Adopting a child exposed to narcotics in utero - guidance please?

[Anonymous]

As a FM from an agency I would definitely advise you first to get an attorney. Then search out all the different services and cost that may be needed, regardless of any signs now. (speech, behavioral, attachment, sleep disorder, vision, community support and more) I have a five year old and we are still diagnosing effects of canabis effects and he has been in care for over three years. Without the services that come from the state I don't know how we could afford it. Waiting for the schools to pick up the services would take to long.

[Anonymous]

Anonymous wrote:As a FM from an agency I would definitely advise you first to get an attorney. Then search out all the different services and cost that may be needed, regardless of any signs now. (speech, behavioral, attachment, sleep disorder, vision, community support and more) I have a five year old and we are still diagnosing effects of canabis effects and he has been in care for over three years. Without the services that come from the state I don't know how we could afford it. Waiting for the schools to pick up the services would take to long.

Is there any real evidence that cannabis caused his problems? My DD had cannabis exposure as well as crystal meth and I am under the impression that there no definitive studies on lasting effects.

[Anonymous]

Anonymous wrote:If you are not using a lawyer or agency, you should to be sure everything is done legally and that once the adoption occurs it can't e overturned.

Agree with PPs who suggest educating yourself on issues with adopting older kids. I did it three times and there are challenges you face that are different than those adopting or having a baby. Educating yourself on loss and attachment issues would be helpful, as well as on resources for support. I have a large support network and most people say that this network was really helpful during the early years after adoption and that people outside the network didn't understand what they were going through.

I know someone posted a link to facial features for alcohol exposure. Don't get comfortable is you don't see signs in the child. Often kids don't develop the features until they start losing their teeth and getting adult ones. Also cognitive signs of FASD often don't show up until kids are older. The people I know who hade FASD kids (which admittedly is anecdotal information) never saw signs in their kids until middle elementary school. All the kids I know we're diagnosed in third grade.

The diagnosis of FAS is based on facial features, especially the length of the palpal fissures (eye openings) and the smoothness of the philibrum and size of upper lip, both of which are indeed present at birth, coupled with being below the 10% percentile in height and weight. Adoption analysts are capable of analyzing the features of babies and determining whether they have FAS. It is how the diagnosis is made, so I'm not really sure what you are talking about, features changing at third grade? Like the length of the eye openings? sorry, that's just wrong. FAS is pretty clearly detected and diagnosed at birth on a regular basis, if not shortly thereafter. If both of these elements -- the eye openings and the lip smoothness/size as well as the small stature and weight are not present, it is not a clear cut case of FAS, but, as PP notes, FASD may still be possible.

As for FASD, that's tricky, and the diagnostic guidelines are fuzzy, I agree.

[Anonymous]

Does the mother even consent to this adoption? Having sole custody does not equate to a termination of parental rights. If she does not agree, then I would assume that you would have to have a full blown hearing to first get her parental rights terminated. That would involve social services, etc.

[Anonymous]

I know two kids who were adopted who were exposed to meth in utero - both are very healthy and developmentally normal. The older one (now 12) has very mild learning issues - basically she doesn't get great grades and has minor focusing issues - but she is a wonderful, highly verbal, fun and loving kid. I believe she was actually born with drugs in her system. The younger one is too young to really know everything yet - she just turned 5, but she seems perfectly fine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:As a FM from an agency I would definitely advise you first to get an attorney. Then search out all the different services and cost that may be needed, regardless of any signs now. (speech, behavioral, attachment, sleep disorder, vision, community support and more) I have a five year old and we are still diagnosing effects of canabis effects and he has been in care for over three years. Without the services that come from the state I don't know how we could afford it. Waiting for the schools to pick up the services would take to long.

Is there any real evidence that cannabis caused his problems? My DD had cannabis exposure as well as crystal meth and I am under the impression that there no definitive studies on lasting effects.

Until they can pinpoint something else all issues have been attributed to cannabis (or as they say drug use) and/or neglect. "His behavior problems are because of the mother's drug use. His low cognitive skills may be from his mother's drug use."

We also have younger brother and see none of the same issues although exposure was the same.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If you are not using a lawyer or agency, you should to be sure everything is done legally and that once the adoption occurs it can't e overturned.

Agree with PPs who suggest educating yourself on issues with adopting older kids. I did it three times and there are challenges you face that are different than those adopting or having a baby. Educating yourself on loss and attachment issues would be helpful, as well as on resources for support. I have a large support network and most people say that this network was really helpful during the early years after adoption and that people outside the network didn't understand what they were going through.

I know someone posted a link to facial features for alcohol exposure. Don't get comfortable is you don't see signs in the child. Often kids don't develop the features until they start losing their teeth and getting adult ones. Also cognitive signs of FASD often don't show up until kids are older. The people I know who hade FASD kids (which admittedly is anecdotal information) never saw signs in their kids until middle elementary school. All the kids I know we're diagnosed in third grade.

The diagnosis of FAS is based on facial features, especially the length of the palpal fissures (eye openings) and the smoothness of the philibrum and size of upper lip, both of which are indeed present at birth, coupled with being below the 10% percentile in height and weight. Adoption analysts are capable of analyzing the features of babies and determining whether they have FAS. It is how the diagnosis is made, so I'm not really sure what you are talking about, features changing at third grade? Like the length of the eye openings? sorry, that's just wrong. FAS is pretty clearly detected and diagnosed at birth on a regular basis, if not shortly thereafter. If both of these elements -- the eye openings and the lip smoothness/size as well as the small stature and weight are not present, it is not a clear cut case of FAS, but, as PP notes, FASD may still be possible.

As for FASD, that's tricky, and the diagnostic guidelines are fuzzy, I agree.

Actually, I think both of you are partially correct. The first poster is right- the facial features may become more prominent as a child ages but I have never heard of a specific age cut off. The absence of the facial features does not rule out FAS though and I have never heard of any doctor definitely diagnosing a baby on just facial features and measurements alone. And then there is the possibility of the diagnosis of Fetal Alcohol Effects and I believe that does not come with facial features.

[Anonymous]

No, PP. Sorry, but I have worked in this area and the misinformation is bothering me.

From the CDC's guidelines for diagnosis/diagnostic criteria:

Based on these scientific findings and the extensive clinical experience of the SWG, the following facial dysmorphic features were determined to meet the dysmorphia criteria essential for FAS (based on racial norms):
••
Smooth philtrum (measured as 4 or 5 on Lip-Philtrum Guide*)
••
Thin vermillion border (measured as 4 or 5 on Lip-Philtrum Guide) (i.e., upper lip)
••
Small palpebral fissures (measured as ?10th percentile according to age and racial norms)
The individual must exhibit all three characteristic facial features; however, additional features also can be present. For example, maxillary hypoplasia is often noted for individuals with FAS as well as those associated features described previously. Cross-sectional and longitudinal studies indicate that many features can change with age or development. After puberty, the characteristic facial features associated with FAS can become more difficult to detect (62). However, recent findings indicate that these three key features remain for the majority of individuals with FAS (47,50).

CRITERIA FOR FAS DIAGNOSIS
A diagnosis of FAS requires the presence of all three of the following findings:
1.
Documentation of all three facial abnormalities (smooth philtrum, thin vermillion border, and small palpebral fissures);
2.
Documentation of growth deficits; and
3.
Documentation of CNS abnormalities (structural, neurological or functional, or combination thereof ).

Also --

Changes in presentation of criteria across development. As would be expected for any congenital syndrome, presentation of the diagnostic features can change over development. With regards to facial features (small palpebral fissures, smooth philtrum, and thin vermillion border), it has generally been accepted that these features are most evident during infancy and the early preschool years.

[PDF]
Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosiswww.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf

[Anonymous]

^^ In sum, a diagnosis/evaluation at an earlier age is more important, and the whole "waiting for adult teeth to come in" is nonsense. I am constantly annoyed and suprised about the complete myths I see on this board about FAS.

[Anonymous]

Anonymous wrote:^^ In sum, a diagnosis/evaluation at an earlier age is more important, and the whole "waiting for adult teeth to come in" is nonsense. I am constantly annoyed and suprised about the complete myths I see on this board about FAS.

PP 10:33 here. Obviously you know a lot about FAS, maybe even are an expert. I am not. I am just the mom of an FASD child who knows a lot,of,other kids who suffer from FASD and FAS. But i do know that FAS is not the only alcohol related problem and that FASD causes very real special needs. I watch my child live that every day. i also know that some adoptive families are risk adverse and some feel they could not handle a child with alcohol related special needs so its important for people to understand that theres a spectrum and that you cant rule out alcohol related,problems at age 2.5 by looking at facial features. Nothing I said conveyed myths or implied that diagnosis or evaluation should wait until kids get their permanent teeth. You are right in that if a parent sees delays, the best thing a parent can do is to figure it out early and do whatever they can to address the issues.

[Anonymous]

Anonymous wrote:

Anonymous wrote:^^ In sum, a diagnosis/evaluation at an earlier age is more important, and the whole "waiting for adult teeth to come in" is nonsense. I am constantly annoyed and suprised about the complete myths I see on this board about FAS.

PP 10:33 here. Obviously you know a lot about FAS, maybe even are an expert. I am not. I am just the mom of an FASD child who knows a lot,of,other kids who suffer from FASD and FAS. But i do know that FAS is not the only alcohol related problem and that FASD causes very real special needs. I watch my child live that every day. i also know that some adoptive families are risk adverse and some feel they could not handle a child with alcohol related special needs so its important for people to understand that theres a spectrum and that you cant rule out alcohol related,problems at age 2.5 by looking at facial features. Nothing I said conveyed myths or implied that diagnosis or evaluation should wait until kids get their permanent teeth. You are right in that if a parent sees delays, the best thing a parent can do is to figure it out early and do whatever they can to address the issues.

PP, I think you might be the poster who pretty frequently posts about FASD in the expectant moms forum, etc. I think you should really get more information -- or disclose more information in your posts -- about your child's alcohol exposure in utero -- the volume, frequency, timing, etc. -- and your child's diagnosis. I just think some of your posts could be chalked up to fear mongering. I know it doesn't feel that way to you, but you give so little information, it is vague enough to be terrifying to people. FASD is not well understood, as you know. Its also hard with most FASD kids to know if the problems are really related to in utero exposure unless you have accurate information about that exposure. PThe overwhelming majority of kids with ADHD, LD's and other problems are NOT FASD. So you really have to know if your child's problems are really attributable to exposure. That's one of the issues with the dignosis and disease. I also think you should read up a bit more on FAS, which is a recognized congential syndrome with clear features and diagnostic guidelines before making vague comments about it on various boards. If you are going to profess to be some kind of expert via personal knowledge, get some actual knowledge. Sorry if this is harsh, but you are scaring people, and I for one think you need to stop.

[Anonymous]

Anonymous wrote:No, PP. Sorry, but I have worked in this area and the misinformation is bothering me.

From the CDC's guidelines for diagnosis/diagnostic criteria:

Based on these scientific findings and the extensive clinical experience of the SWG, the following facial dysmorphic features were determined to meet the dysmorphia criteria essential for FAS (based on racial norms):
••
Smooth philtrum (measured as 4 or 5 on Lip-Philtrum Guide*)
••
Thin vermillion border (measured as 4 or 5 on Lip-Philtrum Guide) (i.e., upper lip)
••
Small palpebral fissures (measured as ?10th percentile according to age and racial norms)
The individual must exhibit all three characteristic facial features; however, additional features also can be present. For example, maxillary hypoplasia is often noted for individuals with FAS as well as those associated features described previously. Cross-sectional and longitudinal studies indicate that many features can change with age or development. After puberty, the characteristic facial features associated with FAS can become more difficult to detect (62). However, recent findings indicate that these three key features remain for the majority of individuals with FAS (47,50).

CRITERIA FOR FAS DIAGNOSIS
A diagnosis of FAS requires the presence of all three of the following findings:
1.
Documentation of all three facial abnormalities (smooth philtrum, thin vermillion border, and small palpebral fissures);
2.
Documentation of growth deficits; and
3.
Documentation of CNS abnormalities (structural, neurological or functional, or combination thereof ).

Also --

Changes in presentation of criteria across development. As would be expected for any congenital syndrome, presentation of the diagnostic features can change over development. With regards to facial features (small palpebral fissures, smooth philtrum, and thin vermillion border), it has generally been accepted that these features are most evident during infancy and the early preschool years.

[PDF]
Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosiswww.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf

yes, you should be sorry because you clearly can only cut and paste words but not actually understand them.

Given there are three criteria, it is not possible to judge solely by facial features/

Further, the guide states "Individual dysmorphic features are not unique to any particular syndrome. Even rare defects or certain clusters of dysmorphic features can appear in a variety of syndromes." which means that the facial features can present for other reasons and be closely matched to those with FAS. This would be why the other two criteria are involved. The guide further says that "THESE GUIDELINES STRONGLY RECOMMEND THAT FUNCTIONAL DOMAINS BE ASSESSED USING NORM-REFERENCED STANDARDIZED MEASURES. DOMAINS SHOULD BE ASSESSED BY APPROPRIATE PROFESSIONALS USING RELIABLE AND VALIDATED INSTRUMENTS."

Diagnosising FASD in a very young child when the information on maternal health is unknown is not an exact science and given that many of the "standardized measures" would not be used until a child is preschool or school age, a definitve diagnosis is not possible in the very early years. I am sure that some doctors would speculate and provide the diagnosis on a cautionary basis with the caveat that as a child develops the diagnosis may need re-visited.

[Anonymous]

Anonymous wrote:

Anonymous wrote:No, PP. Sorry, but I have worked in this area and the misinformation is bothering me.

From the CDC's guidelines for diagnosis/diagnostic criteria:

Based on these scientific findings and the extensive clinical experience of the SWG, the following facial dysmorphic features were determined to meet the dysmorphia criteria essential for FAS (based on racial norms):
••
Smooth philtrum (measured as 4 or 5 on Lip-Philtrum Guide*)
••
Thin vermillion border (measured as 4 or 5 on Lip-Philtrum Guide) (i.e., upper lip)
••
Small palpebral fissures (measured as ?10th percentile according to age and racial norms)
The individual must exhibit all three characteristic facial features; however, additional features also can be present. For example, maxillary hypoplasia is often noted for individuals with FAS as well as those associated features described previously. Cross-sectional and longitudinal studies indicate that many features can change with age or development. After puberty, the characteristic facial features associated with FAS can become more difficult to detect (62). However, recent findings indicate that these three key features remain for the majority of individuals with FAS (47,50).

CRITERIA FOR FAS DIAGNOSIS
A diagnosis of FAS requires the presence of all three of the following findings:
1.
Documentation of all three facial abnormalities (smooth philtrum, thin vermillion border, and small palpebral fissures);
2.
Documentation of growth deficits; and
3.
Documentation of CNS abnormalities (structural, neurological or functional, or combination thereof ).

Also --

Changes in presentation of criteria across development. As would be expected for any congenital syndrome, presentation of the diagnostic features can change over development. With regards to facial features (small palpebral fissures, smooth philtrum, and thin vermillion border), it has generally been accepted that these features are most evident during infancy and the early preschool years.

[PDF]
Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosiswww.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf

yes, you should be sorry because you clearly can only cut and paste words but not actually understand them.

Given there are three criteria, it is not possible to judge solely by facial features/

Further, the guide states "Individual dysmorphic features are not unique to any particular syndrome. Even rare defects or certain clusters of dysmorphic features can appear in a variety of syndromes." which means that the facial features can present for other reasons and be closely matched to those with FAS. This would be why the other two criteria are involved. The guide further says that "THESE GUIDELINES STRONGLY RECOMMEND THAT FUNCTIONAL DOMAINS BE ASSESSED USING NORM-REFERENCED STANDARDIZED MEASURES. DOMAINS SHOULD BE ASSESSED BY APPROPRIATE PROFESSIONALS USING RELIABLE AND VALIDATED INSTRUMENTS."

Diagnosising FASD in a very young child when the information on maternal health is unknown is not an exact science and given that many of the "standardized measures" would not be used until a child is preschool or school age, a definitve diagnosis is not possible in the very early years. I am sure that some doctors would speculate and provide the diagnosis on a cautionary basis with the caveat that as a child develops the diagnosis may need re-visited.

PP, I think you missed the boat by a long shot. My point, and the point of the CDC paper posted above, which I well understand and have applied clincially, thank you, was that FASD is NOT FAS. It is not diagnosed in the same way. FAS is diagnosed using the method I pasted because it is a RECOGNIZED SYNDROME AND THERE ARE REQUIREMENTS THAT HAVE TO BE MET FOR DIAGNOSIS, namely, the three bolded ones listed above. As I pointed out originally, a professional needs to document the facial features, growth deficits, and neurological issues, as well as exposure. My point was that is is possible for professionals to diagnosis FAS, which is a differential diagnosis, meaning other possibilities are ruled out, at a young age. FASD is more difficult to diagnosis, and may indeed present later. What exactly are you taking issue with????

[Anonymous]

Anonymous wrote:

Anonymous wrote:As a FM from an agency I would definitely advise you first to get an attorney. Then search out all the different services and cost that may be needed, regardless of any signs now. (speech, behavioral, attachment, sleep disorder, vision, community support and more) I have a five year old and we are still diagnosing effects of canabis effects and he has been in care for over three years. Without the services that come from the state I don't know how we could afford it. Waiting for the schools to pick up the services would take to long.

Is there any real evidence that cannabis caused his problems? My DD had cannabis exposure as well as crystal meth and I am under the impression that there no definitive studies on lasting effects.

It impacts every kid differently so your's may be fine but other kids can have serious impacts. There are no good studies or evidence as everyone is so individual. Its just pure luck.

[Anonymous]

I agree with the PPs that there are a lot of issues you have to look at, with the in utero narcotic exposure not directly, only indirectly , at the top of the list. The main medical danger of the narcotics was in the newborn period. She is 2.5. What comes to mind is HIV, Hep B and Hep C status. And then, her psychological well being since birth, like PPs mentioned: Bonding? Abuse? Why is dad giving her up? Etc.