There are many life issues faced by older adolescents and adults with FASD. But there are also many promising ideas. With older individuals affected by prenatal alcohol exposure, treatment is usually “multimodal,” with many different types of treatments necessary and applied as needed over time (Streissguth & O’Malley, 2000). For these older individuals with FASD, an essential idea is that intervention can occur using an “advocacy model” (Streissguth, 1997). Briefly put, this model hinges on the central idea that at least some older adolescents and adults with FASD need an advocate who can “translate” the affected individual’s actions to the world— and help the affected individual understand his or her own actions (and how others respond). What happens when the advocacy model is used? Something essential: An interested and caring advocate helps an individual with FASD negotiate life tasks and learn necessary skills.
Family support organizations have suggested action steps, policy directions, and creative ideas for how to advocate for older individuals with FASD. Advocacy resource guides have been published. In Canada and elsewhere there are interesting grassroots and professional efforts now underway to create adapted work environments for those with FASD. A few supervised living arrangements now exist that can serve the needs of those with FASD. One example is “The Willows” in the state of Washington. This residential facility provides transitional housing for pregnant and parenting women participating in an intensive paraprofessional parent support program. (For more information, visit the Fetal Alcohol & Drug Unit (FADU) site of the University of Washington and search for “The Willows.”)
Is there a role for individual counseling for those with FASD? As Huffine (personal communication, October 29, 2006) notes, individuals with FASD have a broad range of neurodevelopmental disabilities that affect all aspects of adolescent and adult development. Teens with FASD experience the pressures of the normal adolescent process, but may lack the right tools to handles these pressures. Effective counseling must be carried out with a clear knowledge of the affected individual’s own areas of strength and difficulty— and by knowing the “normal” process of adolescent development (including what the family considers “normal” social risk-taking and family protection). With this information in mind, counseling can be practical, solution-focused and adapted to deal with the social skills problems, difficulties managing emerging sexuality, educational frustrations and other age-related concerns that are part of growing up with FASD. A counselor may be best accepted if they are seen as an advocate or mentor—someone who the youth with FASD feels is “there for me.” A counselor may be most useful in mediating the sometimes confusing and complex relationships individuals with FASD have with others. Professionals who know about FASD and its developmental impact, and who are flexible enough to adapt their counseling approaches, can likely be very helpful to a teen or young adult with FASD. This kind of knowledgeable professional can also be helpful as part of a team— supporting parents, teachers, and other service providers in working toward the delicate balance between providing an extra measure of structure and the very age-appropriate need of a youth with FASD to take some social risks and test their readiness and capacity for adult life.
At present, there is little research that has tested treatments for older individuals with FASD. The best information can still be gained from the wisdom of parents and clinicians who have worked to help older individuals with FASD to become successful. The issues of appropriate adult advocacy, intimacy, parenting, living, and work arrangement—as well as direct treatment for older individuals with FASD— are myriad and complicated. The questions below address only some of these issues and must be answered before research can be most effective.
• Can supervised living arrangements be created? What kinds of supervised living arrangements are practical? How can they be funded? Who needs what kind of supervised living arrangement? How can these be evaluated for effectiveness?
• What is the best way to adapt work environments for those with FASD, who have individually variable cognitive, learning and behavioral deficits? How can adaptation strategies be evaluated?
• What are the solutions to the long-term planning problems—financial, legal and more—which face families caring for adult individuals with FASD?
• How can counselors be best trained to adapt their approaches for youth with FASD?