At present there are few provinces with the capacity to provide assessment for adults. This, and other factors, make it likely that parents who were prenatally exposed to alcohol do not have a multidisciplinary FASD assessment. In the absence of an FASD assessment, child welfare workers should avoid making quick judgments about labelling behaviours as FASD. There are multiple causes for behaviours commonly associated with FASD.
Note that a diagnosis within the spectrum doesn’t automatically mean a person is unable to parent.
A formal assessment is the best way to determine a program of service for parents who may be alcohol affected. In the absence of a formal assessment, school and medical records are useful sources of information. In conducting interviews with parents, the child welfare worker should note strengths along with difficulties; the strengths will be helpful when developing a relationship with the parent, developing support strategies, and when providing services.
Child welfare workers need to be able to recognize the symptoms of FASD and have an understanding of the general strategies for supporting adults with FASD. (See Intervention tab in this section)
Not all parents and caregivers with FASD will have the same challenges, but indicators of possible FASD include difficulties in the following areas:
- Understanding the concept of money and budgeting, which may impact the ability to provide food and shelter
- Understanding the impact of domestic violence on children
- Understanding why they are being asked to attend a parenting program, even after agreeing to follow through with it
- Identifying or problem solving when their children are being abused
- Initiating actions needed to address safety concerns
- Recognizing the need for personal boundaries (for example, multiple short-term sexual relationships with strangers, where the sexual partner is brought into the home and the parent/caregiver lacks understanding as to why this poses a risk to the children)
- Activities of daily living, such as personal hygiene, time management, cooking, cleaning, organizing and maintaining the home
- Gullibility, making them vulnerable to manipulation, abuse, and other forms of victimization
Children in Care and FASD Assessment
“The cornerstone of responding to Fetal Alcohol Spectrum Disorder (FASD) is assessment and diagnosis. Medical, psychological, occupational therapy, speech and language pathology assessments, along with a detailed social history are critical components of the assessment process for FASD. Sensitive guidelines have been developed to support the diagnostic process” ( D. Badrey, “Inventory of Literature on the Assessment and Diagnosis of FASD Among Adults,” 2010)
Whether the child is in the care of an Agency or out in the community, an FASD assessment provides a blueprint for the type of intervention needed at home, school, and in the community. Due to behaviours observed, developmental delay, or academic performance, a child may be suspected of being alcohol affected. The next step is to contact the birth mother, father, or other significant adults in the child’s life. This is to obtain confirmation of prenatal alcohol exposure for the purpose of referral for FASD assessment. (See Prenatal History below)
What if a worker is unable to obtain confirmation of prenatal alcohol exposure? At this point, it is most helpful to have the child assessed by a developmental pediatrician (children 0-4 years of age) or a psychologist (school-aged children). What is needed is a comprehensive picture of the child’s strengths and difficulties along with recommendations regarding the type of home and clinical or community-based intervention required.
If there is reliable, detailed confirmation a child or youth has been prenatally exposed to alcohol it may be helpful to use the National Screening Tool Kit for Children and Youth Identified and Potentially Affected by FASD. This is to determine to a greater likelihood if the behaviour observed may be the result of an FASD. Using a screening instrument is not a substitute for a formal assessment and diagnosis; it is a tool to help a worker decide if a child or youth is at-risk for FASD.
Benefits of Assessment and Diagnosis
“Commonly used parenting techniques may not work for children with FASD. Without clear information about the disability, parents, teachers, and other professionals, using otherwise good techniques can become frustrated when the child’s behaviours do not change. Because we now understand more about how differences in the abilities of the brain impact behaviour, caregivers and health professionals can provide appropriate interventions and advocate for effective supports and accommodations for the child. A diagnosis can also shift our understanding, for example from ‘trying harder’ to ‘trying differently’ (Diane Malbin), and help us look for ways to assist children to successfully learn, grow and adapt” (Manitoba FASD Centre http://www.fasdmanitoba.com/asess.html )
Why Women Drink During Pregnancy
“Alcohol use in adulthood has been associated with adverse events in childhood such as abuse (emotional, physical, or sexual), domestic abuse of the mother of the child, parental substance use, mental illness in the home, separation or divorce of parents, and incarceration of a family member” (Dube et al., 2002).
Gathering Prenatal History
Appropriate health, education, and social services begin with accurate, comprehensive information about the child and the health of immediate family members. The reason for gathering prenatal alcohol information is to guide case planning and if necessary to make a referral for FASD assessment. A woman with a significant history of using alcohol can experience extended periods of sobriety. Therefore, alcohol history must be gathered for each pregnancy. The prenatal history should include the timing, frequency and amount of alcohol and drugs used during each pregnancy. (Manitoba FASD Centre April 2011)
Reliability of Information
For confirmation of prenatal alcohol exposure to be considered reliable the person making the disclosure must have either witnessed the birth mother drinking alcohol or witnessed the birth mother intoxicated during the pregnancy. It is helpful if the person reporting can confirm the frequency alcohol was consumed, the timing during the pregnancy, the amount and type (potable or non-potable) of alcohol consumed. (Non-potable alcohol refers to products that contain ethanol and are not meant to be consumed as a beverage, such as hair spray, mouth wash, cologne, cough syrup, etc.)
Agency records may contain information about prenatal alcohol use and can be a reliable source of information if the writer has included the following:
- Who received the information
- Where the information came from
- How the information was obtained
- Enough details to link the information to the pregnancy
The person charged with taking on the task of obtaining prenatal alcohol history should be someone without (perceived) bias, able to approach the birth mom without judgment or prejudice, and should not be perceived as a threat by the family.