For years, Mary Ann Holman-Turner was puzzled by the erratic behavior of her foster child Emmanuel, whom she nicknames "Man-man."
Without apparent reason, he would hurl objects, slam doors and lie awake most of the night. In preschool, he had trouble sitting still and was unable to color inside the lines. Doctors wrongly diagnosed him with attention deficit hyperactivity disorder (ADHD) and prescribed him the stimulant Adderall to help him concentrate.
It was not until Man-man, now 15, turned 5 that Holman-Turner learned of a condition called fetal alcohol spectrum disorders (FASD), a range of mental and physical conditions caused by a mother's drinking during pregnancy. "Suddenly, it all made sense," said Holman-Turner, of Minneapolis. "My baby was misbehaving because he had brain damage, and everyone had failed to see it."
Now, under a new state law, foster parents in Minnesota are far less likely to be in the dark about one of the leading causes of developmental delays in children. Gov. Mark Dayton last week signed legislation that makes Minnesota the first state in the nation to require foster parents to receive training on how to recognize and treat the effects of prenatal alcohol exposure.
The law culminates years of grass-roots lobbying by disability advocates, and requires all newly licensed foster parents to receive an hour of training on parenting strategies for children with FASD. While the mandate is modest, public health advocates said it will bring increased attention to a condition that often goes undiagnosed and untreated. Because children with fetal alcohol syndrome often show no physical symptoms, they are frequently treated for emotional and behavioral problems, such as inattention and hyperactivity, that are actually the result of fetal brain damage, psychologists maintain. Many are misdiagnosed as having ADHD or anxiety disorders, and are given powerful combinations of medications.
"The system isn't broken for these kids. The system doesn't even exist," said Sara Messelt, executive director of the Minnesota Organization on Fetal Alcohol Syndrome, an advocacy group.
High risk in Minnesota
Public health officials estimate that about 7,000 children are born in Minnesota each year with alcohol exposure before birth, which puts them at risk of fetal alcohol spectrum disorders. The risk of exposure is particularly high in Minnesota — a state that in 2013 had the second-highest rate of alcohol consumption among women of childbearing age (ages 18 to 44), behind only North Dakota.
Among children in foster care, researchers have found that rates of fetal alcohol syndrome are as much as 10 times higher than the general population, because foster children often come from families with histories of alcohol abuse. Advocates and lawmakers said they expect mandatory training will help foster parents identify the early symptoms, which can include impulsivity, lack of comprehension and poor judgment.
Without recognizing the signs of fetal alcohol exposure, many foster parents become overwhelmed and frustrated, and respond in ways that can actually aggravate the condition, advocates say. They may punish children for behaviors, from missed homework to violent rages, that are largely outside the child's control. Traditional parenting techniques such as "time out" may not work because children who were prenatally exposed to alcohol are often unable to comprehend why they are being punished, health officials say.
Linda Walinski, an adoptive parent and psychologist from Isanti, said she "feels like sobbing" when she recalls the mistakes she made raising four children with fetal alcohol spectrum disorders. The children received mostly failing grades in school and struggled with periodic meltdowns — sometimes screaming, kicking and even biting their classmates, she said. Unaware of their underlying disability, Walinski would keep them inside after school until they finished their homework, only to discover later that it was never handed in. "The kids got straight Fs no matter what I did," she said.
Then, two years after she adopted the children, Walinski had a flash of recognition. At a conference in Bloomington, she heard someone describe the symptoms of FASD and saw similarities with her own children. Months later, Walinski brought all four children in for testing at the University of Minnesota and they were all diagnosed with the syndrome. She changed her parenting approach, relying less on "stern consequences," as she calls it, and more on positive support and redirection. Almost immediately, the family environment became less stressful, teachers tempered their expectations, and their self-esteem improved, she said.
"If we don't know what we're doing, then these kids will never realize their full potential," Walinski said. "The critical thing to remember is this is brain damage. You can get mad at them, scream at them and punish them, but it won't make any difference. It's brain damage and it's not their fault."
'Stressed out' foster parents
Michael Harris, a foster parent and psychologist at the Indian Health Board of Minneapolis, who holds workshops on fetal alcohol spectrum disorders, said foster parents of children with FASD often come to his office "stressed out," seeking advice on how to connect with their children. Often, the children are labeled as "problem kids," and therapists will prescribe them medications for their behaviors without understanding the underlying cause, Harris said.
Even an hour of specialized training, Harris said, would help foster parents identify strategies for coping and interacting with their children. "This will open up awareness," Harris said, "so that parents who go through these problems can understand the primary cause, and know they're not going through it alone."