Fetal Alcohol Syndrome and Forensic Psychology

Written By Carli Tanno
April 2022

Fetal Alcohol Spectrum Disorders (FASD) is something I learned about at my physician’s office while I was waiting for my yearly examination. I scoured the info graphs on the walls and perused the neatly ordered pamphlets, attempting to bide my time as I waited for the physician. I grabbed a paltry pamphlet on Fetal Alcohol Spectrum Disorders (FASD) and quickly read over it before jumping to the next pamphlet. You know the pamphlets, the ones you get handed out of obligation with little to no conversation about them, and while you are expected to thoroughly read through them and absorb every iota of information, you shove it to the bottom of your purse where it becomes crumpled and covered in remnants of dirt, food, or some unknown substance. Later, whilst cleaning out your purse, you find the pamphlet, scoff in disgust, and toss it in the bin. While I did happen to glance over the pamphlet, prior to it falling prey to the disaster that is my purse, I never read the pamphlet thoroughly. Looking back, I wish that I had asked more questions, demanded a conversation with my physician, and learned more about FASD.

Little did I know then that FASDs are something that would come front and center during my time as a clinical psychology trainee with Psychological Assessment Inc. (PAI). FASD is an umbrella term used to describe the constellation of mental and physical symptoms which may result from prenatal alcohol exposure (Abbott, 2022). The Center for Disease Control and Prevention (2022) describes FASDs as a group of conditions, which may occur in individuals exposed to alcohol prenatally, and include physical and mental effects. FASD is comprised of five disorders including Fetal Alcohol Syndrome (FAS), partial fetal alcohol syndrome (pFAS), neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE), alcohol-related birth defects (ARBD), and alcohol-related neurodevelopmental disorder (ARND), which range in severity of symptoms (Abbott, 2022). Symptoms common amongst individuals diagnosed with FASDs range from sentinel facial features, poor memory, attentional difficulties, intellectual disability, poor judgment or reasoning, academic difficulties, hyperactive behavior, poor coordination, speech, or language delays, amongst other symptoms (CDC, 2022). As such, these symptoms can cause problems or impairments in social, cognitive, and adaptive functioning for individuals with such diagnoses.

At PAI, we provide a wide-array of services, ranging from psychotherapy to competency restoration, to sex offender treatment, to neuropsychological evaluations. Primarily, we have three programs: sex offender treatment for individuals on probation, sex offender treatment for individuals with Intellectual Disabilities (ID), and competency restoration training. As a clinician at PAI, there have been many opportunities to work with clients with a range of symptoms and abilities. I have worked with individuals who come with a list of diagnoses, Oppositional Defiance Disorder, Conduct Disorder, Attention Deficit Hyperactivity Disorder, Learning Disorders and find out during the review of records that these individuals also had a prior diagnosis of FASD. Brown (2019) points out that there are high prevalence rates of FASDs in the general population, with even higher prevalence rates amongst the forensic population, highlighting that countries such as Canada and Australia had correctional setting prevalence rates of 23% and 36%. FASD United (2021) highlights that individuals with FASD are 19 to 40 times more likely than those without FASD to become involved with the criminal justice system. These high prevalence rates are understood to be reflective of the psychosocial and neurocognitive deficits faced by individuals with FASD (Khalifa et al., 2021).

For those of us working within forensic settings, understanding FASD and the neurocognitive and behavioral symptoms is important, as we are likely to come into contact with someone who has been affected by these disorders. In therapeutic and evaluative situations, it is paramount to conduct a thorough intake, querying around gestation, developmental milestones, academic performance, social functioning, emotional functioning, and adaptive functioning. It is also necessary to obtain as much collateral information as possible, whether from the caregivers, other care providers, case managers, and available records. Given the prevalence of comorbidities, those who are undiagnosed might present with therapy interfering behaviors. Behaviors I have seen include lack of engagement in session, attentional difficulties, emotional dysregulation, fidgeting, comprehension difficulties, and memory deficits. As a clinician, it is my job to assess each individual’s needs and tailor their treatment in a way that is approachable and comprehensible for them. For those that I have worked with FASD, this has included breaks within session, utilizing visual aids, using concrete language, and repeating concepts as needed. The CDC (2021) also suggests art therapy, relaxation therapy, and meditation as alternative treatment measures.

Looking back, I wish I had paid more attention to that pamphlet handed to me in that doctor’s office that day. Now that I am a clinician, I understand the clinical implications of FASD. I now understand the neurocognitive and psychosocial deficits which may put individuals diagnosed with FASD at risk for higher interactions with the criminal justice setting. Working within the world of forensics for PAI, this has become even more evident to me, and has reinforced the importance of conducting thorough assessments, gathering collateral information, and tailoring treatment to address the client’s specific needs. Using a FASD lens within the forensic setting allows for person-centered approaches, thereby improving treatment efficacy.