Understanding FASD

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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 second 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:

Is the young person in your care showing extreme, unpredictable or unexplained behaviours, sudden outbursts and issues around development or learning? Is it possible they were exposed to alcohol in the womb? 

Foetal Alcohol Spectrum Disorder (FASD) is permanent and unchanging brain damage caused when brain development is affected by alcohol exposure in the womb. Any part of the brain can be affected in varying degrees by any amount of alcohol. It is a spectrum disorder encompassing difficulties and challenges in health, behaviour and judgement, often accompanied by co-morbid lifelong conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum Disorder (ASD), Oppositional Defiant Disorder (ODD), mental health issues and concerns around sight, hearing, development and ongoing medical problems. It’s a full body diagnosis, more than 400 conditions can co-occur. Early diagnosis and appropriate support are key. 

What is the difference between a brain affected by FASD and a brain affected by trauma? 

A brain affected by FASD has permanent organic damage and neurological dysfunction. The struggles are life-long for the affected person. A brain affected by trauma has the neuroplasticity to form new neural pathways for better long-term outcomes. When trauma and FASD mix, the result can be very complex and support at home and school must be FASD-informed. 
Every child with FASD is different. Care and behavioural plans must be individualised, strategies flexible and creative, nurture and boundaries consistent. It takes a whole community to raise a child with FASD. Together we are stronger! 

If you suspect the child in your care is affected by FASD, a diagnosis is important although difficult to achieve. Individuals who are aware of and can accept their condition are more likely to live their best lives. 

Cognitive effects

  • Executive functioning - Difficulties with planning, sequencing, problem solving, organisation, task initiation, flexibility control, prioritising, impulse control, emotion, self-monitoring, transition, consequences, abstract ideas and time. Choices can be difficult.
  • Sensory and motor skills - Hypervigilance, over/under sensitive to sensory input (noise, touch, smell, taste, and light/dark). May not be able to make sense of what is going on around them.
  • Living and social skills - May be vulnerable and easily taken advantage of. May not understand personal space, boundaries or approach strangers inappropriately. Lack of sense of danger. Often act half of chronological age. Will have poor judgement.
  • Focus and attention - Often in ‘fight or flight or freeze’ mode. Impulsive, hyperactive, unregulated and overstimulated.
  • Cognition - Difficulties with reasoning, memory, planning and readjusting.
  • Communication - Delayed speech, slow processing, difficulties following instructions, may speak/read well but not understand content. 
  • Memory - Difficulties with short or long term memory, unable to recall instructions and will learn better from ‘visual memory’.
     

Teamwork is crucial

Ensuring appropriate support for a child with FASD is critical to avoid negative outcomes. Foster carers juggle a complex mix - the impact of the organic brain damage caused by FASD as well as the damage caused by unmet attachment needs, trauma and neglect. This makes the work that foster carers do complex. They need support from an informed team around the child. This means that all of the various plans for a child must complement each other and provide consistent approaches to what is to be achieved. It also means social workers working with the family need to understand FASD.

“As foster carers, understanding FASD empowered us to embrace new approaches, reach out to connect with other families and access our local support group to build our knowledge. Parenting our children ‘traditionally’ was not working; but by changing our views and environment and listening to the boys’ needs made their lives, and ours, so much easier.”