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Section 5
FASD and Adult Depression

Question 5 | Answer Booklet | Table of Contents

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In the last section, we discussed three aspects of adolescents with FASD.  These three aspects of adolescents with FASD included:  difficulties; independence with structure; and help for parents.

In this section, we will examine three aspects of clients diagnosed with FASD as they enter adulthood. These three aspects of adult FASD clients include: financial affairs; social skills; and depression.

Three Aspects of Clients with FASD Diagnosis in Adulthood

♦ Aspect #1 - Financial Affairs
The first aspect of adult FASD clients is financial affairs. Money matters are one of the most difficult areas to master for clients with FASD. Obviously, this subject should be taught and retaught prior to adolescence. These clients will need constant support in managing their financial affairs. I have found that if a FASD client understands that he or she is not completely capable of managing his or her money, he or she is less likely to resist the efforts of family members to help them.

Aid can come in the form of protective payees, parents, spouses, friends, or even lawyers. Although many clients are perfectly able to hold paying full time jobs, the specific occupation that they choose should be compliant with the client’s needs and behaviors. FASD clients work well in predictable and structured environments with an understanding and patient employer.

Jeremy, age 32, had developed his own system of checks and balances for coping with his fairly responsible job in the armed services. Jeremy’s father, Richard, expressed pride in his son’s adaptation to the working environment.  He stated, "A lot of the credit goes to Jeremy. He’s really pulled himself up. He’s developed a system for doing what he calls ‘work arounds.’  Because he thinks he’s wired a certain way that is different from other people, he finds ways to ‘work around’ his problems." 

Jeremy stated, "Everybody’s wired one way or another—it’s like my brain’s not in the same order as everybody else’s. It’s like I’m wired differently. I can’t remember eight numbers; maybe I can do only four or five. But I just use a Post-It note. I find a way to solve the problem:  I write it all down. I had to learn how to do lots of abbreviations to write it all down." 

As you can see, through the support and love of his father, Jeremy was able to develop his own method for handling his disability. Think of your Jeremy. How could he or she work with his or her FASD to better adapt to the working world?

♦ Aspect #2 - Social Skills
The second aspect of adult FASD clients is social skills. Children with FASD lack the modulating capacities to prevent becoming drowned in stimulation. Often, this inability to cope with over stimulation remains with the client into adulthood. Bright lights may dazzle these adults, and loud or unexpected noises may startle them. Excessive social stimulation or incomprehensible demands may also be similarly overwhelming. 

Clients with FASD often fail in the workplace because of the social aspects of the work. They are unable to understand inappropriate statements and the reactions of the other people involved. Social skills training and continuing job coaching are frequently needed. 

Diana, age 32, was having difficulty adjusting to the work environment due to her lack of social skills.  Diana stated, "I’ve had lots of jobs; I’ve had 20 or 30 jobs.  I’ve been trying so hard to get along with people and trying to hold a job, but the people are always the problem.  People get really annoyed with me.  Sometimes I see some problem that needs fixing or something and I make a suggestion and people really get bent out of shape about that.  I just can’t ever seem to pin down what makes them so pissed off.  I feel really frustrated." 

Although Diana had developed skills to help her succeed in the actual tasks of a job, her social skills kept her from keeping a stable income.  Think of your Diana.  How are his or her social skills affecting his or her employment?

♦ Technique:  Play Acting
To help clients like Diana who have difficulty with the social aspect of the work environment, I suggest they try "Play Acting" with family members who can indicate to them the correct social procedures. Diana asked her mother, Nina and brother Matt to help her develop her social skills. Every evening, Diana would ask her mother or brother to play a certain personality that she may encounter at work. 

Nina and Matt would then advise Diana whether or not her behavior was acceptable.  Because of her poor memory, this exercise would be performed many nights a week with personalities being repeated several times. Diana stated, "My mom says that I talk too mean to women.  I have to be more careful about how I speak to them.  Matt says that when I talk to men, I make myself too friendly and affectionate. He says that being more remote will give me better respect." 

Of course, this exercise requires the client to be living at home and to also have a network of dedicated and supportive family members and friends. 

Think of your Diana.  Would he or she benefit from "Play Acting"?

♦ Aspect #3 - Depression
In addition to financial affairs and social skills, the third aspect of adult FASD clients is depression. Depression is found most among the adult population of FASD clients. Often, this depression is a result of frequent past mistakes, the inability to adjust to the rest of the adult world, and continuing dependence on family members and friends. This depression not only can cause regression in the progress of the client’s abilities to adjust, but also discourages him or her from continuing to strive for independence. 

Bethany, age 38, had begun to feel depressed about the outlook of her adult life. She stated, "I’m single, living alone and I can’t really find any friends. I am grateful that I can have a good job which I can keep because I know many people with my disorder have problems having a good job. But I am very lonely and I get confused about how to handle life. I don’t know how to do taxes and I don’t always pay bills all the time. My family can be supportive, but they don’t really understand my needs." 

To help clients like Bethany, I suggest using the Advocacy Model in order to provide a constant lifeline.  We will discuss this model more thoroughly on the next section.

In this section, we discussed three aspects of clients diagnosed with FASD as they enter adulthood.  These three aspects of adult FASD clients included:  financial affairs; social skills; and depression.

In the next section, we will present three concepts of the Advocacy Model.  These three concepts of the Advocacy Model include:  appropriate candidates; inferring needs from behaviors; and identifying limitations and strengths.
Reviewed 2023

Peer-Reviewed Journal Article References:
Acuff, S. F., Soltis, K. E., Dennhardt, A. A., Borsari, B., Martens, M. P., Witkiewitz, K., & Murphy, J. G. (2019). Temporal precedence of self-regulation over depression and alcohol problems: Support for a model of self-regulatory failure. Psychology of Addictive Behaviors, 33(7), 603–615.

Cuijpers, P. (2017). Four decades of outcome research on psychotherapies for adult depression: An overview of a series of meta-analyses. Canadian Psychology/Psychologie canadienne, 58(1), 7–19. 

Flannigan, K. R., Coons-Harding, K. D., Turner, O., Symes, B. A., Morrison, K., & Burns, C. (2020). A survey of measures used to assess brain function at FASD clinics in Canada. Canadian Psychology/Psychologie canadienne. Advance online publication.

Key, K. D., Ceremony, H. N., & Vaughn, A. A. (2019). Testing two models of stigma for birth mothers of a child with fetal alcohol spectrum disorder. Stigma and Health, 4(2), 196–203.

QUESTION 5
What are three aspects of clients diagnosed with FASD as they enter adulthood? To select and enter your answer go to Answer Booklet.