Before Juanita Harrington adopted three children, she'd never heard of fetal alcohol spectrum disorders.

Twenty years later, she's become a bit of an expert on it.

FASD describes the brain damage caused to a child when a mother consumes alcohol during her pregnancy. FASD is an umbrella term to describe the range of abnormalities that may occur, including physical deformities as well as mental, behavioral and learning disabilities.

Nationwide, FASD affects 40,000 infants each year. In South Dakota, 7,759 people are suspected of having FASD. The annual cost of caring for them reaches $17.9 million.

Only about 10 percent of children with FASD have severe abnormalities. The remaining 90 percent suffer from varying degrees of brain damage, which often makes it difficult to diagnose.

"The symptoms of FASD … it's not easily recognized," said Behavior Management Systems therapist Susan Lorenzen. "They don't look like they have any disabilities."

Behavioral characteristics of FASD can include poor coordination, hyperactive behavior, poor memory and delays in speech and language.

Mood swings are also common with children with FASD, as is sensitivity to touch, light or sound.

Children with FASD may have difficulty processing instructions and

understanding cause and effect, which often lands them in trouble with the law. About 33 percent of people with FASD will commit a crime between the ages of 9 and 14.

"A lack of common sense," said Lorenzen. "That's the biggest thing."

Some children with FASD have specific physical traits, including abnormal facial features such as a smooth ridge between the nose and upper lip, a flat nasal bridge, folds in the eyes and a small upper lip. People with FASD also can suffer from heart defects; deformities of the joints, limbs and fingers; slow physical growth; vision and hearing problems; and a small head.

Harrington and her husband, LeRoy, knew none of these things when they began fostering children about 19 years ago.

Already the parents of three biological children, the couple didn't intend to adopt. But when a 1-½-year-old foster child named Frank toddled into their house and said, "Hi Mom," the plan quickly changed.

Although Frank is Native American, the family was allowed to adopt him. The Harringtons went on to adopt two more of Frank's half siblings, 11-year-old Dalton and 10-year-old McKenzie.

Like his brother, Dalton has been diagnosed with alcohol-related neurological disorder, which is under the umbrella of FASD. McKenzie has not.

Before the first adoption, officials warned the family that Frank's mother drank during pregnancy and, as a result, Frank likely would have FASD. The family wasn't worried.

"We knew nothing about fetal alcohol," Harrington said.

Harrington said she assumed love and a stable home life would be enough to help him.

Frank began to exhibit symptoms of FASD very young. He threw temper tantrums and had no tolerance for change. When the Harringtons spoke to him or gave him directions, he looked right through them. He was emotional and sensitive to loud noises and rough clothing. Even now, he sometimes turns his shirts inside out to avoid the seams. When they took Frank to powwows as a child, he covered his ears and cried.

When he began school, Frank struggled to get his work done. By

middle school, his troubles were escalating. Harrington said despite her repeated pleas for help for her son, school teachers and administrators continued to tell the family that he wasn't trying.

Eventually, frustrated and angry, Frank tried to kill himself.

The Harringtons moved their son to Sturgis, where a teacher named Carolyn Schuldies "took him under her wing."

With an understanding of FASD, Schuldies was able to help Frank graduate from high school in 2009. "She took the time to listen," Harrington said.

Graduation didn't end Frank's problems. He has been in jail and attempted suicide four times. He has had problems with drugs and alcohol and struggles to maintain a job. Harrington partially blames herself for failing to understand the extent of his disabilities early on. "We were a lot of Frank's problems," she said.

She has vowed not to do the same thing with Dalton.

Unlike his brother, Dalton's behavior tends to be less physical and more nervous.

"He acts out," she said.

During a recent lockdown drill at Douglas Middle School, Dalton received detention for whistling when teachers had ordered it quiet. Harrington said Dalton becomes anxious in stressful situations, so she taught him to whistle in order to soothe himself. In that situation, it got him into trouble and left him confused.

Harrington said the family now understands FASD better and has learned how to help Dalton rather than pressure him to do things he cannot do.

"He's not being stubborn," Harrington said. "He really doesn't get it."

Dalton has emerged as a gifted athlete in cross country and hockey - sports that help him release energy and deal with pent-up anxiety. He continues to struggle in school, but Harrington is committed to helping him.

As for her oldest son, Harrington helps him as much as she can. The Harringtons rent an apartment for him, help him with food costs and assist him in finding work. At this point in his life, they aren't sure he will ever live unassisted. It's a daunting future, but Harrington said she wouldn't change the decision she made long ago to adopt the little boy who walked into her house and called her "Mom."

"There are days I'm not sure I can handle a lot more," she said. "But I would definitely do it again."

Contact Lynn Taylor Rick at 394-8414 or lynn.taylorrick@rapidcityjournal.com.

For more information

• The Center for Disabilities at Sanford School of Medicine of the University of South Dakota, West River clinic, offers screening for fetal alcohol spectrum disorders. For more information, call 721-3840 or 800-658-3080.
• Clinics are held on the first and third Tuesdays of each month in Rapid City. The clinic consists of clinical psychology, education, genetics, psychiatry and social work. For more information, call 800-658-3080 or 357-1439, e-mail cd@usd.edu or go to usd.edu/medical-school/center-for-disabilities/nofas-south-dakota.cfm