PSYCHOSOCIAL NEEDS ASSOCIATED WITH FAS & FAE
Prepared by Robin LaDue, Ph.D.
Fetal Alcohol & Drug Unit, Dept.of Psychiatry & Behavioral Sciences
University of Washington School of Medicine, Seattle, Washington
(Reprinted with permission)

General Issues

· Early and adequate identification and diagnosis
· Safe, stable and structured home or residential placement
· Unrealistic expectations of persons with FAS/E due to the outward appearance and verbal, gregarious manner
· Appropriate academics, vocational and living skills training programs

Infancy & Early childhood:
Ages 0-5 Years

Problems and Concerns
· Poor habituation
· Sleep disturbances; poor sleep/wake cycle
· Poor sucking responses
· Failure to thrive
· Delays in walking and talking
· Delayed toilet training
· Difficulty following directions
· Temper tantrums and disobedience
· Distractibility

Recommendations
· Early identification
· Intervention with birth and/or foster parents
· Education of parents regarding physical and psychosocial needs of as infant or child with FAS/E
· Careful monitoring of physical development and health
· Safe, stable and structured home
· Assignment of a case manager for coordination of services and support to parents
· Placement of the child in preschool
· Respite care for caretakers

Latency Period:
Age 6-11 YEARS

Problems and Concerns
· Easily influenced and difficulty predicting and/or understanding consequences
· Give an appearance of capability without actual abilities
· Difficulty separating fact from fiction
· Temper tantrums, lying stealing, disobedience and defiance of authority
· Delayed physical and cognitive development
· Poor comprehension of social rules and expectations

Recommendations
· Safe, stable and structured home or residential placement
· Careful and continued monitoring of health issues and existing problems
· Appropriate education and daily living skills placement
· Help caretakers establish realistic expectations and goals
· Caretakers establish realistic expectations and goals
· Caretaker support group
· Psychological, educational and adaptive evaluations on a regular basis
· Use of clear, concrete and immediate consequences for behavior
· Respite care for caretakers
· Case manager role expands to include liaison between parents, school, health care providers and social service agents

Adolescence:
Ages 12-17 Years

Problems and Concerns
· Lying, stealing and passivity in responding to requests
· Faulty logic
· Egocentric; has difficulty comprehending and/or responding appropriately to other people's feelings,, needs, and desires
· Low motivation
· Low self-esteem
· Academic ceiling, which is usually around grade 4 for reading and grade 3 for spelling and arithmetic

Recommendations
· Education of caretakers and patients regarding sexual development, birth control options and protection from sexually transmitted diseases
· Planning and implementation of adult residential and vocational training and placement
· Appropriate and mental health interventions as needed
· Respite care for caretakers
· Caretakers support group
· Safe, stable and structured home or other residential placement
· Shifting of focus from academic skills to daily living and vocational skills
· Careful monitoring of social activities and structuring of leisure time
· Working towards increased independence by teaching to make healthy choices (taught at the child's level)

Adulthood:
Ages 18+ Years

Problems and Concerns
· Residential placement
· Economic support and protection
· Job training and placement
· Depression and suicidal ideation
· Pregnancy or fathering of a child
· Social and sexual exploitation, or inappropriate behavior
· Increased expectations of the patient by other people
· Increased dissatisfaction towards the patient by others
· Withdrawal and isolation
· Unpredictable behavior

Recommendations
· Guardianship for funds
· Specialized residential and/or subsidized living
· Specialized vocational and job placements
· Medical coupons
· Acceptance of the patient's "world"
· Acknowledgement of the patient's skills limitations
· Patient advocates to ensure the above occurs