Helping Your Kids Understand Their Sibling's Fetal Alcohol ...
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Helping Your Kids Understand Their Sibling's Fetal Alcohol ...

ACKNOWLEDGMENTSThis booklet was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) byNorthrop Grumman Health Solutions under contract number 277-01-6068 with SAMHSA, U.S. Department of Healthand Human Services (DHHS). Ammie A. Bonsu, MPH, served as the Government Project Officer.DISCLAIMERThe views, opinions, and content of this booklet are those of the author and do not necessarily reflect the views,opinions, or policies of SAMHSA, or DHHS.PUBLIC DOMAIN NOTICEAll material appearing in this booklet is in the public domain and may be reproduced or copied without permissionfrom SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributedfor a fee without the specific, written authorization of the Office of Communications, SAMHSA, DHHS.COPIES OF PUBLICATIONFor additional free copies of this document, please call SAMHSA’s National Clearinghouse for Alcohol and DrugInformation at 1-800-729-6686 or 1-800-487-4889 (TDD).RECOMMENDED CITATIONSubstance Abuse and Mental Health Services Administration. What Do I Do? Helping Your Kids Understand TheirSibling’s Fetal Alcohol Spectrum Disorder. DHHS Pub. No.(SMA) 06-4246. Rockville, MD: Center for SubstanceAbuse Prevention, Substance Abuse and Mental Health Services Administration, 2006.ORIGINATING OFFICEDivision of Knowledge Application and Systems Improvement, Center for Substance Abuse Prevention,Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20850DHHS Booklet Pub No. (SMA) 06-4246Printed 2006

What’s This Booklet About?Raising children is a tough job for parents. Parentsraising a child with fetal alcohol spectrum disorder(FASD) need special help.This booklet provides guidance on understanding sibling relationshipswhen an FASD is involved. It answers questions youmight have and suggests ways to help your children cope withtheir sibling’s disorder. A list of resources is also providedif you need further information or support.If you have specific questions or are interested in gettingother materials, visit the Web site of the SAMHSA FetalAlcohol Spectrum Disorders Center for Excellence at can also contact the Center at866-STOPFAS (866-786-7327) or via e-mail at

2What Are Fetal AlcoholSpectrum Disorders?“Fetal alcohol spectrumdisorders” (FASD) isan umbrella termdescribing therange of effects thatcan occur in anindividual who wasprenatally exposed toalcohol. These effectsmay include physical, mental,behavioral, and/or learning disabilities with possiblelifelong implications. The term FASD is notused as a clinical diagnosis. It refers to conditionssuch as fetal alcohol syndrome, alcoholrelatedneurodevelopmental disorder, and alcohol-relatedbirth defects.People with an FASD can have a range of disabilitiesfrom mild to extreme. Moreinformation is available on the SAMHSAFASD Center Web site, such as the fact sheetentitled “What You Need To Know: TheLanguage of Fetal Alcohol Spectrum Disorders”( Having a Sibling With anFASD Different Than Having aSibling Without an FASD?Every child is unique, but FASD presents somechallenges that many siblings don’t face. Peoplewith an FASD can have qualities that make themdifferent, such as:■ Being very unpredictable.■ Being moody, making forming a close relationshiphard.■ Having trouble functioning in a typical environment.■ Having memory lapses.■ Showing behavior problems.■ Not understanding ownership. Your childmay complain, “I’ve told him a million timesto leave my stuff along and he just won’t listen.”You can help by explaining that thechild with an FASD isn’t refusing to listenor pay attention. He or she doesn’t rememberbeing told to leave other people’s thingsalone.

Despite the challenges, the relationship between siblings can be avery important part of anyone’s life. A sibling’s disabilities maychange the nature of the relationship but do not prevent your kidsfrom establishing a good one. Siblings share similar family experiencesand can form special lifetime bonds.At times, your children may act like typical siblings, arguing overthe remote or blaming each other for breaking household rules. It’simportant to let the relationship develop in its own way at its ownpace.Many things will affect your children’s relationship with each other.FASD is not the only factor. Your kids might have personality differencesor nothing in common. That can make a relationship difficult.Family situations, such as divorce, can also affect the way a siblingrelationship develops. Some siblings become close and remain sointo adulthood, while others never get close or grow apart as theyget older.You can teach your kids not to snub their siblings because theyhave an FASD. You can guide your children, but don’t force themto be friends. Children shouldn’t be expected to stifle their feelingsor to cut their sibling some slack. FASD does not excusebad behavior. Your children may resent you if you let the childwith an FASD “get off easy.”3

Is My Child Afraid To Tell MeThat He Doesn’t Like HisSibling With an FASD?Kids might hate the problems associated with anFASD but still love their siblings. FASD can beconfusing because your child may not look disabled.He or she might have a typical IQ buthave emotional and behavioral problems. Peoplewith an FASD often misinterpret social cues. Theymight say their sibling is angry with them whenthere’s nothing wrong. Your children might wonderwhat their sibling’s problem is or why he orshe can’t just “get it together.”Other feelings siblings mighthave include:■ Jealousy or anger about all the attentionthe child with an FASD gets.They may seea sibling with anFASD getting attentionfor havingproblems and actout to get attention.They might pretend to have problems withtheir schoolwork or complain of illness sothat they can get attention too.■ Anger about being different from otherfamilies. Your children might be upset thatyour family does not do things other familiesdo.■ Isolation and loneliness or feeling that noone else has the same feelings or experiences.Because of the stigma associated withFASD, your children’s friends might beuncomfortable hearing about it and mightnot want to talk about it.■ Guilt for feeling angry or resentful or for nothaving a disability. Some siblings may feelthey are to blame for their brother or sister’sdisability.■ Embarrassment about the sibling’sbehavior or appearance. Siblings who donot have an FASD might avoid contact withtheir brother or sister or not invite theirfriends home.4

■ Fear that they might develop an FASD. Childrensometimes think that disabilities are contagious.They also might think they have an FASD if they dosomething their sibling with an FASD does. Yourchildren might forget their homework one dayand worry that they have an FASD.■ Pressure to achieve in order to make up for abrother or sister’s inabilities. Your child might actinterested in an activity and pretend to enjoy it just tomake you happy.■ Pressure to help take care of the sibling and resulting anger,especially if taking care of the sibling conflicts with plans withfriends or becomes overly burdensome.■ Confusion about the disability. Siblings often are not giventhorough information about why a sibling has a disability, how itaffects him or her, and what the family can do to help. Talkingabout FASD is important, especially since it provides a goodopportunity to discuss alcohol use.Many of these feelings affect children as they grow up, but siblingsoften continue to have concerns as adults. They may be concernedabout the future of their sibling after their parents die, especially ifthe sibling with an FASD still lives at home.5

Is There Anything Good AboutHaving a Sibling With an FASD?Despite the challenges, there are several positiveaspects of having a sibling with an FASD. Manyadults who grew up with a sibling with specialneeds say that they learned a lot. What theylearned made them stronger and wiser adults.They feel they are more understanding andpatient than they might have been otherwise.Children in families where a sibling has a disabilitycan also become more mature, responsible,self-confident, and independent.Growing up with a sibling who has an FASD mayinstill a greater level of understanding and developmentin the siblings who are not disabled.They may develop greater leadership skills,especially in areas where understanding andsensitivity to human awareness issues are important.Many leaders in The Arc and other contributorsto the field of mental retardation,as well as other notable people, grew up witha sibling with a disability.Having a sibling with an FASD can also make kidsmore aware of the dangers of alcohol use. Theymight be less likely to drink. It can also leadthem into careers in substance abuse prevention,disability advocacy, health and social services,and similar fields.Beyond what they might learn from theexperience, your kids can enjoy their siblingwith an FASD. Kids with an FASD have manygood characteristics, just like other kids. Theycan have a good sense of humor, creativity, caring,a love of animals, determination, musicaland artistic talent, and a desire to please(see Teaching Students With Fetal AlcoholSyndrome/Effects, available online Everyonehas something positive to offer. Encourage yourchildren to look for the good things in their siblings,rather than focusing on the problems frequentlyassociated with an FASD.6

Can My Kids Still Play Together andHave Fun?Children with an FASD can usually participate in mostactivities. Try to avoid competition. It can call undueattention to your child’s disability. Frustration and feelingsof failure may result.Games with lots of rules can be difficult as well. Kidswith an FASD can have trouble remembering how toplay the game. Find things your kids can do together thatallow them to share time without pressure. Singing,dancing, painting, watching videos, going for walks, andreading together are just some ideas.Also remember that children with an FASDmay have difficulty making and maintaining friendships. Theinability to make friends may be stressful. Siblings and otherfamily members can help provide friendship. But don’t pressureyour children to spend time with their sibling with an FASDif they’d rather be with other friends. They might resent beingtheir sibling’s only friend.7

8What Can I Do To Help MyChildren Cope With TheirSibling’s FASD?You can help siblings adjust in severalways:■ Give each of your children individual timewithout interruption. You might need helpfrom your spouse or partner, a friend, or arelative. But it’s important for your kids toknow that they don’t have to have a disabilityto get your attention. You may want toschedule individual time with each child.■ Assure your children who don’t have anFASD that their feelings are okay. Askthem how they feel about having a siblingwith an FASD. Encourage them to expresstheir feelings openly.■ Help your children accept their sibling’sFASD. They can be angry about the FASDbut they still have to be nice to their sibling.After all, no one chooses to have an FASD.You can teach them ways to deal with anybad feelings that arise, such as leaving theroom, counting to 10, or writing about it.Anger management skills help in any relationship.■ Remind your child that differences makethe world more interesting. People withan FASD are different, but they aren’t bad.And we’re all human. A sibling with anFASD may do embarrassing things sometimessuch as being clumsy or interruptingothers. But guess what? The child without anFASD might embarrass his or her sibling attimes too.■ Look for ways to play up the strengthsof your child with an FASD. Try to findactivities that he or she can do well. Giveyour children a chance to see the childwith an FASD doing good things that thewhole family can be proud of, such as participatingin Special Olympics orhelping at a nursing home.■ If your children want to help theirsibling, encourage them. But don’tpressure them to help out. Relationshipsbetween siblings should embrace friendshiprather than caregiving. Treat the child whodoes not have an FASD as a child, not as

another caregiver. Don’t ask your child to take on responsibilitiesfor which he or she is unprepared.■ Help your children learn to communicate with their siblingwith an FASD. People with an FASD may have trouble understandinglong sentences with many parts. They also may have difficultyfollowing multiple directions. Remind your kids to useshort words and sentences and to break things into steps. Forexample, if you want the child with an FASD to come downstairsfor dinner, go upstairs and say that it’s dinnertime. Then lead thechild to the table.■ Suggest positive reinforcement. Tasks that we take for grantedcan be difficult for someone with an FASD. Even a simple “thankyou” can mean a lot. Encourage your children to praise their siblingwith an FASD if he or she gets something right or does somethingwell.■ Provide siblings with choices and include them in decisionmaking.Discuss family matters with your children,especially if it affects them personally. Don’t makeassumptions. You might think that your childrenwon’t want to go to the mall because their siblingwith an FASD mightget overstimulated and act out. They might surpriseyou and say they don’t mind. Also talk witholder children, teens, and young adults about thefuture. For example, who will take care of the9

child with an FASD if something happensto you? Provide your children with availableresources and let them know they do nothave to take on this responsibility alone.■ Provide your children with informationabout FASD. Answer their questions andrespond to their concerns in a simple butprecise manner. Explain the cause of FASDand let them know that they can’t catch it.Siblings may also benefit from the supportof a person outside the immediate family.A relative, trusted friend, or other resourcepeople such as coaches and counselorsmay be helpful.Can I Catch It?” You also might find it helpfulto talk to other parents of kids with an FASD.Some questions may require outside helpfrom a family counselor, therapist, or other professional.For example, if you drank when youwere pregnant, your children might askwhy. They might ask if you drank while youwere pregnant with them and why they don’thave an FASD like their sibling. These are difficultquestions. Your answer will depend on yourchild’s age and maturity and your relationshipwith him or her. It’s okay to tell your child thatyou need to think about it and set up a time totalk later.What If My Kids Ask Me aReally Hard Question, Like WhyTheir Sibling Has an FASD?Kids are curious about FASD. That’s why theSAMHSA FASD Center has a booklet for siblingsto help them learn about FASD and get answersto their questions. The booklet is entitled “MySibling Has a Fetal Alcohol Spectrum Disorder.10

Where Can I Get Help?Many organizations have support groups, such as The Arc’s Sibshops. Siblinggroups provide a forum where siblings can discuss their experiences, shareideas, and give each other support. Other sibling services include seminarsand meetings that address topics of interest to siblings such as future planning(guardianship, alternative living arrangements, etc.). Programs that provide familysupport, such as respite care, also include siblings in the planning processor provide services in integrated settings where all siblings can participate.You may also want to contact the National Organization on Fetal AlcoholSyndrome (NOFAS) for information about additional resources available ineach State, including support groups. Visit their Web site at or call202-785-4585. See the next page for additional resources. Remember, you arenot alone.11

Additional ResourcesThe Arc, 1010 Wayne Avenue, Suite 650, Silver Spring, MD 20910, 301-565-3842, fax 301-565-3843 or 301-565-5342, Community Resource Center, Family Resource Institute, PO Box 2525, Lynnwood, WA 98036, 253-531-2878 or inWashington,800-999-3429,,, D.J. 1990. Brothers, Sisters, and Special Needs: Information and Activities for HelpingYoung Siblings of Children With Chronic Illnesses and Developmental Disabilities. Baltimore: PaulH. Brookes Publishing Co.Meyer, D., and Vadasy, P. 2000. Living With a Brother or Sister With Special Needs: A Book forSibs, Second Edition, Revised and Expanded. Seattle: University of Washington Press.Minnesota Governor’s Planning Council on Developmental Disabilities. 1999. Siblings: Brothersand Sisters of People Who Have Mental Retardation. Silver Spring, MD: The Arc, Family Empowerment Network, University of Wisconsin Medical School, Department ofFamily Medicine, 777 South Mills Street, Madison, WI 53715, 800-462-5254 or 608-262-6590, fax608-263-5813,, Organization on Fetal Alcohol Syndrome, 900 17th Street, NW, Suite 910, Washington,DC 20006, 202-785-4585, 1-800-66NOFAS, fax 202-466-6456, e-mail, Fetal Alcohol Spectrum Disorders Center for Excellence, 866-STOPFAS,, National Clearinghouse for for Alcohol and Drug Information (NCADI)11420 Rockville Pike, Rockville, MD 20852, 1-800-729-6686, Support Project, Children’s Hospital and Medical Center, 4800 Sand Point Way, NE,Seattle, WA 98105, 206-527-5712, e-mail, Underage Drinking,

Stop and think. If you’re pregnant, don’t drink.For more information, visit or call 866-STOPFAS.www.stopalcoholabuse.govDHHS Publication No. (SMA) 06-4246Printed 2006

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