are compromised by prenatal alcohol exposure. BEING BORED Those with FASD repeat words that we use: but in fact the same words may have a different meaning and context for those with FASD, for example “being bored”. I have heard from individuals diagnosed with FASD that they exist in one of two states: a mind of chaotic, uncontrolled and uncomfortable thoughts, usually described as being bored, or a mind perseverating, with or without physical activity. They seek the second to escape the first. What they perseverate on is determined by their particular set of cognitive, emotional, information processing, memory and sensory disabilities; as well as their early childhood experience and their immediate environment, including how others relate to them. What they may perseverate on to soothe themselves extends from cutting, provoking others, to more acceptable behaviors, such as playing video games, reading or sports. Alcohol and hard drugs are used to obliterate the first state of mind. Marijuana and Tobacco generally appear to have a specific action that reduces their multiple chaotic thoughts and allows them to perseverate on one process; that is they are using them for relief, not pleasure. N.. was 19 years old when she first came to see me. She had been diagnosed at the age of five and had been adopted and raised in an ideal rural setting with an understanding family, consequently she had not experienced the secondary disabilities of FASD. The event that caused them to see me was an unexpected and out of character disappearance for a weekend. N. had been persuaded to visit a male, contacted on the internet. Fortunately she was quickly located and returned home by the police.
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Page 5 and 6: Heart rate goes up, cannot be still
Page 7 and 8: The diagnosis was eventually made.
Page 9: Yet isolation is still practiced in

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