Health & Safety

These resources address specific health and safety issues of individuals with FASD.

Health and safety is a subject that most parents and caregivers of individuals with FASD struggle with.

People with FASD may be more susceptible to certain health problems as a result of the effects of prenatal alcohol exposure. These health problems range from mental illness to sleep problems. In addition, they may have difficulties understanding the importance of hygiene, food safety, nutrition, proper use of medication, etc.

Persons with FASD are also likely to be vulnerable to risks associated with common activities in their daily lives. These risks include those that affect their physical safety in public places or other surroundings, knowing how trustworthy their associates are and behaving appropriately with others, traffic and motor vehicle safety, animal safety, and being mindful and careful around hazards in their home, school, or workplace.

If you need immediate help regarding the safety or health of your family member, friend, or coworker with FASD in California:

California 211

Drug and alcohol use is dangerous for youth and adults with FASD because they become addicted quickly.  For this reason, it is best if they completely avoid using alcohol and illegal drugs.

Because alcohol use is widely accepted in our culture and drugs are readily available it is difficult to avoid them. People with FASD may have friends and family members that drink alcohol on a regular basis. Because those with FASD are easily influenced they will want to join in. This is a big problem because of the differences in how their brains work.

Addictions are resistant to change and treatment, especially because traditional treatment approaches don’t work well for people with FASD. Remember too that they are at greater risk when under the influence of alcohol or drugs. Drug and alcohol misuse can lead to criminal behaviors, victimization, poverty, disrupted relationships and homelessness.

Useful Links

Help a Teen or Adult Avoid Drug and Alcohol Use and Abuse

Disabilities and Alcohol Use Disorders. See the headings on “Alcohol and Intellectual Disabilities” and “Traumatic Brain Injury” in this page.

SSDI and SSI Disability Benefits for Drug Addiction Although this page is used for advertising a specific company, it presents facts that might be useful.

 
 

Picky Eating

Persons with FASD are often very picky eaters. This may be related to a problem with sensory integration.

 

Some individuals are very sensitive to taste and texture. He or she may not like raw whole carrots, but slicing or shredding the food might make it more acceptable. Fresh tomatoes may not be pleasant , but peeling and removing the seeds or using them in a sauce might be fine.

At times, mixing foods may make them more palatable. At other times, separating foods may be better so that there is not an unusual combination of tastes and textures.

Some individuals may also benefit from smaller, more frequent meals.

Adding a daily multivitamin to round out their diet is also a good strategy.

Not so well known is the impact of underlying brain dysfunction on taste sensation for many individuals with FASD. For many, their sense of taste is so attenuated that they will only eat food that is very spicy or very sour.

Sometimes individuals with FASD may not eat apples or oranges but will eat lemons because they are able to taste them.
Nathan E. Ory, 2004
Meals and Diet

Some children with FASD eat relatively little, and their parents are concerned about their child’s ability to maintain a normal weight for healthy growth. Doctors may recommend feeding the child high calorie nutritional supplements.

Maintaining a healthy diet seems to have a significant effect in helping persons with FASD to control behavior.

Good rules of thumb include:
  • Avoid additives
  • Read labels
  • Minimize fast food
  • Patronize restaurants that don’t use preservatives.

Teachers know that the worst days for behaviors are the day after Halloween, Christmas time, and Valentine’s Day. It’s not necessarily the sugar, which in reasonable amounts should not cause problems. Rather it’s the food coloring; red coloring agents seem to cause the most problems. Other likely culprits are aspartame and preservatives.

Try an additive-free diet for about a week, then try adding one potentially troublesome food at a time to see what affects your child and what does not.

Mealtime Issues

Eating problems are common for alcohol-affected children. Parents should be flexible in your expectations:

  • Allow ample time to eat. A child with FASD may eat slowly because of poor muscle control or a poor swallowing reflex.
  • Accept that FASD children may be sloppy eaters.
  • Work on one kind of table manner at a time. Integrate a new manner only when the previous one has been successfully used for some time.
  • Avoid restaurants at peak times when eating out.

Useful Links

FAS and Nutrition

Nutritional Interventions for Children with FASD

When “Attitude” Comes From Low Blood Sugar

Nutrition Program for Daughter with FASD

Picky Eater Strategies

 
 

Medical Treatment Issues

The medical care of the child with fetal alcohol syndrome (FAS) or fetal alcohol syndrome disorder (FASD) is treatment for every type of health problem, not only  associated birth defects and intervention for potential cognitive and behavioral abnormalities.

As every affected individual is unique, each person’s medical needs are different as well.

Dental Treatment Issues

Dental problems occur in the majority of persons with FASD.

For children born with Fetal Alcohol Syndrome (FAS), dental anomalies that can occur include cleft palate, over- and underdevelopment of the upper and lower jaw, as well as malformed, missing and/or misaligned teeth.

Other problems that affect dental treatment that can occur with FASD include:

  • Weak muscles around the mouth that make it difficult to take food off a fork or spoon or to suck on a straw or the nipple of a bottle
  • Unusual taste preferences for salty or spicy food at an inappropriate age
  • Cavities occurring at a young age
  • Prolonged and excessive drooling
  • Weak muscles that prevent the proper placement of food for chewing
  • Late loss of baby teeth; late eruption of permanent teeth.

In addition, the patient with FASD may have unusual behavioral patterns and tissue and sensory issues that make dental treatment difficult.

Patients with FASD may experience more “loud” sounds than the average person. The sound of the some of the tools used by a dentist or hygienist may seem extremely loud to them. Music headphones can be a great help.

The weight of the lead apron used during dental x-rays is very comforting to the patient with FASD, and it may be useful to let her wear it throughout the treatment.

Sensory integration dysfunction of the mouth may create some unusual problems.

Ask the dentist to suggest another type of toothpaste if the taste or texture annoys the person with FASD.

Baking soda is a good semi-tasteless substitute and brushing with water is better than no brushing at all.

There are commercial rinses that contain plaque removers and/or fluoride that would help with your child’s oral hygiene.)

Rinsing should be practiced and done often during the day.

Flossing or use of the WaterPik may be more comfortable. The mouth may be desensitized with oral massage.

Daily massaging with a small portion of a towel or a rubber stimulator will help the individual to become used to objects in the mouth.

Making Treatment Less Traumatic

Persons with FASD function best with a great deal of structure and routine in the environment. Unfortunately, even when they are scheduled far in advance, visits to doctors and dentists are usually breaks in the normal routine, and therefore they may be upsetting to the individual. This is especially true if he or she is in pain or has a sudden illness.

Make the Visit Concrete, Less Abstract

In order to avoid the anxiety around an unanticipated visit to the dentist or the doctor, parents can try to obtain take photos of the office and staff beforehand. Many health care offices have websites that have pictures you can use for this purpose.

Use these to remind your child of previous visits, or to show her pictures of who she will be meeting. Review the photographs each day for about two weeks before a scheduled appointment.

Reduce Fear of the Unknown

If possible, make the appointment at the quietest time of the day or even after regular hours.

For a routine examination, ask the practitioner for a “practice visit.” During this time, have the staff member walk the FASD-affected person through the procedures and use the exact treatment rooms and instruments that will be used during examination and treatment later.

Patients with FASD often need to “unwind” or calm themselves down before treatment begins. This may include walking around the room or fidgeting with their hands.

Let you child bring a rubber ball or any other soothing object to squeeze or hold during the visit.

Unless the practitioner is examining the person’s eyes, allow him or her to wear dark glasses if they help to reduce discomfort from the glare from overhead lights (such as at the dentist’s office).

Note about self-harm in young children with FASD: It is not uncommon for your child with FASD to want to have an injury just like someone she knows. She may want to hurt herself to try and be like this person. And when she does, you should validate this and take her to the doctor, or put an ice pack or a tensor bandage on the injury. This should prevent her from actually harming herself.

Advocate for the FASD-Affected Health Care Consumer

Most health care recipients who are affected by FASD should be accompanied to the doctor’s or dentist’s office by a trusted adult who can act as his or her advocate. Usually the advocate is a parent or caregiver, but if the patient is an adult the advocate could be a sibling, spouse, roommate, friend, or coworker.

The advocate should be ready to do the following:

  • Review the FASD-affected person’s medication history with the practitioner carefully. It is not unusual for persons with FASD to have extreme reactions to medications. Dentists and specialists should always consult with the person’s parents (guardian or conservator, if applicable) and pediatrician (or primary physician) when administering anesthetics.
  • Make sure that the practitioner understands that the patient with FASD is very literal, and will likely become confused if anyone on the staff uses terms such as “(name of instrument or procedure) like this”, and then that instrument or procedure is not used.
  • Stress that the practitioner should talk about and show the person the actual instruments and materials that will be used during treatment in order to avoid confusion and misunderstanding.
  • Encourage the staff and practitioner to warn the patient about noise and new phases of the procedure. This will reduce tension.
  • Make sure that the practitioner and other staff members understand that they should speak directly to a patient with FASD.
  • Stress that the individual is very visual and often cannot understand if you turn away when you speak.
  • Hand gestures, signing, and visual aids will help them to understand you more clearly.

Sensory Integration Issues and Health Care Treatment

Sensory integration dysfunction is a neurological condition that causes sights, sounds, and physical sensations to be over or under exaggerated. It is also not uniform in each individual; hypo- and hyper-sensitivities may exist in different areas on the same individual.

Visually, objects on the wall or hanging from the treatment lamp may be disturbing.

Patterned curtains that sway near an air vent may be very distracting. Making the treatment room as plain and uncluttered as possible will help to prevent over-excitement and over-stimulation.

About Patient Education and FASD

Patient education is a vital segment of good health.

Persons with FASD benefit from visual reminders. For examples, a series of photos or hand drawn pictures showing how to to brush and floss can lead them up to an through the daily routine of good oral health. Step by step pictures are the best.

Break down the instructions into doable segments; do not combine instructions or make them overly long.

Have patients demonstrate their oral hygiene for you. Simply repeating the instruction does not mean that they understand them…remember patients with FASD are visual and literal and need to be very hands-on.

It helps to remember that patients with FASD may have an emotional age that is one half of their chronological age..gear your explanations to that emotional level.

Useful Links

Note: There are few FASD-specific web sites that deal with addressing the challenges of medical (including psychiatric and mental health) or dental treatment. This is likely due to the fact that every fetal alcohol-affected person is unique. The links to Internet sites here are targeted toward individuals who have challenges commonly observed in many persons with FASD, such as slow information processing speed, sensory integration problems, impulsiveness, poor memory, problems with understanding, remembering  and following multi-step or complex directions, etc.

Special Needs Dentistry: Treating Patients with Fetal Alcohol Spectrum Disorders

Medical Treatment of Adults with FASD

Following Treatment Guidelines for Developmentally Disabled Adults

Dental Hygienist Tips: Caring for the Developmentally Disabled

Caregiver Satisfaction with Healthcare Access for Individuals with Developmental Disabilities

Preparing Dental Graduates to Provide Care to Individuals with Special Needs

Special Needs Dentistry

I’ll never forget my horror at discovering my daughter’s repeated attempts to go shopping in the middle of the night by climbing out of her bedroom window.  She would manage somehow to get $10 or $20 and would hide it in the inner sole of her shoe. Then she would wait until 2 in the morning to walk to the 24-hr. supermarket over a mile away to get all the sweets and goodies her money could buy. The weight gain would be serious enough.  But I was truly concerned for her safety, as she was a trim 110-lb. teenager with long blonde hair.  Oh!  I still shudder to think about it.

Teresa Kellerman, 2006

Many families with a loved one affected by FASD are concerned with keeping the individual safe and secure; in addition, families also may need to protect other family members or valuable possessions from the impulsive behavior of the FASD-affected person living in the household.

Most children, many teens and some adults with FASD need close supervision at all times.

A small percentage do not need to be monitored very closely and only need minimal supports.

A majority need closer supervision than they would if they did not have any disabilities.

And some need very close supervision that is beyond what parents (or other caregivers) can reasonably provide in a family setting.

Security is an issue especially for two groups of FASD-affected individuals:
  • Those who sneak out of the house to engage in risky behavior at night (sexual behavior, substance abuse, etc.). They lack control over their impulses, have very poor judgment, and are naively vulnerable to the suggestions of their peers.
  • Those who, in addition to FASD, have a mental health issue (Reactive Attachment Disorder (RAD), Bipolar Disorder, etc.) that prevents them from having control over their behavior. These individuals may engage in behavior that places themselves or others at risk.

Some FASD-affected individuals need to have objects that can serve as weapons (such as  knives and scissors) locked up. Some families need to restrict access to food. Some parents need to monitor their child’s behavior during the night.

In addition to controlling where the FASD-affected individual goes, what he does and who she spends time with, watching the child’s every move (waking and sleeping), keeping valuables in locked drawers or safes, padlocking kitchen cabinets and the refrigerator, locking all exterior doors and all windows, and putting keyed doorknobs on all bedroom doors (and making sure that parents are the only ones with access to the keys), perhaps the easiest way to monitor children’s behavior is by getting and using alarms in the home.

Useful Links

Related / Co-Occurring Conditions

Security Alert… FASD Style

Sexuality-Related Behavior of Children With FASD

Younger children with FASD often may have no fear of danger, do not respond to verbal warnings, and have no stranger anxiety.

Younger children are highly tactile and may explore their bodies at inappropriate times (for example, during class time). They may also be very curious about the opposite sex.

Older children with FASD may seek close personal contact with everyone, share inappropriate information, and have difficulty distinguishing how to talk to or what to talk about with strangers, professionals, family, neighbors, school staff, etc.

They are sexually curious (as all older children and adolescents are) but they have difficulty interpreting social cues from the opposite sex (“He smiled at me, so he’s my boyfriend”).

Teenagers with FASD may have trouble remembering to use a condom every time they have sex, and can’t foresee pregnancy in order to take precautions every time.

Teaching Safe Behavior Around Sexuality for Persons With FASD

Strategies for Younger Children With FASD

  • Practice constant supervision.
  • Teaching personal boundaries is very important and must be taught at a young age, and constantly reinforced.
  • Teach relationships at home and wherever you go. If your child approaches strangers, deal with it on the spot, in front of the stranger.
  • Clearly state that this is not a familiar person. Say, “This is a stranger. You do not talk to strangers (unless I give you permission).” Or use a phrase such as “Stranger Danger.”
  • Teach “private bodies” rather than “private parts”, so that children are not confused.
  • Teach the names of body parts.
  • Explain to your child that everyone must be an arm’s length away.
  • Ask your child’s school about resources that teach “how to make a friend, how to be a friend.” Get the printouts and take them home to use.
  • Model social interactions step by step; for example, how to shake hands, and how to give or receive hugs. Watch to see if your child is understanding; if not, help her to see the connection.
  • (Note: If your child is sensitive about touching, tell your relatives in advance what your child prefers.)

Strategies for Older Children and Teens With FASD

  • Supervise your child’s outings and activities as much as possible.
  • Use of chairs with arms may help to delineate personal space.
  • Provide cues for boundaries such as masking tape on the floor and furniture.
  • Consider making some simple rules (for example, “Everyone has to be an arm’s length away.”).
  • Arrange a friendship as early as possible with a peer of your child who is responsible and who can act as a buddy when you are not around. Keep this person in mind to consider a friendship that can be taken into adulthood.
  • Educate your child’s peers about FASD, and educate your child about what is a safe and acceptable request from a friend.
  • Provide safe activity options for your teen to get involved in. (It’s not about what she can’t do; it’s what she can do).
  • Be aware of the grade in which sex education is taught.
  • Reassure your daughter that she will not get her period if she goes to school and learns about menstruation.
  • Be open and willing to talk about menstruation. Explain it in concrete ways your daughter will understand.
  • Let your daughter know that it’s okay to practice with panty liners months or years before her period begins.
  • Mark your daughter’s period on a calendar. It will remind you and her.
  • Show your daughter strategies for treating menstrual cramps, like using a hot water bottle.
  • Be open and willing to talk about masturbation for pleasure and stress relief.
  • Keep books about sex education all around the house.
  • Practice with condoms and birth control months before required.
  • Give lessons in sex education regularly. These lessons should cover a variety of topics, at the level of your child’s understanding, and in concrete terms:
    • Dating
    • Responsibilities of engaging in sexual behavior
    • Relationships
    • Assertiveness/the right to refuse to be touched and the right to refuse to have sex
    • Sexually transmitted infections
    • Pregnancy
    • Contraception strategies
    • Masturbation
    • Sexual abuse
    • Personal care and hygiene
    • Puberty changes/menstruation
    • Medical/gynecological examinations
  • Provide longer-acting birth control than the traditional daily pill (Depo-Provera, the Patch or, an IUD) for your daughter.
  • Discourage inappropriate displays of affection.

Express clear behavior expectations that conforms with family and societal standards.

If your family values include “only married couples have sex”, say so, and make sure your child knows what you mean by “sexual behaviors.” (Many teenagers, for example, will argue that “oral sex” or “anal sex” is “not really sex”; so parents need to be very clear about their expectations.)

Recognize the importance of feelings.

Practice appropriate displays of affection.

If possible, chaperone your child’s dates, or have a responsible friend double-date with your child and his sweetheart.

Teach the difference between acceptable behaviors in a private setting and those which are acceptable in public.

Useful Links

Fetal Alcohol and the Rules for Sex

Healthy and Safe Sexuality for Teens and Adults with FASD

Working with Children Exhibiting Sexual Behavior Problems

Safety Issues: FASD and Sexuality

Marriage and Relationships

Parenting

Sex Rules for FASD

A majority of children and adults with FASD have sleep disorders.

One study found that 82 out of 100 caregivers reported that their children with FASD have sleep issues.

Sleep issues can range from night terrors, waking in the middle of the night, having difficulty falling asleep, and sleepwalking.

Sleep Issues In Children With FASD

Sleep difficulties in children with FASD are a common and important problem that can impact daily functioning.

Intervention may include cognitive strategies (bedtime stories or other rituals the child uses to mentally prepare for sleep, sensory-based strategies, and medical strategies (such as the over-the counter remedy Melatonin, or prescription medication such as Trazodone or Seroquel).

Providing supportive environmental accommodations often helps children with FASD.

This can include strategies such as altering the environment, reducing stimuli, manipulating the sensory input, and self-regulation strategies, such as outlined in the Alert Program™.

A strategy for the FASD-affected child may include the provision of a “sensory diet”; for example, the therapeutic use of sensation via activities embedded in the daily routine to meet the child’s individual sensory needs and preferences.

This may include the method for waking the child in the morning (lighting in the room, type of alarm, music).

Strategies include:

  • The room should be a calm, uncluttered, safety-proofed space, with dark or low lighting, and room darkening blinds.
  • Use a nightlight as needed.
  • A slow moving, rhythmical, visual tool, such as a fish tank, can also be calming.
  • In some instances, having the child sleep in a small tent can help with limiting distracting visual stimuli and aid sleep.
  • A quiet room that is carpeted for noise absorption is generally preferred.
  • Providing “white noise” from a fan can be calming and can help to block out noises from the environment.
  • Relaxing music, or music with a strong beat, has been recently reported to be helpful for falling asleep.
  • Often removing tags from pajama/nightgown clothing, and softening new pajama/nightgown and sheet and pillowcase material by multiple washings can be helpful.
  • Deep pressure, a calming massage, or sleeping with a weighted blanket may provide needed tactile input.
  • Some children with FASD engage in “picking behavior” which may result in stuffed animals or mattresses being pulled apart. Giving the child “hand fidgets”, such as a stress ball or blankets with preferred fabric tassels may help to meet his or her tactile needs.
  • Sleeping in a sleeping bag, or “nesting” with multiple stuffed animals may help a child who feels that his body is “unmoored” in the dark.
  • Slow rhythmical rocking, as in a rocking chair, can be calming before bed and can address the child’s vestibular processing needs.
  • In general, fast movements, such as running or spinning, may cause over-stimulation and should be avoided before bedtime.
  • Children with FASD often have a keen sense of smell. Parents, caregivers, and other adults should be aware of all scents in the environment (for example, laundry soap, fabric softener, toothpaste, body soap, or lotions), as they can be overwhelming, especially before bed. Determining which scents are calming for the child (for example, vanilla, banana, or lavender) can be helpful.

Sleep Issues In Teens and Adults With FASD

Many adults with FASD have poor sleep patterns. This can be due to irregular schedules, a lack of structure to ensure a reasonable and regular bedtime, and a lack of
self-regulation without assistance.

As with children or teenagers with FASD, adults with FASD also may have difficulty with sleep because of an inability to block out sensory information; not being able to understand cause and effect (for instance, they do not understand they should get to bed early because they have to get up early in the morning); memory problems; or other brain-based issues.

To avoid conflicts or rushing in the morning which may impact on the entire day, here are some accommodations which may help the FASD-affected adolescent or adult to manage sleep challenges:

  • If possible, arrange work/school schedules to accommodate the person’s sleep patterns. For example, some individuals do better sleeping in during the morning and then going to a job later in the afternoon and evening.
  • Provide assistance with ensuring the person has clean clothing, packing lunches, and organizing backpacks, purses, or other items, so that the person avoids being anxious about it the night before or in the morning, and so that the morning routine is as calm as possible.
  • Help the person to establish evening routines and maintain them.
  • Emphasize calm activities to help with relaxation and restful sleep.
  • Keep the bedroom uncluttered and limit stimulating distractions.
  • Use any helpful and healthy strategies (see above) to improve the person’s ability to fall asleep and sleep through the night.
  • Talk about what might help during transitions between sleeping and waking. Decide with the person on creative methods for waking them calmly, to reduce their negative reactions to your assistance.
  • Discuss motivators for getting up and getting ready to help encourage successful responses to wake-up calls.

Everyone needs a reason or a purpose to get up in the morning. If a person is engaged in their work/activity, and it’s a good fit, the motivation to get enough sleep and to get up on time is intrinsic.

Useful Links

Chronic Care for Sleep

Sleep and FASD Are Not Friends

Sleepless in FAS Land: How to Help Your Child Sleep Better

Sleep Health Issues for Children with FASD: Clinical Considerations

Sleep Strategies for Children with FASD

Nightmares and Disturbed Sleep in FASD

Sleep Problems in Children with Fetal Alcohol Spectrum Disorders

According to the U.S. Substance Abuse and Mental Health Services Administration, FASD can co-occur with many mental health disorders. the include major depressive disorder, psychotic disorders, personality disorders, substance use disorders, conduct disorder, and reactive attachment disorder.

Failure to recognize mental health issues among individuals with an FASD increases the risk of any or all of the following signs of poor mental health:

  • Low self-esteem
  • Psychiatric hospitalization
  • Problems in school
  • Family and relationship problems
  • Alcohol and drug abuse

What Kind of Counseling Works with an FASD-Affected Person?

Although every FASD-affected person is unique, parents, teachers, and clinicians commonly recognize that the individual has chronic behavior problems and poor understanding of their own impairments and how to mitigate their effects.

Because persons with prenatal alcohol-caused brain damage have difficulty understanding abstract concepts and have memory and problem-solving difficulties, “insight-based” therapy tends to be ineffective.

We tried many counselors for our son. Some said they knew about FASD; others didn’t seem to understand his difficult behaviors, and they wanted to work more with us as parents instead of (with) him.

(Finally) it was a mutual decision (with the therapist) that we not waste any more time and money, so we stopped the sessions.

Our son’s cognitive skills are too delayed; he can’t remember what is discussed, and he didn’t like talking to the counselors, so (therapy) was a waste of time.

From a mom named Tabitha

Choosing a Therapist

My daughter has had the same (wonderful) therapist for the past ten years, starting when she was 13 years old…(The therapist) is an LCSW who is exceptionally relational, and a very skilled and caring and flexible (in approach) person.

At the onset, the clinician knew little about FASD, but she was exceptionally open-minded and willing to take my input and read whatever I offered to her.

Before choosing her, I interviewed a half dozen other (recommended) folks and felt she was the best choice…you just can’t take someone whose name is on your insurance panel, or whose name you find online.

It can help if the therapist is able to modify their therapy from what I would call “High Level Insight Oriented” to something more akin to supportive therapy, combined with mothering — but mothering that the person with FASD will accept — to coaching, to guiding and advising.

I am not going to be around forever and I am thrilled that my daughter has learned that there are others in the community who she can go to for help.

I call them her ‘helper people’ and she has some mighty good ones in our community, including (her) therapist…(who) has been a crucial steadying force for my daughter all these years.

My daughter can go months without seeing her, but when the going gets rough, she knows she can always call her therapist — and does…My daughter will take input/advice/cautions from the therapist that she will not take from me, and getting that from the therapist takes the burden off me.

From a mom named Susan

Parents, caregivers or others who seek good therapists for a person with FASD should be aggressive in choosing a counselor who meets the following counseling practices:

Ability to establish and maintain a genuine rapport with a client with FASD.

Therapy has worked so-so for our… son.

I often question whether we have the right therapist, whether the therapy works, etc. I don’t think so; but, our son connects with him, has a rapport, and wants to meet with him.

The benefit I see is that there is another adult besides (my husband and me) who knows (our son) over several years and is a proponent of him.

He’s helped us when we’ve needed to convince our son to try different programs and schools. The jury is still out, but I feel it is important for (my son) to have connection with another adult outside of the family who has his best interests at heart.

From a mom named Annette

Problem-centered therapy works best for FASD-affected clients.

Ideally, counseling for persons with FASD combines coaching and mentoring with coordinating services and advocating for the individual

Good mental health case management aligns home and school (or work) behavior programs.

Depending on the individual’s symptoms and behaviors, much counseling emphasizes working on eliminating aggressive behaviors, and building anger management and socialization skills.

Effective counselors must be knowledgeable about FASD or willing to be proactive about learning about it — and to demonstrate it over time.

It certainly can’t help if the therapist doesn’t ‘get it’ about FASD, though someone who doesn’t get it and is willing to learn can, over time, get it, and even spread their knowledge to other clinicians…

I know that (my daughter’s therapist) now has identified three or four other young people in her practice as being affected with FASD – before my daughter I don’t think she would have spotted them or known much about how to think about this part of their neurocognitive functioning.

From a mom named Susan

Within standards of therapeutic confidentiality, therapists must collaborate and communicate openly with the client’s family or other loved ones.

They must also work with the client’s psychiatrist or other practitioner who prescribes medication for the individual’s behavioral symptoms.

On more than one occasion, the therapist has called me or signaled me with concerns that I would otherwise not have been aware of….

We have worked it out that the therapist will listen to my voice-mail messages about what’s going on in a situation in which my daughter may not be giving the whole story, and incorporate that knowledge into the session (mostly, I think, in influencing the questions she asks and what she takes as the ‘gospel truth’ and what she doesn’t), without necessarily revealing that I had called or added more info to her picture of things…

Again, she is very careful to share with me in ways that allow her to still feel that she is honoring my daughter’s confidentiality above all.

And my part of the bargain is to absolutely and totally keep confidential anything she lets me know about, or even hints about.

From a mom named Susan

Because of memory difficulties in FASD-affected clients, therapists need to be patient and willing to re-teach the FASD-affected client information or strategies that have already been learned.

Therapists who are adaptable to the FASD-affected client’s difficulty with time and time management, and to be understanding and flexible if the client is occasionally early or late for appointments.

For adult clients especially, willingness to make reminder calls on the day of the appointment, and to make check in with the client to be sure that the client has a way to get to the therapist’s office, are valuable.

Therapy that incorporates time for the client to role-play problem-solving scenarios is very helpful.

Because persons with FASD are concrete thinkers and have difficulty understanding and generalizing concepts expressed in words, such as “self-esteem”, “depression”, or even “anger”, letting the client express himself through drawings, photographs, music, or other “right-brained” ways can be very useful, both in allowing the client to express themselves, and for therapists to understand the FASD-affected client’s perspective.

Useful Links

Psychiatry and FASD

FAS and Mental Health Services: A Therapist’s Perspective

An Approach to Psychotherapy for Individuals with FASD

Group Therapy for Youth with FASD

Mental Illness in Adults With Fetal Alcohol Syndrome or Fetal Alcohol Effects

Discussion of Adolescent Therapy Groups

A New Concept of Mental Health Part A: A Focus on Strength

Related / Co-Occurring Conditions

Anger and Violence

Coping with Anxiety in Your FASD-Affected Loved One

Fetal Alcohol Syndrome: Implications and Counseling Considerations