The Invisible Disability

Janice Goldwater, LCSW-C
Founder and Executive Director
Adoptions Together

For years, many professionals and parents believed that without facial features or a lower IQ, the impact of prenatal alcohol exposure was not severe.  Some thought that bright-eyed kids who exhibited highly impulsive and very challenging behaviors just needed more intensive and creative interventions from their stable loving parents.  Yet their parents were pulling their hair out with frustration!   We thought there was little that could not be understood within the parameters of early adversity, attachment, trauma and temperament.  We asked ourselves why some children responded so well to treatment, to the stability and attunement their parents provided, while others’ behavior and ability to function just seemed to get worse with each passing year.

Why were some children so able to function well one moment and be so out-of-control the next?  How can they struggle so much with cause and effect thinking and make the same poor choices over and over again?  Clearly, something was missing in how parents and professionals understood what was happening.  Could children with no facial features of alcohol exposure, no maternal reporting and a normal IQ have brains that were altered by alcohol use?

The answer is YES.  It is now widely recognized that depending on the gestational age at which alcohol is consumed, different parts of the brain/body are impacted.  In fact, for facial features to be altered by alcohol, consumption must have occurred between the 5th and 7th week of pregnancy.  Today we know that the majority of people who are impacted by prenatal alcohol consumption have no external manifestations and many of the difficulties do not surface until school age and beyond.  The list below includes some of the challenges that may occur when alcohol is consumed during pregnancy.

  • Learning difficulties
  • Problems with language
  • Lack of appropriate social boundaries (such as over friendliness with strangers)
  • Poor short term memory
  • Inability to grasp instructions – problems with math
  • Failure to learn from the consequences of their actions
  • Egocentricity – Concrete thinking
  • Mixing reality and fiction (truth telling)
  • Difficulty with group social interaction
  • Poor problem solving and planning
  • Hyperactivity and poor attention
  • Poor coordination.

Despite our new knowledge, prenatal alcohol exposure continues to be overlooked when children experience problems at home and in school.  When unrecognized, this Invisible Disability can become even more complicated as secondary mental health problems may emerge when affected children and youth try to manage expectations that they may not be able to achieve.

The good news is that when the impact of prenatal alcohol consumption is recognized, specific interventions can and do work.  Simply helping parents, therapists and teachers understand what affected children and youth may struggle with allows all of those involved to relate in the most enriching manner possible.

With the advent of brain imaging and a much greater understanding of how the brain works, it is incumbent upon all of us to educate ourselves so we can best meet the needs of our growing youth, including those who may have been impacted by alcohol.  Information is power.  The more we know, the more precise we can be in responding to the needs of others.

To enrich your understanding of the impact of FASD and learn strategies for helping children who may be affected, please consider a conference for professionals, parents and educators on April 29th:  Fetal Alcohol Spectrum Disorders (FASD); Attachment; Trauma; Implications for Managing Behavioral Challenges.  For more information, please visit
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Tags: Conferences,FASD,Attachment,Trauma,Behavioral Challenges,prenatal alcohol exposure
Category: Foster Care
Category: Adoption

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