Q: I'm so confused. After reading all the info on FAS/ARND, I was pretty confident that this was what my two adopted sons have. Now after reading info on attachment disorders, I see they have some of those symptoms, but more FAE/FAS. What is the difference? Pretty soon they will be seeing someone that deals with attachment disorders - will they be able to know which is which?

A: Sometimes there is not much difference between FAS/ARND and attachment disorders because sometimes kids have both.

Attachment disorders can be mild or severe. They can be caused by abuse, neglect, trauma of multiple placements, and/or lack of bonding with the primary caregiver. Attachment disorders can also be caused by alcohol exposure before birth.

Most kids with FAS/ARND have some degree of attachment disorders. It is hard to tell how much is from their early years before being placed in a stable, permanent home and how much was present at birth due to brain damage from alcohol. We have seen many children with FAS/ARND who were placed in healthy nurturing homes from the very first day who still display symptoms of attacment disorder, from mild to severe. So we do know that a substantial part of it is neurological dysfunction, in which case the typical psychological therapies might not be very effective, because those are based on the assumption that it is entirely due to lack of healthy bonding. It could be partly this, in the case of children who have been bounced around, but therapists should also look at the possibility of permanent brain damage, in which the focus of therapy might be adjusted.

My son has mild attachment symptoms. Like many kids with typical FAS, he had a hard time making eye contact when he was young, did not want to be held close or cuddled as an infant, and was hypersensitive to being touched. He became more affectionate as he got older, but still wanted to hug rather than be hugged, and his show of affection was often indiscriminate. He may show people he has just met as much "love" as he shows his old mom. He has a hard time understanding "stranger danger" and is easily engaged in conversation by strangers in public, and will even tell someone he has just met "I love you so much." My son and I eventually developed a healthy parent-child bond, and he knows what real love is, but he obviously has a hard time with social boundaries.

Some children with FAS/ARND show delays in normal social development. For instance, the fear of strangers or separation anxiety might occur sometime between the ages of 2 and 5, rather than between the ages of 6 months and 18 months. Studies by Dr. Ed Riley in San Diego indicate that children with FAS/ARND often have arrested social development with stunted social skills that do not reach adult maturity. This is a neurological disorder rather than psychological, but of course life experiences can have a psychological impact that compounds the problem.

A number of individuals with FAS/ARND have the more severe Reactive Attachment Disorder (RAD), which is due in most cases to a combination of permanent brain damage and difficulty in the bonding process.

Prenatal alcohol brain damage may interfere with the child's ability to develop healthy reciprocal relationships, develop a mature working conscience, to become fully self-reliant. This does not apply to all individuals with FAS/ARND, but to a great majority.

Traditional psychological approaches to behavioral disorders in children with FAS/ARND are often not very effective and could sometimes make the problems worse, especially if there is lack of understanding of the neurological nature of FAS/ARND behaviors. The psychological approach by therapists who have adequate insight into FAS/ARND might be helpful. Knowledgeable therapists who treat attachment disorders should be able to identify alcohol exposure as a possible cause in addition to the ones most people think of that interfere with bonding.

Read another Q&A on FAS and Attachment.

More information on Attachment Disorders can be found here:
http://attachmenttherapy.com/ad.html
http://www.attachmentcenter.org/
http://healtheheart.org/
http://www.come-over.to/FAS/AttachmentHealing.htm
Treatment of Attachment Disorders
FAS and Reactive Attachment Disorder
Online Course on Attachment NEW!