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If you have a tween or teen adopted from or in foster care, they may have come to you with one or more diagnoses.  Prenatal exposure to alcohol or drugs is one of the most underdiagnosed and misdiagnosed conditions. Yet the U.S. government estimates that 10-11% of all children born in the U.S. have been prenatally exposed.  For children in or adopted from foster care, the statistics are staggering.  It’s estimated that as many as 80% of those children are affected by prenatal exposure.

What is Prenatal Exposure?

While a mother is pregnant, using drugs or drinking alcohol of any kind can cause malformations in a developing baby.  It’s difficult to separate the effects of prenatal alcohol exposure from prenatal drug exposure. According to a 2020 report by the CDC, “the use of other substances was common among pregnant women who reported alcohol use.” Prenatal exposure can cause irreversible brain damage to the developing baby with lifelong effects.

Getting Prenatal Exposure Diagnosed

Often obtaining a diagnosis for your tween or teen can be difficult. Understandably, you might even be hesitant to seek a diagnosis, fearing your child may be stigmatized. But as we’ve said before, believes that knowledge is power. We love the way that Diane Malbin, author of Trying Differently Rather Than Harder,* and mother to a child with Fetal Alcohol Spectrum Disorder (FASD), says it,

Without identification or diagnosis, parenting a child with Fetal Alcohol Syndrome (FAS) or fetal alcohol effects (FAE) is like trying to find your way around Denver with a road map of Cincinnati. 

You can read more about seeking a confirmed diagnosis by a professional in Part 1 of this article series. Early diagnosis and intervention are one of the strongest factors in the success of prenatally exposed children and their families. If your tween or teen joined your family later in childhood, you may not have the advantage of an early diagnosis. However, a later diagnosis can still be made. You still have plenty of time to learn strategies to help you and your tween or teen succeed. 

What are the Primary Symptoms of Prenatal Exposure?

With alcohol exposure, you might see physical abnormalities in babies and young children, including a thin upper lip, lack of a groove between the nose and the mouth (the “philtrum”), small head circumference, and small eyes. However, these are only present in 10-15% of children with prenatal alcohol exposure. These features also become less pronounced with age. If you have access to pictures of your tween or teen as a baby or young child, they can be helpful to you and your child’s doctors. However, there are other symptoms to consider.

Behavioral and Learning Symptoms of Prenatal Exposure

The effects of prenatal exposure can manifest differently in various life stages.  Prenatally exposed children usually exhibit a cluster of the following behavioral and learning symptoms.

1. Developmental disparities.

Your tween or teen may be on age target for some skills and behaviors while well below others. Because of this, you may want to familiarize yourself with the impacts on younger kids with prenatal exposure. They may also have “on days” and “off days,” where they seem to remember information and routines some days but not others. 

2. Slow processing speed.

Adolescents who had prenatal exposure may need extra time for everything, from making their bed to following directions and completing tasks.

3. Executive functioning deficits.

“Executive function” is a term that describes a wide array of skills, such as planning, organizing, and completing tasks. Your young person may not understand or be able to predict the consequences of their actions. They might appear very impulsive. They may repeat the same mistakes and lack common sense. Prenatally exposed kids often struggle with time and money management and other abstract ideas. These deficits will typically significantly impact your young person’s success in school and at home.

4. Attention deficits, hyperactivity, and impulsivity.

Researchers have found that as high as 75% of children prenatally exposed to alcohol and drugs are also diagnosed with ADD/ADHD. Your tween or teen might find it challenging to sit still, stay focused, and sustain attention for long periods. Their impulsivity can lead to poor judgment and being easily led or manipulated by others.

5. Lying and stealing.

It may appear that your tween or teen with prenatal exposure is intentionally lying. However, it could instead be a result of their memory deficits and challenges with executive functioning skills, as well as their slow processing speed and impulsivity.

For example, when questioning your tween or teen, they may impulsively say the first thing that comes to mind without thinking. Often, that quick answer (that may or may not be true)  is their brain’s attempt to slow down the questioning and give themselves time to catch up mentally. It might also be that they truly do not remember what happened when they feel the pressure of being questioned.

Deficits in executive functioning can also contribute to stealing. For a young person who had prenatal exposure, the concept of personal ownership can be very abstract. They may understand that an object belongs to a person when that person is physically connected to that object by holding it or wearing it. However, if no one is holding it, the object is up for grabs in your tween or teen’s mind. Punishing them for stealing can thus be ineffective or disconnected in their minds.

Impulsivity can also contribute to what appears to us to be stealing. Their minds say, “I see it, I want it, I take it,” without pausing to think through the consequences. Additionally, a tween or teen with memory deficits may not remember that they took the object yesterday. Stealing may also be an attempt to fit in socially. Remember, your young person with prenatal exposure can be particularly vulnerable to peer pressure. Stealing could be an attempt to gain friends.

6. Poor social skills.

Another behavioral symptom of prenatal exposure is that these kids often fail to read social cues. They may gravitate toward friends much younger than themselves because of developmental disparities. They often have difficulty making and keeping friends.

7. Emotional dysregulation.

Mood swings and meltdowns are typical of most tweens and teens. However, adolescents with prenatal exposure can experience these with greater intensity, duration, and frequency than their peers. Anger and aggression can also be part of these challenging dysregulations.

8. Inappropriate sexual behavior.

There is a wide range of inappropriate sexual behavior that can be common to adolescents who were prenatally exposed:

  • sexual advances
  • sexual touching
  • promiscuous or dangerous (risky) sexual behavior
  • masturbation in inappropriate settings
  • exposing oneself
  • voyeurism
  • using obscene or offensive language

These behaviors are challenging for parents and kids alike. It’s critical to remember that your tween or teen likely doesn’t recognize the inappropriateness of their actions or the risks involved in their behaviors. They also may not understand the nuances of giving and receiving consent. The gaps further complicate these challenges in their biological and social maturity. 

Understanding the Secondary Symptoms.

Your prenatally exposed child was not born with the following secondary symptoms. However, these can develop as your child grows, especially if there is a mismatch between their abilities and their expectations. Common secondary symptoms of prenatal exposure can include frustration, aggression, anxiety, dropping out of school, depression, and legal trouble. 

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Developing a Plan to Parent Your Tween or Teen with Prenatal Exposure

Parenting a tween or teen with prenatal exposure is difficult, but having a plan can make all the difference for you both. Underscore everything you do for them by acknowledging that the child is not intentionally misbehaving. It’s not a matter of “being bad” or not doing what is asked of them due to stubbornness or defiance. Rather, you can reframe your parenting to accept that this youth can’t do what is asked or expected of them.

Acknowledge that they are missing skills or delayed in developing necessary skills because of brain damage from their prenatal exposure. Regardless of whether your young person has a confirmed diagnosis, the following strategies can help.

10 Parenting Strategies for Prenatally Exposed Adolescents

1. Slow things down.

Allow more time for everything your young person needs to do, from getting ready for school to completing household tasks and homework. Teach your teen to use self-talk to remember their routines. Give only one direction at a time.

2. Establish predictable routines.

Set a structure and routine that your tween or teen can learn to predict. Include the steps for getting ready for school and completing homework. Teach your tween or teen to use organizational tools such as schedules, agendas, calendar apps, cue cards, or google forms. Break their routines into steps, and use pictures or short written phrases for each step.

3. Teach money management.

There are many helpful online resources to help you help your tween or teen, such as this downloadable tip sheet. Focus on concrete, practical applications to support their learning.

4. Streamline their life.

For kids who were prenatally exposed, think “less is more.” You should limit choices whenever possible to avoid overwhelming their thought processes. It’s also helpful to keep your home environment clutter-free. You can further support them by using low lighting, limiting the background noise in your home, and simplifying your decor.

Create a designated homework space free from distractions and noise. Alternate activities that require their sustained attention, such as homework, mealtimes, long car rides, and church services with opportunities for movement breaks. When they must sit and attend to a task, let them choose a fidget toy and another sensory object.

5. Prioritize their safety.

Impulsive behaviors can also be dangerous. Consider safeguarding your home by locking up potentially risky objects like matches, medications, etc. Set up an established list of safety questions you ask when your tween or teen wants to do an event or activity. Teach your young person an inner mantra to repeat, such as “Stop. Think. Do.” The goal is to help them slow their processing speed and allow them to choose safely.

6. Considering medication.

If you and your child’s doctor are considering a diagnosis of ADHD or ADD and possible medication, remember that medicine will likely impact a child with prenatal exposure differently than typical peers. Expect more trial and error to find the best type and combination of medications for your young person.

Tips for Raising Kids with Prenatal Exposure, a free course

7. Increase time and supervision.

Sometimes what appears to be lying results from your youth’s missing skills. To support and help them learn how to process questions, slow down and allow them extra time to answer. Consider how to slowly and carefully retell the event in question, as they may not accurately remember it or the order of events that occurred. They may not understand the difference between reality and fantasy and will need your time and practical scaffolding to decipher. Consider what unmet needs could lead them to lie or steal and deal with the need rather than the lie.

The best strategy for stealing is prevention, primarily through supervision. This requires a lot from you, but it’s the support your tween or teen needs. When you know they are prone to stealing, don’t allow them to go into a store or mall without an adult. Reinforce the concept of ownership early by continuing to label possessions. Routinely go through your child’s room or backpack as matter-of-factly as possible and remove items without their label.

8. “Less is more” when socializing.

Remember that your young person might act by their developmental age rather than their chronological age. They may gravitate toward kids younger than themselves for social interactions. That is generally okay, though you should be careful to supervise diligently. Think “less is more” for adolescents with prenatal exposure. Having a few close friends is more realistic than having a large circle of acquaintances. One-on-one time with a safe, trusted friend is better than big parties or sleepovers.

Teach your youth the social skills of listening, taking turns, not talking when others are, and taking an interest in others by asking them questions. Role-play everyday friendship interactions to help them get comfortable with these skills.

Again, maintain supervision by knowing who your tween or teen’s friends are, where they are, and what they are doing.  As often as possible, communicate with the adults in charge of your tween or teen’s group activities. Give them the relevant information to set your adolescent up for safety and success.

9. Focus on calming skills and language.

Intervene at the earliest signs of escalation and use distraction or re-direction tools to de-escalate your young person’s dysregulation. Create a calm space with your tween or teen, getting their input on its design. Teach them to experience it as a safe and peaceful space before they feel overwhelmed. Avoid sending them to the space only when they are dysregulated or acting out so they don’t perceive it as a punishment.

Limit, anticipate, and plan for changes and transitions in routines. For example, if your family is getting ready to go on a trip, show your child pictures of where you’ll be staying or of unfamiliar people, they’ll be seeing. Take along familiar objects and snacks to provide comfort during the unfamiliar. Always have a “plan B” for when your youth gets overwhelmed. Use as few words and instructions as possible during times of high stress and rising emotion.

10. Teach healthy boundaries and respect.

To help protect your tween or teen, have regular and consistent conversations about healthy sexuality, safe boundaries, and respectful touch. Name your family values clearly. Even if it feels uncomfortable, be specific, use real names for body parts, and repeat these talks often. Role play how to ask someone out on a date and different ways to understand consent. Keep the conversations specific and literal. Remember that nuance or tacit understanding is challenging for kids with prenatal exposure.

Please include talks about the dangers of the internet, focusing on access to online porn, communication with strangers, and sharing personal information. And certainly, supervise their internet use and group activities to protect all the children involved.

Guiding Your Tween or Teen Through the Transition to Adulthood

All parents worry about their tween or teen succeeding as an independent adult.  This worry is understandably magnified when you have an adolescent with prenatal exposure. Whether or not they will be capable of living independently as an adult, teaching them now about good habits and routines can set them up for success. Start teaching life skills as early as possible, such as preparing healthy meals, laundry, and managing time and money. Be prepared to advocate for them throughout their lifetime.

Experts have determined that several protective factors can lessen the effects of prenatal exposure, including early diagnosis, access to social and educational services, the absence of violence in the home and the community, and the child’s resilience. Finally, the most powerful protective factor is time spent in a stable, nurturing, and stimulating home environment. You are cultivating hope for your child’s future by providing a safe, loving home. By continuing to educate yourself about prenatal exposure, you can gain the knowledge and tools needed to better parent and support your child across their entire childhood.

FASDUnited offers many additional tools and supports for parents and caregivers, including a resource directory and advocacy opportunities. Hugs for Teens with FASD: a book of encouragement* is written for teens and young adults struggling with disabilities.

Hang in there – remember that raising a tween or teen with prenatal exposure can be rewarding and enjoyable. Their humor, particular strengths, and unique way of experiencing life can add a beautiful layer to your family.  Don’t forget to lean on your support system when needed, and schedule regular self-care for yourself, your partner, and your tween or teen.

What strategies have you tried in raising your prenatally exposed tween or teen? Tell us more in the comments!

Image Credits: Eren Li; George Dolgikh; Alexander Mils; Ron Lach; Gianne Karla Tolentino

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