Fetal Alcohol Issues In International Adoptees
You have probably heard the term Fetal Alcohol Syndrome (FAS) in the context of issues that are common among international adoptees. However, FAS is better thought of as a spectrum that encompasses all of the diagnoses below:
- Fetal Alcohol Effect (FAE), the term used for when a child has many but not all of the diagnostic criteria for FAS,
- Alcohol Related Neurodevelopmental Disorder (ARND), in which a child has neuro-cognitive disabilities consistent with prenatal alcohol exposure but none of the defining facial characteristics, and
- Alcohol Related Birth Defects (ARBD), used to describe physical deformities that are linked to prenatal alcohol exposure.
Each of these is categorized under the broader term Fetal Alcohol Spectrum Disorders (FASD). Each indicates the presence of brain changes that occurred because of alcohol exposure during certain critical points in the fetus’s development.
The effect of and extent of brain damage sustained by the fetus can depend on the amount of alcohol consumed and number of times the mother drank over the course of her pregnancy, the stage of development that the fetus was at when the mother drank alcohol, and the pattern and amount of alcohol abuse. Other possible factors are whether other drugs were also being used and the biological features and resiliency (ability to recover from adversity) of both fetus and mother. In general, the sooner a woman stops drinking during pregnancy, the better the outcome for the child.
Although FASD are life-long disabilities that affect each child differently, early identification and intervention can help decrease the severity of related disabilities. These related disorders include emotional and behavioral disorders, mental health problems, disruptive school experiences and delayed social skills.
HOW IS A DIAGNOSIS MADE?
Once your child comes home to the U.S., he/she should have a comprehensive health evaluation that includes a review of preadoption medical history, a thorough physical examination, and assessments of growth and development. Vision and hearing evaluations by pediatric ophthalmology and audiology are also important because they can sometimes pick up subtle changes that are associated with FASD. Children are sometimes identified as at-risk for FASD at that first clinic visit (due to characteristic facial features), but because of the normal delays in growth and development that IA children almost always have when they first arrive, it is usually not possible to make a diagnosis right away. Therefore, we recommend assessments at 2-3 weeks post-arrival, and then again at 6, 12 and 24 months post-arrival. We feel it is best that your IA child is followed on an ongoing basis, so if delays continue, we can address the issues before they become larger problems.
FETAL ALCOHOL SYNDROME
For FAS specifically, the United States Centers for Disease Control (CDC) has delineated specific diagnostic criteria. The Fetal Alcohol Syndrome Diagnostic and Prevention Network at the University of Washington has developed a software tool that, with training, can help make the diagnosis when indicative facial features are present, as in FAS.
Documentation of each the following must be gathered in order to make an FAS diagnosis:
- Three facial abnormalities, including short palpebral fissures or a small eye opening from the inner canthus (the corner of the eye closest to the tear duct, where the eyelids meet) to the outer corner of the eye, a long, smooth philtrum (the area between the nose and the upper lip), and a thin upper lip compared with the lower lip.
- Growth deficiency for height and weight
- Central nervous system abnormalities, either structural (e.g., small head circumference) or functional (including cognitive or intellectual deficits)
- Proof of alcohol use during pregnancy. For IA children, obtaining prenatal history is not always possible, but they still can be considered to be on the FASD spectrum if they meet the other criteria.
The additional challenge in making a fetal alcohol-related diagnosis in an internationally adopted child is that growth and developmental delays are common among children cared for in institutions for reasons other than FASD, for instance malnutrition and stress.
DEMOGRAPHICS
Components of the FASD spectrum are seen in higher percentages among children adopted from Eastern European countries due to a high incidence of chronic alcohol abuse. Prenatal alcohol exposure is also becoming more of a concern in countries where women’s consumption of alcohol has increased significantly, i.e., South Korea and some other southeast Asian countries, attributable to the increasing pervasiveness of Western cultural influences there. While overall use of alcohol by women tends to be low in developing countries or by poor women, prenatal alcohol exposure is still possible because of the use of home-brewed alcoholic beverages.
PREADOPTION CONSIDERATIONS
Given the fact that often so very little is known about the child’s health history prior to being given up for adoption, there is always a risk of prenatal alcohol exposure and the possibility for deficits in behavior and learning.
What should families do who are considering adopting a child? First, mentally prepare for the possibility that your referred child may have been exposed to alcohol while in utero. Second, have your referral information reviewed by an international adoption medicine specialist or health care provider experienced with FASD. While fetal alcohol exposure is sometimes impossible to detect, just taking this step of consulting with a professional will help you screen for the signs of FAS and gain insight into the kind of parenting the child is likely to require. Being prepared with as much knowledge as possible will allow you to know make an informed decision about whether to adopt.
Remember, there are a number of resources in your community designed to help you with these parenting challenges, and medications are available that can help your child cope with symptoms like hyperactivity, impulsivity, and sleep disorders.
Learn as much as you can about FASD (Fetal Alcohol Spectrum Disorder). Once you understand the risks associated with adopting a child with FASD, you will be able to be more objective in assessing your ability both emotionally and financially to parent a child with special needs—which can be a very rewarding experience. You as the parent or family, will be critical in providing the supportive environment a child with FASD requires. You will provide the consistent routine, limited stimulation, realistic expectations, concrete language and multi-sensory learning that will help your child perform to the best of her/his abilities.
ADDITIONAL RESOURCES AND READING
Fetal Alcohol Syndrome: A Guide for Families and Communities by Ann Streissguth
Fantastic Antone Succeeds by Judith Kleinfeld and Siobhan Wescott
National Organization on Fetal Alcohol Syndrome www.nofas.org
Minnesota Organization on Fetal Alcohol Syndrome www.mofas.org
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