Parenting a Child with Prenatal Exposure

What are the long-term impacts of prenatal alcohol and drug exposure and how can we parent these kids to help them thrive? In this episode, we talk with Dr. Mona Delahooke, a clinical child psychologist and the author of Beyond Behaviors: Using Brain Science and Compassion to Understand and Solve Children’s Behavioral Challenges.

In this episode, we cover:

The long-term impact of prenatal alcohol and drug exposure: Research has found that most drugs that are commonly abused easily cross the placenta and can affect fetal brain development. In utero exposures to drugs and alcohol thus can have long-lasting implications for brain development resulting in behavioral challenges and mental and physical health implications. Some things to consider:

The amount of drugs and alcohol used by the mom and the timing in the pregnancy matter, although this is information that is seldom available to adoptive or foster parents.
Very often children are exposed to more than one substance in utero. For example, it is not uncommon for a pregnant woman who is drinking alcohol to also use drugs.
Untreated drug abuse/addiction often coincides with poor nutrition and prenatal care, which increases the risk further for pre-natal and post-natal trauma with potentially lifelong impacts.

It helps to begin with understanding how alcohol and drugs exposure in pregnancy can affect the child not just in infancy but throughout their life.

Alcohol
Fetal Alcohol Spectrum Disorders (FASDs) is characterized with a broad range of deficits. Children with FASD may not have the facial dysmorphology and other physical abnormalities associated with Fetal Alcohol Syndrome (FAS).
FASDs currently represent the leading cause of intellectual disability in North America.
Of all the substances of abuse (including cocaine, heroin, and methamphetamines), alcohol produces by far the most serious neurobehavioral effects in the child and into adulthood.
Alcohol exposure can cause a host of cognitive and behavioral impairments, including:
- Low to average IQs (IQ can range from mental retardation to normal)
- Poor executive functioning skills
- Poor information processing skills
- Lack of social and communication skills
- Lack of appropriate initiative
- Discrepancy between their behavioral age and their chronological age (i.e., acting younger than they are)
- Difficulty with abstract concepts, such as time and money
- Poor judgment
- Failure to consider consequences of actions. Doesn’t learn from mistakes.
- Poor concentration and attention
- Social withdrawal
Other drugs: Methamphetamines, Amphetamines (speed and also some of the medications used to treat ADHD), 3,4-Methylenedioxymethamphetamine (MDMA)- street name Ecstasy, Opioids-(including heroin, fentanyl), Methadone or Suboxone, cocaine (including crack), and marijuana. While there are distinctions, after reviewing a lot of research it is fair to say that the following long-term impacts are often found.
In newborns: growth restriction, decreased weight, length, and head circumference, but these don’t necessary follow the child through life.
Executive function impairments. (Executive function is a set of mental processes for the management of cognitive operations that include attention, behavior, cognition, working memory, and information/problem solving.)
- Attention and impulse control issues.
- May include some learning difficulties.
- Increased child externalized behavioral problems.
Neonatal Abstinence Syndrome (NAS) for some of the more addictive drugs such as the opioids, but the absence of NAS does not indicate the absence of the brain damage caused by prenatal exposure.

The bottom line is that prenatal exposure to alcohol and drugs can cause brain damage that impacts how a child behaves and learns, and adoptive, foster and kinship parents may not know if the child has been exposed, or how much, or when. Ultimately, we can’t change the brain damage caused by prenatal exposure to alcohol and drugs but we can learn parenting techniques that can prevent some of the secondary impacts such as feelings of inadequacy, frustration, and low self-worth that can lead to defiance and other difficult behaviors.

How does the long-term impacts of prenatal exposure impact parenting?
One of the most frustrating things parents face when parenting a child with FASD or other prenatal exposures is that the don’t seem to understand cause and effect. This makes it difficult to “punish” or “give consequences” or in other ways discipline these children. It also leads parents and other adults to assume that the behaviors are intentional.
One of our goals at Creating a Family is to help parents and teachers move past “won’t” towards “can’t”. (Credit to Diane Malbin with Fetal Alcohol Spectrum Consultation Education and Training Services)
We call the brain damage caused by exposure to alcohol and drugs in pregnancy an invisible disorder because you can’t tell that the child has a disability just by looking at them. How does the lack of easy recognition impact parenting and impact teaching these children?
If a child’s behavior is interpreted as being bad rather than understood as the result of brain damage caused by prenatal exposure, how does it impact them? What are some of the secondary impacts from this mismatch between perception and reality?
How can we best help children who have been exposed prenatally to alcohol and drugs reach their highest potential and thrive? What parenting approach works best?
How much should we share with our child’s teachers and how can we help the teacher better work with our child?