By Gwendolyn Messer
“My job isn’t to make you feel better.”
That may be a strange thing for a doctor to say, but it’s something I often tell people during a pre-adoptive consultation.
As I see it, my job is not to placate or offer empty reassurances. It’s to make sure that prospective adoptive parents are informed and educated as they build their families. There is no doubt that love is powerful and absolutely necessary, but unfortunately it doesn’t fix everything. As you’re making decisions that will impact you and your children for a lifetime, it’s important to have a clear idea of the challenges you may face in the future. And to be clear, uncertainties are inherent in bringing a child into any family and are not unique to adoptive families. However, the set of unknowns for adoptive parents is often different, and may include things such as prenatal drug or alcohol exposure.
Love is powerful and absolutely necessary, but unfortunately, doesn’t fix everything.
And just so you don’t think I’m entirely hard-hearted, after I explain all of this to adoptive parents, I also convey my strong belief that there is a family for every child, and a child for every family. I know families, such as one that adopted 7 children with a range of special needs, and to be honest I cannot fathom how they do all that they do without turning into whirling dervishes…yet they are usually (not always!) peaceful and collected and are raising lovely families. On the other end of the spectrum, I know people who’ve adopted one child with minimal difficulties who are overwhelmed, and it often seems they didn’t realize the potential challenges they might encounter in raising their child. One of the keys is for parents to have a clear vision of what they want and what they can handle and gather the information they need to make an informed decision, always knowing that there are many unforeseeables that may pop up down the road that will need to be addressed.
Most of the pre-adoptive consultations I do are related to concerns about a baby being exposed prenatally to drugs or alcohol or having a family history of substance abuse or mental illness. There are very real risk factors associated with prenatal substance exposure that parents should know about when making their decision. It may be that you decide not to move forward on a referral based on the potential risks, or you may decide to proceed with the adoption, in which case it’s important to be aware of potential challenges so you can identify them if they arise, and get your child the help she needs.
So what are the basics? First, while it’s obviously best not to have any substance use in pregnancy, people are often surprised to hear that I am more concerned about prenatal exposure to alcohol than to anything else, including illegal drugs such as cocaine, marijuana, heroin, etc. Of all the substances of abuse, prenatal exposure to alcohol has the potential to have the most profound effect on the child because it can impact so many areas, including cognitive development and intelligence, language, executive functioning (the way you use what you know), learning disabilities, and behavioral and emotional problems. These are very real possibilities, though not certainties. Some children who were prenatally exposed don’t end up with any deficits related to their exposure, but many do. Unfortunately, the impact of alcohol on the child often cannot be seen simply by looking at the child. The majority of children whose developing brains were affected by prenatal exposure do not have visual evidence of the damage that was done to the brain. There are a variety of conditions that are included under the umbrella of Fetal Alcohol Spectrums Disorders. Children who do not have facial features of Fetal Alcohol Syndrome (FAS) but whose brains were nevertheless impacted by alcohol may have Alcohol-Related Neurodevelopmental Disorder (ARND) or Neurodevelopmental Disorder with Prenatal Alcohol Exposure (ND-PAE); these diagnoses often cannot be made for a few years after a child is born, or even later in elementary school. A normal physical examination does not rule out a diagnosis related to prenatal alcohol exposure.
Each child affected by prenatal alcohol exposure has a unique combination of challenges that requires a unique combination of supports. When parents are aware of what issues may arise, then they are prepared to get help. If a child may have been prenatally exposed to alcohol, it is important to monitor developmental milestones carefully — we know that starting developmental or educational interventions early leads to a better long-term outcome. Any area of development may be impacted, but speech and language development and sensory integration are some of the more common areas of concern. In addition, if a child who may have been prenatally exposed develops behaviors that seem extreme or unusual for his age, his parents will want to seek guidance. Another thing I tell pre-adoptive parents is to be careful where they “Google.” For example, some internet sites suggest that there’s nothing to be done to help children with a Fetal Alcohol Spectrum Disorder, but that’s not true. While you can’t undo the damage that alcohol did to the brain, you can provide interventions that improve a child’s outcome. Similarly, children who’ve been prenatally exposed have an increased risk of ADHD. But some sources suggest that ADHD in children who were prenatally substance exposed cannot or should not be treated with medications, which is false. While treatment may be challenging and may require a physician with dual familiarity with ADHD and the effects of prenatal substance exposure, there is no doubt that it is helpful for many children with ADHD. There is so much information out there to help families make their decision and parent their children, but it’s important that you find a team of people you trust to help sort through it all, rather than relying on the sea of information that comes up on the internet!
Some parents schedule consultations as they’re completing forms for their adoption agency and struggling to answer questions about their risk tolerance. Some talk to me after they’ve gotten a referral and have to give an answer in a short period of time but have questions about prenatal exposures. Some call soon after their child is born, when they’re surprised that either the baby or the birth mother tested positive for drugs. Others come for consultations after their baby is already home and they want to better understand how to support her and what to look for that might suggest she needs extra help. Whatever way fits your family is the way you should go…unless your approach is to stick your head in the sand…denial doesn’t make anything go away. There will be many joyful and carefree times as you raise your family but there will also be times when your child needs you to make careful, informed decisions on his behalf, and that starts right now.
I wish you all the best on your journey to creating your unique family.
Gwendolyn J. Messer, MD, FAAP is Medical Director of Children’s Research Triangle where she works with a team of child psychologists, infant mental health specialists, social workers, and therapists to provide comprehensive evaluations and treatment for children with a history of prenatal exposure to drugs and alcohol, childhood traumatic stress, ADHD, emerging mental health disorders, and developmental delays. Dr. Messer is a faculty member of Chicago Medical School in the Department of Pediatrics. She is committed to educating students, professionals, and caregivers about the impact of prenatal substance exposure and traumatic stress on the developing child, with a goal of improving access to informed care and promoting prevention. You can reach Dr. Messer at gmesser@cr-triangle.org.