Having a diagnosis of FASD is considered a “protective factor”; with an official diagnosis, individuals with FASD are more likely to be connected to helpful services and supports and are more likely to avoid involvement with the criminal justice system altogether. Unfortunately, there are obstacles in obtaining a diagnosis for adults; access to official health and school records and other collateral information may be limited; the facial features associated with FASD may diminish with age; and finally, research and resources are typically focused on diagnosis of children with very few clinical teams specializing in adult diagnosis.
In the absence of official diagnosis, many agencies and clinicians are focusing instead on developing screening and assessment practices to assist with identifying individuals who are likely to be impacted by FASD. It is important to note that screening is not diagnosis and equally important to consider the stigma that may be associated with labelling. Effective screening and assessment endeavours not to simply label an individual as FASD-impacted, but to identify specific issues of concern along with more appropriate strategies for relating and intervening.
From a correctional perspective, screening for FASD should be facilitated as soon as possible following sentencing. Information gathered early in an individual’s sentence can then be used to anticipate and address the person’s needs throughout incarceration as well as in preparation for community release. Observations made during custodial remand offer an opportunity to identify the need for an assessment of possible FASD prior to sentencing, as do pre-sentencing assessments. While not all individuals with FASD will present with identical behaviours and reactions, indicators of possible FASD that may be evident during incarceration include:
- Victimization and exploitation by other inmates
- Involuntary distractibility and poor concentration
- Inappropriate sexual behaviours
- Difficulty in recognizing and setting interpersonal boundaries
- Mental health concerns, such as extreme anxiety and panic as well as depression
- Reactions such as withdrawal or aggressive outbursts when feeling overwhelmed
- Intense mood swings
- Emotional immaturity
- Grandiose (exaggerated) sense of self and an unrealistic view of the world
- Sensitivity to external stimulation like noise, crowds, bright lights, etc.
- Difficulty managing stress, often resorting to self-harming behaviours
- Difficulty with activities of daily living, such as personal hygiene, time management, etc.
For further information regarding identifying the signs of possible FASD, please refer to the “Recognizing” tab on this web-site.
In conducting interviews with collateral sources or in reviewing reports, correctional professionals may look for the following predisposing factors to FASD (Conroy, 2006):
- Early onset conduct problems including disruptiveness in school, dishonesty, and aggression
- Attention Deficit Hyperactivity Disorder, including poor concentration, restlessness, risk-taking, and impulsivity
- Lower intelligence and poor school attainment
- Parental alcoholism
- Parental criminality
- Deficient parenting, separation from parents, poor supervision, and parental conflict
Additionally, Adler, Brown, Connor, and Wartnik (2009) have developed the following Forensic Assessment of Fetal Alcohol Spectrum Disorders – FASD Experts Screening Questionnaire (retrieved from http://www.fasdexperts.com/Screening.shtml).
- Impulsive and illogical actions with high risk of detection
- “Simple” offense plan (focus is only on the objective)
- Poor exit strategy
- Aggressive over-reaction to unforeseen events (“fight or flight”)
- More sophisticated/experienced co-defendants
- Immediately or easily waives rights
- Over-confesses (suggestible)
- Brags about prowess or takes full responsibility if co-defendants
- Emotionally detached from crime (shows little remorse or guilt)
- Behavioural regression (breaks down in tears, infantile behaviour)
Interview with Client
- Short stature (not always)
- Unstable lifestyle
- Socially inept, immature, and naïve
- Eager to please or stubbornly resists the obvious
- Can’t provide coherent, detailed narrative
- Can’t concentrate
- Doesn’t add much to discussion
- Doesn’t seem to remember what you tell him/her from appointment to appointment
Prior Legal History
- Easily led by more sophisticated peers
- Multiple low-grade offenses in teen years, often with co-defendants
- Lots of stealing
- Illogical offenses (e.g., stealing something with little value)
- Oblivious to risk
- Impulsive, opportunistic crimes
- Probation violations
- Mom abuses alcohol/drugs
- Involvement with child welfare
- Adoption/foster or relative placements/juvenile commitment
- Special Education / learning disabilities in school
- Mental health diagnoses in childhood (especially ADD/ADHD)
- Anger control problem
- Rule-breaking behaviours in childhood (lying, cheating, stealing, fighting)
- Disrupted education
- Substance abuse
- Poor understanding of personal boundaries
- Difficulty living independently
- Poor employment history
Tips for developing a comprehensive assessment with someone with an FASD:
When a correctional professional knows or strongly suspects the existence of an FASD, there are a number of suggestions for developing a comprehensive and person-centred assessment. The assessment will be richer and more meaningful when gathered from a number of sources, including the individual, supportive family members, official records (birth, school, medical, justice, etc), invested community agencies, etc. Some key considerations for a holistic assessment include:
- Background information: Include descriptions of major life events and transitions, medical issues and hospitalizations, psychological assessments, important relationships, experience of trauma, etc.
- Present circumstances: Explore the individual’s current quality of life along with their personal preferences. What might make things better? What would make things worse?
- Environmental considerations: What are the individual’s current and past living arrangements; what are the individual’s abilities in completing activities of daily living (such as cooking, cleaning, budgeting, transportation, etc)?
- Future goals: Determine the goals of both the individual as well as the correctional system, identifying the goals that merge as well as those that might conflict. Emphasize the individual’s strengths, their hopes and dreams.
- Obstacles and opportunities: Highlight the obstacles to achieving these goals, but keep a positive outlook for new opportunities and supports or those that may have gone unrecognized in the past.
- Strategies and resources: Identify strategies employed by the individual, family members, teachers, mental health professionals, and so on that may have worked in the past. Consider the introduction of new strategies and resources to address the characteristics and challenges associated with FASD.