Vol. 20, No. 1 • November 2015

Parenting a Child with FASD

When a pregnant woman drinks alcohol, it can harm her developing baby's brain, even before she realizes she is pregnant. This can result in Fetal Alcohol Spectrum Disorders (FASDs), a term used to describe a range brain-based challenges and disabilities caused by prenatal exposure to alcohol.

FASD is a leading cause of preventable intellectual disabilities and birth defects. Up to 5% of children born in the U.S. are possibly exposed to alcohol during pregnancy (FASD Center for Excellence, 2014). Based on this projection, in North Carolina close to 6,000 babies are born each year with FASDs (NC State Center for Health Statistics, 2015). Some of these children, at some point in their lives, are served by the foster care system.

Characteristics of FASD
Behavioral Traits. According to the Wisconsin Foster Care and Adoption Resource Center (2010), young people with FASD may exhibit one or more of the following behavioral or neurological traits:

  • Trouble understanding abstract concepts (e.g., math, time, money).
  • Poor short term memory; this may prevent a child from linking a behavior to a consequence; can lead to academic problems.
  • Difficulty making predictions; this may lead to poor social skills or risky behavior.
  • Poor impulse control.
  • Poor judgment, caused in part by poor memory, prediction, and impulse control.
    Poor boundaries. The young person may misunderstand personal space and property or be over friendly with strangers.
  • Hyperactivity and attention deficits; children with FASD often have these.
  • Developmental delays; may affect physical, social, and academic development.
  • Sensory issues; may affect a child's mood or behavior in certain environments, as well as their preferences for lighting, food, noise, or clothing.

For children with FASD these symptoms are not behavior problems. Rather, they are "soft signs"--symptoms of permanent, unchanging damage to the brain. They are not within the child's control (Kellerman & Kellerman, 2002).

Physical Traits. Many children with FASD show no physical signs of the disorder. However, if the mother drank alcohol when the child's midface was developing during pregnancy, the child may have facial characteristics such as small eye openings, thin upper lip, a smooth, wide philtrum (area between your upper lip and nose), and a smooth, wide nose bridge. Children may also have other physical traits such as low birth weight, low body weight, and small head circumference. Often physical signs of FASD diminish or disappear with the onset of puberty.

If You're Concerned
Diagnosing FASD can be difficult. The physical, behavioral, and neurological symptoms of FASD can have many other causes. Many people are never diagnosed, misdiagnosed, or have co-occurring disorders such as ADHD, sensory processing disorder, bipolar disorder, and other challenges.

If you think a child in your care may have FASD, talk to your social worker and the child's doctor. They may refer the child to a clinical geneticist or developmental pediatrician for clinical assessment. Diagnosing FASD often includes:

  • A comprehensive history, which includes a medical record review and an interview with the family.
  • Standardized testing and consultations given by an occupational therapist, speech/language therapist, neuropsychologist, and/or genetic counselor.
  • Genetic testing (to rule out other disorders).
  • Physical examination by a geneticist.

If a child or youth in your care is diagnosed with an FASD, keep in mind that behaviors, abilities, and physical characteristics vary greatly from one child to another. It's also important to note that the way this disorder presents may change across the lifespan, as the box below shows.

The Way FASD Presents May Change Over Time

Small in height and weight

Poor sleep patterns

Poor feeding

Difficult to soothe

Bonding problems

Stranger anxiety

Temper tantrums

Trouble learning rules

Shuts down easily

Overly sensitive or under responsive to stimulation

Memory problems

Trouble processing information

Delays in social emotional development

Executive functioning deficits


Difficulty with abstract concepts

Lower IQ

Behavior problems

Less obvious facial features; in puberty, both the facial abnormalities and the growth deficit tend to disappear, making detection challenging

Poor judgment and impulsivity

Defiant and uncooperative

Can't predict consequences

No "stranger danger"

Parenting Suggestions
The following is adapted from Wisconsin Foster Care and Adoption Resource Center, 2010
Parents of children with FASD usually find that strategies focused on routine, structure, clear rules, and increased awareness of environmental factors are most helpful.

  • Young people with FASD often struggle connecting consequences to their actions. Concentrate on the desired outcome rather than on correcting inappropriate behavior. Stay positive.
  • Role-playing can be very helpful. Try practicing appropriate behavior before a situation that may be challenging or after a situation where the child's behavior was not appropriate.
  • Consistently adhere to rules and routines; always follow through.
  • Give no more than one direction at a time.
  • Anticipate unsafe situations, such as a parking lot or a busy street. If they are thinking about something else, often children with FASD don't see potential dangers in the environment (e.g., traffic).
  • Always think about the child's developmental age, not their chronological age.
  • Consequences (positive or negative) should immediately follow the behavior.
  • Don't negotiate basic rules.
  • Frequently review expectations for behavior and rules with the child.
  • Avoid circumstances where the child is likely to be overwhelmed (e.g., crowds).

If a parenting technique isn't working, don't try harder--try something else.

Creating a Calming Environment
Environmental factors influence how children with FASD behave. A calm, plain room free of bright colors and background noise is usually best. This is true in the classroom, too. Sometimes even having a locker at school can be overwhelming for children with FASD, since items can collect there quickly. Here are some other environmental suggestions:

  • Keep bedrooms simple and furnished with things that aren't easy to break.
  • Use digital clocks, since they are easy to read.
  • In each room, post rules specific to that room.
  • Don't move things around: furniture and the child's basic self-care items should always be in the same place.

Helping Them Reach Their Potential
Young people with an FASD may be at increased risk for mental health issues, disrupted school experience, substance use disorders, involvement with the criminal justice system, employment problems, and difficulty living independently. You can mitigate these risks by ensuring the following key protective factors are in place:

  • Diagnose early (before age 6)
  • Link the child to early intervention services
  • Provide a stable and nurturing home environment
  • Prevent exposure to violence
  • Connect the child to social and educational services

Children with FASD can be caring, creative, determined, and eager to please the adults around them. They also do best with structure and routine, good communication, and close supervision. While parenting a child with FASD isn't always easy, having a good support network helps. It's also important to remember to look after yourself (Wisconsin Foster Care and Adoption Resource Center, 2010). For self-care suggestions and ideas for building your own resilience, see the May 2015 issue of Fostering Perspectives.

To Learn More about FASD

  • For more information on preventing alcohol-exposed pregnancies and Fetal Alcohol Spectrum Disorders, contact the NC Fetal Alcohol Prevention Program's Amy Hendricks ([email protected]).
  • Additional information about FASD can also be found here: http://www.nofas.org/parents/
  • The SAMHSA FASD Center for Excellence (http://fasdcenter.samhsa.gov/) contains helpful resources, including an an interview with FASD Specialist Dan Dubovsky. In addition to 30+ years as a trainer and provider specializing in FASD, and an extensive background consulting with biological and adoptive parents of children with an FASD, Dan also raised Bill, his son with an FASD. In the interview Dan discusses the unique issues of parenting a child with an FASD, modifications that can increase parenting effectiveness, and the importance of identifying the special gifts of a child with an FASD. To read the interview, click here.

Click here for references

~ Family and Children's Resource Program, UNC-CH School of Social Work ~