Do kids with prenatal exposure to alcohol (and other substances) have higher risks for mental health diagnoses? Yes. Names such as ADHD, Depression, OCD, Autism Spectrum Disorders, RAD and Attachment Problems, Developmental Delays and the rest of the alphabet soup of diagnoses may be in a child’s social history, or may be in the child’s future and not known at the time of adoption.

Is it scary to think about this as you plan for adoption? You bet it is.

Should this turn you away from adoption? NO! Whether adopting domestic or international, infant or older child, you should be aware that these issues may quite likely affect your child to some degree. Just because the social history does not say "Prenatal Exposure to Alcohol or other drugs"... always assume there is a high likelihood of prenatal exposure to substances.

If I adopt as young as possible, will I lessen the risks of mental health problems for my child? Not necessarily. One of the things I stress is that “Younger does not mean easier. Younger just means we do not know as much.” Some of the hardest children I know were infant placements. With older children, we know more, we can do assessments that are more accurate. We know more of how they are developing.

I find that the diagnoses occur earlier and are more serious for the children who have had prenatal exposure, trauma and losses early in life. All of these things affect brain development. Many medical providers may not be willing to diagnose or even treat young children with medications. Change providers!

Be very aware of depression in late elementary and early Junior High. Even for children whose only diagnosis is ADHD, especially in girls, depression emerges in adolescence as an additional diagnosis. Newer research is showing the different ways ADD/ADHD manifests itself differently in girls than with boys.

So, what can you as a parent or potential parent do to prepare yourselves and help your child grow to be the most functional human being possible? Empower yourselves with the best pre-adoption training you can. However, the learning will not stop when you finish your last class. Think of building a family through adoption as a lifelong journey of learning.

1. Get the VERY BEST history on your child you can. Have the social worker look at child protection and court records with a fine-toothed comb for any indications of existing mental health histories. Chemical dependency and alcohol use are often self-medicating behaviors masking mental health issues. Look up the Medical Assistance historical record in your state to make sure all of the clinics the child ever visited are noted. How many vaccinations has the child really received? Birth information from the hospital files should be reviewed. Sibling history can also be very relevant for your child. Remember, later siblings usually have increasingly obvious effects of pre-natal alcohol exposure.

2. Get the earliest and most competent assessments and intervention possible. Talk to other parents and social workers, and find out who really can work the best with your child.

3. Advocate with your health care provider, school district, early childhood education, and preschool. Educate yourself. “Home schooling” happens 24/7... so make it work for you and your child. You are your child’s most constant teacher.

4. Provide the greatest environment for emotional stability possible. BE with your child. Fewer transitions are better. Constancy, consistency, structure, and predictability will empower your child and allow their energy go toward mastery, not coping.

5. Supervise more carefully than you would with other children. For safety yes, but also for exposure to influences that these children may not be able to filter in the same ways that other kids can.

6. Consider a variety of interventions to help the child function to their maximum and train the brain to work as effectively as possible:

• Medication: remember that many medications do not seem to work on FASD kids as they do for other kids. Use a medical provider knowledgeable of FASD who will work with you and your child. You may have to try several medications to find what works. A medication or “medication combination” probably will not work forever based on age, hormones, tolerances, etc. and you will need to adapt over time. This requires regular follow-up appointments and a good working relationship with your clinic. They should be able to talk to you over the phone and you should not have to go in every time you have a question. It is so much easier on the child and you... (and the office.)
• Nutrition: give the brain the food it needs to function best... If you do not know what this means, find out. You will benefit and so will your child.
• Sensory Integration: this is one of the most useful areas of intervention to help children self-regulate and learn. The sensory system is how we all take in information. Work with an experienced Occupational Therapist to maximize your child’s ability to receive, store and retrieve information. Develop neurological pathways that are useful.
• Auditory therapy: this is useful for processing information and right brain/left brain developmental work.
• Visual therapy: get a developmental ophthalmology assessment
• Homeopathy: some families find this approach invaluable
• Allergies and food sensitivities: it seems so many children and adults are impacted daily by what we put in our bodies without realizing the negative side effects. ADHD-like behaviors can be mimicked by foods. Rages, poor learning, impulsive/explosive behaviors, etc. can be caused or exacerbated by foods or environmental substances. Traditional allergy tests may not suffice.

7. Consciously focus on ways to encourage attachment. Prenatal exposure alone can cause difficulties with attachment. When we add in separations, loss, and trauma, adopted children always have a higher likelihood of attachment problems. Do you have competent attachment therapists in your area? Use them. Some wonderful books are available that address attachment and adoption. If you are able, plan to reduce work hours or take maternity/paternity leaves.

8. LEARN... we are learning more and better ways to work with prenatally exposed brains everyday. You cannot do it all yourself, but you may have to teach those who are working with your child.

9. GET SUPPORT from those who know! Find other adoptive parents and other parents whose children are challenged by brains and bodies that do not regulate themselves well, those children who may look normal, but who have developmental delays or gaps.

10. Get as much support from the adoption assistance program as possible. Find out what benefits your child may have before the finalization occurs. Sometimes you can get more services before finalization.

11. Consciously teach coping skills, "decompression" skills, self-regulatory approaches and self-awareness to kids. Teach them to hook up their feelings in body and mind with the words. These are the tools for mental health for all of us.

The job of any parent is to help their child grow into the best they can be. Even if our adopted kids may face an increased likelihood of challenges, we can still find creative ways to help grow and develop them using a teambuilding approach. Parenting is always the most challenging thing we can do as adults and definitely not for sissies. Find the humor in everyday small things. This will carry you through almost anything. As a friend of mine once told me, if you do not have a sense of humor now, you better go out and get one. Parenting through adoption is rewarding and definitely worth it. Your lives will be enriched in ways you never imagined.

Cathy Bruer-Thompson
Training Coordinator, Adoption Program
Hennepin County, MN
952-541-6251
cathy.bruer-thompson@co.hennepin.mn.us