It is true that there is a higher rate of RAD in children with FAS disorders than the general population. But there are some misconceptions about this. Because interruptions in the normal, healthy parent-child relationship at birth is a major cause of RAD (abuse, neglect, lack of bonding soon after birth), it is sometimes assumed that this is the ONLY reason behind RAD. Not true! It is obvious that the abuse and neglect shortly after birth is a risk for babies born to alcoholic mothers. But we also have to look at the brain damage from alcohol expsoure, especially the frontal lobes that regulate social behavior. I have seen several children with FAS/E who were adopted immediately, bonded with adoptive mom on day one, brought home from the hospital on day two, who still show signs of RAD. The truly wise expert will acknowledge that RAD is caused by lack of healthy bonding, and/or exposure to alcohol before birth, and/or physical/sexual abuse and/or neglect later. Sometimes it is a combination of factors.

Why is it important to acknowledge this? Because if the experts and parents only look at the psychological factors (bonding, neglect, abuse), then the therapy will be based on psychological treatments, such as cognitive therapy, psychoanalysis, holding therapy, etc. If in fact the symptoms are caused by prenatal alcohol exposure, then we are looking at permanent brain damage, and psychological treatment might be ineffective, unnecessary, and sometimes can make matters worse.

While most kids with FAS disorders have some attachment problems, most of the time it is a matter of slow bonding with the caregiver, lack of stranger danger, poor eye contact, and indiscriminate affection. But not that many kids with FAS/E have true Reactive Attachment Disorder, which is much more serious. There is also a higher rate of bi-polar disorder in kids with FAS/E (caused by hereditary factors rather than the alcohol, but bi-polar women are at higher risk of drinking during pregnancy), and the symptoms of bi-polar in children are very similar to the symptoms of RAD.

The kids in whom I have noticed symptoms of RAD along with FAE are those adopted from Russia. The very kids that adopting families hope are normal, healthy kids, turn out to have one of the most problemmatic combination of disabilities: FAE and RAD.

In short, kids who are alcohol exposed and have RAD symptoms are most likely to be experiencing the effects of a combination of psychological trauma and brain damage from alcohol, and the FAS/E disorder should be considered the "umbrella" diagnosis. All other disorders (ADHD, RAD, ODD, OCD, etc.) should be treated with FAS/E in mind, considering that most of the behaviors and symptoms are a result of permanent brain damage and may not respond to treatment the same as disorders that are mainly caused by psychological trauma. Counseling therapy is historically not helpful, but healthy role models and practicing by role playing social situations over and over might help. Healthy environments with supervision and security restrictions are necessary to ensure safety. Also medications are very helpful, and should include a combination of meds that treat both the FAS and the RAD. It is not unusual for a child with FAS/RAD to be on 4 or 5 different meds to help the child function without placing the child or others at serious risk. But one of the most important factors is UNDERSTANDING of the nature of the FAS/E disorder, whatever other disorders might be diagnosed.

If I repeated myself, well, it's important to remember, when there is prenatal alcohol exposure, we are dealing with brain damage.

Teresa