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Scenarios for Discussion

One of the primary stressors in the family is about the behaviors associated with the condition. Frequently parents and caregivers find behavior very challenging. To come up with effective accommodations, supports and interventions, caregivers and professionals need to view specific behaviors through an FASD-informed lens. This workbook will guide you through the steps needed to support an individual and their family from an FASD-informed perspective.

Read the scenarios below and choose one to use for this assignment. If you prefer, you may use a scenario from real life experience, but please discuss it with your instructor first.

Scenario 1:

My daughter Eve, is 18 years old. She was adopted when she was 4 from an orphanage in Russia. She lives with me (her mom), her father Jim, and two younger sisters, ages 14 and 12. She is the only one who is adopted and the only one with FASD.

When she was adopted she showed a number of negative attachment behaviors. Those were addressed through counselling and therapy. FASD was not diagnosed until she was 11 years old, when she started struggling in school. She is also diagnosed with ADHD.
She has some of the FASD traits but not all and she is considered “high-functioning.” At school she is in mainstream classes but on an IEP. She has never been a stellar student but that may be because of her lack of motivation more than ability. Looking at the list of traits, I have to say she also may have memory issues but they seem to be selective. LOL. She always had a problem with hygiene and I had to stay right on top of that and remind her all the time. She is a very literal thinker and although she laughs a lot, she doesn’t really get jokes. She prefers hanging out with younger girls. Eve is very social and has always been the life of the party. She frequently acts like the clown in social situations. She is pretty, giggly, and has a sparkle about her that is very endearing. She is a really good cook, although she isn’t as good at cleaning up.  

Recently we have had a lot of problems with her online interactions. She has been talking to men online a lot. We took away her phone and limited her computer use so she could only use the internet to do homework. She also was caught drunk in the boy’s restroom at a school dance with two male classmates and suspended.

Scenario 1: Eve, an 18-year-old with FASD and ADHD

Last week she found a way around our security and managed to get back online. Within a week she had made a fake email and social media accounts, stole her guardianship account card from me (then put it back after) but used it to buy a prepaid cell phone (which she had delivered to our next door neighbor!). She then made arrangements to be picked up from her volunteer job by a total stranger, ostensibly for a swim party but he intended sex.

My husband is out of town, and I am busy but didn’t notice. Luckily her sister saw something was up and let me know before the meeting happened.

How should I handle this?

What should I do to prevent it from happening again?

Scenario 2:

Jason is 7 years old but he is the size of a 4 year old kid. He is an only child, and I am a single mother. I work as a waitress at a café. I don’t make a lot of money but we survive. We live in an apartment with our dog, Ralph, who is Jason’s best friend.
Jason was diagnosed at birth. I have been clean now for 6 ½ years. Jason was my motivation because at birth he was put in foster care and I had to get clean and dry to get him back.

Jason was diagnosed with FASD because he has the facial features and also I admitted to drinking during pregnancy. He has always been behind in development and I only got him toilet trained 2 years ago. He is in a special school for kids with disabilities. He is a very active kid and exhausts me because he’s always on the go. He doesn’t have many friends but that’s okay because neither do I so it is me and him.  Right now I am having big problems because he won’t sleep. I need him to sleep because I work hard during the day and I need my rest. Also I think it is hard on his body to just be going all the time. I put him to bed at 8 and he starts getting out of bed about 9:30 p.m. From 10pm till well past 3am he gets out of bed over and over. He said he’s scared and wanted ALL the lights on in the apartment. It doesn’t matter what I say or do, he wouldn't stay in bed. He has a night light in his room but that isn’t good enough. One day I even took him to the trampoline park for 4 hours before bed, and even though he uses up a lot of energy and should be exhausted, he still didn’t sleep. He does take 5 mg melatonin and he has a regular bedtime routine. I am EXHAUSTED and frustrated.  Any advice on what to do?

Scenario 2: Jason, a 7-year-old with FASD

Scenario 3:

Lillian is 12 years old. She is my granddaughter but lives with my husband and I. We got Lilly when she was a baby because they took her away from my daughter, her mother, who had a drinking problem, and Lilly had no place to live. It’s important to keep children in the family so my husband and I fostered her. My daughter, her mother, lives nearby but she hasn’t been an active part of Lilly’s life. I raised 5 children and now Lilly and she is by far my hardest. I am not a young woman anymore.

Lilly is a good kid though and we enjoy her too. She keeps us young, even when she exhausts us. She is always willing to help us when we need it. She is also very cheerful and gives our life meaning.

The problem is that she steals constantly. It was such a problem at school they gave her a clear book bag but then she stuck things in pants. We try taking stuff away, we tried talking, and we tried reward systems. Half the time the stuff she steals has no meaning or worth to her.  This is really causing a lot of tension in the house right now because she takes people stuff while they are sleeping and sometimes you don't even notice for days that it's gone. So far she hasn’t started stealing from stores, but I think she might if we don’t find a way to deal with this. What can we do?

Scenario 4:

I am a single father and my 14 year old son Cody has FASD. We live in a small town. His mom is not with me anymore but he is Indigenous and we live near the reserve and his mom’s family sees him sometimes. He is smart but not in the traditional ways. He likes to take apart electronics and he’s really good at fixing stuff, which is amazing since he reads at a grade one level according to his teacher. He has started refusing to go to school or do anything we ask him to do that he doesn’t want to do. This has been accompanied by incidents of explosive anger. A few weeks ago I tried calling the police when he got out of control but they came out and just made things worse. Then the next week Child Protective Services contacted me, and although they have let things go this time I sure don’t feel like dealing with them again, so I don’t feel I can ask for help from the police anymore. Cody just snaps when he doesn’t get his own way. I can hardly live with him anymore because he has scared me so bad when I say no that I just started saying yes to everything. Things got a bit better at the end of July but now he’s doing it again. I don’t know what to do anymore. Please help me.

  1. Read the following list of traits associated with FASD and circle the ones that you think describe or may describe the person with FASD in the scenario you chose.

Developmental Dysmaturity (functions below chronological age): may seem irresponsible for chronological age, actions, and interests like a younger person; prefers younger friends

Adaptive Behaviors: difficulty with daily self-care, behaves in unsafe ways

Language Skills: expressive language is better than receptive language (can say lots, but understands little); struggles to find words or uses inappropriate words; speech is hard to understand, has difficulty reading and responding to verbal cues

may interact inappropriately in conversations ie. not act reciprocally; often doesn’t follow directions, seems to have gaps in understanding,

Attention difficulty paying attention, hyperactive behavior or shuts down

Abstract Reasoning: difficulty with math, managing and counting money, time management, frequently late, difficulty predicting outcomes; difficulty making decisions; doesn’t recognizes what others may be thinking or feeling; difficulty generalizing from one situation to another; standard parenting and behavior techniques or teaching seem ineffective.

Memory: not able to remember multi-step instructions; confabulates (tells stories that appear to be lies); inconsistent abilities on different days and times; needs frequent reteaching; doesn’t seem to learn from experience.

Executive Functioning: academic challenges; difficulty organizing and planning; has difficulty switching from one activity to another; gets upset by changes in routine; impulsive; displays strong emotional responses; emotions often seem irrational; may run away or become aggressive when stressed; perseverates

Sensory Behaviors: easily overstimulated, oversensitive to lights, touch, sounds; under sensitive e.g. Doesn’t feel pain; has sleep difficulties; stands too close or far from others; reacts strongly to sensory information like some foods, etc.; may appear clumsy; needs to eat or drink often or forgets to do so

Processing Speed: slow speaking; slow to respond; often says “I don’t know”

  1. What are the individual’s strengths and interests?
  2. Circle the learning style in the following list that you think the individual displays or might display. 

Scenarios for Discussion

A case study of a child named Eve is undertaken in this report suffering from Fetal Alcohol Spectrum Disorder (FASD) and Attention Deficit Hyperactivity Disorder (ADHD). The disorders were diagnosed at the age of 11 and the child has been suffering through it till yet at the age of 18. The problems of the child have gotten worse with age due to lack of awareness towards the issue by her parents as she also has two younger siblings that need to be taken care of. The child affected by the disorders has been provided therapy for her ADHD but have not received any proper attention or care for her FASD. This report sheds light on the issues faces by the child due to the disorders, its effects, accommodations that could be followed along with the difficulties that might occur in applying the mentioned accommodations (FASD Prevention, 2018).

This scenario is about Eve, a child adopted from a Russian orphanage who had been diagnosed with Fetal Alcohol Spectrum Disorder and Attention Deficit Hyperactivity Disorder at the age of 11. As soon as the child was adopted at the age of 4, she started showing signs of negative attachment towards the family she was adopted into.  The negative attachment factors were taken care of by the adopting family by continuous support and counseling along with therapy sessions. In school, the child performed average and has been attending the mainstream classes although on an Individualized Education Plan. Eve showed some signs of FASD but not all the traits which made her family consider her not being stellar in studies to be a motivational issue rather than a psychological or physical one (Government of Alberta, 2008). The main reason behind selecting this scenario is to bring the issue of FASD into the light and understand the effect the disorder has on children throughout their lives making them the victims. In addition, there is no permanent solution or cure of this disorder, which can easily be avoided by undertaking some prevention at the time of pregnancy by the mothers birthing children.

The adopting family of Eve has been supportive of her growth and development throughout her life of 18 years. They have always tried to help her in whatever situation she faced while having to care for two other younger children. Although Eve's adoptive parents have been trying their best to provide her with the best care, they are still quite unaware of the reason behind Eve's disorder and consider it mostly as a motivational issue rather than a disorder. The major visible effect of FASD is the lack of hygiene and relativity to the younger generation. These were the major signs that categorized Eve’s illness to be FASD. ADHD has also played a major role in deforming Eve’s psychological growth, leading to her shortened attention span, inability to relate to the kids her age and finding solace in the company of unknown individuals empathizing with her with hidden alter intentions (Lange, Probst, & Popova, 2017). Trusting strangers easily too has been a part of Eve’s psychological development in the presence of ADHD. This has made her more susceptible to fall prey to strangers trying to harm her and also her being more secretive towards her wrongdoings. It is mentioned that in order to prevent Eve from talking to strangers, her phone was taken from her and also her computer use was limited. This happened in the developmental phase of Eve's life when children go through puberty and understand the social norms in the aspect of rights and wrongs. Although Eva understood that talking to strangers was wrong, she was never confronted regarding the understanding of the reason behind it and as she found solace in the false empathies of these men, she tries to escape back to them secretively as she is aware of her family not allowing it on the first hand. Eve’s family hence suffers the problem of lack of communication amongst the family.

Scenario 1: Eve, an 18-year-old with FASD and ADHD

Due to one of the children suffering from FASD and ADHD in the family along with two other younger children, the family is suffering in terms of managing their daily chores and preventing their oldest child from following unethical practices in her life. As Eve, the oldest child is a teenager and also suffering through FASD and ADHD, it becomes difficult for her to share her emotions and mindset with any of the family members as she feels she would be either judged or be further prevented to do other things in life rather than being understood or heard. Her family too might feel that the issues going on with Eve might be due to hormonal changes that she is going through being a teenager that she represents by being rebellious and not doing what her family and parents ask of her (Pacey, 2009). Her parents might even consider Eve to be a negative influence on her two younger siblings. Eve, on the other hand, is quite resourceful and innovative when it comes to doing something that she wants to do. Her mother, on the other hand, her hands full of taking care of the household, Eve and her special needs and also the younger siblings while her husband is not at home which might be a stressful situation for Eve's adopted mother. Already her mother is trying her best to keep up with the work while Eve keeps on doing the task she is prevented to do leading the trail further by getting suspended in school and underage drinking, making the situations worse for her mother. Eve is secretive of her plans with her mother and due to her problem of trusting strangers easily, she goes out with unknown men that might have a high potential of hurting Eve. She has also partaken in stealing her mother’s guardianship account card in order to purchase a phone, an act that if not stopped, could lead to more serious troubles in the future. The impact of a child suffering from FASD is highly negative on the adopting family, in this case, making them suffer even more as the child grows older (Warren, Hewitt, & Thomas, 2011).

At the moment, Eve is an 18-year-old teenager living with her mother and two younger siblings. She is a child who lands into trouble constantly for doing everything against the school’s rules and regulations or her parents’. The family of the child tries its best to help Eve in her situation but is incapable of doing much being unaware of her condition and its requirements. Her mother treats her as she would any other teenage daughter and punishes her for her mistakes. This creates a boundary between the two also leading to a lack of communication between the two and subsequently loss of trust. Eve's sisters are mostly unaware of their sister's condition and are closer to their mother than they are with their older sister which is evident by the act of telling on her when she is about to get into trouble. Although this act also shows the caring side of Eve's siblings as they worry about her and hope nothing wrong comes her way (Gerberding & Cordero, 2014). Eve finds solace in mingling with men that are unknown to her family rather than spending time with her family. The reason behind this could be her inability to discuss her feeling and issues in life with her mother and perceiving her mother to be someone who would rather be interested in judging and condemning Eve's acts rather than understanding her reasons or feelings behind doing them.

Scenario 2: Jason, a 7-year-old with FASD

Eve's mother is the perfect example of an uninformed perspective on the FASD condition that Eve is going through. Although her mother is aware of Eve's disorders, she does not know its effects and issues that it creates for a person. In addition, she is unaware and unknown to the ways in which the issues raised by the affected person could be resolved in the best possible manner leaving both Eve and her mother frustrated in this situation and at a loss of communication making the problem even worse for the future. Anyone being unaware of the disorder or its effects would act in the same way as Eve's mother does (Kellerman, 2013). To her, Eve is a teenager that is indulged in wrong practices and in order to prevent her from doing so and getting into trouble in the future, her mother takes away her phone, her laptop, limits her computer time and even stops her from meeting people without understanding the reason behind it. She acts as any other parent might act in that situation. Eve's mother instead of understanding the motive and driving force behind the deeds that Eve does rather prevents the child from doing it without an argument. It could be better understood with an example of a patient and a doctor. If a patient with cervical spondylosis visits a doctor, complaining of neck pain and the doctor prescribes the patient with painkillers rather than understanding the cause behind the pain and treating it accordingly, the problem is bound to get worse affecting the patient more in the future and could prove to be untreatable in later phase. Same is Eve's mother's case, rather than getting to the root cause of the issue, she tries to sort it out by evening out the symptoms causing Eve’s condition to worsen as the time passes (McLean & McDougall, 2014).

According to the setting, Eve is expected to behave in a manner as any other teenager is expected to behave. She is expected to be an average teenager and not get into trouble, which could cause problems for her parents and her siblings. She is also expected to behave as an ideal older child in the family to provide a benchmark for her younger siblings to look up to. However, due to her disorders, she is not able to perform any of those tasks leading to frustration and wrong-doings on both ends. Although it can clearly be understood, that Eve tries to do well by her family by cooking and being an overall happy child. This shows her strong will to change for the better of her family. What she lacks is an effort from her parents' end.  It is difficult for Eve to be a socially cognitive child suffering from both FASD and ADHD. She understands the rules and regulations of social behavior and can recite it when asked for but has difficulty in applying it to her life and also in following the same. FASD might cause her to be an alcoholic in the future and highly unstable as well which might lead to impulse control issues in the future (Popova, 2019). FASD and ADHD also affect her judgment skills and adaptive skills letting her take poor decisions and trusting strangers. For Eve, the decision towards trusting someone that she does not know becomes equal in a yes and no dimension. She also lacks judgment and basic cleanliness and hygiene as her mind constantly fluctuate in thought that she is unable to deliver making her forget the day-to-day activities that are required to be followed. When she is poked on the same every day, she is bound to get upset and frustrated despite her lack of effort leading to her giving up on trying after a while. In order to accommodate all these factors, Eve's parents need to understand her special needs. They need to be sensitive towards her demands and patient towards her understanding and accepting of routines. She is required to be trained each day to follow the same basic steps in order to maintain hygiene so that she can get into the routine and the process becomes like clockwork that takes place subconsciously without having Eve to think about it each day. Expectation setting is required to be altered at the pace at which Eve is comfortable rather than at which other kids her age develop. The communication gap between the parents and the child needs to be bridged so that Eve is comfortable telling her issues and her parents could help her get rid of them one by one. Eve could be motivated into doing a task that she likes or is good at that would streamline her thinking process while at the same time calm her down, for example, cooking which she's good at. Although the aforementioned tasks are easier said than done, with patience a lot of children with the same issues have been able to live normal lives. The process takes time and in some cases, the children too become restless and lose hope. In these cases, they are required to be properly motivated to keep their morale boosted and to help them develop a certain confidence in themselves. Medical help could also be provided in severe cases to care for these children in the early stages of the problem (Williams & Smith, 2015).

Scenario 3: Lillian, a 12-year-old with FASD

In the given scenario, the provided recommendations are enough to prove beneficial for the child as the child still is not that extremely affected by the disorder and can be helped without the medical care. Although this whole process depends on the child's parents on how they are able to apply the accommodations. If they find themselves incapable of helping the child in the case, external medical help like therapy sessions could always be considered with the recommendation of a doctor. Children like this are always in need of special care and attention, which is best when it comes from the close family rather than an outsider. Most children provided proper care to recover almost entirely from this disorder and live a normal life like everyone else (McLean & McDougall, 2014). The whole process is a time taking one and can lead to frustration for both the child and the family. FASD is an issue, which if intervened upon early in the child's life, can recover the child completely over a period of time. Although if too much time passes, the condition of the child, both physically and psychologically deteriorates over time. Hence, FASD and ADHD once detected in a child need to be worked upon as soon as possible with the help of the child's family as well as external medical help if required.

This report helps in understanding the effects on the behavior of a child due to a combination of Fetal Alcohol Spectrum Disorder and Attention Deficit Hyperactivity Disorder with the help of a case. From this, it could easily be understood the problems that a child suffering from both the disorders face and the problems faced by the parents as well. There are various reasons behind the not recovering of a child from these disorders, which include lack of attention, lack of understanding and empathy and also lack of knowledge on the subject. A severe disorder such as FASD is incurable, although if identified at early stages at the time of the birth of the child, it could be completely cured by understanding the child's need, consulting a doctor regarding the same and following simple procedures provided.

Conclusion

This report concentrates on the problems in day-to-day life of a child suffering from disorders like FASD and ADHD. It also concentrates on other aspects of the child’s life including their family and siblings who are also affected by the behaviour of the affected child. The primary concern is to identify and diagnose the disorder on time so that its cure could be applied and the child could be taken care of. If not worked upon on time, the disorder can only get worse and affect the child throughout their life and would hamper the daily functions of the affected child. Various recommendations are provided as well to help the child be understood with respect to their requirements so that the cure could be tailored according to it. In most cases of FASD, a medical opinion is always beneficial in getting rid of the disorder entirely at an early age of a child’s life.

References

FASD Prevention. (2018). PREVENTION of Fetal Alcohol Spectrum Disorder (FASD): A multi-level model. Retrieved from https://fasd.alberta.ca/documents/CanFASD_4_levels_of_prevention_brief.pdf

Gerberding, J., & Cordero, J. (2014). Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Retrieved from https://www.cdc.gov/ncbddd/fasd/documents/FAS_guidelines_accessible.pdf

Government of Alberta. (2008). FASD 10-year strategic plan . Retrieved from https://fasd.alberta.ca/documents/FASD-10-year-plan.pdf

Kellerman, T. (2013). Characteristics and Symptoms of Fetal Alcohol Syndrome . Retrieved from https://come-over.to/FAS/brochures/characteristics.pdf

Lange, S., Probst, C., & Popova, S. (2017). Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. pp. 290–99. Retrieved from https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(17)30021-9.pdf

McLean, S., & McDougall, S. (2014). Fetal alcohol spectrum disorders: Current issues in awareness, prevention and intervention. Retrieved from https://aifs.gov.au/cfca/sites/default/files/publication-documents/cfca-paper29-fasd.pdf

Pacey, M. (2009). Fetal alcohol Syndrome & Fetal alcohol Spectrum diSor der among abor iginal canadians: Knowledge Gaps. Retrieved from https://www.ccnsa-nccah.ca/docs/health/RPT-FASDKnowledgeGaps-Pacey-EN.pdf

Popova, S. (2019). Epidemiology of Fetal Alcohol Spectrum Disorder. Retrieved from https://www.paho.org/hq/index.php?option=com_docman&view=download&alias=48267-epidemiology-of-fetal-alcohol-spectrum-disorder-svetlana-popova&category_slug=webinar-fetal-alcohol-spectrum-disorders-fasd-epidemiology-and-diagnosis-10-april-2019&Itemid=270&l

Warren, K., Hewitt, B., & Thomas, J. (2011). Fetal Alcohol Spectrum Disorders: Research Challenges and Opportunities. 34(1), pp. 1-11. Retrieved from https://pubs.niaaa.nih.gov/publications/arh341/4-14.pdf

Williams, J., & Smith, V. (2015). Fetal Alcohol Spectrum Disorders. pp. 1-14. Retrieved from https://pediatrics.aappublications.org/content/pediatrics/early/2015/10/13/peds.2015-3113.full.pdf

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