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Everyone has seen children's tantrums, but when first-time parents Alicia and Josh Dougherty welcomed 4-year-old foster child Alex into their home, they soon learned that his were titanic by any standards.
"It could be over anything as minimal as, 'Get your shoes on,' or, 'No, you can't have five donuts,'" Alicia, 39, tells PEOPLE in this week's issue.
By the time Alex had been with the family for nearly a year and legally adopted, his behavior had escalated to physical aggression.
"Once he rolled up a giant area rug and threw it down the stairs at me," says Alicia. "The strength when they tantrum is unbelievable."
The Doughertys, of Pittsford, New York, were unaware that Alex is one of millions of American children who suffer from Fetal Alcohol Spectrum Disorders (FASD), a group of conditions that can occur in a person whose mother consumed alcohol during pregnancy. FASD can cause a lineup of physical and learning disabilities as well as behavior problems.
"It was the most heartbreaking, soul-ripping, life-altering experience," says Josh, 41, "but we never considered giving up."
Instead, the couple immersed themselves in helping their new son, and with the right blend of therapy, diet, medication and careful parenting, "Alex turned that corner," says Alicia.
For more on the Doughertys, pick up the latest issue of PEOPLE, on newsstands Friday, or subscribe here.
And then the Doughertys decided to do it again — and again. Caseworkers were so impressed with the couple's dedication and success that they continued sending complicated children their way.
"So many people gave up on these kids," says Alicia, "but they knew we wouldn't."
In addition to Alex, now 14, they have adopted five other children suffering from FASD: James, 13, Patrick, 12, Bree, 9, and twins Jordan and Jason, 5.
"We became known as the parents who could handle the difficult behaviors," says Alicia.
"We figured, if we're already doing this for one kid, what difference will another one make?" says Josh, a lower school special education teacher and middle and high school coach.
The six join the couple's four biological children: Zoey, 8, Dashel, 6, Bodhi, 3 and Harlee, 2. As does any family with 10 kids, the Doughertys see their share of "controlled chaos," as Josh calls it, but he and Alicia work hard to focus on the positive and reinforce kindness and acceptance.
"We see parenting as a privilege," says Alicia.
The couple says the key to parenting their FASD-affected children starts with an appreciation and understanding of their limitations. All of them suffer from developmental delays — James can't manage buttons, Patrick has severe speech delays and Bree lacks the muscle tone to chew well — and struggle with transitions.
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"They can't handle making choices," explains Alicia. "You have to be specific, and say, 'You're going to go sit and do this puzzle.'"
But without direction, Patrick, for example, will just pace around, unable to choose something to play.
"We get told all the time by friends and family that we're too strict," says Alicia, "but that's the type of parenting these kids need."
To that end, each child's daily activities are posted on a white board in the kitchen, where their day is broken down into time slots.
And because temper tantrums often lead to fights, every room (minus the bathrooms) in the six-bedroom home is outfitted with cameras. These are also helpful, Alicia says, in keeping the children accountable by providing evidence if they steal or destroy property.
Josh and Alicia lock kitchen food cabinets and the refrigerator at night to keep the kids, who are prone to compulsive behaviors, from eating to the point of becoming sick.
"And that's another thing," says Alicia. "They have to know when and what they're eating next for food assurance."
The kids enjoy regular activities and small rituals — many common to families everywhere: The big boys play football on their dad-coached team; all of the older children receive music lessons; and in warm weather, all of the kids swim daily for hours "to burn off excess energy, and because water is a calming, therapeutic source," says Alicia.
At the end of every dinner, each person recalls the best part of his or her day. (On a recent night, the kids get impatient when Jason hems and haws. "He takes a little bit longer to think, so we're going to be kind," Alicia reminds them.)
And they've been spending a lot of time this summer creating and posting TikTOk videos featuring the entire family.
All of the affected kids understand FASD as the source of their difficulties.
"We are 100 percent honest and transparent with them," says Josh. "It's their truth. But a person is not their diagnosis, and we're doing our best to help them move forward with their life."
Alicia and Josh have open minds when it comes to the kids' birth parents, helping them stay in touch when possible.
"Our children's family is our family and we continue to believe in them," says Alicia. "Their birth parents love them. They just can't care for them."
Alex's eyes well up with tears when he talks about his FASD.
"People with fetal alcohol have harder problems because of how their brain thinks," he says. "Regular kids without fetal alcohol can think a little bit harder than fetal alcohol children. That's why my mom and dad figured out what to do with me, and now I'm having a great life."
The rewards of raising kids able to push through such adversity make the challenges worthwhile, Alicia says.
"When times are tough," she adds, "we refer to our family motto: 'Doughertys Don't Quit.'"
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