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Forest Cottage Centre Email Newsletter:
October 2004
"Love means loving the unlovable - or it is no
virtue at all."
-- GK Chesterton
In this issue:
Helping Children who have Fetal
Alcohol Spectrum Disorder AND Attachment Disorder
This dual diagnosis is a very complex
challenge for parents and professionals. Here is a framework
for you to build on, as you work with such children:
Be a brickwall… made
out of rubber.
Those with FAS and Attachment Disorder need a high degree
of structure and consistency from their caregivers.
They have difficulty predict consequences and have distorted
cause/effect thinking. When combined with memory problems,
a tendency to run away from problems, lying, and manipulation,
the need for a firm authority figure is obvious. Be
a brick wall, so that no matter how hard they look for
a gap in the fence, they will find that it is a solid
and dependable surrounding. At the same time, we must
ALWAYS remember that these children have permanent neurological
and emotional deficits that they will be unable to undo,
regardless of the consequences we impose. This means
that our wall may have to bend or stretch like a rubber
band to accommodate their functioning ability at that
time. We may have to tighten up when they are functioning
poorly but can expand when they are doing well. No matter
which state they are in, though, they need to know that
we will be there for them.
Have clear and immediate consequences,
varying the consequences only to the degree the child
is functioning on that day. You should vary the consequences
based on that child’s CURRENT functional age (not
chronological age). If they are having a month of poor
functioning and are acting three years old, then consequences
should be geared towards a three-year-old, even if they
are 12.
Reduce the Success of the
Child’s Manipulation.
A child with FAS is rarely on time preparing for school,
a common problem of poor time comprehension (consistent
characteristic; unintentional manipulation). On the
other hand, an Attachment Disorder child may only dawdle
on days he knows that you have a big meeting at work
(inconsistent characteristic; intentional manipulation).
A child with both may be consistently be slow but also
clearly enjoy the fact that you are stressed by the
delay (unintentional and consistent characteristic;
intentional manipulation).
Question: How can a parent determine
the degree of this child’s intentional manipulation
vs. inherent time management problem? Answer: You can’t.
No matter how much your gut is telling
you that he meant to drive you crazy, you really will
never be able to determine the level of real manipulation.
Therefore, stop trying! (Trust me, this just leads to
a whole new level of crazy).
The ONLY thing you can change here is
the environment and your response. If there is a constant
time management problem, deal with this first. You may
provide a schedule with picture cues and divide some
of the preparation tasks to the night before. Or you
may have your spouse or neighbour drive that child to
school so that you don’t have to be late for work.
No matter what, always respond neutrally so that you
do not reinforce the behaviour (intentional or unintentional).
Have high hopes and reasonable
expectations.
It is great to hope for the best for these kids but
we must also accept that they may never function at
the same level as their peers (or at least it may take
10 years longer to master the skills).
The caution is to never stop expecting
the child to do their best, to set limits on their behaviour
(e.g.. "I understand that you are frustrated but
you will still have a consequence for swearing at the
teacher.") The challenge is to keep requiring the
child to try. Some parents and professionals have been
so empathetic that they have lowered the bar to below
the child’s ability, allowing the child to think
that if they just act out, they can escape from the
frustration of trying. I am not saying that we should
purposely antagonize or overwhelm such children, but
rather keeping walking beside them encouraging them
to move forward. Adapt work to their level, but do not
stop challenging then to grow.
My favorite story about this is from
a mom in Terrace, BC who shared:
My daughter was diagnosed with FAS and
I was told by all of the specialists that she was so
delayed that she would probably never learn her colors.
But I decided that even if it took years I would keep
trying to help her. I sat down with a box of Smarties
(like M&M’s for those of you in the USA), and
pointed to one. I asked her what colour it was. She
guessed the wrong colour so I ate it. I told her that
if she guessed right, then she would get to eat it.
I never got another Smartie!
Sometimes growth depends on motivation!
At the same time, I am confident that this same mom
would have sat with her child practicing colors in various
ways for as many years as it took. We need high hopes
and reasonable expectations.
Model empathy.
The challenges facing these kids are enormous. We have
little understanding of how discouraging it must be
to have a brain that does not comprehend what we understand
easily. Those with the added challenge of attachment
disorder have the extra challenge of not being able
to trust or connect with those around them. These kids
will make mistakes and try to push us away. The only
way to make a difference to show them how to be different.
In the effort to be firm, remember to be empathetic
and see life through their eyes. Show kindness, forgiveness,
and flexibility to those around you, including that
child. When they mess up, make sure they know that you
care about them even when you are giving them a consequence.
Make it tangible.
These kids are concrete thinkers and need things to
be black and white. If you are going to change a rule,
write it out in clear language and put it on the fridge.
Double-check that they understand all of the elements
involved in what you are discussing.The worst case conference
I ever attended was one where the teenager with FAS
declared that she wanted to be a paleontologist. The
facilitator of the meeting took this idea and ran with
it, laying out all the long-term ways that the team
would make this happen. As this was the first time I
had ever heard of it, and given that this child had
not yet been able to pass Grade 7 classes, I thought
this was over the top. After the meeting I asked the
child why she wanted this career. "Because I heard
you can make $60K a year!," she replied. "Do
you know that you have to go to university to do that
job?" I asked. "Screw that," she replied.
Let’s make sure that the "dots"
are all laid out so that kids can connect all the necessary
pieces of information. Sometimes this means clarifying
information every step of the way.
Provide adequate supervision.
One of the challenges of children with
FAS is the increased sexual curiosity and lack of inhibition.
When combined with possible previous sexual abuse, a
desire for power and control, fire-setting, and abuse
of animals, there is an increased risk that this child
will target vulnerable children and animals.
Even if you have no evidence that this
child is abusive, having this dual diagnosis should
be reason enough to provide constant supervision. This
means that this child should not be permitted to be
alone with other children (even those who are older
or bigger) or animals EVER.
You will probably not know there is a
problem until it is too late. Prevention is absolutely
necessary.
Simplify the process.
No matter what the process is, keep it simple.
Have a brief checklist that will help them clean their
room, step by step, and have clearly labeled containers.
Have assigned seating at home and in the vehicle so
that there is no fighting over seats. Use Velcro, not
laces. For everything you do, there is an easy way and
a hard way.
If something is not working for your
child right now, simplify the process.
Supply cues.
Part of simplifying the process may be to increase the
number of verbal, visual or symbolic reminders. There
are many pictures available for free online. For example,
visit www.dotolearn.com .
Know when to help/intervene.
While being firm and consistent, we must also know when
to help these kids out. Whether child, teenager, or
adult there are times when these individuals will get
themselves into messes or situations that will require
assistance, even if they caused the problem. If their
life or limb, or those of another, will be endangered
if you do not intervene, you must intervene.
My brother was already an adult when
he decided to try many hours to a large city, using
a borrowed car. The decision to use a car of questionable
quality, to drive many hours there and back, and to
take his girlfriend and baby daughter along was frightening
but as an adult he made the decision to go. At 2am the
next day, I received an emergency call because he had
hit a deer. He had no way to get home, no money, and
no food. If he had been alone, I would have had to tell
him to find a way home. However, because his baby was
also at risk, I wired bus tickets (which he later had
to repay by mowing my lawn), and made sure that an emergency
shelter provided them with food.
Don’t give up.
The challenge of working with these kids
will be intense. It may take 25 years for them to function
as a twelve-year-old. You may need some respite. You
may have to allow the police to arrest your child. You
may have to allow them to live somewhere else and maybe
even stop answering their phone calls. You may have
to stop blaming yourself if they never grow up. However,
amazing things can happen and other people will have
an influence over these kids’ lives. Perhaps success
will not be as clear as we would like it to be but we
can also keep hoping and praying that these kids will
end up the BEST THEY CAN BE, no matter what that looks
like. Our job is to provide the best conditions we can
for this to happen.
–Tanya
Special thanks to Linda Schmidt, FOCUS Employment
Program for adults with FAS (College of New Caledonia,
Burns Lake, BC), Helen Creamore; and Jacqueline Janssen
for their input.
Resources
The same agency that created Multiple Transitions:
A Child’s View of Foster Care and Adoption
has created a new video from the perspective of parents
who adopted an infant from overseas. The video, Is
Anyone in There? Adopting a Wounded Child, is highly
recommended for those who knew immediately that their
child was different than other babies. To order: Call
the Parent-Child Institute in Illinois at 217-352-4060
or visit www.infant-parent.com . Film is available on
VHS or DVD ($70 USD, postpaid).
Forest Cottage has copies in-stock of
Parenting with Love and Logic and Parenting Teens with
Love and Logic. Cost: $35 CDN (plus tax + postage).
To order by credit card, call 1-877-261-6361.
© 2004 Forest Cottage Centre. All rights reserved.
You are free to use material from this newsletter in
whole or in part, as long as you include complete attribution
and copyright information, including website link and
email link. Please also notify Forest Cottage where
and when the material will appear.
Comments or questions? Contact Tanya
Helton, M.Sc., Parent Coach at Forest Cottage Centre
Inc.
Fort St. John, BC, Canada Phone Toll-Free 1-877-261-6361
Tanya@ForestCottageCentre.com
www.ForestCottageCentre.com
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