Fetal Alcohol Spectrum Disorder Behavior Screening Tool (FASD BeST) © 2001, rev. 2006 Jocie DeVries, Ann Waller, M.Ed., Victoria McKinney, and Glena Andrews, Ph.D. FAS Family Resource Institute

Name of person being screened:_______________________________________ Date of birth _________________ Current grade (if in school):________________

Last grade completed (if out of school):_______________

Name of person completing form ______________________________________________

Date ________________

Relationship to the person with possible FASD________________________________________________________

Consider the behavior of the person being screened over the past 12 months as the form is completed. Please circle the number that most closely identifies the frequency with which the child or adult being screened for possible FASD displays the listed behavior. Behavior/Situation

Never

Sometimes

Frequently

Always

1. Needs constant supervision

0

1

2

3

2. Highly manipulative

0

1

2

3

3. Exhausted from disrupted sleep

0

1

2

3

4. Irritable from disrupted sleep

0

1

2

3

5. Doesn't connect cause and effect (behavior and consequences)

0

1

2

3

6. More difficult to manage in public than at home

0

1

2

3

7. Can't easily distinguish between friend or foe

0

1

2

3

8. Impulsive

0

1

2

3

9. Unpredictable

0

1

2

3

10. Engages in dangerous behavior

0

1

2

3

11. Appears desperate for stimulation and excitement

0

1

2

3

12. Moral chameleon (excessively vulnerable to peer pressure)

0

1

2

3

13. Shows anti-social behavior

0

1

2

3

14. Needs more structure and supervision than peers

0

1

2

3

2 Behavior/Situation

Never

Sometimes

Frequently

Always

15. Has trouble learning and/or using concept of time

0

1

2

3

16. Difficulty managing money

0

1

2

3

17. Overreacts negatively to transitions

0

1

2

3

18. Extremely vulnerable to sales pitches (ads)

0

1

2

3

19. Doesn't take care of hygiene needs

0

1

2

3

20. Unable to take responsibility for actions

0

1

2

3

21. Cannot consistently follow plan of action

0

1

2

3

22. Doesn't follow rules of society

0

1

2

3

23. Vulnerable to depression

0

1

2

3

24. Vulnerable to stress and overload

0

1

2

3

25. Lies and/or replaces fact with fantasy unconsciously in memory

0

1

2

3

26. Steals from family members

0

1

2

3

27. Appears more capable than he/she really is

0

1

2

3

28. Emotionally volatile; has outbursts

0

1

2

3

29. Destructive with possessions/objects

0

1

2

3

30. Violent toward animals or people

0

1

2

3

31. Void of normal level of empathy for others

0

1

2

3

32. Unexplained mood swings

0

1

2

3

33. Behavior doesn't improve in spite of consistent consequences

0

1

2

3

34. Looks innocent when confirmed guilty

0

1

2

3

35. Continues to deny guilt when confronted with indisputable evidence

0

1

2

3

36. Egocentric–acts on own needs first

0

1

2

3

37. Unable to stay focused on task

0

1

2

3

38. Detached attitude toward own behavior and its consequences

0

1

2

3

3 Behavior/Situation

Never

Sometimes

Frequently

Always

39. Takes the path of least resistance

0

1

2

3

40. Lives in the moment–shortsighted

0

1

2

3

41. Chooses immediate gratification (Can't wait for greater benefit.)

0

1

2

3

42. Doesn't display remorse (not sorry for doing something wrong)

0

1

2

3

43. Not recognized by others as disabled

0

1

2

3

44. Appears undisciplined regardless of consistent discipline/consequences

0

1

2

3

45. Charismatic

0

1

2

3

46. Holds a grudge

0

1

2

3

47. Doesn't get the whole picture

0

1

2

3

48. Misunderstands what is expected

0

1

2

3

49. Predatory–plans to harm others

0

1

2

3

50. Becomes angry when confronted with wrongdoing

0

1

2

3

51. Thinks he/she is the exception to every rule

0

1

2

3

52. Has trouble remembering rules from one day to another

0

1

2

3

53. Diagnosed with other mental health disorder(s) If yes, please list all known mental health diagnoses:

No

Yes

Unknown