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Fetal Alcohol Spectrum Disorders in Mental Health
and Criminal Justice
Instructor: Dr. Dawn-Elise Snipes
Executive Director, Counseling Continuing Education
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery

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– Where to begin…
– Explore the scope of the problem
– Identify the impact of the impairments across life domains
– Discuss specific issues for adolescents

– National Institute on Alcohol Abuse and Alcoholism, the prevalence of FAS in the general population ranges from 2% to 5% for the entire continuum of FASD.
– 94% of individuals with an FASD also have a mental illness
– 73-80% of children with full-blown FAS are in foster or adoptive placement
– 61% of adolescents with an FASD experienced significant school disruptions

Stats cont…
– The prevalence of FASD in the child welfare system is approximately 17 to 19 times higher than that in the general population in North America (meta-analysis published online September 9 in Pediatrics).
– 12.8 is the average age children with an FASD begin having trouble with the law. (
– 60% of people with an FASD have a history of trouble with the law

What is FASD
– FASD is not a diagnostic term, but is an umbrella term encompassing four categorical diagnostic entities:
– Fetal alcohol syndrome (FAS)
– Partial FAS
– Alcohol-related neurodevelopmental disorder
– Alcohol-related birth defects
Impact of Functional Impairment
– Problems in multiple domains interferes with treatment success, including inability to:
– Remember program rules or follow multiple instructions.
– Remember and keep appointments, or to get lost on the way there.
– Independently make appropriate decisions about treatment needs/goals.
– Appropriately interpret social cues
– Observe appropriate boundaries, either with staff or other clients.
– Attend to (and not disrupt) group activities.
– Process information readily or accurately.
– ‘Act one's age.’
– When indicators occur in any these domains (and particularly when they occur across multiple domains), it is worthwhile to apply the FASD 4-Digit Code Caregiver Interview Checklist (Astley, 2004b)
Special Considerations for Adolescents

– Evidence shows that adolescents will commonly exhibit learning and behavior challenges, especially in
– Adaptive function/getting along from day to day
– Remaining organized and regulated
– Learning information slowly (especially what is said to them)
– Tending to forget things they have recently learned
– Making the same mistakes over and over.
– Impulsivity/finding it hard to inhibit responses
– Social communication (leaving out important details/being vague).
– Suggestibility (and therefore easily influenced by others)
– Immature social skills. (too friendly/trusting,/difficulty recognizing dangerous situations.
Differential Dx
– There is some evidence for distinguishing between children with FASD and children with ADHD. Using the four-factor model of attention it has been shown that:
– children with FASD have difficulties with encoding (taking in and processing information) and shift (shifting attention (hyperfocus))
– children with ADHD have problems with focus and sustain. (Using Mirsky (1989) 4 factor model of attention)
– Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders in children: clinical guidelines Neuropsychiatr Dis Treat. 2010; 6: 509–515.

– Additional modules will focus on topics including…
– Accommodations for the clinician to prevent exasperation and burnout.
– FASD in the criminal justice system
– Case management and Unmet needs for caregivers