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The Math Interactive Learning Experience (MILE)

by Hannah McIlroy, M.S., OTR/L


We’ve all been there – math homework is frustrating. If your child has FASD (fetal alcohol spectrum disorders), this may be the case more often than not. Individuals with FASD have unique strengths, but without the right accommodations, may have difficulty learning any or all of the following:

  • Addition, subtraction, multiplication, and division
  • Identifying size, shape, or quantity
  • Categorizing, sorting, and patterning
  • Counting
  • Symbolic understanding (e.g., “+“ means “add”)

The Math Interactive Learning Experience (MILE) is an evidence-based program for increasing math skills in children ages three to 10 with prenatal exposure to alcohol, researched and developed by Emory School of Medicine (Coles et al., 2009). At Hope RISING Clinic for Prenatal Substance Exposure, we know that children with FASD are more likely to have difficulty in academics, resulting in behavioral challenges and higher rates of suspension and expulsion. Part of our mission is to close that gap, using the MILE activities. By collaborating with the child and parent, and letting the child take an active problem-solving role, the MILE program increases math skills for children with FASD. Occupational therapists are well-positioned to provide this intervention because of our training in activity analysis – the skill of breaking an activity down into all the skills needed to perform it. In this case, we answer the question, “What cognitive skills does the child need to use math in their daily life?” In this article, I will answer that question and discuss how MILE closes that gap.

Consider all the skills your brain uses when it solves a word problem: attention, exploring all available information, focusing on the relevant pieces, memory, ability to write numbers and shapes, and self-regulating when it becomes frustrating. Which, let’s be honest, we have all felt frustrated at some point in our math classes! Imagine your brain has difficulty with one of those pieces – let’s say memory. One day you know your times tables, but the next day in class it’s like you’ve never seen it before. How frustrating might that be? With MILE, we aim to assist the child in identifying strategies for compensating for those demands.

How does MILE do that? What might those strategies look like? MILE uses the F-A-R strategy, or Focus & Plan, Act, Reflect. If you are a therapist, teacher, or caregiver, you may be familiar with the Goal, Plan, Do, Check method. F-A-R draws upon this method, which is evidence-based for increasing cognitive strategies across many client populations (Kraversky 2020). The child is asked to Focus & Plan (What is my goal? How am I going to get there?), Act (Carry out my plan), and Reflect (What worked well about my plan? What might I do differently next time?). This meta-cognitive approach helps the child to form new pathways in their brain. In my clinical experience, it has also facilitated increased communication between the child, caregiver, and therapist regarding what external supports were helpful to that child. For this population, this is an important part of helping that young person be successful.

This year, I’ve used MILE intervention activities with families at Hope RISING Clinic. Here are a few strategies children and their caregivers have identified that allow the child to show off their strengths by supporting them in areas like attention, impulse control, and self-regulation:

  • Decrease visual distractions
  • Provide concrete instructions and expectations
  • Give instructions before presenting materials
  • Know the child’s coping strategies for frustration
  • Remind the child to start with their strengths and what they know

Prenatal exposure to alcohol impacts the cognitive skills required to be successful with math learning, and MILE aims to close that gap. At Hope RISING Clinic, we are excited to serve families with this evidence-based intervention in order to achieve our overall mission of seeing children with prenatal substance exposure grow, learn, and flourish. For more information on the research supporting the effectiveness of MILE, please visit

If you are interested in MILE and are already enrolled in a service with our clinic, please reach out to your Family Support Specialist. If you are not already enrolled with us, please begin the intake process at or email

About the author: Hannah McIlroy, M.S., OTR/L, is an occupational therapist and therapy supervisor at Hope RISING Clinic for Prenatal Substance Exposurehas a master’s degree in occupational therapy from the University of Puget Sound. She was born in Washington, studied psychology at the University of Washington, and worked as an ABA behavior technician. Hannah has experience with hippotherapy, sensory, and feeding interventions. She values play-based and family-centered therapy and is bilingual in English and Spanish. Outside of work, she enjoys hiking, reading, and playing soccer.


Coles, C. D., Kable, J. A., & Taddeo, E. (2009). Math performance and behavior problems in children affected by prenatal alcohol exposure: Intervention and follow-up. Journal of Developmental and Behavioral Pediatrics, 30(1), 7-15. doi: 10.1097/DBP.0b013e3181966780

Kraversky, D. G. (2020, July). Cognitive orientation to daily occupational performance (CO-OP) approach: Evidence-based, occupation-centered intervention for children. Special Interest Section Quarterly.

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