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When FASD is Stealthy

August 1, 2011

Since I’ve begun blogging about FASD in Korean adoption, I’ve met a dozen other adoptive moms who are now in the process of seeking FASD (Fetal Alcohol Spectrum Disorder) evaluations for their prenatally exposed children. I’ve met dozens more who know their kids have PAE (prenatal alcohol exposure) are in the wait-and-see stages.

As we talk, patterns have begun to emerge. Those parents who know their child has been heavily exposed are generally better educated about FASD, are actively watching for developmental clues, and have a game plan for when/if they need to reach out for professional help.

The rest of us are emerging from denial rooted in our belief that our child’s level of PAE was too low to be significant.

Among those who have adopted kids with lower-levels of disclosed PAE, there are several commonalities:

  • Extreme hyperactivity and impulsiveness in a toddler is often the first red flag parents see. (Universally we are reassured that this is typical toddler behavior.)
  • Kids who do not display hyperactivity as toddlers are assumed to have escaped PAE neurologically unscathed. (But only 60% of kids with FASD also have ADHD. Therefore we could expect that 40% of the children who have brain damage due to PAE will not be hyperactive as toddlers.)
  • Kids who seem sparkling-smart are also assumed to have escaped without brain damage. This myth arrises from the early research on FAS (Fetal Alcohol Syndrome) showing that at the full-FAS end of the Fetal Alcohol spectrum, children can have diminished IQ. It also goes along with the idea that intelligence is universal: that a child who as a toddler is gifted at manipulating people must be otherwise bright. But formal IQ tests on children with PAE often show holes –discrepancies in IQ sub-test scores that illuminate a child’s challenges.

Birth Order

However, the biggest surprise  is that birth order sometimes confounds the early diagnosis of FASD. (In adoption, “birth order” generally means a child’s place in her adoptive family, not her ordinal place in her birth family.) First-time parents have fewer preconceptions about “typical” behavior and until a sibling comes along, often have an unusual amount of time and attention to bestow on their first and only child with PAE.

Parents who were previously in the dark may not begin to wonder if the child has FASD until after a sibling comes home. The transition to being a family with a younger child seems especially hard when the child with PAE is 1-3 years old. It is even tougher if the new child is close-in-age. FASD sends the conventional caveats like “a year apart in age and placement” flying out the window because the child with FASD does not develop or mature at the same pace as a non-exposed child. This is especially challenging when only-child status has masked symptoms of FASD that suddenly seem manifest when a sibling enters the family picture.

Just like the common reassurance that all kids go through “phases” that they outgrow, the unusual challenges that ensue when adding a child to a family where a sibling has undiagnosed FASD are often dismissed as the typical challenges of an adoption transition.

In reality, they are much more difficult. The sibling friction (which looks like rivalry, but is not) may take years to morph into a more-livable form and can unleash a host of damaging family dynamics, like when parents begin to resent the child who abuses the younger sibling without conscience, and who resists every parental attempt at reform via discipline. At the very time the “FASD?!” alarm bells should be going off in parents’ heads, they are deafened by the cacophony of family dynamics disrupted by the addition of another child.

And that puts us in new territory: the unusual dynamics of adding more children to a family when one  or more kids in the family has FASD. I’ll come back to that in a future post.

2 Comments leave one →
  1. Nora permalink
    August 1, 2011 11:06 am

    I am looking forward to your next post Carrie–we have always operated under the assumption that our son would not be the only child who joins our family through adoption. We have wanted for him to have a sibling who looks like him and who shares his cultural heritage. Yet I also worry about the family dynamic challenges you mention–is it perhaps in his best interst to let him retain the position of youngest child? So much to consider.

  2. August 5, 2011 11:12 am

    Thank your for all of your wonderful posts Carrie. You have our little one pegged at every turn! The end of this post is where we are finding ourselves hung up right now – wanting to add to the family so that Grace has a sibling who shares her heritage, but feeling a lot of terror at the thought because we suspect things might be pretty tough if we do. Heck – the sibling rivalry right now is more than I can take!! Also, I’m scared to death of parenting another child with PAE – and Korean adoption seems to be a real shot in the dark with that right now. There’s an awful lot of PAE with so many children coming home from Korea. Scary stuff. Not that kids with PAE don’t need families, but that I’m about as taxed on that front as I can handle for now. Sigh. Tough stuff, for sure.

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