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The FASD ADHD Tangle

July 15, 2011

Hold onto your thinking caps.  Circular logic ahead.

Understanding that prenatal alcohol exposure (PAE) is common in children adopted from Korea, my antennae go up when I meet parents of adopted Korean kids diagnosed with ADHD.

To be clear: Kids with no prenatal alcohol exposure can have ADHD. And some kids with prenatal exposure do not have ADHD. But 60-70% of kids with FASD also have an ADHD diagnosis.

Recently, I’ve connected with several Korean adoptive moms over a mutual ADHD diagnosis in our kids. Each time, when I’ve volunteered that Hope’s ADHD is a feature of FASD, the other mom has shared that, like Hope, her child was prenatally exposed to alcohol. But the question of PAE was not raised by their ADHD clinician. Or their ADHD clinician dismissed known PAE in the absence of obvious physical characteristics of FAS (fetal alcohol syndrome).

In each case, the parents were concerned the child had ADHD symptoms and their primary care doctor referred them to an ADHD specialist.

Hope was also referred to an ADHD clinic. But the ADHD intake nurse referred us to a FASD clinic when I answered yes to a screening question about known PAE. She said it was the policy of their clinic to have kids with known PAE seen first by a specialist in FASD. So in Hope’s case, her dual FASD/ADHD diagnosis was rendered by an FASD specialist.

These other moms’ experiences resonate because Hope’s FASD clinician subsequently referred us to an ADHD specialist. That ADHD doctor seemed to suggest that the FASD portion of Hope’s diagnosis was dispensable. Known PAE was not highly relevant because hypothetically, many things can cause ADHD.

Confused yet?

I was momentarily befuddled before rallying, citing the other clinically significant findings in Hope’s evaluation besides ADHD. He was a nice guy and conceded that yes, ADHD alone does not cause all those things.

But, he pointed out, they often occur together in kids with ADHD.

To which I wanted to say: “So what is the incidence of prenatal alcohol exposure in that subgroup of kids with ADHD and co-morbid disorders?” But by that point I had concluded that we did not seem to be on the same page about FASD.

What is happening here?

Is this a turf war between a stalwart (ADHD) and a newcomer (FASD) in the psychiatry world? Does the stigma of FASD carry over even among professionals? Has our understanding of FASD developed so rapidly that there is not yet consensus outside the FASD specialty?

Any insights? The questions are poignant, and their answers, practical. Each mom has asked the same question: what is to be gained by pursuing a FASD evaluation if I already know my child has ADHD? I’ll save my thoughts on that for a future post.

3 Comments leave one →
  1. July 15, 2011 8:55 pm

    I truly think that the majority of the medical professionals still do not understand FASD. I just did a training on FASD for the pediatricians at Children’s Clinic and Hospitals (the one in the gen peds clinic)in June. They were blown away. They did not fully understand ARND, and the hidden part of it. They all got FAS, but not ARND. They learned about FAS in med school. I spoke at length to them about the importance of the diagnosis. I told them how my husband and I would be banging our heads against the wall if we didn’t understand what we were dealing with, and if we “just” thought we were dealing with an ADHD child, since it is soooo different. And I also told them that we would probably have been reported to child protection already if we did not have the diagnosis, due to some of her “odd” behaviors and tendancies to “stretch the truth”. I also gave my OB/GYN a copy of Damaged Angels a year ago at my annual check up and she was blown away. She said she had no idea about FASD. They just don’t know about it. MOFAS is trying to work with the med schools, I think that is really important!!

    • July 15, 2011 9:46 pm

      Wow, Barb… I’m am sorry to agree that this rings very true in my experience. Thank you for helping educate the doctors! Carrie

      • July 15, 2011 9:56 pm

        Thank you for your blog. You are doing a great job on educating people! I have been working behind the scenes and not had the energy for my blog lately, but have been trying to do some behind the scene things and trainings to try to do my part. We’re switching to the north campus this fall so I hope to meet you soon.

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