SPECIAL ISSUE INTRODUCTION: Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders
Kenneth Jones, M.D. and Ann Streissguth, M.D.
A Proposed Model for Forensic Assessment of Fetal Alcohol Spectrum Disorders
Natalie Novick Brown, Ph.D., Hon. Anthony P. Wartnik, Paul D. Connor, Ph.D., and Richard S. Adler, M.D.
A model protocol is proposed for multidisciplinary assessment of Fetal Alcohol Spectrum Disorders (FASD) in the forensic context. Used effectively on both sides of the courtroom in the United States in criminal and post-conviction matters in state and federal courts, the model relies on the FASD literature and best-practice standards of care in terms of clinical as well as forensic evaluation. It is suggested that FASD diagnostic criteria for older adolescents and adults in the criminal system may need different emphasis if facial features have diminished with age and confirmation of prenatal exposure is impossible.
Adaptive Behavior and Fetal Alcohol Spectrum Disorders
William J. Edwards, J.D. and Stephen Greenspan, Ph.D.
Adaptive Behavior is a construct originally invented as a prong for diagnosing Mental Retardation, but it has come to also play a role in diagnosing Fetal Alcohol Spectrum Disorders (FASD). In this paper, we: (a) describe the meaning and measurement of adaptive behavior, including the need for improved measures (b) illustrate clinical and research uses of the construct, in establishing the diagnosis and behavioral profile of people who have FASD and (c) discuss the forensic uses of adaptive behavior for people with FASD in establishing a mitigation case in criminal proceedings, including possible extension of Atkins (death penalty exemption) protection for people with organic impairments who function just as if they have mental retardation in spite of possessing IQ scores in the borderline range.
Bringing Morphometrics into the Fetal Alcohol Report: Statistical Language for the Neurologist/Psychiatrist
Fred Bookstein, Ph.D. and Arthur P. Kowell, M.D., Ph.D.
The components of a diagnosis in the fetal alcohol spectrum consider, among other domains, evidence of prenatal alcohol exposure, facial features, neurological or neuropsychological deficits, and neuroanatomical form. Most of these assessments are based on traditional sorts of quantifications (e.g., length measures, IQ scores, quantity of alcohol drunk by the mother), but for one of the domains, the morphometric assessment of neuroanatomical form as abnormal in a way suggesting fetal alcohol damage, the associated quantifications are relatively recent. For purposes of a forensic report, this morphometric component of the diagnostic judgment would seem to go best in the form of one classic statistical quantity, the likelihood ratio (odds ratio) of two hypotheses as they both attempt to explain the form of a particular structure within the defendant’s brain (in our approach, the midcurve of the corpus callosum). On one hypothesis, the subject is presumed to be from a normal population; on the other, he is from a group all characterized by diagnosable fetal alcohol damage. Our article explains in simple terms how the forensic physician might wish to couch that component of the FASD diagnostic system for the purpose of aiding those in the courtroom who have the task of determining guilt or culpability.
Screening, Diagnosis and Intervention with Juvenile Defenders
Eileen Bisgard, J.D., Suzette Fisher, S.N.D., Ed.S., Susan Adubato, Ph.D., and Meghan Louis, B.A.
This article overviews the research regarding youth with FASD in the juvenile justice system and describes three programs in the United States in which juvenile offenders are screened for FASD, then diagnosed and provided interventions specific to their needs. Programs in Colorado and Minnesota identify youth placed on probation and a program in Ohio was within an inpatient facility for delinquent youth. Each program has raised the awareness of providers so that the needs of the youth with FASD can be met more appropriately. The goals are to help these youth function better so that they will have lower rates of recidivism and a better chance of becoming productive citizens. The large number of youth identified in these projects demonstrates the importance of increasing awareness and identification of FASD in juvenile courts.
Children with Fetal Alcohol Spectrum Disorders in the Dependency Court System: Challenges and Recommendations
Blair Paley, Ph.D. and Barbara E. Auerbach, J.D.
Children with Fetal Alcohol Spectrum Disorders (FASD) are at a greatly increased risk for developmental delays, learning disabilities, and behavioral, social, and emotional problems. High rates of secondary disabilities have been reported in this population, including mental health problems, school failure, delinquency, plus alcohol and substance abuse problems. Long-term outcomes for adolescents and adults with FASD include increased risk for unemployment, suicidal ideation and behavior, and confinement in psychiatric facilities and correctional institutions. Many children impacted by prenatal alcohol exposure are raised in out-of-home placements, and thus will likely have extensive involvement with the child welfare and dependency court systems. However, child welfare agencies and dependency courts are often not well-equipped to handle cases involving these children. This article will address the challenges that children with FASD and their families face in those systems, as well as recommendations for improvements in how those systems respond to the needs of these highly vulnerable children.
Fetal Alcohol Spectrum Disorder as a Marker for Increased Risk of Involvement with Corrections
Larry Burd, Ph.D., Diane K. Fast, M.D., Julianne Conry, Ph.D., and Andrew D. Williams, M.P.H.
Fetal alcohol spectrum disorders (FASD) may be common in adolescents and adults in the corrections systems. However, current prevalence estimates for FASD suggest that nearly all affected people are undiagnosed in corrections systems. In this article we provide an overview of our experience with FASD in corrections populations and present strategies for screening, assessment and intervention. We conclude with a plan to provide training to corrections staff in response to identified preferences and needs identified by Canadian and American corrections staff.
An Arctic Judge’s Journey with Fetal Alcohol Spectrum Disorders
Hon. Michael Jeffery
A trial court judge knowledgeable about Fetal Alcohol Spectrum Disorders struggles with adapting the operations of his court to the needs of FASD-affected individuals in the Alaskan Arctic. His background in learning about FASD through cases and training and the methods he has brought to the Barrow Superior Court to attempt to make the justice system more understandable and fair to persons affected by FASD are described. His frustration at not being able to evaluate the degree of impairment from FASD experienced by the affected persons in the courtroom and the appropriate accommodations needed for each person are also described