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Fetal Alcohol Syndrome Child Case Study

Birth

Matthew B. is a 20-year-old male of Native descent who was born to a 16-year-old girl who consumed at least 6-10 cans of beer a day throughout much of her pregnancy. From the time of his premature birth, Matthew showed developmental delays. He was longer than normal at birth but markedly underweight. His biological father was later determined to be 6' 5" tall and his birth mother was 5' 1".

Child Protective Services

Matthew's mother, due to her age, emotional problems, and heavy alcohol use, was unable to care for him. She had left him at home alone and unattended for several days. Child Protective Services could consider this as "Neglect." The neighbors became worried about the baby and the Child Protective Services agency was called. Matthew was placed in foster care at the age of 17 months. The neighbor, a young married Caucasian woman who made the initial call to CPS, took Matthew as a foster child 1 month later. His birth mother gave her consent for this placement, and voluntarily relinquished her maternal rights 6 months later.

Infancy

Matthew was adopted by his foster family in an open adoption. He has had sporadic contact with his biological mother up to the present. His rate of visitation depends on her level of alcohol use and Matthew's ability to handle his birth mother's erratic behavior. Matthew's family originally lived in a small rural community. His adoptive parents divorced when he was 5. He, his mother, and her biological daughter, an infant of 2 months, moved to a large urban center. The mother remarried 2 years later and the family has remained in the urban area, indeed in the same home, for the past 13 years.

Matthew, throughout his developmental history, continued to be above average for height but below the 5th percentile for weight. He showed significant developmental delays in walking, talking, and toilet training. Much of this was thought, originally, to be related to the repeated physical neglect he experienced in his birth home. Matthew was placed by his adoptive mother in preschool at the age of 3.

While his home environment was calm, well structured, and predictable, the preschool he had been placed in did not have these qualities. Matthew was unable to function in this environment. Because of difficulties related to his behavior, it was necessary for him to remain at home with his mother until age 6 when he began kindergarten.

School

Upon entering first grade, Matthew's challenging behaviors and various successful interventions (scheduling, specific structure, adapting the classroom) were shared with the administrative and teaching staff at the elementary school he was to attend. A psychological and adaptive behavior assessment was done at the request of his adoptive mother to determine his level of functioning. About this time he was diagnosed with ADHD, Mental Retardation, and high-functioning Autism. As a result of this evaluation, an IEP team was formed consisting of the adoptive mother, regular and special education teachers, and a behavioral interventionist. Matthew was placed in a self-contained special education class.

He was maintained in self-contained classes until the seventh grade when he was mainstreamed into regular classes with the exception of math and language arts. Despite remediation attempts in these subjects, Matthew had great difficulties with abstract concepts and tasks. He is, however, musical and artistic and has good visual spatial skills.

Matthew's social skills have been poor and he has had psychiatric and behavioral difficulties as well. The latter have included impulsivity, psychotic episodes, perseverative behavior, anger outbursts, and severe social withdrawal. At the age of 10 or 12 he was diagnosed as having Asberger's disorder (DSM IV code 299.80), and placed on a series of medications including Cylert, Ritalin, and Imipramine in conjunction with an anti-psychotic agent. At the age of 13, Matthew was finally diagnosed with FAS. In senior high school, a vocational assistant joined Matthew's IEP team, and they began transition planning for him. During this time, he received special vocational training.

Vocational rehabilitation

Matthew graduated from high school at the age of 18. He was placed in a Department of Vocational Rehabilitation program and trained in computer data entry and processing. After successfully completing his training, he was placed in a small accounting firm where it is his job to input a variety of data. The vocational assistant on his high school IEP team became his supervisor at his job. He also had a job coach for 3 months full time, then 3 more months part time. Since then, he has been on all natural supports for the past 7 years. His data entry program is such that he receives automated quality control feedback on a continuous basis.

He works 5 hours per day or more if he is able. His supervisor works in the same area and allows Matthew up to 10 minutes per hour of break time. Matthew has been in this placement for more than 7 years. Matthew's IQ at age 19 was 68 (FSIQ), with a substantial disparity between verbal (VIQ = 62) and Performance (PIQ = 103). His academic achievement, as determined by WRAT-3, showed near normal Reading, but his Arithmetic skills were equivalent to Fifth Grade norms. His adaptive behavior scores revealed social skills at a 7-year-old level. He is currently living in an adult DD home with four other young men. He is still on his medication and still showing serious signs of social withdrawal. He has overnight visitation with his family twice a month.

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