Fetal Alcohol Syndrome and Reactive Attachment Disorders

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Fetal Alcohol Syndrome (FAS) babies are born with distinct facial characteristics created by the effects of alcohol on the bones as they are forming on the 19th or 20th day of pregnancy. Fetal Alcohol Effect (FAE) babies are born with other problems (especially neurological) but do not have the facial signs. They may have an IQ anywhere from 30 to 130, but are likely to have such problems as an unusually small head, stunted growth, hyperactivity, distractibility, explosive temper, difficulty forming relationship, and specific learning disorders.

Reactive Attachment Disorder (RAD) refers to problems created by inadequate attachment to the caregivers in the first three years of life, a time when a child requires a consistent, responsive, empathic, nurturing environment for normal neurological and emotional development. Children who do not have anyone attending to their needs in a loving way, who are moved from caregiver to caregiver, who are ignored may also grow up to have multiple problems. While they may be indiscriminately affectionate with strangers, they make poor eye contact and seem to be unable to give or receive affection from peers or caregivers. They are so involved with survival in the present that they have no sense of consequences. Being in control is more important to them than any relationship or outcome of an interaction, so these children are often cruel and destructive to themselves, others, animals, and property.

Tragically, many children in foster care suffer from both FAS/ FAE and RAD. A baby who has been exposed to alcohol and/or other toxic substances in the womb is often born into a family that is unequipped to provide the love and care needed by a normal newborn, much less a child who requires extra vigilance and patience.

Is your CASA child charming and adorable when alone with you, yet given to explosive emotional outbursts, especially when transitioning from one activity to another? He or she may seem alert and intelligent, and yet be falling farther and farther behind in school. If you see the psycho-educational test scores, they can be as high as the 97th percentile in some areas and as low as the 3rd in others. He or she may be FAS/FAE or RAD, but by the time a child like this is school age, it matters less how he or she got that way than what to do about it.

Even the best caregivers often despair. And yet some professionals are optimistic about the possibility of affecting change in both FAS and RAD children. Improvements come not from preaching “shoulds,” but by suspending blame and providing a carefully planned, consistent environment.

The path to normalcy starts with a realistic appreciation of the depth of the problems. Truly, “love is not enough.”

Children with FAS/RAD require special programs that can contain the emotional disorders enough to address the specific learning disabilities. Not only the kids but also the families (whether biological, adoptive, or foster) need support that is both practical and free from blame.

For programs and support in working with difficult children, try a search on the internet with key words “reactive attachment disorder” or “fetal alcohol syndrome.”

—Libby Colman, Ph.D.