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Adopting Again with PAE in the Family, Part IV

August 12, 2011

Part III of this series ended with this: For better or worse, how your child actually develops will tell you more about the state of his mental health than the hints in his referral did.

That is the danger of over-focussing on PAE and the possibility of FASD in a referral.

But how can anyone over-focus on the risk for something as life-changing as FASD?

While prenatal alcohol exposure (PAE) may be the most obvious risk factor evident  in a referral, it increasingly only one of a number of risk factors. And while educating yourself about FASD is an outstanding starting place, the only co-morbid diagnosis you will find developed in detail in the FASD literature is ADHD. So you’ll encounter information about FASD+ADHD, but not FASD+other mental health diagnoses.

“But,” some parents protest, “There are no mental health risk factors mentioned in our referral. His mom only finished middle school because after her mother died, she left home to escape her abusive father. But she couldn’t find steady work because she didn’t have enough education. With no income she could not get prenatal care. It seems natural that she would smoke and drink sometimes under stress in those circumstances.  But it was not her fault.  Our son’s birth mom’s life would have been different if she had been born into a functional family.  That’s why she wanted a family like ours to adopt him –to give him the chances she never had.”


Or maybe her father abused her because he abuses alcohol. Maybe her mom’s death was suicide. Maybe she quit school and could not find a job because with her undiagnosed learning disabilities she could not read well enough to keep up with the workload. Maybe she smokes and drinks to self-medicate depression or anxiety or obsessive compulsive tendencies. Maybe riding the bus one day she actually saw the bill-board campaign warning that drinking during pregnancy is dangerous for a baby’s health, but she kept drinking anyway because she’d already emotionally detached herself from this child she felt she could not raise.

See how we read our own sense of entitlement into other people’s stories? This child we love so much and in whom we are investing so much of our life deserves to believe the very best about his mother, and therefore himself, right? Actually, in the absence of concrete information to the contrary, given that many of our children will have the opportunity to inquire of their mothers directly someday, I think we should withhold judgment aloud. We are not God and we could easily be wrong.

However, it is especially crucial if you are trying to gauge your family’s capacity to adopt again that you mentally “go there” and consider the possibilities between the lines of your referral. Why? Because I’ve spent the past two days mentally cataloging all the adopted children I know with FASD (some IRL, others, vicariously via their moms) and I can’t think of a single one who only has a diagnosis of FASD. In theory, it’s possible. But the families I know are coping with FASD+Other Diagnoses.

All the privilege in the world conferred on a child by an adoptive family cannot reverse genetic tendencies that may be exacerbated by the circumstances of the adoption. (Adoption itself is a mental health risk on the life-circumstances Axis of the DSM-IV.) And if a child with FASD also inherited mental health issues, it is certain that the same brain impairments embodied in the FASD diagnosis will impair her ability to cope with the mental health diagnoses in her future.

The truth is, having FASD does not exempt kids from also having mental health issues any more than it exempts them from autism, cerebral palsy, or endocrine disorders. So screening a child with PAE for FASD before committing to adopt again may only tell you part of the story.

Your child’s adoption story is private and you are the only one who can screen it by reading between the lines for other risk factors.

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