ADHD and FASD: making sense of the connections

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Author: 
Robert More
Source: 
Focus on Adoption magazine

It's very common for adopted children to be diagnosed with both attention deficit hyperactivity disorder (ADHD) and fetal alcohol spectrum disorder (FASD). In this article, adoptive father and FASD advocate Robert More explains how his family learned how to manage these conditions effectively.

Never a dull moment

As the father of three adopted children diagnosed with ADHD and FASD, life can get interesting quickly. Whether it is my teenage daughter screaming at me because I got home 15 minutes early, my other teenage daughter creating some concoction she saw on the Food Network, or my son having chopped down every small tree in the yard because his teacher used a cross voice with the class, my wife and I just keep rolling with the punches. Thankfully, with my 20 years of special education teaching experience and Master’s degree in this field, we've been able to find some solutions.

Ten years ago, my wife and I adopted two beautiful sisters through the Children’s Aid Society in Ontario. As the years passed, we noticed that our older daughter was prone to emotional outbursts, rapid mood changes, and organizational challenges. She was struggling at school, so we had a psychological educational assessment done. She was diagnosed with a learning disability as well as ADHD.

It's all in the brain

Recent research suggests that ADHD is caused by underdeveloped connections in the brain’s frontal lobes. Those are the parts of the brain that solve problems, plan ahead, understand the behaviour of others, and restrain impulses.

In other words, ADHD is an impairment of executive functioning skills. This means the child will struggle with organization, emotional and behavioural regulation, maintaining focus and effort, memory recall, and dealing with change. Some people also experience learning disabilities, oppositional defiant disorder, conduct disorders, anxiety, and depression connected to the ADHD.

It’s important to note that inattentive, impulsive, or hyperactive tendencies don’t necessarily mean a child will be diagnosed with ADHD. We all have moments where we struggle with executive functioning. The difference is that a child with ADHD is going to struggle with the majority of these skills all the time.

Child and building blocks The fundamentals of FASD

Thanks to my experience as a special education teacher, I knew what supports my daughter would need. Even with those in place, though, she continued to have challenges. Things really went off the rails when she reached high school. Her anxiety was high, her impulsivity got worse, and she started running away from home. Our pediatrician made a referral to the genetics department of Children’s Hospital of Eastern Ontario, where she was diagnosed with fetal alcohol spectrum disorder (FASD).

"Does this mean we should ignore the earlier diagnoses and just focus on FASD?" we asked.

"Not necessarily," said the pediatrician. He explained that all her diagnoses were actually connected.

We learned that FASD is a permanent brain injury where the connections within the brain are essentially missing. Different impairments arise depending on when and how much alcohol is consumed during the fetus’s brain development. Common challenges associated with FASD can include executive functioning issues, learning disabilities, neuromotor difficulties, and sensory concerns.

People impacted by FASD often experience a wide range of physical conditions and mental health challenges, which is why researchers now describe it as a whole-body disorder. A 2016 report from CanFASD lists attention deficit hyperactivity disorder, reactive attachment disorder, oppositional defiant disorder, trauma, stress, addictions, self-harm, and suicide as particular areas of concern.

A step-by-step solution

Armed with our new understanding of FASD, our family and medical team started putting together the supports our daughter needed to succeed. We started with her anxiety because when her anxiety is high, her emotions take over and she can’t think logically anymore. Her impulsivity increases, she makes really bad decisions, and she can’t remember her coping strategies. Her pediatrician put her on some medication that thankfully worked pretty well. We had been warned to be patient because people with FASD sometimes need to experiment with medication for a while to find the right fit.

Next, we focused on getting her to talk to us or her counselor as soon as she started feeling anxious. She tends to get hives or stomach aches or become really quiet when she is feeling anxious. We follow up on these signs because they usually mean she’s trying to hide something from us.

After that, we focused on structure. We started by recording every episode of impulsivity. We noted the date, time, preceding circumstances, and action. After a couple weeks, we saw that if we were calm, our daughter was calm. But any time she was exposed to emotional intensity, she would copy the behaviour. If we got agitated, so did she. If she was around an angry person, she became angry. If a boy showed interest in her, she would reciprocate.

If she talked her feelings out with someone or used one of her coping strategies (working with her horses, drawing, listening to music, or writing in her journal), her anxiety would decrease. We also found she struggled the most during unstructured periods at school, especially lunchtime, so we arranged for her to be able to hang out with safe adults during those times.

Finally, we focused on her learning disabilities. We found that simple instructions with minimal information worked best for her. Writing is a big challenge, but she finds the voice recorder on Google Read and Write to be very helpful. It can be accessed on any electronic device with data or Wi-Fi. She can communicate her thoughts and ideas verbally and then have it read it back to her with spelling and grammar corrected.

Her psycho-educational assessment showed that she is a concrete, hands-on learner, so we often use examples that involve her beloved horses to explain things. She used to complain about the lack of freedom at school, so we explained that she has the same situation as the horses. The horses have all the freedom they want within the fenced paddock. They can wander, eat, drink, and hang out with other horses. However, if they leave the paddock, they’ll just stand right beside the fence unless they have a trusted human to lead them. Our daughter understands this, and no longer complains about a lack of freedom.

Success through support

The key thing for us to remember is our daughter doesn’t have a choice about any of this. The brain damage caused by FASD is permanent, and we recognize that her FASD, ADHD, and learning disability will be a constant challenge. For example, even with medication and structure, she still makes poor decisions because of her impulsivity, and then tries to hide it because she’s ashamed. The difference is that she now fesses
up quickly, because she understands that talking it out is the solution.

What keeps us going is that we can see that with the right supports and the right environment, our daughter will be a valuable and successful member of society. Nothing has ever come easy for her, but that has honed her indomitable spirit that never, ever quits. At the age of 16 she’s already told her adoption story at regional heritage fairs, won awards for her artwork, and shown her cow at provincial fairs; she now trains other people’s horses. Her FASD is not "what’s wrong with her," it’s what makes her unique. And most of all, despite being a third generation foster child, she will be the one who breaks the cycle.

Robert More has been a freelance writer and publisher for more than 30 years. He has also served as a special education advocate for the Children’s Aid Society in Ontario, and is currently the Lanark County FASD Support Group moderator and a Special Education Resource Teacher for the Ottawa Catholic School Board. Find Robert online at giveusmorespecialneeds.blogspot.com.