Q&A: FASD and adoption


Allison Pooley
Focus on Adoption magazine

Allison Pooley is the Program Director at the Asante Centre. She assists individuals, family members, and service providers in understanding the diagnostic process as well as the implications for providing integrated post-assessment supports and services. Allison has been involved in FASD prevention and intervention efforts for numerous years both in northern B.C. and the Lower Mainland, including work in early childhood education, the public school system, the criminal justice system, and adult support settings.

Here she answers your questions about Fetal Alcohol Spectrum Disorder (FASD).

What is the Asante Centre?

The Centre is a nonprofit organization that provides a variety of services for individuals of all ages with Fetal Alcohol Spectrum Disorder (FASD), Autism Spectrum Disorder (ASD) and other complex developmental needs.

We offers assessment and diagnostic services, family and community support, education and training, research projects, resource development, and more. We’re located in Maple Ridge, BC, but serve the province and beyond. Visit our website at www.asantecentre.org, or call 604-467-7101 for more information.

Is it true that children from international adoptions don’t have FASD?

Whenever and wherever a woman of child-bearing age consumes alcohol, there is a risk of her having a child with FASD. The same is true of children from around the world, though awareness of FASD and the broader risks  associated with alcohol consumption in pregnancy varies considerably in different countries. The concern for children adopted internationally (as well as locally) is that an accurate prenatal history isn’t always provided.  Without accurate prenatal information, it’s very difficult to make an alcohol-related diagnosis. A comprehensive developmental assessment will likely be beneficial to help the adoptive family understand the child’s needs and any potential concerns, such as the impact of trauma, neglect, or other medical conditions.

I keep hearing that it’s safe to have an occasional glass of wine during pregnancy. The French do it, our mothers did it, and we all turned out fine. Have researchers been able to determine if there is such a thing as a safe amount of alcohol consumption during pregnancy?

The Governor General recommends no alcohol use in pregnancy, and emerging research supports that assertion. In the discussion of light or moderate drinking in pregnancy, it’s important to recognize the difference between FASD and the broader spectrum of people who have been prenatally exposed to alcohol. Not every person who’s exposed will be diagnosed with FASD. The diagnosis only identifies individuals who have a specific level of disability that can be attributed to alcohol exposure. Other people may be more subtly impacted by alcohol exposure in a way that isn’t diagnosable as a disability but still represents a real, if clinically immeasurable, loss of potential (the term for this is “blunting”).

I read that there are new guidelines for diagnosing FASD. Can you tell us about that?

The 2005 FASD Canadian Guidelines for Diagnosis are currently under revision and are expected to be published in June 2015 (Editor's note: A draft of the revisions can be found on the CMAJ website). The new Guidelines address FASD across the lifespan, including expansions on how to diagnose young children and adults. There will likely be significant changes to the diagnostic terminology and the distribution of brain domain information to reflect new research in the field. All changes are flexible until formally published. You can view the new guidelines online, or call the Asante Centre for more information once they’re released.

How can a doctor tell whether a child has FASD or ADHD, and what are the differences?

Approximately 60% of individuals with FASD also present with attention difficulties and may be diagnosed with ADHD as part of their FASD (though ADHD has other causes as well). Individuals with FASD experience global delays; they must demonstrate disabilities in multiple areas in order to be diagnosed. A child with ADHD may be high functioning in all other areas.

My child with FASD is 10, but she functions more at the level of a four-year-old. It can be hard to remember that. Sometimes her behaviour frustrates me. Any suggestions?

No matter how well we understand FASD and its associated special needs, it can be difficult to maintain patience at all times. FASD is challenging! Children work very hard to do well, and can get as overwhelmed as you. First, remember that you’re human and frustration is normal. There are many strategies that can be helpful. Some families join support groups, and others memorize a key phrase from their child’s assessment report that struck them. Try to make this your mantra: “We all do the best we can with the internal and external resources that we
have.” Every time you have an “aha” moment, consider writing it down so you can keep track of what you’ve learned.

My daughter’s assessment showed that she has some challenges consistent with her prenatal alcohol exposure, but her scores weren’t high enough for a diagnosis. How can we help her?

My first response is to consider the age of your daughter. Many younger children do not meet the brain criteria, but they may be diagnosed later when the discrepancy between their chronological and developmental ages widens. She may need another assessment in a few years. Without a diagnosis, you may not be able to access disability services but can still work with the people in her life, such as her teacher, her soccer coach, her social worker, or her family doctor to meet her needs.

You can use her assessment findings as a starting point from which to brainstorm accommodations for her. Some possibilities include adaptations to communication approaches, additional tutoring for school, or support around calm-down techniques if she has emotional regulation or sensory concerns.

Are there any medications that can help with the symptoms of FASD? When and how are they used?

There are no medications that treat FASD in general, but there are medications that may help alleviate particular symptoms such as attention difficulties. Supplements that promote brain health may also be beneficial for people with FASD, as well as to anyone in the general public who wants to ensure optimal nutrition for their central nervous system. Please consult with your healthcare practitioner to find an approach that works best for your child.

Learn more about the Asante Centre at www.asantecentre.org.