Creating a Family: Talk about Adoption & Foster Care

Parenting Kids with Prenatal Exposure (Part 1): Practical Tips

March 09, 2022 Season 16 Episode 10
Creating a Family: Talk about Adoption & Foster Care
Parenting Kids with Prenatal Exposure (Part 1): Practical Tips
Show Notes Transcript

Do you suspect (or know) that your child was exposed to alcohol or drugs during pregnancy? We discuss tips for how to best work with these children with Dr. Robin Gurwitch, a professor at Duke University's Department of Psychiatry and Behavioral Sciences and the Center for Child and Family Health.

In this episode, we cover:

  • How does prenatal exposure to alcohol or drugs affect children at different ages? 
  • Oftentimes adoptive, foster, and kinship families may not know specifically if their child was exposed in pregnancy to alcohol or drugs? How can a parent determine if their child was prenatally exposed?
  • What are some of the more common signs, symptoms, and behaviors a parent might see at different ages? 
    • Birth to age five
    • Elementary age
    • Tweens and adolescence
    • Young adults
  • Parents, teachers, and other adults working with these children often don’t think about prenatal exposure because of the lag in time between the exposure and when the more disruptive symptoms appear. At what age do you see parents and kids beginning to struggle more?
  • What are some of the common misdiagnoses that these children receive?
  • How do the attention and focus issues common with kids who have been exposed to alcohol and drugs differ from ADHD? Is ADHD medication effective to improve attention in prenatally exposed kids?
  • Is it common for children with prenatal exposure to be uneven in their abilities? For example, average to above average in verbal skills but substantially below average in other areas.
  • What do we mean by “executive function” or “higher level thinking skills” and how does prenatal exposure to alcohol and drugs impact this?
  • We hear from parents that one of the most frustrating symptoms is not being able to learn from their mistakes. Doing the same thing even though they have been told not to. Not learning from cause and effect. Is this common with kids who have been exposed to alcohol and drugs during gestation?
  • What are some practical tips for working with kids with prenatal exposure to help them thrive at home and at school?

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Please pardon the errors, this is an automatic transcription.
Welcome everyone to Creating a Family talk about adoption and foster care. As you probably know, I'm Dawn Davenport for I am both the host of this show as well as the director of creating a Today I am so looking forward to this show, we are going to be talking about practical tips for raising kids with prenatal exposure. This is the first of a two part series. So make sure you tune in next week when we're going to be talking about transitioning kids who have FASD, or prenatal exposure to adulthood or to adolescence and adulthood. So, tune in then, also make sure you listen to the end of this show because we're going to be giving you some practical tips. Today we're going to be talking with Dr. Robin Gurwitch. She is a professor at Duke University's Department of Psychiatry and Behavioral Science, and the Center for Child and Family Health. I am so excited to be talking with Dr. Gurwitch. You guys are in for a treat. She and I had, gosh, when was it Robin? It was probably about two months ago, we were supposed to be able to be talking for about I think it was gonna be like a 20 minute call or something like that. I think I blocked it out on my calendar for like 30 minutes. And she and I were going strong. At the end of one hour both of us had meetings we had to get to I just had a it's funny because it's it's weird to say I was having so much fun, because we were talking about well also trauma in general, which is of course not a fun topic. And prenatal trauma and prenatal exposure specifically, but it is so it is fun. It's rewarding when you're talking when you're on the same wavelength to somebody and, and we weren't quite finishing each other sentences. But it was it was enjoyable. Maybe fun is not the right word, but it was enjoyable. So welcome, Dr. Robin Gurwitch to creating a family. Thanks so much for being here with us today.

Dawn, it is my pleasure to be with you and everyone listening out there. Yes. To echo Dawn's comments, it was like finding a kindred spirit. As we got talking, we kept finishing in one idea. I am delighted to be joining you today on such an important topic for the families that you serve. Yeah,

it is a very important topic because many of the of the demographics that we serve as foster adoptive and kinship families are parenting kids who've had prenatal exposure to either alcohol or drugs. So let's start at the beginning, I think it's helpful to lay the groundwork for how the use of alcohol and drugs during pregnancy affects children. And I'd like to talk about how it affects kids at different ages. But But let's start we're gonna we're gonna jump into that. Let's start more just generally, just how do alcohol and drugs affect the developing fetus? And then we're going to break it down by what are the signs and symptoms we see at different ages?

Sure. So let's let's start even one step back. How big is this problem? Yeah, so it is it is huge. We know that about 11% of all births seem to be impacted by parental drug or alcohol

use 11%. Wow, not 11%.

But what we also know is when we look at children that come through the top Protective Service system that come through child welfare systems, then the percentage has changed tremendously. So we're looking at around, you know, close to 50,000 kids ending up in child welfare, this was from 2019 information, because of prenatal substance exposure, the majority of those kids in out of home placements, you're talking about children primarily in that birth to six age range that end up in foster adoptive kinship care placement, with kinship being one of the biggest, fastest growing placements that we have. And so we look at those numbers. And while it's 11% of all births, when we look at that specific group that are in the families that you serve, you're talking about children that around close to 50%, right, of the children that you serve, and that's the kids that we know about.

I was just gonna say 50% seems low to me.

Those are the kids we at we know about. But like you and I talked how many times do you have a child that comes in and you don't have that information? Or most

of the time? Most of the time you have you don't have that information?

I think that is that's a big issue. And maybe we can talk about that at some point about how how would you even know or what kind of information would you seek? So We can, we could probably talk for hours, but yeah. And when we think about these children, we know that as they come in this is not anything they asked for. Right? And sadly, there's nothing that when a pregnant woman ingests drugs or alcohol, that there's a little sentry at the uterus that says, No, you can't pass through here. So anything that mom uses comes through to the baby. There's often a question, well, what about Dad? What does? What does that contribute to all? Right? And, and, yeah, Dad's important, but once the baby occurred, then it's really on what is mom done? What we do know is, dads have a tremendous role. Because we know that if there was domestic violence before it continues through pregnancy, oftentimes, and being hit or punched or slapped or taking falls, being kicked in the stomach, when you're pregnant is not good for the baby, or for the mom, for that matter, we know that oftentimes, couples use together. So if, if a pregnant woman is trying to cut back or to stop, she's got to have the support from her partner, if a partner is not supportive of it, then the likelihood that she will continue to use goes up. So we know that dads are and moms, whoever the partner is have tremendous roles to play. But what happens to the baby really is dependent on what the pregnant woman is, is putting into her body.

What we do know is that alcohol especially but also other, both legal and illegal drugs, alter the brain structure of the developing fetus. And so what we result the end result can be depending on the substance, the timing, and the pregnancy, and how much can can cause brain damage. That's the, that's the end result.

Right? The sad end result. And, and you're right, there's, there's not a magic formula, if you use at this point in your pregnancy versus this point, or if you do this much, and not that much. We don't have that magic formula. We know that anytime that a woman stops is better for the baby, as soon as she can stop. But sometimes if if women are really struggling with addiction, may not even appreciate they're pregnant until they're well into that first trimester. So sometimes damage has already been done.

Even when they even when they want to stop, right, even when they want to

stop. So again, better stop. Sooner stop. But what we also know is that it'd be really nice if we had the little silos, alcohol here, cocaine here. Methamphetamines or pills hear it sadly, and tobacco please, let's not forget cigarettes

and marijuana, because marijuana

and it is more common. define multiple substances rather than just a substance. Right. So that makes the picture much more challenging. Because how do I know this resulted from substance a versus substance B when what we're really looking at is probably alcohol and other drugs. Mm hmm. Yeah. I think you hit the nail on the head, please. I do not want anybody out there to say, Well, Dr. gurwitch said it's okay if we do all these other drugs just don't drink. But if I had to pick one thing, if you if you forced me to do stuff, the one thing I would say absolutely please think twice or three times and just don't even consider it is to alcohol use during pregnancy, because alcohol use during pregnancy is what we call a Taran ajan. And utter antigen is just a really fancy name for a poison that affects the fetus during development. And what we know right now, is of all the substances out there. Alcohol use during pregnancy is the known to Ratjen of all substances that means we absolutely know it creates a syndrome and it is, it is the leading cause of developmental delays and cognitive impairment intellectual challenges than any other reason higher than Down Syndrome higher than in cerebral palsy. Alcohol really does create this syndrome and then you have what if they did lots of other things on top of the alcohol and alcohol Don is also challenging because in the Last mom comes in and she is completely wasted. The likelihood that she would ever test positive for alcohol unless you do these super expensive tests to look at hair follicles. Right? It doesn't show up.

Yeah, it doesn't. And that's, that is one of the misperceptions that if a child is not born dependent on any substance, but that is that then the child is likely not to be impacted. But that is just the tip of the iceberg. Because that's simply mothers who have used an addictive substance in the last, say, eight weeks of their pregnancy with the where the baby then would be born dependent. So that's in no way reflective. It's a it is it is such a misperception. Now, let me You have mentioned that as, as you, as you pointed out, it's if it's alcohol, we're probably not going to know unless we get a good history from the mom. And that's something that that that we we certainly have done a good job of advertising that it is not safe to drink when you're pregnant. Because of that, there's a lot of shame associated with it. And women don't necessarily want to jump up and say, Yeah, sure, I you know, so it's hard to get that information because of of the the human tendency to want to protect yourself and also not want to fess up.

And I think the other thing that is equally challenging is that to diagnose an infant or young child or even an older child and adolescent with fetal alcohol spectrum disorders, it requires the diagnosis be made by a physician by an MD. So for for almost two decades, I was fortunate to direct a program specifically for birth to sevens who had been impacted by peroneal drug and alcohol use. It didn't matter as a psychologist, I could guarantee this is a child that would meet that diagnosis. Because we look at lots we look at how their face is formed, we look at other kinds of medical issues, we look at learning and behavior challenges. It wouldn't matter because I'm a PhD, not an MD. And so fortunately, I had a wonderful working relationship with someone in genetics, who could make that diagnosis. Sadly, most physicians are not trained to look at or appreciate an FASD fetal alcohol spectrum disorder. So if you're concerned, you really have to ask for a referral to a geneticist. And the older the child becomes, actually, the harder it is to make that diagnosis. I think too, you know, as, as we talked about, if if you can't see it at birth, you can pick up other things. But with the exception of opiates, babies are born and they may be processing the drugs that went in, they may have impacts from the drugs that are there. But the only thing babies are born truly addicted to needing to have a medical withdrawal are those opiates heroin, which sadly are up in use, though we are projecting that the number of babies prenatally exposed to opiates are also up because the biggest jump in for that group is childbearing rage. So physicians actually have to do a medical withdrawal of that baby from opiates. other substances may have lingering impacts when that baby is born. So you see things across drug and alcohol use, like shaky tremors, jitteriness, problems, sleeping babies can be super either hypo which means lack of or hyper meaning extra stiff in their in their muscle tone. It can go either way. They can have some sleep problems and eating problems and all of those things we often see in infants, they're irritable, hard to soothe, hard to very hard to soothe. We've seen some studies many years ago, looking at just the quality of the baby's cry, saying that it is you know, louder and more shrill and last longer. So think about, oh, think about a baby with colic, multiply it by about six and have it last for about three months straight. That is gonna test the mettle of even the most caring, loving, committed caregivers. You are also exhausted. So this isn't a Oh, it's just it's just affecting the infant. It's affecting the whole family.

Yeah, for sure. I am so excited to tell you about a site where you can get more expert based content that expands on today's podcast topic. Jockey being family foundation has supported our ability to offer you 12 free online courses at our creating a online Parent Training Center. You can get there by this shortened link, and it's Bitly slash JBf support, that's bi T dot L, Y, slash, J. B. F support, there is a great variety of topics to choose from. And so example would be how does adoption affect the bio siblings and a family a really good course. And one if you have bio kids you should be thinking about. So check it out at Bitly slash JB F support. Okay, so we've talked about some of the common signs, symptoms and behaviors for birth to six months. So let's now move into the toddler preschool age. What are some of the signs symptoms and behaviors of parent might see it this age for a child who was exposed to any type of substance, alcohol or drugs. So let's talk about the preschool age and you know, the toddler to preschool. Sure,

so I'm gonna put these all together under the, you know, prenatal exposure, the drugs and the alcohol and other drugs umbrella, recognizing that there's not absolutes. Perfect, but I think when we talk about the toddler to preschool years, sometimes what we be, we may see are some mild developmental delays. So maybe they're not meeting milestones is easily. Some of the things that we see are problems with their attention span, they're more hyperactive. So many, many of these children end up being diagnosed with attention deficit hyperactivity disorder. And that's one of the characteristics that we often see in children across the age span, but it really begins to show itself in those preschool, those toddler and preschool years, they may have a hard time just getting used to different things that come into their little worlds. So loud noises consistently, grab their attention, whereas kids without this exposure begin to habituate. They get used to it, there's a siren that passes or, or there's construction outside, that sound being there. Whereas these children's sometimes each time is harder, or like a new thing. children this age oftentimes have difficulty following your directions, they have difficulty adapting to change, and change is part of childhood. But it can really throw these children for a loop if there's multiple changes happening. So later when we talk about some tips and strategies, say it now and I'll say it again, the more you can have a stable routine in your family, the better it's going to be these children, it's actually good for all children. But definitely, for this group of kiddos, when we go to the sort of the school year, don't just go away because they've gotten older. And that's oftentimes if we don't know what's contributing to the issues, we may hope that the children grow out of it. So maybe with experience maybe with time, things will get better. Things just change, particularly for children with fetal alcohol spectrum disorders. Those are that happens and it lasts a lifetime. There's nothing there's no quote, cure for fetal alcohol spectrum disorders.

We say you don't outgrow brain damage. That's just the truth. You don't Yes,

it's just the way children are wired. And so when we think about going into school and sort of middle childhood, this is where we have to recognize particularly if there's alcohol exposure, that being able to stay in sequences, even if you've told them many times, if you do this, then this is going to happen. It doesn't sink in. As you would expect. For the majority of children. This is very hard for them. And as caregivers, we often misinterpret it, as they're being willful or stubborn, or they just won't learn. It's not that they won't learn they can't without some a lot of help to understand those consequences. Thinking becomes very concrete for this age child. So think that like sarcasm, maybe completely misunderstood by a child, they have a hard time thinking outside the box. They don't always understand social rules and expectations. And again, it's not that the child is trying to be difficult, I truly am trying my very best, but the way my brain is wired just doesn't allow that to always happen. Again, at this stage, if they haven't been diagnosed with Attention Deficit Hyperactivity Disorder, the likelihood that they will get it in school is is very, very high.

Yeah, let me ask we often see more questions and more of a light bulb going off for parents that something is wrong, when their kids are entering? Second, third, fourth grade that that age and I think you you said it well, that when our children are five, and under there is this expectation that well, all kids are, are are active all all kids are many kids are active, many of this this active, many kids have trouble following directions, many kids don't seem to learn from their mistakes, but the expectation is a little maturity, and they're going to do fine. And then and then and then even sometimes in first grade, the expectations academically are just the acquisition of the basic knowledge and and these kids may be able to keep up but at some point, our schools expect something different, you know, they call it executive functioning or higher level thinking skills. And then are these kids really struggling at this point and their behaviors, their lack of picking up on social cues, their their activity, level impulsivity, their lack of attention? They stand out more from their peers? Do you see that as well? And in kind of that early to mid mid elementary age?

Yeah, we do we do die, I think we see a lot of times expectations with in school change. And this would be true with children with drug and alcohol exposure. This is also true of children that have had other types of trauma. And for these children with prenatal drug and alcohol exposure, it's often linked with higher risk for child maltreatment. So it's compounded potentially, which makes it even more challenging. And they go into school, their different expectations placed on them, not only at school, but also honestly at home as well. Sure they're growing up, and I take my child to the doctor, the doctor says, Is he doing these things, check, check, check. And so some of them, the more subtle issues wouldn't ever come to attention until the parents say, hey, wait a minute, this is not what I had with other kids in my home. This is not what I see with my friends, children are my relatives children's, and I have this feeling that there's something else wrong, be the voice for your child, because sometimes your voice is the strongest, most powerful voice to get the problem diagnosed, to get the problem identified. And you mentioned earlier, and I think it's really important that a lot of times we don't want to put a diagnosis on we don't want to say this has happened because there's a stigma attached. The problem goes the other side, too. If we don't accurately evaluate what's happened, then two things, one, we cannot get the school programs in place for the child that the child really will benefit from. Because oftentimes it requires that assessment and that diagnosis, and to if I don't label it, then I don't know what to do about it. I don't know what to expect down the road. If I if I know what to expect as a mom, then I'm better able to handle what comes down the pike. But if I don't know, then I may be expecting one thing and it just doesn't happen.

There's also potentially federal money that would be available for a child with developmental delays, including those resulting from prenatal exposure, developmental disabilities, I meant, but a diagnosis is required. So that is something absolutely, yeah, that's something else to think about. We want this podcast to meet your needs. And the best way to do that is to actually talk with you so what I'm doing is asking you if you would please let me talk with you. If you've got about 10 minutes to share your feedback and you're willing to talk with me personally, please email me at info at creating a and then in the subject line put talk with On, and I will reach back to you and try to schedule a time that works that works well for you. I truly would like to connect with people individually. So I really would appreciate it, if you will, if you'll email me and let me talk to you. All right, now let's talk about behaviors and symptoms that we might see in tweens and adolescents, or is it and it may just be a continuation of what we've seen in elementary school. But But what are some some other signs that if you have a tween in a team,

or that you might think, yes, the same things that have been there continue into adolescence, but sometimes what we see with with tweens and teens is, as they are starting to have more and more responsibilities, they have a harder time just adapting to these new demands, we may see some academic achievement that's lower than we would expect. And so sometimes we do have a learning disability. So that sometimes means that IQ is pretty good, but they're still struggling with with reading, for example. And if we don't know that could be a sign of a learning disability, we say, Oh, well, the IQ is just fine. So they're just my start be trying hard enough. So we really have to look and as you said, if we have a diagnosis that opens up show many services in the schools, sometimes with adolescents, what we see is an increase at times with things like lying, and it's, again, I don't know what you want, and I'm trying to make sure that I maintain the status quo. So I will, I will tell you something that may not be true, but sometimes it's really concrete. So the child is tossing a ball around the house, it doesn't matter that you've told them a million times not to do that he's 13 He should know better. The lamp breaks and we say did you break the lamp? And the answer is no. Well, because really and truly, I didn't break the lamp the ball broke the lamp but I don't I'm fairly concrete in my thinking and I don't put it together that I threw the ball the ball hit the lamp, the lamp broke so it's me.

Yeah. Or Or I've also seen where the the first response is? No, it's not it's not as much a lie in that sense is it is a buying time to figure things out and to allow processing absolutely

in the reality is if you know the lamp was broken by the child, don't ask the question. You know the answer to this, when you say did you break the lamp, then I'm gonna guess that may be there's a chance you don't know. So just deal with it. I know you broke the lamp. Now we're going to talk about what happened and go from there. We also sometimes see for adolescents, because they do have a hard time sometimes reading social cues, may have more difficulty with friendships and relationship issues, they may have lower self esteem motivation. So oftentimes, these children are higher risk for mental health issues like depression and anxiety, just because of how they're fitting into the world around them. And expectations, like money being reliable with money are challenging for them. We oftentimes sometimes see some inappropriate sexual behaviors, or children easily taking it or teens, easily being taken advantage of. So that also can become an issue, behavior problems from the time they're toddlers, to the time they're through adolescence. So being able to sort of regulate my emotions becomes a tough thing. Regulating emotions at any age becomes harder. And as kids get bigger, they don't necessarily learn how to regulate better, it just changes. But the bottom line is that I have a hard time regulating behaviors. So behaviors are often seen as disruptive behaviors are seen as non compliant, which leads to a host of problems from the time they're walking until their time they're, you know, all the way through graduation from high school. Right.

You know, I think that sometimes with one of the hard parts for kids with prenatal exposure is the impact is not always even, that they they will have they will be uneven in their abilities. In fact, it can actually be a hallmark of how we can determine a child who may have been prenatally exposed. You know, that could be a above average, even in their verbal skills, but substantially below average in other areas that the term that you use and I some people find it offensive, but I actually find it helpful. So I apologize to somebody else. A is offended. But Swiss cheese brain is such for me it's a good, it's a good description that people get that that this child is, is the impact is not even therefore parents are looking about. Come on now, you know, you can you can read out the wazoo and you know, but you can't do this or you're able to do X and you're not able to do this, this makes no sense. You're not trying

it. Exactly, exactly. And I think from the very beginning, again, it is not, it's not the fault of this child of this infant. But sometimes just being able to make eye contact while they're eating is hard. Sucks follow brief becomes a challenge for some children. And so as the caregiver, I may see that this child really isn't bonding are connecting with me rather than attributing it to too much stimulation coming in. And then, as adults, we're looking to get some reinforcement from the children too. It's a two way street. It's bi directional. And so sometimes we may pull back with keynoting it, and attachments, insecurities may be more challenging. And that continues all the way through the child growing up, or when a child comes into placement, and they're a little bit older. And they've had a hard time forming secure attachments, they come into your home, and they don't know how to do that. So that continues to be a problem. And so it's what the child's bringing in and also what the parents and the caregivers are experiencing. And what we know is when you look at parenting stress, whether it is kinship, bio adoptive, what we see are foster parents is higher parenting stress for these kids, then told them that don't have it. So parents have

this, we hear from parents saying, you know, this kid is just more they intuitively have that gut feeling that yeah, all the diagnoses that are coming in, don't quite, they're not capturing it, there is something more going on, or and or, at this kid's not trying hard enough, this kid is willful, this kid is, you know, struggling with attachment when in fact they're struggling with the ability to figure out either overwhelmed by too much coming in or are not picking up on social cues. You know, one of the things you've mentioned is that another common misdiagnosis is ADHD. So how do the attention and focus issues that are common with kids who have been exposed to alcohol and drugs? How does that differ from Attention Deficit Hyperactivity Disorder, ADHD?

Sure. So one of the things that we know is that ADHD is a neurological issue. Again, not the fault of the child has nothing to do with how their brain is going to be wired, right. And so oftentimes, children with ADHD, we know that sometimes medication can help wonderfully well, because I use the example of an insulin dependent diabetic, that it doesn't matter if I have good exercise, good eating habits, I do everything I'm supposed to do. But I, my pancreas can't make the insulin it needs. So without the insulin, I cannot function well. And for children with ADHD, it's it they may have the you may get the best help you can to manage the behaviors, you may be doing everything you can to structure the home, you may be doing everything you can, but the brain still needs something else to help it it function the way it can to help that child's attention. So for typically, for kids with ADHD without the drug and alcohol exposure, oftentimes, one medication there there many out there may do the trick and help help that child be able to focus attention and concentrate better. There's no such thing as good behavior pills. We don't have one of those yet. So you oftentimes need some support to help manage behavior to help kids make better decisions for kids with alcohol and other drug exposure. It is not it is oftentimes some trial and error work on the part of you as the caregivers as information back from teachers information from the physician that's going to continue to follow what combination may work best for this child. So sadly, it again adds one more layer of what can make parenting a little but more challenging

is ADHD medication as effective at improving attention in prenatally exposed kids as it is for kids who have ADHD, but it's not connected to prenatal exposure.

So what we know, again, I was really fortunate to work with with a physician that this was what he did for most of his career, and he would talk about having to find that right combination. And with that right combination, you can get wonderful results, as you know, just like kids without the prenatal exposure, but the other piece that has to be addressed, that oftentimes is not needed with kids without the drug and alcohol exposure is what to do with those disruptive behaviors that are often hand in glove with the attention deficit problems. So we may deal with the attention deficit problem with medication, but there really has to also be dealt with as an independent issue, to deal with those disruptive behavior issues. So the child can learn to make better choices, they begin to understand what happens. And again, as kids develop, I really put those children on the fetal alcohol spectrum in a class, sometimes by themselves, because that is even more challenging than for kids with other dry type exposure, including cigarette smoke.

Okay, I didn't follow that. Okay. So you're saying that kids who have had prenatal exposure, are going to be harder to regulate both behaviorally as well as through medication with ADHD? Is that what you were saying?

Yeah, so the medication with ADHD, I think if you get the right combination, if you're working closely with your physician or psychiatrist around medication, you can probably find something that is going to work very, very well. But it doesn't unwire the brain, it doesn't change some of the behavior challenges. So that needs to be dealt with this is sometimes almost an independent issue.

That makes sense. What is the latest research on whether children who have been exposed prenatally to alcohol or drugs? Are they more likely to abuse drugs or alcohol and adolescence and adulthood? Is the you know, has their brain been we rewired to be seeking more of the of the chemical input that drugs would provide or alcohol. So really

good question about are they more likely to develop their own substance abuse problem, there's a couple of things that feed into that. We're learning more and more that genetics plays a role in addiction. your genetic makeup may predispose you to be more susceptible for drugs and alcohol. So that's one, two, I think we we recognize that children who've experienced adverse events in childhood trauma, lots of moves from foster home to foster home to foster home, they may have had some problems with bullying, they may have had problems with exposure to violence, or maltreatment, all of those things, we know make children make young adults much more susceptible to trying illicit drugs being involved with some disabused issues. And so it would I hate to be unequivocal and say yes, absolutely. If you've been prenatally exposed, you are absolutely boy higher risk. So so I'll try a different way. Yes, you may be at higher risk because of some genetic makeup. But it also is lived experiences that you've had that may also put you at higher risk. I've had problems making friends, I've had difficulties in school, which leads to lower self esteem and self image, which puts children at higher risk for experimentation with drugs and alcohol. So again, it starts at how what's the youngest we can start and make some changes so as children get older, they may be less likely to go down that road.

And I think that it's also that the research is compounded because and you're alluding to this, many of these children are now being raised in a home with substance abuse disorders or with alcoholism or, or excessive alcohol use. And so and that also makes it makes it hard to tease out if that child is more likely to abuse drugs because of the environment they were raised in or because of the fact that that that they have a brain their brain has been reset or they have a genetic component.

Yeah. It's really interesting, I will never forget one time doing an intake interview with this absolutely lovely grandmother who was raising her grandson. And I was trying to get some information about what may have happened prenatally. And when we said, tell us about alcohol use, she went through? Not she said, None. And then because we've learned, we went back and said, What about beer? Oh, yeah, but everybody drinks beer mom would drink maybe a case every couple days. But she didn't think about that when we got to drugs while everybody in the neighborhood does cocaine. So she didn't think it was important because cocaine was such a part of the neighborhood, it really wasn't seen as abnormal. So sometimes, we don't always get the information we would like because the person providing the information. Thanks for giving a good story. Good history, but it's incomplete. I think the other thing that's hard is oftentimes children end up in kinship, foster or adoptive placements. And there's incomplete records, right? Yeah, absolutely. I don't even know. I think, ask, say, I really want to know find out was, was there any during pregnancy? Was there any drunken disorderly 's? So was there any any kind of involvement with the police did anybody else report that mom drank or use drugs, ask them even if they're 14 to go back and look at birth records to go back and look at her. And I'll tell you that other thing that is really to ask for if you're concerned about alcohol exposure, and being on that fetal alcohol spectrum disorder, it becomes harder and harder to make that diagnosis, as children get older, because the facial features change. And some of the hallmarks of making that diagnosis is based on facial features, measurements and other things. Take a look to get baby pictures and toddler pictures. And under six pictures, if you have some photographs that you can share with the specialist that can help if your child is now 14 1516. Because I can go back, they can go back and look, wow, when I look at these pictures, that's what I'm seeing. But now his face is changing. So it's harder to look at that around alcohol. So sometimes we don't know. And we get sort of a blank slate that we now are asked to figure out how to open our hearts and homes to give this child the best chance of meeting his or her full potential. And there's some things we can do. Yeah,

that's exactly where I want to move. Let's now move into the we've talked about what are the symptoms? We've talked about the causes, we've talked about one of the symptoms, and some of the misdiagnosis now want to move into perhaps a more hopeful part. And that is, what are some practical tips for working with these kids with prenatal exposure to help them thrive at home and at school?

Absolutely. You know, as you mentioned, at the top of this conversation, I'm a psychologist. So if I didn't believe that change was possible, then I really probably need to get a new career. So I really do believe that there's hope. And that should be one of the very most important things that we offer is that this isn't a oh gosh, dish, nothing I can do. But rather, given what I know or what I think is happening, what can we do? So a couple of things. One, we know again, I told y'all I was going to bring it back here, structure is your friend, the more routine and more structure you have in the child's life, the better they're going to do across the board. So having a schedule of, you know, we get up, we get dressed, we have breakfast, we go wait for the school bus, that we do that every single day. So I know what to expect. I know when I come home, this is the routine after school in terms of when I have my stack when I can watch TV or do screen time. What is that and how does that fit in? We know for example, that it is imperative that caregivers are also involved in any type of intervention, particularly from the mental health side around some of the behavior issues. So if someone says okay, I'm going to just take your child back with me and we're going to do some magic and then I'll bring it back to you. You're all ready to go. That let's that doesn't include you and you are so critical to the child's overall well being and development that the treatments for children didn't really need to be a family affair ticularly in those early those early years, those birth to five birth to seven years becomes so critical to help children develop those attachments. We know that there are treatments, for example, and I will freely admit that I am extremely biased, because one of my areas that I specialize in is work for two to seven, and was very fortunate to have a CDC grant years ago to actually look at interventions for children with drug and alcohol, particularly alcohol exposure. And what we found is there's an evidence based treatment that is covered by so many funds out there. It is called PC I T, or parent child interaction therapy, and PCIT is developed for children specifically, from two to seven, it's now been extended downwards to those less than 12 months years to to help children develop secure attachments to deal with behavior problems to give caregivers an idea of how to put in place positive, predictable, consistent discipline programs that work for everybody and work well into the beginning of adolescents. There are also programs for adolescents that may have experienced other types of trauma, trauma focused cognitive behavioral therapy, or TF CBT. Any type of cognitive behavioral therapy CBT approach will work best for these children because it does help give them tools and give you tools as well of what you can do, how you can help. The good news is they work and they work for these children as well.

I want to thank our partner Vista Del Mar for a long time now they have supported creating a family and our mission of supporting and training adoptive Foster and kinship families. This to Del Mar is a licensed nonprofit adoption agency with over 65 years of experience helping to create families, they offer home study only services as well as full service, infant adoption, international home studies, and post adoption support as well as foster to adopt programs. You can find them online at vista del Thank you Vista Del Mar. Okay, so the tips you've given us so far would include having a routine structuring your home making her home predictable, basically so that your child knows what to expect. It doesn't have to waste time trying to be on edge trying to figure out what's going to happen next. The next tip is therapy. And in specific if you've given us two types behavioral therapy as well as PCIT therapy, what are some other tips that parents can utilize? One I will throw out? Is making giving your child visual clues this goes back. sure our kids tend to be with prenatal exposure tend to be fairly concrete and often visual. So yeah, talk to us about that.

Yes, you beat me to the punch Stein. We are such kindred spirits. I love it. So yeah, if you can, if you have routines, you can put some visual cues there. So if there's a place for dirty clothes to go, then put a little picture above your hamper. where that goes, if you have if they're one of their jobs is to put dishes away label where where they go on the shelf. So if you have a schedule of routines, put visuals next to that visuals can be so, so helpful. I think that that becomes critical. If you've got babies, some of the kinds of things that work really well. It's just something as simple as infant massage that can help with colic and help with ways to comfort babies. I will tell you that swaddling is great for these kiddos. They're really little ones. But when you swaddle a traditional swaddle, the baby's hands are inside the blanket. We find that swaddling infants and having their their fists up and up and readily available to suck on seems to help better for babies. Even sometimes simple things like when you're feeding infants that have a hard time being able to remember suck, swallow both while I'm looking into beautiful eyes and your loving eyes. So I have to turn you away and face a blank wall while I feed you, and then turn you back around and engage with older kids, when they start into school, one of the things that sometimes happen is we think, Okay, I'm going to give you a quiet space, don't play music while you're trying to do your schoolwork. That's not going to help. But what actually sometimes for some kids, having that hard bead of rhythm serves to help them better focus than the absolute silence. So sometimes it's working in conjunction what works best. And while I can't, I need like, like classical music, if I'm really focused. And if I were hearing hard rock, I would never be able to focus. But for some of our tweens, teens, that heavy beat may actually be very helpful.

At what point do you recommend? Or maybe? Or maybe the question should be, do you recommend sharing this diagnosis or your suspicions? If it's beyond just suspicion? With your, at this point? Older elementary tween teen, at what age? And is it? Or is it important to share? And if so at what age?

So I will tell you my opinion is the more people that know, the better. Because if I know that I can best help. If I'm if my child has some speech delays, or some sensory motor delays, and they're in physical therapy, or occupational therapy or speech therapy, and I don't share that information with those allied health professionals, then I'm handicapping them from thinking about what are some strategies that may more work a little bit better for these kids, then just my general kids with speech language or sensory integration issues, because sensory integration isn't, is an issue. So we want to put that in, in place, if the teacher doesn't know that I can't make the accommodations that are going to be critical for the child to learn the best they can.

What about the child? When should you share with the child.

So as kids get older, one of the things that when they've gone back in interviewed kids that have had these issues, their self esteem and self worth was so low, because I'm trying the very best I can and I never seem to be able to get it right. I never seem to be able to do it. You send me to the store to pick up a loaf of bread and I come home with a gallon of milk instead. And, and because you wrote it down, but I forgot I put it in my pocket. And I just feel terrible. So how do we sit down and talk to kids? Generally, I would think about late elementary tween teen here is one of the things similar to how you would talk to children about adoption. This is what I know. And I am so grateful you're in our home. Some of the things that I know have been really hard for you, but it has nothing to do with you. You're just wired a little different. But that's one of the things I love about you is that you are different. And because of that there's some beauty in our differences. And how do we teach each other? How do we learn from each other? So helping children understand that while they're trying to the very best they can we also understand that sometimes we need a little help to do that.

Excellent. Any further, I'll give you the last word any other practical tip that you can think of for for families who have parents who are raising kids who were or they suspect were prenatally exposed to alcohol or

drugs? Sure. I'll give you just just a couple of I can sure absolutely. One of the things that we sometimes forget is we are quick to don't do that. doing that. No, no, don't stop, quit no and wait. Think about how many times you use those words in a day, um, score all of those, all of those may be necessary. But all of those also take a toll. So think about finding opportunities in twofold one telling your child what to do rather than stop, you know, banging your spoon, give them what to do, please put your spoon next to the bowl. Right if I know what to do i with with changes in wiring, then I don't have to think about okay, I have to stop this and start something else because you've given me what I need to do. The second thing that is so important is we sometimes forget how important it is to let children know when they do something we like. There is nothing more powerful to change behavior and I mean nothing done. Zero nothing that will change behavior more than positive praise is letting your child know thank you for sharing with me, I appreciate you using your inside voice. What a good job you're doing trying hard on your homework today. When we tell children, what they do well, the more we tell them about that behavior, the more that behavior gets repeated, it is stronger than any kind of consequence you can ever give a child is giving them the positive side of the ledger. That is so important. It's good from the beginning, all the way through. I mean, think out there when's the last time you said, Oh, my God, I got way too much praise for what I've done in my life, we can all benefit from it. These children, particularly will benefit in so many ways, Don, I know we're getting close to the end of our time together. So I just want to make a couple of points. And while they're at the end, please don't take them as a quick throw away, but really take them to heart. One is we have been living through a pandemic unprecedented times. And it would be disingenuous to think that all of us haven't been impacted in some way, shape, or form. So our stress is through the roof, as we've been trying to come to grips with this normal for now time. Recognize that as hard as it is for us, it's also difficult for our children. So a little bit of extra patience, a little bit of extra attention, and love goes a long way for our kids. But in that same vein, please give the same to yourself, your self care, you're taking care of yourself, not only because of the pandemic, but just because of the other stressors that you have. Think about what are you doing to take care of yourself, it is not selfish, it is actually critical. Because if you're not at your best, then you're not going to be able to be the best parent or caregiver that you can be. So thinking about what are you doing for yourself, to help nourish your mind, body and spirit? What are you doing for yourself to make sure you're getting rest and, and time to yourself? I know, it seems like oh my gosh, I can't even imagine that. Figure out how to build it in. It is so critical. So during these times, as you're working so hard for your family, make sure you're thinking about how to care for yourself. And I really just want to say to your families that you reach thank you for what you do. There are so many children out there that need the loving, caring supportive homes that you offer, that those social connections that family relationships. Oh, my goodness, thank you. Thank you. Thank you from the bottom of my heart for everything you do on behalf of these children and families.

Thank you so much, Dr. Robin gurwitch for being with us today to talk about tips for raising kids with prenatal alcohol and drug exposure. For everyone else. I look forward to seeing you next week for the second part of this series, which is moving these kids into adolescence and early adulthood. Don't miss it. See you then.

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