FASD (Foetal Alcohol Spectrum Disorder) affects children in care disproportionately, but it's little understood.
Sue and Tony Sharp are long-term foster carers looking after twin 10-year-old boys with a diagnosis of FASD along with a number of other diagnoses - and all this on top of the trauma the boys experienced in their early years.
This is the last in a series of four blogs about FASD and trauma, based on a briefing that Sue and Tony developed in association with The National Organisation for FASD and the East Hertfordshire and Area FASD Support Network.
Read the other blogs:
A recent study from Alan Price (Oct 2019) concluded that if a person has FASD and has experienced trauma, they tend to be functionally more similar to children with just FASD than they are to children with just trauma. Without overlooking trauma, it may be best to think of these children’s difficulties as being caused primarily by prenatal alcohol exposure and to use strategies that are designed for FASD. Parenting should be mainly therapeutic and can be learned through relevant training groups and book publications but needs to be amended to suit each individual with FASD. Traditional parenting strategies for trauma or attachment may backfire on a child with FASD as these strategies concentrate more on rebuilding neuro pathways for different outcomes.
A trauma-informed care model for those with FASD builds on brain-based strategies. People with FASD are vulnerable to further trauma. They experience sometimes even small things with far greater subsequent impact. FASD-informed brain-based strategies protect against further compounding trauma.
Here are some top tips in regards to FASD and trauma:
- Consider self-care and caregiver affect management
The better position you are in mentally and physically, the better placed you will be to help the child in your care. Be mindful of your wellbeing. Recharge your own batteries. Talk to others. Share your experiences with professionals. Investigate support groups and peer support. Eat healthily, exercise regularly and stay positive.
- Use the ‘halve their age’ rule
Meet the child where they are at socially and emotionally. Pitch expectations about behaviour and their need for supervision and support to that age rather than chronological age. Your child with FASD will need you to be their support person/ coach. Fill in the gaps they cannot. Calm their insecurities. Guide and reassure them. ‘Risk assess’ each given situation for them.
- Give constant supervision to keep the child safe
Help them make the right decisions. Due to their cognitive challenges they need to develop habitual patterns of appropriate behaviours to keep them away from danger and help them to reach their full potential.
- Be attuned
Pre-empt tricky, uncomfortable or overwhelming situations. New experiences need careful and therapeutic management.
- Listen to your child
If they tell you “I don’t know,” believe them. Don’t jump to any conclusions around them ‘lying’. They are probably filling gaps with confabulation. “I am bored” could mean they don’t know what to do next. “Help me” could simply mean “stick around/ be near me and guide me” rather than intervene/takeover.
- Allow the child time to process questions and instructions
It can take them 30-40 seconds to process and answer. Give them time to get ready to leave the house or go to bed. Give them limited choice. Ask them what they need to do before they can end one task to move onto another and help them do it. Use visual timers and planners.
- Remember children traumatised and living with FASD are hypervigilant
They know your mood before you do! Always act calmly (even if you are not inside). Keep your voice lower than theirs. Smile more. They will also notice what is new or changed in their surroundings. Put away items you don’t want them to see or that may tempt them.
- Choose your battles!
Does it really matter if they want to eat at a different time/place/setting? Or if they want more than one toy out? If they want to stay in all day on a weekend?
- Build on their many strengths
Use a rotation of strategies to bring distraction, patience, humour, positive reinforcement and reward of good behaviour into the daily care of your child with FASD.
- Environment will influence how children with FASD behave
Adjust the surroundings to what they need. Provide sensory toys - many will have sensory issues. Less is often best. They may be easily overwhelmed and overexcited. Hyperarousal may suddenly cause high alert (fight/flight/freeze). When anxiety is up, impulse control goes down.
Teach your child to help themselves self-regulate
Breathing techniques. Crossover exercises. Deep pressure like pushing against a wall or jumping. Count backwards. Blow a harmonica. Engage all senses. Create a calm space. Have fun together.