Parents with Fetal Alcohol Spectrum Disorders: Using the Neuropsychological Assessment as an Instruction Manual for Success

Nancy WhitneyNancy L. Whitney, MS, LMHC, Clinical Director, King County Parent Child Assistance Program, University of Washington

Summary: The author describes how neuropsychological testing may be used as a guide to providing services that can keep FASD parents and their children together.

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Given the multi-generational nature of chemical dependency, many parents involved in the child welfare system may have a fetal alcohol spectrum disorder (FASD), as the result of their mother’s prenatal alcohol use. In our program, the Parent Child Assistance Program (PCAP), 52% of the mothers report that their own mother had heavy alcohol use during their childhood, and 21% reported that they knew their mothers drank during the pregnancy with them. (PCAP report to Division of Alcohol and Substance Abuse, December 2009)

Individuals with FASD can go their entire lives without a diagnosis or help. Organic brain damage leads to problems with daily life. They fail in school, have trouble with the law, and have substance abuse problems. And when they have kids, their substance abuse and cognitive impairments may result in neglect of their children and involvement with the child welfare system. Working with these parents is often frustrating due to the lack of progress. Their difficulties are often not understood and their failures are seen as lack of motivation and “not loving” their kids. In fact, the way the child welfare system works makes reunification unlikely for these individuals. However, if FASD is identified, a neuropsychological assessment can identify the individual’s abilities and the system can help the client be successful in parenting.

Mary was 26 years old when she enrolled in PCAP. She had two kids in foster care. She was pregnant with her third child and had been using methamphetamine. Mary’s mother was a heroin addict who had used during her pregnancy with Mary. No one thought about alcohol. Later Mary’s father confirmed that his partner had been using alcohol daily, with heroin, throughout the pregnancy.

Because of Mary’s history and the report of prenatal alcohol exposure, the child welfare team requested a neuropsychological assessment. The results were startling. This young, street-smart woman had been faking it for a long time. Her IQ was 68. (If her IQ had been known when she was a child, she would have received many special services.) More telling were her scores in individual areas. Her daily living skills were age appropriate—she could manage her household. But her functional age for community living skills was that of a six-year-old. She read at the fifth grade level. Her math ability was equivalent to a ninth grader’s. She had poor verbal memory. Her receptive communication skills were the equivalent of a third grader’s. That meant, for her to understand what was being said to her, people needed to use vocabulary and sentence structure that was on a third-grade level. Much of what was said in court was over her head. She couldn’t understand the documents that were given to her. And if someone gave her information or instructions verbally, she forgot in a matter of minutes. So she repeatedly failed, not following through with court-ordered services and not understanding why she was in trouble. Frustrated with not understanding what she needed to do to get her kids back, she relapsed over and over.

After some time in an inpatient treatment center, Mary moved into a structured transitional housing program for women with children. Her two older children were placed with her. When the third child arrived, she maintained custody. Her weekly schedule included mental health treatment, chemical dependency treatment, visits by a public health nurse and case management services. She received social security as a result of the testing, and her mental health provider serves as her payee. All of her providers were given basic information about her neuropsychological assessment so they could modify their communication with her. More importantly, Mary was taught about her disability. She asked her providers to write things down for her, remind her, and to “not use such big words.”

From the transitional housing program, Mary and her children moved to a permanent supportive living situation that requires she participate in case management services. (“Do your services or you will lose your housing.”) Her children attend a therapeutic child care program, which monitors her parenting and provides coaching for her. All of these services were available in the community, without accessing special funding.

Mary’s providers have created a safety net for her and her family. Today she is clean and is parenting all of her kids. She understands that she has been successful because she is willing to use the services. She has been able to build a natural support system, in addition to the professional support.

There are parents with FASD whose disabilities may be too severe, or who won’t use the services. It may be that the resources needed to provide adequate support, to continue beyond the dependency case, are not available. However, using the neuropsychological testing as a guide, success is possible and it may keep families together.

** Note: Mary is a "composite client" representing two clients.

Author biography:

Nancy Whitney is the Clinical Director of the King County Parent Child Assistance Program (PCAP), a program at the University of Washington School of Medicine, Department of Psychiatry’s Fetal Alcohol and Drug Unit. She is a licensed mental health counselor and is a clinically certified forensic counselor. Whitney contributes to PCAP’s ongoing research and to the development of interventions for high-risk populations. She has co-authored research papers and a book chapter on these issues. Whitney has been a mental health professional in the community settings for 22 years. She has worked in treatment settings with clients who are chronically mentally ill and have co-occurring disorders. She regularly provides training to professionals who serve the community’s most difficult clients on topics including FASD, case management and clinical interventions.

References:

PCAP report to Division of Alcohol and Substance Abuse, Washington State, December 31, 2009

Resources:

Fetal Alcohol and Drug Unit, University of Washington, School of Medicine

Washington State Parent Child Assistance Program, University of Washington

 

 

 

 

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