To Parent or Not To Parent?
©2003 Teresa Kellerman

Q:  Do you know of any really good articles/books about how to help people with Fetal Alcohol Syndrome to be good parents?  What does one do when a child with FAS grows up and has children?  Is it possible for them to become good parents?  Does it depend on the individual?  What kinds of help do they need?  Are there predictors to look for that will tell which alcohol affected people can or cannot be safe parents?

A:  Wow!   Good questions.  

Hmmmm.  How do we help people with FASD to be good parents?  That all depends on the individual and how they are affected.  Statistically, according to studies done by researcher Ann Streissguth, 90% of adults with Fetal Alcohol Spectrum Disorders (FASD) are not capable of functioning successfully on their own in life and employment.  Only 10% will be able to live and work on their own, and I'm not sure how many in this group would be able to parent on their own successfully.  They are the exception, and probably have quite a bit of external support from family and community services.

I think that if someone who cared were to read two or three of the books I have recommended in the FAS Book Store, they would understand that the individual would need INTENSE support in order to raise a child safely.  Read the "Antone Grows Up" book and "Overcoming Secondary Disabilities"

I would say that it IS possible for them to be good parents, in that most of them, if they are classic FAS or FAE with no serious mental health issues, are loving and caring individuals.  

What level of supports they need depend on the individual.  My son John cannot remember to take his own meds and cannot care for his dog without lots of cuing and prompting.  He is 25, has pretty much reached his max level of maturity, and will never be able to parent a child, even with lots of help, which would mean full time live-in 24/7 support, which is not available, and which I am not able to provide.  

I have email friendships with many parents of young adults with FASD who have given birth to children.  A few are success stories, most are heart-breaking horror stories.  The one real success that I know of involves full time support of Grandma in the loves of the affected child/parent and the grandchildren, without which support there would surely be abuse, neglect, or drastic disaster of some sort, with the children being removed from the mother (who truly loves them) to be bounced around the court system and foster care system, which seems to be the scenario in most cases.  

The predictors can be made by asking some key questions: What level of maturity does the person show in daily life, in self care?  Can he/she take meds on time?  Make doctor appointments?  Know when to consult the doctor?   Can tell the difference between a mild medical problem that can wait until Monday morning and a medical crisis that requires emergency care immediately?   Can he/she responsibly take care of a pet, with no neglect or abuse ever?  The thing to look at is the judgment.  What kind of life-or-death decisions have they made in the past few years?  Can they hold down a job for longer than a year?  Can they pay for their own vehicle and insurance?  Can they manage a budget?  Will there be enough money on hand to pay for prescriptions three days before payday?   Or is the money gone a few days after they cash their check?  If they need cautious guidance to manage their money, how will they do at caring for an infant?  Is their judgment stable and consistent?  They might show good judgment 90% of the time, and 10% of the time will just blow it.  What if the poor judgment involves the safety and health of a child?  

If the person has been identified and diagnosed as having FAS or FAE, they probably will not be able to parent a child successfully and safely (with a few exceptions).  If the person is suspected of being affected, but has made it through high school, is in a stable relationship, and lives on their own and holds down a job, then maybe there is reason for cautious hope.  

If the person was affected enough to be in a special ed placement in school, take a look at the psychological evaluations, if there are such reports available.  If the individual is in the mental health system, then a psychologist or psychiatrist who understands FASD issues could perform a global assessment using various evaluation tools to determine the individual's ability to use what life skills they have in fucntionings as a parent.

An assessment of functional abilities like the Vineland Adaptive Behavior Scales, which is often performed as part of a special education assessment, would be a good indicator of the person's ability to function in life.  John's IQ is right on the border line.  But his Vineland score is 30 points below that, and shows life skills that vary from first grade level to teenage level.  You would never know it by looking at him, he talks a good talk, and can convince people that he is capable of normal function.  But his ability to function and make decisions can be anywhere from 5 year old level to 25 year old level.  Neither he nor anyone else can predict on any given day where he will function.  He knows this and accepts the need for close supervision at all times, just in case the 5 year old inside is in control.  

But he did not have this level of acceptance 7 years ago, when at age 18 we had the following interaction:

John was sitting on the family room floor, next to his dog, patting and hugging the patient puppy, who weighs 50 pounds and can defend herself against his rugged affection.  John looked up to me and asked, "Mom, I would make a good dad...  wouldn't I?  Don't you think I would, Mom?"

My heart sank, as I knew it was time for another one of our Reality Check discussions.  I didn't want to break his heart or his spirit, but neither did I want to enourage him with false hope for a normal future.  I stifled my first instinct to declare "I don't THINK so!"  I asked him a few questions instead.  But first I affirmed his good qualities.  

"Well, John, let's see.  I think you are a very loving person.  You are nice to little kids, and you love your dog, and your dog loves you back.  You are affectionate and like to give hugs and like to make people smile.  Those are great qualities for a Daddy to have.  But do you think you could take care of a little baby?"

He frowned and thought about that, but continued to listen.  

"How well do you take care of your dog?  Do you always remember to feed her?   Do you check on her water, or do I have to remind you about that every day?  Do you remember to take your meds every day?  Could you remember to do all the things you would need to do for a baby?"

"I don't know." More thoughtful frowns.  

"Would you be able to provide for a baby and the baby's mother as well as yourself?  Do you make enough money to take care of three people?  Because the mother would not be able to work if she has a new baby.  Would you be able to help her take care of the baby?  Would you be patient if you had to wake up two or three times at night because the baby was crying?  Would you be able to remember to change the baby's diaper?  What if the baby had dirty pants and you forgot to change the diaper and the baby got a bad rash on his bottom?"

At this point, John burst into laughter at the thought of a baby with a dirty diaper.  He switched into silly mode, as he does unexpectedly sometimes, maybe to break the tension of a serious discussion, maybe just because the FAS went into 5-year-old mode.  

"Diaper rash would be really painful, John.  The baby could get sick and have to go to the hospital.  And if you could not take care of the baby, social services would have to place the baby in a foster home, and you would not get to raise the baby, and the baby would not get to be with you and the mother.  The baby might have lots of emotional problems because of this.  Would that be the kind of life you would want for your child?"

Serious again, he shakes his head no, as he continues to pat his doggie.  I suggest that maybe he had better stick to taking care of a pet.  He agreed.  I asked him to think of other ways he could meet his need to love children.  He said that maybe his brother would have a family some day and he could be Uncle John to his nephews and neices.  I thought that was a great idea.  I asked him what would happen if he was in a sexual relationship and his girlfriend got pregnant.  He decided that they should prevent that from happening.  I asked him how?  Since condoms and other forms of birth control are not very reliable, and they might get pregnant anyway.  He said that maybe he should get a vasectomy.  I was so proud of him.  The experience of seeking and getting that procedure is another story for another web page.   Some people see this solution as sad.   I see it as a happy resolution to a very difficult issue.

Seven years later, he has had his vasectomy.  He has been in a romantic relationship for 2 years now, with a lovely young lady who also has FAS.  They are a perfect match.  At this point in time, John has still not become sexually active (a result of his own decision based on guidance from his parent and protector).  If and when he becomes sexually engaged, parenthood is one option we will not have to worry about.  

Further reading:

FAS Community Resource Center