Lessons from the Playroom
Podcast Ep. 185
“Every child has the capacity to heal and grow, but it starts with meeting them where they are—with respect, curiosity, and an understanding of their unique needs.” – Natascha Lawrence
In this episode, Lisa reconnects with Natascha Lawrence, a Synergetic Play Therapy Supervisor, EMDR Practitioner, and founder of the FASD Institute, for an essential conversation about supporting children with Fetal Alcohol Spectrum Disorders (FASDs) through play therapy. This is Part 2 of their dialogue, revisiting a topic that rarely gets the attention it deserves in the field of play therapy.
Together, Lisa and Natascha dive into:
- What play therapists need to know about FASD: A holistic understanding of FASD as a whole-body diagnosis and its implications for therapeutic practice.
- Creating neurodivergent-friendly play spaces: Practical steps to make playrooms sensory-safe and accessible for children with FASD and other neurodiverse conditions.
- The FASD iceberg analogy: Understanding the layers beneath the surface and how they influence behavior, communication, and regulation.
- Challenging the stigma: Reframing the narrative for children with FASD and their families, starting with compassion and respect.
- Supporting caregivers: Why empowering parents and destigmatizing FASD is vital for meaningful therapeutic outcomes.
With Natascha’s blend of professional expertise and personal insights as a parent of a child with FASD, this conversation provides invaluable tools and perspectives for therapists and caregivers alike.
Join Lisa and Natascha for this heartfelt and eye-opening episode, and discover how to make your play therapy practice more inclusive, effective, and empowering for children with FASD.
Resources Mentioned:
Lisa:
Hi, listeners! Thank you once again for joining another episode of the Lessons from the Playroom podcast. I am really… excited isn’t even the word. It’s more of a deep sense of gratitude. Today, we’re going back to the beginning. My special guest was one of the very first guests I ever had on this podcast. We’re revisiting a topic that, frankly, doesn’t get talked about enough in the world of play therapy—FASD, which stands for Fetal Alcohol Spectrum Disorders, right?
Natascha:
Fetal Alcohol Spectrum Disorders.
Lisa:
Spectrum! Thank you. See, even I’m catching up here. We did an episode on this way back in the beginning, and I’ve asked my special guest to return for a Part 2. So, I have Natasha Lawrence with me today. I’ll introduce her in a moment, but first, I want to share a quick story about when Natasha and I first sat down to record that initial episode.
Natasha, thank you so much for coming back and for offering your education and insight about FASD.
Natascha:
Thank you.
Lisa:
Listeners, Natasha is a registered clinical counselor supervisor, an ABC-registered play therapist, a certified Synergetic Play Therapy supervisor, and an EMDR practitioner. She’s based in British Columbia and specializes in neurodiversity, particularly FASD. Natasha is a BIPOC, first-generation Canadian settler of mixed Asian ancestry, an ADHDer, queer, and has a mobility disability due to a chronic pain neurological condition. She’s also the founder of the FASD Institute—something we’ll discuss today—and, most importantly, the parent of two incredible neurodivergent children, one of whom has FASD.
Thank you, Natasha.
Natascha:
Thank you.
Lisa:
I remember when we recorded the first episode. We were at the University of British Columbia in downtown Vancouver, having a discussion about FASD. I asked if you’d be a guest on the podcast, and we ended up finding a hallway to record in—literally sitting on the floor.
Natascha:
Yes, with your computer and a little mic.
Lisa:
Right! We were just recording with my headphones. Students were walking by as we sat there, recording in the middle of the hallway. That was way back at the start of this podcast.
But I really wanted you to come back because our understanding of how to work with FASD has evolved. And, Natasha, when I think about all the play therapy conferences I’ve attended in my career, I honestly can’t recall one where FASD was presented on stage as a topic. That’s such a sad reality.
Natascha:
Mm-hmm.
Lisa:
So, tell us why this topic is important to you. Then we’ll do a quick refresher before diving into more details.
Natascha:
When I teach about FASD, I say this isn’t just about facts—though, yes, we’ll talk about clinical and research-based facts. This is heart work for me. My daughter is 20 years old, and I share about her with her permission when I teach. I want every child, youth, and person with FASD to be able to see a play therapist or counselor and be treated with respect—without stigma, judgment, or stereotyping. They shouldn’t face barriers.
Why is this so important? It’s personal. It’s about my child, but it’s also about others. Just recently, I heard from someone who reached out to a play therapist and was told, “I don’t accept FASD clients because there’s no learning that can happen.” The stigma within some mental health circles is still so pervasive. That mindset does so much harm.
Lisa:
My heart just sank hearing that. For our listeners, let’s be clear: that statement is completely false.
Natascha:
Yes.
Lisa:
There’s so much support and healing that can happen for individuals with FASD.
Natascha:
Exactly. Everyone can learn; we just need to adapt to how people with FASD learn.
Lisa:
Right. So, let’s do a quick refresher on FASD. Could you give us an overview and then tie it back to play therapy?
Natascha:
Sure. I’ll start by noting that terminology varies by country. In Canada, FASD is a diagnostic term, while in other places it’s considered an umbrella term. For example, in Australia, they refer to it as FASDI, which I think rolls off the tongue a bit easier.
In Canada, we moved away from terms like “Fetal Alcohol Syndrome” to simplify things under the umbrella of FASD. But globally, definitions can differ. When working with clients, I realized I needed a way to explain FASD that was accessible and affirming, especially for kids.
So, here’s how I describe it now: FASD is a whole-body diagnosis. While many people associate it solely with neurodiversity or brain differences, that doesn’t capture the full picture. It’s a diagnosis linked to neurodiversity and various disabilities.
Lisa:
Got it.
Natascha:
Some people describe FASD as a disability, which isn’t untrue, but it doesn’t fully convey all the interconnected aspects of the diagnosis. From a play therapy perspective, it’s essential to understand FASD holistically to best support these clients.
Lisa:
There’s something so honoring in the way you just described it, even just the term “whole body.” It feels deeply respectful to encompass someone’s experience in such a broad and meaningful way.
Natascha:
Mm-hmm.
Lisa:
I’m curious, with that in mind, how do we as play therapists begin to orient ourselves toward helping a client with FASD? And I imagine we’ll also need to touch on the stigma that caregivers face—because that feels like such an important component of the work.
Natascha:
When I think about what a play therapist needs to know before stepping into a session—when you get a referral, for example—the first thing is cultural safety, which is what we’d do when working with any special population. You need to learn about FASD. There are excellent, free online programs available globally, and I’m always happy to share recommendations if you email me. Some are easier to navigate than others.
When I talk about working through an FASD lens, I mean adopting a lens that doesn’t require you to shift entirely when working with different clients. That’s one of the beautiful things about it—it works for every child. And play therapy, in particular, is a wonderful fit because it doesn’t require language.
Lisa:
Right.
Natascha:
Working through an FASD lens means working without needing language, which is crucial because FASD is a language-based disability. To receive an FASD diagnosis, there’s always a receptive language disability present, along with an expressive language disability. But this can get masked or confused because individuals with FASD are often excellent talkers. Their speech can be very rote, off-topic, or repetitive, which can lead to misunderstandings. With play therapy, you don’t have to worry about any of that.
This approach works for everyone, but it’s especially critical for neurodivergent children. Many individuals with FASD have significant sensory needs—equal to or even greater than those of autistic children. And while we use identity-centered language for autistic individuals, for FASD the preference is person-centered language.
It’s heartbreaking how often children with FASD are misunderstood. I’ve worked with kids who’ve experienced significant trauma, like abuse, and their diagnosis was used to funnel them into anger management classes instead of addressing their trauma through play therapy.
Lisa:
Right. They need to work through their trauma—just like any other child.
Natascha:
Exactly.
Lisa:
You’re highlighting something that might be a unique consideration for many play therapists: creating a play space that’s neurodivergent-friendly. And as you’ve said, for children with FASD, this becomes even more critical.
Natascha:
Yes, absolutely.
Lisa:
Can we talk about that? Beyond the skills we bring to therapy, it sounds like the physical space itself plays a significant role in supporting children with FASD.
Natascha:
Yes. A sensory-friendly playroom is beneficial for all children, but it’s critical for those with FASD. Sensory preferences and needs can be profound, particularly because interoception—the ability to sense internal bodily states—is often affected in children with FASD.
For example, many of the behaviors we see—like refusing to enter a music class or acting out—are sensory-related. These kids aren’t necessarily verbalizing their sensory preferences, so it’s up to us to notice and adapt.
Lisa:
So, not just the playroom, but the entire environment, like the waiting room, needs to be considered.
Natascha:
Exactly. If you’re not familiar with sensory systems or neurodiversity-affirming practices, start learning. There are great resources out there—podcasts, books, and courses.
Lisa:
Yes, dive into those resources. Find anything that talks about sensory processing and start there.
Natascha:
I learned so much from occupational therapists (OTs) when I started incorporating these ideas into my practice. For example, creating options in your playroom is key—dimmers for lighting, sensory items, crash mats, rebounders, mini trampolines, tents, and Bop Bags.
Lisa:
It sounds like you’ve covered everything!
Natascha:
It’s important to ensure that children can take their time exploring the space without feeling overwhelmed. Play therapists often love having lots of toys, but it’s essential to be intentional about how you present them.
Lisa:
Absolutely. Turn your playrooms into sensory-friendly spaces—they’ll benefit all children, not just those with FASD.
Natascha:
Yes! This approach benefits everyone because trauma affects sensory processing. But for kids with FASD, these accommodations are absolutely critical.
Lisa:
I think what you’re describing highlights something I’ve talked about before. It’s why I recorded an episode called What Does Your Playroom Say About You? Often, play therapists create their playrooms in ways that are aesthetically pleasing to them—the therapist.
Natascha:
Yes.
Lisa:
It’s like, “Oh, I love my room. It looks great. It feels great to my sensory system.” And yes, that’s important, but are we creating a win-win? A space that works for me as the therapist but also works for the systems of the children I’m serving? Is my playroom me-focused or we-focused? I don’t think we talk about that enough.
With kids who have FASD, the playroom needs to be we-focused, not me-focused. How many sensory options can we provide? I remember Robert Jason Grant talking about the beloved sand tray in playrooms. For many children, that sensory experience is a hard no. He suggests having trays with different textures—offering options. It’s about finding ways to make even standard items more sensory-friendly.
Natascha:
I think we need to remove the word “standard.”
Lisa:
Yeah.
Natascha:
I’ve heard terms like “standard” or “normal,” and one of my clients gave me a brilliant perspective on this. They said, “Normal is just a setting on a washing machine.” Why do we need any child to be “normal” or to fit into a box?
Kids with FASD are beyond the metaphor of a square peg in a round hole. They’re multidimensional shapes—full of points and colors that spin. Trying to fit them into a round hole is impossible. So, instead of focusing on standards, we should offer options.
Part of offering options is giving kids permission to have preferences, to express their needs, and to feel autonomy. For children with disabilities or neurodivergence, choice and autonomy are often stripped away. Things become prescriptive.
For example, I have multiple sand trays—one sealed, wooden tray for aesthetics because, yes, I like a beautiful space. But I also have five plastic trays for kinetic sand, messy sensory play with paint or water, and other textures. I offer options.
I let kids play with the dimmer switches for the lights. Some prefer it brighter, others dimmer. I’ve had sessions where we sat in the dark for 30 minutes, passing a fidget back and forth without words. That complete sensory calm allowed the child to shift internally. It was like they woke up.
Lisa:
You can feel that shift as you describe it—the calming of sensory overload, giving the child a moment to find themselves.
Natascha:
Exactly. Sensory systems are the foundation, and they benefit everyone. When you create a sensory-friendly environment, you’re supporting every child, youth, or adult who walks through your door.
People often ask me about the different presenting issues in FASD clients—why they’re being referred. These issues can seem big or scary, leading therapists to shift their approach, thinking, “I need to teach this child skills.”
But would we do that with any other child in play therapy? No. We’d meet them where they are. Yet kids with FASD carry so many stigmatizing labels—aggressive, violent, unable to learn. Much of the information online about FASD is outdated or methodologically flawed, but it’s still being used.
We’re in the same fight the autism community had decades ago. Even now, there’s a push to eliminate the FASD diagnosis altogether. For example, a recent article in The Lancet, a top medical journal, questioned whether FASD should even be recognized as a diagnosis.
Lisa:
Wow.
Natascha:
This highlights why kids with FASD often don’t receive appropriate care. No one is looking at them through an FASD lens—through a whole-body perspective. That’s why I emphasize learning more about FASD. I didn’t come up with the term “whole-body diagnosis.” It originated with adults who have FASD, such as those in the Adult Leadership Committee.
Lisa:
Can you tell us about the FASD Iceberg framework?
Natascha:
Absolutely. The iceberg analogy is widely used in mental health, and I’ve adapted it for FASD because it’s such a helpful visual. Most people stick to what’s visible above the surface—behaviors. But FASD is a whole-body diagnosis, so we have to look beneath the surface.
In Synergetic Play Therapy, we view behavior as an attempt to regulate. It’s the nervous system crying out to take care of itself. The iceberg framework for FASD came from adults with FASD, like Myles Himmelreich, CJ Luckey, and Emily Hargrave. These adults are thriving and now teaching others about FASD. They identified over 3,000 medical conditions that are more common in individuals with FASD—some up to 100 times more common.
Lisa:
So, what you’re describing is that the presenting symptoms—like aggression—are just the tip of the iceberg. Underneath are medical, sensory, and neurological challenges that are often misunderstood.
Natascha:
Exactly. For example, I often get referrals for “aggression in school.” But when we dig deeper, it’s not about aggression—it’s about unmet sensory needs or unrecognized medical issues.
Let me share a personal story to illustrate this. My daughter was lucky to receive early services from birth, which is rare. Most kids aren’t diagnosed with FASD until they’re 10 or 12 because diagnosis requires extensive psychoeducational assessments.
Her very first suspension in kindergarten happened because she spat in a teacher’s face. That meeting could have gone in a very negative direction, but instead of shaming or blaming, the principal asked, “What can we do differently?” That’s the mindset we need—looking at the whole child, not just their behavior.
Our principal asked, “What do we need to know?” because this was probably the first child with FASD they’d encountered. We estimate that 4 to 5% of the general population has FASD—that’s double the prevalence of autism.
Lisa:
Wow.
Natascha:
They didn’t have prior training on FASD, but they stepped up. They trained every single member of the school—not just the kindergarten teacher or the EA (Educational Assistant). They brought in specialists who spent an entire week observing and training staff.
After that, my daughter never had another incident of aggression in school. Not one—for the rest of her entire school career. Because the staff was able to ask, “What do we need to support this child? What are the underlying factors below the iceberg?”
Lisa:
That’s incredible.
Natascha:
As play therapists, when we get a referral, talk to parents, and review reports from schools, we’re in a unique position to observe and understand what’s beneath the surface. Through play therapy, we can identify sensory needs, communication needs, processing needs, and even physiological needs. FASD is a whole-body diagnosis.
For example, we know that FASD is a chronic condition, often involving chronic inflammation. Are you noticing signs of fatigue in the child? Are there toileting challenges no one talks about because the child is 8 or 10 years old? Are there developmental delays that haven’t been addressed?
Through play therapy, we can help reframe these observations for parents and schools in an affirming way, rather than focusing on “fixing” the child.
Lisa:
I imagine this isn’t short-term therapy. I’m hearing layers, processes, and the need to settle into a long-term relationship with the child.
Natascha:
Yes. That’s a key shift I had to make in my work. As a mental health clinician, I used to feel a sense of shame or stigma around long-term therapy—like it reflected poorly on me if I couldn’t help a child “graduate” quickly.
But within a neurodiversity-affirming framework, as Robert Jason Grant often emphasizes, we recognize that new challenges will arise because of the systemic oppression neurodivergent individuals face.
For children with FASD, the world isn’t built for them. Schools, for example, aren’t designed for neurodivergent children, let alone kids with FASD. So, therapy often involves longer, stretched-out curves of progress.
Lisa:
And that can feel overwhelming for therapists, especially those just starting out.
Natascha:
Absolutely. When I talk to new clinicians or supervisees, I explain this longer timeline upfront. I also prepare families by front-loading what therapy will look like.
Most of the children, youth, or adults referred to me aren’t just dealing with FASD. They’ve often experienced additional trauma—adoption, attachment issues, or multiple placements in foster care.
We also have to address the stigma around prenatal alcohol exposure. Alcohol exposure can happen for many reasons, and it’s not about shaming or blaming. As play therapists, we create a space free from that judgment.
Children with FASD often have big hearts—they love indiscriminately, which can make them highly vulnerable. Their ability to judge danger is impaired. FASD includes memory-based disabilities, with long-term memory often intact but short-term memory—encoding, storing, and retrieving information—being affected.
This can lead to repeated mistakes or behaviors that others might label as defiant or irresponsible. But it’s not a choice—it’s a neurological challenge.
Lisa:
So they may repeat a behavior without understanding why or remembering the consequences.
Natascha:
Exactly. Trauma compounds this because the body and nervous system remember, even if the child doesn’t consciously recall. Imagine carrying all of that while being expected to navigate a world that doesn’t accommodate your needs.
Some children hold it together at school but fall apart at home. That’s often due to unrecognized nervous system dysregulation. For these kids, therapy needs to address what’s happening below the surface.
For example, the vagus nerve and polyvagal theory are well-known in our field, but there’s an adjacent system called the hypothalamus-pituitary-adrenal (HPA) axis.
Lisa:
The HPA axis—right, that’s the neuroendocrine system involved with hormones like cortisol and adrenaline.
Natascha:
Yes. Prenatal alcohol exposure significantly impacts the HPA axis. For many individuals with FASD, this system doesn’t turn on as it should. Instead, it requires co-regulation or intense physical activity—something that makes them sweat—to activate.
That’s why you may see a child screaming, hitting, or crying for 20 minutes—it’s their body’s attempt to regulate. They’re trying to turn on the HPA axis.
Understanding this physiological process helps us unshame these behaviors. It allows us to teach strategies, provide support, and create longer-term therapeutic plans that address the whole child.
Lisa:
Let’s round out this conversation by talking about parents. I love that you’ve already addressed one of the most important points, which is the potential for judgment. I can imagine a parent bringing in their child with an FASD diagnosis and feeling judged by the play therapist. Thank you for naming that. Parents don’t deserve or need judgment—they need support.
Things happen, and they’re here seeking help for their child and themselves. Sometimes children with FASD come into a parent’s life through other means, like adoption or foster care. There isn’t always a biological connection. Let’s talk about parents for a few minutes before I let listeners know where they can learn more about you and your institute.
Natascha:
There’s an incredible amount of stigma surrounding FASD, and it’s unique because the mechanism is embedded in the diagnosis. It’s the only condition like this. When I present on FASD, I always start by destigmatizing prenatal alcohol exposure.
Alcohol consumption is promoted in many cultures, and most people don’t know they’re pregnant right away. Since most pregnancies are unplanned, exposure can happen at any time. FASD can occur in any community, regardless of socioeconomic status, ethnicity, or ancestry. However, it isn’t diagnosed at the same rate across groups.
The stigma often focuses on women, unfairly blaming them for prenatal alcohol exposure. That judgment extends to the children, and whether we’re working with biological families, adoptive families, or other caregivers, there should never be any difference in treatment.
Unfortunately, caregivers are judged and shamed in nearly every system they interact with. They’ve heard grim statistics and outcomes, and they’re told things like, “If you don’t do X, this is what’s going to happen.” It creates a sense of hopelessness.
When parents walk into the playroom, they’re often parenting from a place of fear. As play therapists, our job is to empower parents, help them feel supported, and move away from blame and shame. If we only focus on the surface behaviors—the tip of the iceberg—we risk perpetuating these judgments.
Talking about FASD openly is crucial. Some families want to keep the diagnosis a secret, and I always ask, “What is that like? What message does that send?”
When I co-founded the FASD Institute with my husband, who is from the Squamish Nation, we focused on decolonizing our work and using a neurodiversity-affirming lens. We created what we couldn’t find for our daughter.
Even in British Columbia, where we once hosted the International FASD Conference, there were only three mental health professionals specializing in FASD: my supervisor, my colleague, and me. When I started the institute, people told me, “Don’t call it FASD—it’s too stigmatized.” But I refused to perpetuate that shame.
As play therapists, we wouldn’t want any child to feel ashamed about any part of who they are. Destigmatizing FASD starts with us.
Lisa:
That’s such an important message. Natasha, I can’t thank you enough.
Listeners, I hope you took lots of notes and will listen to this episode again. If you missed the first episode we recorded—our conversation in the hallway—go back and check it out.
Where can people learn more about you and your institute?
Natascha:
You can find us at fasdinstitute.com. It’s nice and easy to remember. For inquiries, you can email us at admin@fasdinstitute.com.
Lisa:
Wonderful. Listeners, if you’re looking for more education, Natasha also teaches workshops and presents at events. If you’re part of an organization, a school, or another group that could benefit from learning about FASD, reach out to her.
Natasha, thank you again.
Natascha:
Thank you.
Lisa:
As I say at the end of every episode: wherever you are, whatever is happening in your life, tune into yourself. Take care of yourself. Honor yourself.
Let’s go a step further today—honor your sensory needs. Honor what’s unique about you. Honor the way your body works, your brain works, the way you move through the world, the way you speak. Honor what is uniquely true about who you are as a human being.
Remember, you are the most important toy in the playroom. Every part of you deserves to be seen, acknowledged and loved—just like the kiddos we work with.
Until next time, everyone.
Lessons from the Playroom
Podcast Ep. 185
![185](https://synergeticplaytherapy.com/wp-content/uploads/2025/01/185-300x300.jpg)
“Every child has the capacity to heal and grow, but it starts with meeting them where they are—with respect, curiosity, and an understanding of their unique needs.” – Natascha Lawrence
In this episode, Lisa reconnects with Natascha Lawrence, a Synergetic Play Therapy Supervisor, EMDR Practitioner, and founder of the FASD Institute, for an essential conversation about supporting children with Fetal Alcohol Spectrum Disorders (FASDs) through play therapy. This is Part 2 of their dialogue, revisiting a topic that rarely gets the attention it deserves in the field of play therapy.
Together, Lisa and Natascha dive into:
- What play therapists need to know about FASD: A holistic understanding of FASD as a whole-body diagnosis and its implications for therapeutic practice.
- Creating neurodivergent-friendly play spaces: Practical steps to make playrooms sensory-safe and accessible for children with FASD and other neurodiverse conditions.
- The FASD iceberg analogy: Understanding the layers beneath the surface and how they influence behavior, communication, and regulation.
- Challenging the stigma: Reframing the narrative for children with FASD and their families, starting with compassion and respect.
- Supporting caregivers: Why empowering parents and destigmatizing FASD is vital for meaningful therapeutic outcomes.
With Natascha’s blend of professional expertise and personal insights as a parent of a child with FASD, this conversation provides invaluable tools and perspectives for therapists and caregivers alike.
Join Lisa and Natascha for this heartfelt and eye-opening episode, and discover how to make your play therapy practice more inclusive, effective, and empowering for children with FASD.
Resources Mentioned:
Lisa:
Hi, listeners! Thank you once again for joining another episode of the Lessons from the Playroom podcast. I am really… excited isn’t even the word. It’s more of a deep sense of gratitude. Today, we’re going back to the beginning. My special guest was one of the very first guests I ever had on this podcast. We’re revisiting a topic that, frankly, doesn’t get talked about enough in the world of play therapy—FASD, which stands for Fetal Alcohol Spectrum Disorders, right?
Natascha:
Fetal Alcohol Spectrum Disorders.
Lisa:
Spectrum! Thank you. See, even I’m catching up here. We did an episode on this way back in the beginning, and I’ve asked my special guest to return for a Part 2. So, I have Natasha Lawrence with me today. I’ll introduce her in a moment, but first, I want to share a quick story about when Natasha and I first sat down to record that initial episode.
Natasha, thank you so much for coming back and for offering your education and insight about FASD.
Natascha:
Thank you.
Lisa:
Listeners, Natasha is a registered clinical counselor supervisor, an ABC-registered play therapist, a certified Synergetic Play Therapy supervisor, and an EMDR practitioner. She’s based in British Columbia and specializes in neurodiversity, particularly FASD. Natasha is a BIPOC, first-generation Canadian settler of mixed Asian ancestry, an ADHDer, queer, and has a mobility disability due to a chronic pain neurological condition. She’s also the founder of the FASD Institute—something we’ll discuss today—and, most importantly, the parent of two incredible neurodivergent children, one of whom has FASD.
Thank you, Natasha.
Natascha:
Thank you.
Lisa:
I remember when we recorded the first episode. We were at the University of British Columbia in downtown Vancouver, having a discussion about FASD. I asked if you’d be a guest on the podcast, and we ended up finding a hallway to record in—literally sitting on the floor.
Natascha:
Yes, with your computer and a little mic.
Lisa:
Right! We were just recording with my headphones. Students were walking by as we sat there, recording in the middle of the hallway. That was way back at the start of this podcast.
But I really wanted you to come back because our understanding of how to work with FASD has evolved. And, Natasha, when I think about all the play therapy conferences I’ve attended in my career, I honestly can’t recall one where FASD was presented on stage as a topic. That’s such a sad reality.
Natascha:
Mm-hmm.
Lisa:
So, tell us why this topic is important to you. Then we’ll do a quick refresher before diving into more details.
Natascha:
When I teach about FASD, I say this isn’t just about facts—though, yes, we’ll talk about clinical and research-based facts. This is heart work for me. My daughter is 20 years old, and I share about her with her permission when I teach. I want every child, youth, and person with FASD to be able to see a play therapist or counselor and be treated with respect—without stigma, judgment, or stereotyping. They shouldn’t face barriers.
Why is this so important? It’s personal. It’s about my child, but it’s also about others. Just recently, I heard from someone who reached out to a play therapist and was told, “I don’t accept FASD clients because there’s no learning that can happen.” The stigma within some mental health circles is still so pervasive. That mindset does so much harm.
Lisa:
My heart just sank hearing that. For our listeners, let’s be clear: that statement is completely false.
Natascha:
Yes.
Lisa:
There’s so much support and healing that can happen for individuals with FASD.
Natascha:
Exactly. Everyone can learn; we just need to adapt to how people with FASD learn.
Lisa:
Right. So, let’s do a quick refresher on FASD. Could you give us an overview and then tie it back to play therapy?
Natascha:
Sure. I’ll start by noting that terminology varies by country. In Canada, FASD is a diagnostic term, while in other places it’s considered an umbrella term. For example, in Australia, they refer to it as FASDI, which I think rolls off the tongue a bit easier.
In Canada, we moved away from terms like “Fetal Alcohol Syndrome” to simplify things under the umbrella of FASD. But globally, definitions can differ. When working with clients, I realized I needed a way to explain FASD that was accessible and affirming, especially for kids.
So, here’s how I describe it now: FASD is a whole-body diagnosis. While many people associate it solely with neurodiversity or brain differences, that doesn’t capture the full picture. It’s a diagnosis linked to neurodiversity and various disabilities.
Lisa:
Got it.
Natascha:
Some people describe FASD as a disability, which isn’t untrue, but it doesn’t fully convey all the interconnected aspects of the diagnosis. From a play therapy perspective, it’s essential to understand FASD holistically to best support these clients.
Lisa:
There’s something so honoring in the way you just described it, even just the term “whole body.” It feels deeply respectful to encompass someone’s experience in such a broad and meaningful way.
Natascha:
Mm-hmm.
Lisa:
I’m curious, with that in mind, how do we as play therapists begin to orient ourselves toward helping a client with FASD? And I imagine we’ll also need to touch on the stigma that caregivers face—because that feels like such an important component of the work.
Natascha:
When I think about what a play therapist needs to know before stepping into a session—when you get a referral, for example—the first thing is cultural safety, which is what we’d do when working with any special population. You need to learn about FASD. There are excellent, free online programs available globally, and I’m always happy to share recommendations if you email me. Some are easier to navigate than others.
When I talk about working through an FASD lens, I mean adopting a lens that doesn’t require you to shift entirely when working with different clients. That’s one of the beautiful things about it—it works for every child. And play therapy, in particular, is a wonderful fit because it doesn’t require language.
Lisa:
Right.
Natascha:
Working through an FASD lens means working without needing language, which is crucial because FASD is a language-based disability. To receive an FASD diagnosis, there’s always a receptive language disability present, along with an expressive language disability. But this can get masked or confused because individuals with FASD are often excellent talkers. Their speech can be very rote, off-topic, or repetitive, which can lead to misunderstandings. With play therapy, you don’t have to worry about any of that.
This approach works for everyone, but it’s especially critical for neurodivergent children. Many individuals with FASD have significant sensory needs—equal to or even greater than those of autistic children. And while we use identity-centered language for autistic individuals, for FASD the preference is person-centered language.
It’s heartbreaking how often children with FASD are misunderstood. I’ve worked with kids who’ve experienced significant trauma, like abuse, and their diagnosis was used to funnel them into anger management classes instead of addressing their trauma through play therapy.
Lisa:
Right. They need to work through their trauma—just like any other child.
Natascha:
Exactly.
Lisa:
You’re highlighting something that might be a unique consideration for many play therapists: creating a play space that’s neurodivergent-friendly. And as you’ve said, for children with FASD, this becomes even more critical.
Natascha:
Yes, absolutely.
Lisa:
Can we talk about that? Beyond the skills we bring to therapy, it sounds like the physical space itself plays a significant role in supporting children with FASD.
Natascha:
Yes. A sensory-friendly playroom is beneficial for all children, but it’s critical for those with FASD. Sensory preferences and needs can be profound, particularly because interoception—the ability to sense internal bodily states—is often affected in children with FASD.
For example, many of the behaviors we see—like refusing to enter a music class or acting out—are sensory-related. These kids aren’t necessarily verbalizing their sensory preferences, so it’s up to us to notice and adapt.
Lisa:
So, not just the playroom, but the entire environment, like the waiting room, needs to be considered.
Natascha:
Exactly. If you’re not familiar with sensory systems or neurodiversity-affirming practices, start learning. There are great resources out there—podcasts, books, and courses.
Lisa:
Yes, dive into those resources. Find anything that talks about sensory processing and start there.
Natascha:
I learned so much from occupational therapists (OTs) when I started incorporating these ideas into my practice. For example, creating options in your playroom is key—dimmers for lighting, sensory items, crash mats, rebounders, mini trampolines, tents, and Bop Bags.
Lisa:
It sounds like you’ve covered everything!
Natascha:
It’s important to ensure that children can take their time exploring the space without feeling overwhelmed. Play therapists often love having lots of toys, but it’s essential to be intentional about how you present them.
Lisa:
Absolutely. Turn your playrooms into sensory-friendly spaces—they’ll benefit all children, not just those with FASD.
Natascha:
Yes! This approach benefits everyone because trauma affects sensory processing. But for kids with FASD, these accommodations are absolutely critical.
Lisa:
I think what you’re describing highlights something I’ve talked about before. It’s why I recorded an episode called What Does Your Playroom Say About You? Often, play therapists create their playrooms in ways that are aesthetically pleasing to them—the therapist.
Natascha:
Yes.
Lisa:
It’s like, “Oh, I love my room. It looks great. It feels great to my sensory system.” And yes, that’s important, but are we creating a win-win? A space that works for me as the therapist but also works for the systems of the children I’m serving? Is my playroom me-focused or we-focused? I don’t think we talk about that enough.
With kids who have FASD, the playroom needs to be we-focused, not me-focused. How many sensory options can we provide? I remember Robert Jason Grant talking about the beloved sand tray in playrooms. For many children, that sensory experience is a hard no. He suggests having trays with different textures—offering options. It’s about finding ways to make even standard items more sensory-friendly.
Natascha:
I think we need to remove the word “standard.”
Lisa:
Yeah.
Natascha:
I’ve heard terms like “standard” or “normal,” and one of my clients gave me a brilliant perspective on this. They said, “Normal is just a setting on a washing machine.” Why do we need any child to be “normal” or to fit into a box?
Kids with FASD are beyond the metaphor of a square peg in a round hole. They’re multidimensional shapes—full of points and colors that spin. Trying to fit them into a round hole is impossible. So, instead of focusing on standards, we should offer options.
Part of offering options is giving kids permission to have preferences, to express their needs, and to feel autonomy. For children with disabilities or neurodivergence, choice and autonomy are often stripped away. Things become prescriptive.
For example, I have multiple sand trays—one sealed, wooden tray for aesthetics because, yes, I like a beautiful space. But I also have five plastic trays for kinetic sand, messy sensory play with paint or water, and other textures. I offer options.
I let kids play with the dimmer switches for the lights. Some prefer it brighter, others dimmer. I’ve had sessions where we sat in the dark for 30 minutes, passing a fidget back and forth without words. That complete sensory calm allowed the child to shift internally. It was like they woke up.
Lisa:
You can feel that shift as you describe it—the calming of sensory overload, giving the child a moment to find themselves.
Natascha:
Exactly. Sensory systems are the foundation, and they benefit everyone. When you create a sensory-friendly environment, you’re supporting every child, youth, or adult who walks through your door.
People often ask me about the different presenting issues in FASD clients—why they’re being referred. These issues can seem big or scary, leading therapists to shift their approach, thinking, “I need to teach this child skills.”
But would we do that with any other child in play therapy? No. We’d meet them where they are. Yet kids with FASD carry so many stigmatizing labels—aggressive, violent, unable to learn. Much of the information online about FASD is outdated or methodologically flawed, but it’s still being used.
We’re in the same fight the autism community had decades ago. Even now, there’s a push to eliminate the FASD diagnosis altogether. For example, a recent article in The Lancet, a top medical journal, questioned whether FASD should even be recognized as a diagnosis.
Lisa:
Wow.
Natascha:
This highlights why kids with FASD often don’t receive appropriate care. No one is looking at them through an FASD lens—through a whole-body perspective. That’s why I emphasize learning more about FASD. I didn’t come up with the term “whole-body diagnosis.” It originated with adults who have FASD, such as those in the Adult Leadership Committee.
Lisa:
Can you tell us about the FASD Iceberg framework?
Natascha:
Absolutely. The iceberg analogy is widely used in mental health, and I’ve adapted it for FASD because it’s such a helpful visual. Most people stick to what’s visible above the surface—behaviors. But FASD is a whole-body diagnosis, so we have to look beneath the surface.
In Synergetic Play Therapy, we view behavior as an attempt to regulate. It’s the nervous system crying out to take care of itself. The iceberg framework for FASD came from adults with FASD, like Myles Himmelreich, CJ Luckey, and Emily Hargrave. These adults are thriving and now teaching others about FASD. They identified over 3,000 medical conditions that are more common in individuals with FASD—some up to 100 times more common.
Lisa:
So, what you’re describing is that the presenting symptoms—like aggression—are just the tip of the iceberg. Underneath are medical, sensory, and neurological challenges that are often misunderstood.
Natascha:
Exactly. For example, I often get referrals for “aggression in school.” But when we dig deeper, it’s not about aggression—it’s about unmet sensory needs or unrecognized medical issues.
Let me share a personal story to illustrate this. My daughter was lucky to receive early services from birth, which is rare. Most kids aren’t diagnosed with FASD until they’re 10 or 12 because diagnosis requires extensive psychoeducational assessments.
Her very first suspension in kindergarten happened because she spat in a teacher’s face. That meeting could have gone in a very negative direction, but instead of shaming or blaming, the principal asked, “What can we do differently?” That’s the mindset we need—looking at the whole child, not just their behavior.
Our principal asked, “What do we need to know?” because this was probably the first child with FASD they’d encountered. We estimate that 4 to 5% of the general population has FASD—that’s double the prevalence of autism.
Lisa:
Wow.
Natascha:
They didn’t have prior training on FASD, but they stepped up. They trained every single member of the school—not just the kindergarten teacher or the EA (Educational Assistant). They brought in specialists who spent an entire week observing and training staff.
After that, my daughter never had another incident of aggression in school. Not one—for the rest of her entire school career. Because the staff was able to ask, “What do we need to support this child? What are the underlying factors below the iceberg?”
Lisa:
That’s incredible.
Natascha:
As play therapists, when we get a referral, talk to parents, and review reports from schools, we’re in a unique position to observe and understand what’s beneath the surface. Through play therapy, we can identify sensory needs, communication needs, processing needs, and even physiological needs. FASD is a whole-body diagnosis.
For example, we know that FASD is a chronic condition, often involving chronic inflammation. Are you noticing signs of fatigue in the child? Are there toileting challenges no one talks about because the child is 8 or 10 years old? Are there developmental delays that haven’t been addressed?
Through play therapy, we can help reframe these observations for parents and schools in an affirming way, rather than focusing on “fixing” the child.
Lisa:
I imagine this isn’t short-term therapy. I’m hearing layers, processes, and the need to settle into a long-term relationship with the child.
Natascha:
Yes. That’s a key shift I had to make in my work. As a mental health clinician, I used to feel a sense of shame or stigma around long-term therapy—like it reflected poorly on me if I couldn’t help a child “graduate” quickly.
But within a neurodiversity-affirming framework, as Robert Jason Grant often emphasizes, we recognize that new challenges will arise because of the systemic oppression neurodivergent individuals face.
For children with FASD, the world isn’t built for them. Schools, for example, aren’t designed for neurodivergent children, let alone kids with FASD. So, therapy often involves longer, stretched-out curves of progress.
Lisa:
And that can feel overwhelming for therapists, especially those just starting out.
Natascha:
Absolutely. When I talk to new clinicians or supervisees, I explain this longer timeline upfront. I also prepare families by front-loading what therapy will look like.
Most of the children, youth, or adults referred to me aren’t just dealing with FASD. They’ve often experienced additional trauma—adoption, attachment issues, or multiple placements in foster care.
We also have to address the stigma around prenatal alcohol exposure. Alcohol exposure can happen for many reasons, and it’s not about shaming or blaming. As play therapists, we create a space free from that judgment.
Children with FASD often have big hearts—they love indiscriminately, which can make them highly vulnerable. Their ability to judge danger is impaired. FASD includes memory-based disabilities, with long-term memory often intact but short-term memory—encoding, storing, and retrieving information—being affected.
This can lead to repeated mistakes or behaviors that others might label as defiant or irresponsible. But it’s not a choice—it’s a neurological challenge.
Lisa:
So they may repeat a behavior without understanding why or remembering the consequences.
Natascha:
Exactly. Trauma compounds this because the body and nervous system remember, even if the child doesn’t consciously recall. Imagine carrying all of that while being expected to navigate a world that doesn’t accommodate your needs.
Some children hold it together at school but fall apart at home. That’s often due to unrecognized nervous system dysregulation. For these kids, therapy needs to address what’s happening below the surface.
For example, the vagus nerve and polyvagal theory are well-known in our field, but there’s an adjacent system called the hypothalamus-pituitary-adrenal (HPA) axis.
Lisa:
The HPA axis—right, that’s the neuroendocrine system involved with hormones like cortisol and adrenaline.
Natascha:
Yes. Prenatal alcohol exposure significantly impacts the HPA axis. For many individuals with FASD, this system doesn’t turn on as it should. Instead, it requires co-regulation or intense physical activity—something that makes them sweat—to activate.
That’s why you may see a child screaming, hitting, or crying for 20 minutes—it’s their body’s attempt to regulate. They’re trying to turn on the HPA axis.
Understanding this physiological process helps us unshame these behaviors. It allows us to teach strategies, provide support, and create longer-term therapeutic plans that address the whole child.
Lisa:
Let’s round out this conversation by talking about parents. I love that you’ve already addressed one of the most important points, which is the potential for judgment. I can imagine a parent bringing in their child with an FASD diagnosis and feeling judged by the play therapist. Thank you for naming that. Parents don’t deserve or need judgment—they need support.
Things happen, and they’re here seeking help for their child and themselves. Sometimes children with FASD come into a parent’s life through other means, like adoption or foster care. There isn’t always a biological connection. Let’s talk about parents for a few minutes before I let listeners know where they can learn more about you and your institute.
Natascha:
There’s an incredible amount of stigma surrounding FASD, and it’s unique because the mechanism is embedded in the diagnosis. It’s the only condition like this. When I present on FASD, I always start by destigmatizing prenatal alcohol exposure.
Alcohol consumption is promoted in many cultures, and most people don’t know they’re pregnant right away. Since most pregnancies are unplanned, exposure can happen at any time. FASD can occur in any community, regardless of socioeconomic status, ethnicity, or ancestry. However, it isn’t diagnosed at the same rate across groups.
The stigma often focuses on women, unfairly blaming them for prenatal alcohol exposure. That judgment extends to the children, and whether we’re working with biological families, adoptive families, or other caregivers, there should never be any difference in treatment.
Unfortunately, caregivers are judged and shamed in nearly every system they interact with. They’ve heard grim statistics and outcomes, and they’re told things like, “If you don’t do X, this is what’s going to happen.” It creates a sense of hopelessness.
When parents walk into the playroom, they’re often parenting from a place of fear. As play therapists, our job is to empower parents, help them feel supported, and move away from blame and shame. If we only focus on the surface behaviors—the tip of the iceberg—we risk perpetuating these judgments.
Talking about FASD openly is crucial. Some families want to keep the diagnosis a secret, and I always ask, “What is that like? What message does that send?”
When I co-founded the FASD Institute with my husband, who is from the Squamish Nation, we focused on decolonizing our work and using a neurodiversity-affirming lens. We created what we couldn’t find for our daughter.
Even in British Columbia, where we once hosted the International FASD Conference, there were only three mental health professionals specializing in FASD: my supervisor, my colleague, and me. When I started the institute, people told me, “Don’t call it FASD—it’s too stigmatized.” But I refused to perpetuate that shame.
As play therapists, we wouldn’t want any child to feel ashamed about any part of who they are. Destigmatizing FASD starts with us.
Lisa:
That’s such an important message. Natasha, I can’t thank you enough.
Listeners, I hope you took lots of notes and will listen to this episode again. If you missed the first episode we recorded—our conversation in the hallway—go back and check it out.
Where can people learn more about you and your institute?
Natascha:
You can find us at fasdinstitute.com. It’s nice and easy to remember. For inquiries, you can email us at admin@fasdinstitute.com.
Lisa:
Wonderful. Listeners, if you’re looking for more education, Natasha also teaches workshops and presents at events. If you’re part of an organization, a school, or another group that could benefit from learning about FASD, reach out to her.
Natasha, thank you again.
Natascha:
Thank you.
Lisa:
As I say at the end of every episode: wherever you are, whatever is happening in your life, tune into yourself. Take care of yourself. Honor yourself.
Let’s go a step further today—honor your sensory needs. Honor what’s unique about you. Honor the way your body works, your brain works, the way you move through the world, the way you speak. Honor what is uniquely true about who you are as a human being.
Remember, you are the most important toy in the playroom. Every part of you deserves to be seen, acknowledged and loved—just like the kiddos we work with.
Until next time, everyone.
AUDIO
VIDEO
Listen On Your Favorite Podcast App:
Enjoy this Podcast? Then why not …..
- Explore our SPT Level 1 Intro & Level 2 Certification Programs
- Browse all of our courses for CE credits
- FREE Resources to support you on your journey
- Read on! Aggression in Play Therapy: A Neurobiological Approach to Integrating Intensity
- Subscribe wherever you listen to podcasts
- Give us a five-star rating and review on Apple Podcast
- Invite your friends/fellow colleagues to join us