Fostering FAS

Dear Dena,
What are some symptoms of a child with fetal alcohol syndrome and what interventions and support do you recommend? 


Fostering FAS


Dear Fostering FAS,

This is such an important question for our population of foster and adoptive kiddos! Studies find that as many as 80% of the foster/adopt population are somewhere on the spectrum of Fetal Alcohol Spectrum Disorder (FASD) or Alcohol Related Neurodevelopmental Disorder (ARND). I am an adoptive mother of 7 and this statistic holds true for us.
While this can be a daunting statistic, it should also be a rallying cry for foster and adoptive parents (as well as agencies, social workers and legislators) to be informed of and prepared for parenting kids with the difficulties that come along with FASD/ARND.

In general, symptoms range from sensory processing disorders (sensory seeking or sensory avoiding), impulse control issues and executive function difficulties, working memory limitations, learning and cognitive delays, anxiety and/or depression, rages, oppositional behaviors, and relational difficulties. Essentially, the FASD/ARND brain has experienced structural and/or functional central nervous system damage ( Understanding our kiddos brains as damaged is a great place to begin in growing our compassion and patience.

Early intervention is essential, and we are finding that occupational therapy, speech therapy, and attachment therapy work can provide excellent foundations for future success. Additionally, kiddos with prenatal exposure will benefit from predictable and consistent schedules, clear boundaries, ample opportunity to get physical exercise and movement, and diets that are high in protein and adequate hydration. Remembering that the brain is largely composed of fluid and fat, keeping our kids well hydrated and eating a diet rich in healthy fats is essential.

Additionally, social skills don’t come easy to kids who have prenatal substance exposure. Social skills groups are a great place to help our kids learn appropriate physical and emotional boundaries and to practice communication skills that are essential to later life success. Parents of kids with FASD/ARND need not feel shy about clearly articulating expected behavior and training through repetition and role play. It’s not uncommon for my kids and me to have conversations that go like this:
“Hey buddy, it’s pretty awkward when you stand that close and talk so loud. Try this: Step back 4 paces and talk half as loud. Ok, go!”
Or, “Honey, girls are really not okay with you calling and calling even after they have asked you to stop. Let’s sit down and write a letter to her and her parents explaining that you understand how that might have made her feel uncomfortable and that it won’t happen again.”
Or, “Dude, your B.O. can be smelled from downstairs. It’s time to shower but also, please consider that you impact the people you live with so it’s not ok to let it get this bad next time.”
Communication needs to be direct, not unkind or sarcastic, but clearly spelling out expectations and training for future success. What may seem embarrassing or dismissive to a kid without FASD can actually serve as vital information and skills training to the substance exposed child. Assuming they “get” social norms is actually much more unkind because it sets them up for failure and shame.
Parents of children with FASD/ARND also need to be very intentional about their own self-care and social support. It can be a lonely and isolated path parenting kids with special needs. Often we find that this leads to parental depression or anxiety, substance use and dependency, and even abusive and violent behaviors towards children. And it’s not surprising, because parenting this population of kids is demanding and often without reward or the warmth of healthy attachment. Please look after yourself and seek out trauma informed care and find a group of people who get what you’re going through.


-Dena Johnson MS, LMHC

Licensed Mental Health Counselor, Attachment-Trauma Focused Therapist, TBRI Practitioner