A Tornado in the Family: Aggression Towards Family Members in the Context of Fetal Alcohol Spectrum Disorder

Abstract

Caregivers of children and youth with Fetal Alcohol Spectrum Disorder (FASD) often face significant challenges in managing behavioral issues, which can lead to mental health difficulties for the entire family. The COVID-19 pandemic, with its social isolation and withdrawal of services, exacerbated these challenges, increasing aggressive behaviors in children with FASD. To address this, the first study in this thesis evaluated the virtual support services provided by a community- based organization for families with children with FASD. The study used surveys and qualitative interviews, revealing that parents struggled without usual support structures, leading to traumatic experiences such as adoption breakdown, mental health challenges, and physical injuries. This highlighted the urgent need for further research and support, prompting a scoping review of potential and existing psychosocial interventions for children with FASD displaying disruptive or aggressive behaviors. The review identified a significant gap, with only five published papers on severe behavioral challenges and none specifically targeting aggression. Existing interventions focused primarily on child outcomes, neglecting the complex needs of the entire family. One promising intervention identified was Non-Violent Resistance (NVR), which has been effective for other neurodevelopmental and mental health disorders. In collaboration with PartnershipProjectsUK, a pilot program using NVR was undertaken with adoptive/kinship families raising children with FASD and experiencing increased aggression. Preliminary findings suggest NVR is effective, with caregivers reporting improved parental self-regulation, better parent-child relationships, and prevention of explosive situations. This thesis underscores the importance of raising awareness about the costs and consequences of aggression in families affected by FASD and developing evidence-based practices to support them. Key recommendations include: acknowledging and supporting the needs of all family members; creating multisectoral and personalized interventions delivered promptly; and preventing the need for intensive interventions by providing early support to at-risk families.