Attention Deficit Hyperactivity Disorder (ADHD): A neurological disorder characterized by a persistent pattern of inattention, hyperactivity and impulsivity, or both, occurring more frequently and severely than is typical in individuals at a comparable level of development. Some children affected by FASD are mistakenly diagnosed with ADHD; however, typical medications for ADHD are ineffective on FASD. Sometimes both conditions exist together, making diagnosis and treatment difficult.
Oppositional Defiant Disorder: A pattern of disobedient, hostile, and defiant behavior toward authority figures that persists at least 6 months and goes beyond normal childhood misbehavior.
Conduct disorder: A pattern of repetitive behavior where social norms or the rights of others are violated.
Reactive Attachment Disorder: Breakdown of a child's social ability, associated with the failure of the child to bond with a caretaker in infancy or early childhood (typically within the first 3 years of life). This can be caused by many factors, ranging from child neglect to the child being hospitalized for severe medical problems. Children may display indiscriminate social extroversion or show mistrust of nearly everyone as they grow older.
Depression: A general term for "the blues," a temporary sadness or loss of pleasure. Clinical depression is a prolonged state of sadness or despair that disrupts a person's social functioning and/or activities of daily living. The condition includes clusters of symptoms such as markedly-decreased mood, motivation, interest, and energy levels.
Post-Traumatic Stress Disorder (PTSD): A disorder that can occur after experiencing or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent crime (such as rape, abuse). If a person continues to relive the trauma, have nightmares, sleeping difficulties, flashbacks, or feelings of detachment to the point that it interferes with daily life, the person is said to have PTSD.
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FASD is an important issue in child placement situations. Sometimes fetal alcohol exposure is suspected, but there is no way to confirm this with the birth mother. Even if exposure is confirmed, the implications are not always clear to the placement family; and parents find themselves unprepared for a lifetime of altered expectations.
To complicate matters, the manifestations of FASD change as a child grows.
As a child welfare or social service worker, your concern is for the whole person. That’s why it’s important to know what FASD is and the extent of the services that an affected person needs. The caregiving family needs supportive services as well.
If you deal with placements or family follow-up, look for signs of FASD in both the child and the biological mother. Although FASD is not inherited, it does tend to be generational.
For specifics on interventions for children and their birth mothers, see the Interventions page of this section.
Community Impact and Cost
The Substance Abuse and Mental Health Services Administration (SAMHSA) says that FASD is one of the most costly birth defects or disorders.
- The CDC estimates that the number of FAS babies from 1985 to 2000 increased by six-fold.
- Women consider alcohol to be more “benign” than other drugs. However, it can actually be more harmful to the baby than other drugs.
- Drinking is on the rise with women, as is binge drinking.
- Children are “invisible” if they do not possess facial features of FAS or don’t qualify for services based on developmental disabilities.
- In 2004, diagnosed cases of Fetal Alcohol Syndrome alone (one form of FASD) cost the U.S. $4.6 billion per year.
- Latest estimates say the lifetime cost for one child with FASD is $3.7 million.
- FASD prevention is needed—not only for the child’s quality of life, but also for economic reasons. Each state could save an estimated $516,000 per child per year if it did not need to provide FASD-related services to only one less child.
- Alcohol abuse, and its consequences of FASD consume approximately 2.1% of the GDP.
- A woman who bears one child with FASD has a 75% chance of having another affected child. Each subsequent birth results in a more severe case of FASD. More than a third of all children with FASD are products of “recurrent” births (the mother drinking during multiple pregnancies).
The community bears the brunt of these costs, plus the cost of supportive programs for the birth parent. Dollar figures aside, having sufficient community resources to support a person with FASD is a large burden on a strained public service system.
Comorbidities
FASD often doesn’t exist in a vacuum. It can co-exist with a number of mental health disorders:
- ADHD
- Oppositional Defiant Disorder
- Conduct Disorder
- Reactive Attachment Disorder
- Depression
- Post Traumatic Stress Disorder
The next pages give you more information about FASD, strategies and tools for screening birth mothers, and interventions for children.
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