Diagnosis
Issue 		Aspergers Syndrome Autistic Spectrum Disorder Neglect Family& School Needs
Affective Regulation (Mood) issues
Yes, Anxiety and anger due to predictability problems, sadness due to social rejection.
Not unless the child is pushed into a difficult situation. Anxiety and anger related.
Variable with improvement in many children over time.
Needs to be skilled in handling their own affect and helping with children's affect.
Control Issues
Yes, Can not read body or social cues, Control instead of cope.
Yes, Particularly when overwhelmed
Variable
All will need structure and adults able to teach social skills.
Specialized Educational needs
Needs predictable and structured classroom.
Variable but needs a safe predictable environment.
Variable depending on severity and length of time of neglect .
School must use placement preference, accommodations and social skills groups.
Developmental Delays Lifelong
No
Probably
Probably not, but higher rate of learning disabilities.
Excellent assessments with defined future goals.
Capacity for Emotional Connection
Impacted with improvement later into the life cycle. Improves with specialized help.
Variable Attachment often delayed but does occur. Reciprocity is difficult.
Usually good given social and emotional help for children who lack empathy or self-reflection.
Home and school must promote emotional exchange within context and in real time.
Normal Experiences Over-Stimulation
Yes
Yes
Initially, yes. Over time not usually
Calm, predictable, interesting and structured.
Aspergers Syndrome is part of Autistic Spectrum Disorder but is broken out for clarity.

The chart above clearly illustrates that the techniques and accommodations used in most contexts for ASD are the same as those used for neglect. This is why a functional outlook is so important. It is enormously helpful for parents to know that there is a "why" for children's behavior so that they do not take it personally, It helps parents to come alongside children, recognizing their neurological differences instead of feeling defeated or as if their children do not care about them. Children with ASD require an intentional approach to skill-building.

It can be difficult initially to determine whether the child has traumatic stress or has FASD, which will require some accommodations. The chart below shows that many of the things done for traumatized children also work well for children who have been neglected or who have FASD.
Diagnosis
Issue 		FASD Trauma Neglect Family Capacity required
Affective Regulation problems (emotions are unstable
Yes
Yes, almost universal when trauma has happened before the age of four
Yes
Needs to be skilled in handling their own affect and helping with children's affect
Control
Yes Structure decreases control battles
Yes Predictable safe homes decrease need for control
Variable
Need structure, skills in defusing control battles and access to respite care
Specialized Educational needs
Yes, school will need to accommodate for success
Variable but needs a safe predictable environment
Variable
Needs to be able to advocate within school setting
Life Cycle Needs
Needs continued help in adult life
Prognosis for independence is good
Prognosis for independence is good
Resources and parent age a consideration with FASD
Child care use for working Parent(s)
In calm setting consistent child care provider tends to work well.
Variable, in calm setting consistent child care provider often works well
Variable, but with careful attention to number of hours, consistent child care provider often works well
Flexible working schedule and access to structured, and nurturing day care
Normal range of experiences caused over-stimulation
Yes
Yes
Yes, with sensory integration problems common
Should be calming and structured
Diagnosis
Issue 		Traumatic Stress Mood Disorder Reactive Attachment Disorder Family and School Needs
Special Educational Needs
Needs predictable and structured classroom
Bipolar will need attention to arousal levels
May need help with behavioral issues
Assessment accommodations
Developmental Delays Life Long
No
No
No
Excellent assessments with defined future goals
Impacts on Attachment
Most common reason for attachment issues
Yes, Especially at each end of the mood spectrum
By definition. May show indiscriminate affection
Family is nurturing, predictable, and working with therapist closely
Normal experiences over-stimulate
Variable
Variable. Responds well to medication
No
Calm predictable, interesting and structured.


It makes sense to begin teaching a skill set of attachment and attunement, rather than immediately diagnosing a mood disorder in children coming into therapy with dysregulated moods, poor attachment, and backgrounds that have included ample incidents of functionally, it makes sense to first teach children the skills necessary to attach, calm and relate to others on an emotional level.

After completing attachment, calming and connection work is a much easier time to asses where children are having trouble functioning. It is easier to distinguish the reasons behind reactive and over-sensitized behaviors as being caused by overstimulation in a manner typical of FASD or autism, a reaction to trauma, or a mood disorder that does not yet show a particular pattern. The contribution of ADD or ADHD in behavioral problems also becomes clearer as the therapist gets to know the child. Referrals and the use of medications , when appropriate, help children to function better.

 

The above material is from Nuturing Adoptions by Deborah D. Gray, Perspective Press, Inc. 2007, all rights reserved. It is reproduced here with the express permission of the author.


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