Newsletter #118 for Internationally Adopting Parents
September 10, 2009 PAL Center Inc.

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Children with FAS - A Psychological Profile
B. Gindis, Ph.D.

Fetal Alcohol Syndrome Disorder (FASD) is a range of medical and psychological conditions produced by exposure to alcohol before birth. Alcohol acts as a neuro-behavioral agent that interrupts or alters the embryo's normal development with the potential for a wide-ranging and individually variable compromise of the Central Nervous System. Based on research and my own clinical experience, children with this condition are presented in significant numbers among international adoptees, particularly in those from Eastern Europe. FASD is found in population born in the US as well, but the IA children may experience additional and very specific difficulties, described below.

Primary disability and diagnosis

The primary disability of a FASD child is rooted in the organic impairment due to prenatal alcohol exposure and revealed in certain dismorphic facial features, physical characteristics of growth, medical status of inner organs (e.g.: heart) , sensory processing, weakness of the Central Nervous System (CNS), etc.

The diagnostic procedure for FASD is a complicated and multifaceted process; one of the elements of this process is the analysis of facial features of a child. But in children from the republics of former Soviet Union the resemblance of FASD dysmorphology can be explained by the ethnic origin (e.g.: Kalmyk or Kazakh nations). It takes special cultural awareness and clinical experience to properly interpret such facial features as smooth philtrum, epicanthal folds, widely spaced eyes, flat midface, short upturned nose, thin upper lip, etc., especially when we have no documented evidence of the ethnicity of the parent(s).

Another element of diagnostic analysis - retardation in growth, revealed in below the 10th percentile height and weight, is typical for FASD children in general; but in IA children it can be due to malnourishment rather than FASD. Thus, it's known that after living for a year in the US, and having a dramatically changed diet/eating habits, IA children can reach 25 to 50 percentile in weight and height. On the other hand, international adoptees without FASD conditions may remain below the 10th percentile in height, weight, and head circumference due to their genetic make-up and/or their ethnicity, which is common in children adopted from certain regions of Russia and Kazakhstan.
The next element of diagnostic analysis - the presence of developmental delays noticeable in cognitive, emotional, and behavioral domains and usually attributed to FASD condition in population at large, may be induced by the extreme deprivation and institutionalization, or may be mediated by institutional upbringing, often to the extent that it is practically impossible to separate the causes of delays.

A significant predictor of FASD in a child is a documented evidence of the mother's drinking habits. But in the majority of FASD cases in international adoptees, no unambiguous evidence of the mother's drinking is usually available; only a small minority of cases in our data bank contains a documented evidence of mother's excessive drinking during pregnancy (e.g.; mother is a registered alcoholic subjected to mandatory treatment in a narcological clinic).

Characteristics of "secondary" disabilities

The term "secondary" disability refers to distortions of higher psychological functions due to social factors: organic impairment prevents children with FASD from mastering cognitive, social, and academic skills at an age-appropriate rate and level. Progressive divergence from social and natural milestones of development leads to social deprivation (in the form of exclusion, humiliation, segregation, etc.) as the society's response to a child's organic impairment. This, in turn, adversely affects the whole developmental process and leads to the emergence of delays and deficiencies that are not directly related to organic impairment, but rather to societal treatment of children with FASD. From this perspective, many symptoms of this handicapping condition (e.g.: behavioral infantilism or primitive emotional reactions) are considered to be secondary defects, acquired in the process of social interaction. It is the child's social milieu, not the organic impairment per se that modifies the course of development and may lead to compensation and rehabilitation or to aggravation of the primary disability. If not treated, FASD may lead to such secondary disabilities as emotional/behavioral disorders (e.g.: PTSD, depression or conduct disorder), disrupted formal schooling due to behavior problems, violation of the law (from shoplifting to crimes against individuals and property, to promiscuity), and alcohol/substance abuse.

The previous publications of Dr. Gindis on FAS are:

• Deterioration of Cognitive Abilities in FAS Children
• Outcome for FAS children in Long Perspective
• FAS in Internationally Adopted Children
• A "Laundry List of Symptoms" or Impaired Neurology?

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