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Section 2
FAS and Mental Health

Question 2 | Answer Booklet | Table of Contents

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In the last section, we discussed three different modes of diagnosis of clients with fetal alcohol syndrome.  These different diagnostic modes included:  physical and behavioral characteristics; emotional characteristics; and less severe characteristics. 

In this section, we will examine four secondary disabilities frequently found in FASD clients.  These four secondary disabilities include: mental health; frequent troubles with authoritative institutions; alcohol abuse; and inappropriate sexual behavior.

Four Secondary Disabilities

♦ #1 Mental Health Problems
The first secondary disability is mental health problems.  In a study conducted by Ann Streissguth and H. Barr, more than ninety percent of the clients with FASD had mental health problems, and more than eighty percent had had treatment for mental health problems. There is no difference in the prevalence of mental health problems for children vs. adolescents and adults, but children and adolescents are more likely to have attentional deficits whereas depression was the most prevalent mental health problem among adults. 

Many times, parents of young FASD clients will bring their son or daughter into therapy for a secondary disability such as attention deficit. They believe, as many parents will, that their child has ADD, a condition highly-touted and diagnosed among school teachers. However, once the wide range of their other behavioral problems comes to light, it becomes apparent that the client is actually experiencing the effects of FASD. 

Carol’s adopted daughter, Hannah, age 8 was referred to me by a school counselor for having ADHD. In her notes, the school counselor included, "Does not follow directions well; has difficulty with cognitive learning abilities; has problems sitting still and concentrating on the lesson." Carol, however, did not believe the counselor’s diagnosis. 

She stated, "I believe ADHD is a blanket that covers more serious problems. Hannah is a little more hyperactive than other children, but she always tells me that she loves to learn and wants to please the teacher. ADHD children don’t have that drive." Upon looking at Hannah, I could see the facial characteristics of a child with FASD. 

I stated to Carol, "Your daughter does not seem to have ADHD, but she does appear to have the characteristics of FASD, which can be accompanied by the same symptoms as ADHD.  It may be difficult for her to follow many commands at once, so she loses track of what she is doing.  However, there are fairly simple tasks that you may do at home with Hannah that can help her become less overwhelmed. When doing a task at home, give her step-by-step instructions. Let her complete one step before giving her instructions for the next one. Also, perform the task with her.  For instance, if she is picking up her toys, help her so that she feels that the situation will not go beyond her control." 

Think of your Hannah.  Is he or she being diagnosed with mental health problems when in fact he or she has FASD?

♦ #2 Frequent Troubles with Authoritative Institutions
The second secondary disability is frequent troubles with authoritative institutions.  "Authoritative institutions" refers to such systems as schools and the law.  These institutions are designed for emotionally balanced and healthy individuals, not for clients with FASD. More than sixty percent of adults and fourteen percent of children with FASD have had a disrupted school experience. Suspensions were the most common disruption among clients of all ages, but the drop-out rate among adults was almost as high. 

Clients with disrupted school experiences had twice as many learning and behavioral problems as those without disrupted school experiences. In addition, sixty percent of adults and fourteen percent of children had trouble with the law, with shoplifting and theft the most common crime.   Trouble with the law is usually strongly related to disrupted school experiences. Clients who didn’t have disrupted school experiences were only forty percent as likely to be in trouble with the law.

Kyle, age 17, had been suspended twelve times from his high school.  During his time away from school, he would become angry at what he termed "the system" for having such little patience and began to shoplift from video stores. Kyle stated, "They didn’t have the time to understand my problems, so I would get angry and take things. I didn’t have time for their rules." 

Kyle’s single father, Bill, stated, "I don’t have time to watch him because I work and his mother ran off years ago. I don’t know how to control him when he’s out of school." I suggested to Bill, "The next time Kyle is threatened with suspension, go to the dean and explain the situation to him.  Suggest putting Kyle in an in-school suspension program or offering to have Kyle work in the library or cafeteria as a punishment. These alternatives will keep him in school and out of trouble with the law." 

Think of your Kyle. What would facilitate his school experience?

♦ #3 & #4 - Alcohol Abuse & Inappropriate Sexual Behavior
In addition to mental health problems and frequent troubles with authoritative institutions, the third and fourth secondary disability is alcohol abuse and inappropriate sexual behavior. Thirty-five percent of the individuals in the Streissguth and Barr study reported problems with alcohol and other drugs in adolescents and adults. Many individuals did not drink at all, citing no access to the substances or the fact that drinking was against the client’s beliefs. 

Those clients who do drink do not show any signs of unusual abuse when compared to the general population. However, when coupled with another secondary disability, the client may find their nights of binge drinking result in different consequences than non-FASD individuals. Inappropriate sexual behavior occurs in forty-nine percent of adolescents and adults and thirty-nine percent of children. The most common inappropriate sexual behaviors were sexual advances, sexual touching, and promiscuity. When paired with alcohol abuse, this behavior obviously becomes more prominent.

Heather, age 9, had been brought in by her mother and father, Judith and Vince, because they were concerned by her inappropriate attitude towards some of the other children. Judith stated, "She becomes extremely affectionate towards other children, and improperly so. She touches boys on the crotch and the teacher has seen her trying to kiss other boys in her class." Because Heather had been diagnosed early with FASD, I knew that her parents were already aware of her special needs.

I stated, "Heather doesn’t know the difference between right and wrong. Although she’s already nine, she still has the learning capabilities of a six-year old. It is important that you constantly and lovingly remind her that touching other people like that is wrong. Because of her learning disabilities, she needs constant prompts and support from both of you in order to finally learn appropriate behavior." 

Think of your Heather. Are his or her parents concerned by the inappropriate sexual behavior of their son or daughter?

♦ Technique:  Measuring Protective Factors
I have found that the rate and extent of secondary disabilities can be deterred by differing factors.  These factors are known as "protective factors" and to predict the severity of the secondary disabilities later in life, I have found the "Measuring Protective Factors" exercise helpful.  There are five environmental factors that can help in the treatment and prevention of secondary disabilities.  Deficiency in any of these can result in a more severe secondary disability efficacy. 

5 Environmental Factors that can Help with Secondary Disabilities

1. Living in a stable and nurturing home of good quality
2. Not having frequent changes of household
3. Not being a victim of violence
4. Having received developmental disabilities services
5. Having been diagnosed before six years of age.

Kyle, as you have seen, lived with only one parent and was frequently in and out of school.  Heather and Hannah, however, were both under the care of two supportive parents.  However, Hannah had been diagnosed with FASD at eight, which would make her development slower; and Heather’s parents had been reluctant to engage and accept their daughter’s disability.  All these risk factors contributed to the onset of the client’s secondary disabilities.  These five factors will form the center of the structuring of the family home later on in the course.

In this section, we discussed four secondary disabilities frequently found in FASD clients.  These four secondary disabilities included: mental health; frequent troubles with authoritative institutions; alcohol abuse; and inappropriate sexual behavior.

In the next section, we will examine FASD in the early stages of life and the most effective familial structure for them.  The three stages we will examine in this track include:  infancy; toddlers and preschool years; and school-age years. The three types of familial structure during these stages are, respectively:  soothing atmospheres; developing communication skills; and clear demands.
Reviewed 2023

Peer-Reviewed Journal Article References:
Key, K. D., Ceremony, H. N., & Vaughn, A. A. (2019). Testing two models of stigma for birth mothers of a child with fetal alcohol spectrum disorder. Stigma and Health, 4(2), 196–203.

Liebschutz, J. M., Crooks, D., Rose-Jacobs, R., Cabral, H. J., Heeren, T. C., Gerteis, J., Appugliese, D. P., Heymann, O. D., Lange, A. V., & Frank, D. A. (2015). Prenatal substance exposure: What predicts behavioral resilience by early adolescence? Psychology of Addictive Behaviors, 29(2), 329–337. 

Marceau, K., Rolan, E., Leve, L. D., Ganiban, J. M., Reiss, D., Shaw, D. S., Natsuaki, M. N., Egger, H. L., & Neiderhiser, J. M. (2019). Parenting and prenatal risk as moderators of genetic influences on conduct problems during middle childhood. Developmental Psychology, 55(6), 1164–1181.

McLachlan, K., Gray, A. L., Roesch, R., Douglas, K. S., & Viljoen, J. L. (2018). An evaluation of the predictive validity of the SAVRY and YLS/CMI in justice-involved youth with fetal alcohol spectrum disorder. Psychological Assessment, 30(12), 1640–1651.

Streissguth, A. P. (1977). Maternal drinking and the outcome of pregnancy: Implications for child mental health. American Journal of Orthopsychiatry, 47(3), 422–431.

Wedding, D., Kohout, J., Mengel, M. B., Ohlemiller, M., Ulione, M., Cook, K., Rudeen, K., & Braddock, S. (2007). Psychologists' knowledge and attitudes about fetal alcohol syndrome, fetal alcohol spectrum disorders, and alcohol use during pregnancy. Professional Psychology: Research and Practice, 38(2), 208–213.

QUESTION 2
What are four secondary disabilities frequently found in FASD clients? To select and enter your answer go to Answer Booklet.