FASD & the Justice System

“The diagnostic process consists of screening and referral, physical examination, differential diagnosis, the neurobehavioural assessment, treatment and follow-up.  Because of the complexity and the range of expression of dysfunction related to prenatal alcohol exposure, a multidisciplinary team is essential for an accurate and comprehensive diagnosis and treatment recommendation.” (Chudley A, et al. 2005).  As an informed lawyer, judge, police officer, probation officer or other criminal justice worker, what you can do to help is recognize that a person before you may be affected by FASD   

The diagnostic criteria for Fetal Alcohol Syndrome and the other alcohol-related disabilities included under the umbrella of FASD have developed over time.  In 1996, the US Institute of Medicine (Stratton K. 1996) recommended five major diagnostic categories aimed at distinguishing between cases where maternal drinking during pregnancy could be confirmed, and those where maternal drinking during pregnancy was unclear:

Fetal Alcohol Syndrome (FAS) with a confirmed history of maternal alcohol exposure requiring evidence of facial dysmorphology, growth retardation, and central nervous (CNS) dysfunction;

FAS without confirmed maternal exposure requiring evidence of facial dysmorphology, growth retardation, and CNS dysfunction;

Partial FAS (pFAS) requiring a confirmed history of prenatal alcohol exposure, facial dysmorphology, and either growth retardation or CNS abnormalities;

Alcohol-related birth defects (ARBD) to denote the presence of congenital anomalies (heart, skeletal, renal, ocular, auditory) known to be associated with a history of prenatal alcohol exposure;

Alcohol-related neurodevelopmental disorder (ARND) requiring a confirmed history of prenatal alcohol exposure and evidence of CNS abnormalities.

(Roberts, G. and Nanson, J. 2000; 49-50.)

Since then Canadian researchers and clinicians have worked to clarify the diagnostic criteria.  Canadian diagnostic guidelines were published in 2005, after widespread consultation among expert practitioners and partners in the field. (Chudley, A. et al. 2005).  Those guidelines have been further refined through new research conducted by Dr. Chudley and colleagues to address clinical concerns about standard measurements of eye size -- a key measurement in the diagnosis of FAS.  

Still, diagnostic capacity is limited and what does exist is generally not funded by health care plans. (Roach, K. and Bailey, A. 2009).  It is therefore not surprising that most individuals who have FASD do not know it. They may have grown up thinking they were different or may be diagnosed with something else, such as Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder, Conduct Disorder, Intermittent Explosive Disorder, Bipolar, Psychotic Disorder, Antisocial Personality Disorder, Borderline Personality Disorder etc. (Streissguth, 2008, PowerPoint). Canadian researchers and clinicians are trying to reduce the chances of confusing FASD for some other behaviour disorder, by refining the behavioural profile of FASD.  For example, to the untrained eye the restlessness and extreme impulsivity of individuals with FASD and Attention Deficit Hyperactivity Disorder can look the same.  But a new study has uncovered crucial differences between FASD and ADHD. Their findings show that children with FASD have more severe behavioural problems than those with ADHD, and that these problems are caused by an inability to understand and interpret social information, such as the emotions expressed on people’s faces (Rovet, J. 2009). Learning the particular reasons for the behaviour of people with FASD is helping psychiatrists and others develop appropriate interventions to deal with their unique problems.

Researchers and clinicians are also developing evaluated screening tools to help identify people at risk for FASD, and facilitate diagnosis.  One such tool is the Asante Centre for Fetal Alcohol Syndrome, Probation Officer Screening & Referral Form for use by trained workers in the youth justice system. The validity of the tool is still being tested before releasing for wider use (Goh, I. 2008).