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Fetal Alcohol Spectrum Disorders (FASD): How Judges Can Improve Outcomes for Affected Children and Parents

Larry BurdKatrine HerrickPeggy Walker

 

 

 

 

Larry Burd, PhD, Professor, Department of Pediatrics, University of North Dakota School of Medicine
Director, North Dakota Fetal Alcohol Syndrome Center and FAS Clinic (left)
Katrine Herrick, MS, Court Teams Project Coordinator, ZERO TO THREE (middle)
The Hon. Peggy Walker, Juvenile Court Judge, Douglas County, GA (right)

Summary: The authors provide extensive background on FASD and its prevalence among court-involved children and their parents, and introduce a draft of the FASD judicial bench cards.

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The adverse effects of alcohol on the developing fetus have been documented for centuries (Sullivan, 1899, Jones & Smith, 1973). Despite this, 53% of women in the United States in their childbearing years used alcohol in 2006, and 12.5% of pregnant women reported frequent alcohol use in 2001 (Floyd et al., 2008; Floyd & Sidhu, 2004); 4.6% reported still drinking in their third trimester (Floyd & Sidhu, 2004). In the United States, these rates translate to 500,000 pregnant women drinking at least weekly and about 80,000 drinking at very high levels. The cumulative number of infants, children and adolescents with prenatal alcohol exposure in the United States is likely in the millions.

Adverse outcomes from prenatal alcohol exposure result from the interaction of several variables including: dose and timing of the alcohol exposure during prenatal development, other prenatal exposures such as smoking, poor diet, other drug use and genetic risks. One message is clear: there is no known safe amount of alcohol women can drink during pregnancy.

Children who are exposed to alcohol prenatally are at risk for fetal alcohol spectrum disorders (FASD). FASD comprises four diagnostic categories: fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol related neurodevelopmental disorder and alcohol-related birth defects (Stratton, Howe, Battaglia, & Institute of Medicine, 1996). These diagnostic categories cover a range of lifelong alcohol-related damage including: birth defects; central nervous system or brain damage; cognitive abnormalities; behavioral abnormalities; neurodevelopmental abnormalities; growth impairment; facial abnormalities; and vision or hearing abnormalities (Herrick, Hudson, Burd, 2011). Outcomes from exposure change over time in response to age and development.

Infants and toddlers with FASD may have difficulty feeding; experience delays in walking, talking and toilet training; suffer from frequent sleep disturbances; become easily distracted; be sensitive to sound and light; and be incredibly irritable. Older children with FASD may display other behavioral problems (Herrick et al., 2011). Adolescents with FASD experience many of the same symptoms as older children, and are at increased risk for substance abuse and involvement with the corrections system (Streissguth, Barr, Koga, & Bookstein, 1996). At all ages, children affected by FASD have difficulty with impulse control and behave in ways more consistent with children much younger than their chronological age.

If an accurate diagnosis is not made, children with FASD are at risk for acquiring secondary disabilities related to incorrect diagnoses and treatment strategies. Developmentally appropriate interventions and supports are critical in managing this lifelong impairment. An important component of services is risk reduction. By decreasing the affected child’s exposure to stressors (e.g., neglect, abuse, malnutrition, stressful life circumstances) it may be possible to prevent—or at least ameliorate— the catastrophic outcomes of misdiagnosis.

Because children in foster care are at increased risk for FASD, judges are in the unique position to act on behalf of affected children. First, judges can require routine screening for prenatal alcohol use. A bench card is provided here with questions that will help a judge ascertain the mother’s drinking history. If the screen determines that prenatal alcohol exposure did occur, the judge can order an FASD assessment for the child, which can be discussed at subsequent hearings. Once diagnosis is made, the judge may order developmentally appropriate services with an emphasis on risk reduction to prevent substance abuse and school failure. Siblings of children with a diagnosis of FASD should be routinely referred for FASD assessments.

Children with an FASD diagnosis require extremely predictable family interactions and routines. This makes safe, stable and loving homes tremendously important if they are going to thrive. Case plans should focus on reducing the number of placements, and making sure that any caregivers have adequate training and community resources to meet the needs of an FASD-affected child for the long term. If reunification is the ultimate goal, frequent visitation allows parents to become accustomed to the child’s needs and routine, and allows the child the opportunity to become accustomed to parent-child interactions.

Finally, due to the intergenerational nature of FASD, judges should consider that the parents of an FASD-affected child may need to be screened for FASD. Adults with FASD may have multiple cognitive impairments that are likely to complicate completion of substance abuse treatment and meeting other court ordered requirements for parents working toward reunification. Table 1 lists some of these impairments and compensatory strategies. As a result, judges must tailor the adult’s case plan to ensure inclusion of developmentally appropriate treatment and intervention strategies for these services. Table 2 provides an overview of training needs identified by corrections facilities that serve people with an FASD.

Two bench cards have been drafted to help promote these considerations in court. They will be reviewed by the NCJFCJ Permanency Planning for Children Department Advisory Committee.

Author biographies:

Dr. Larry Burd is a professor in the Department of Pediatrics at the University of North Dakota School of Medicine and Director of the North Dakota Fetal Alcohol Syndrome Center and FAS Clinic. Dr. Burd has been with the Pediatric Therapy Program for 31 years, where he has evaluated over 15,000 children with birth defects, developmental disorders and mental illness. He has ongoing longitudinal studies of linked cohorts of subjects with Tourette syndrome, autism, fetal alcohol syndrome and infant mortality risk that are in their 26th year of data collection. He published over 130 professional papers on topics dealing with development and behavior in children and adolescents. Dr. Burd is a consultant for the ZERO TO THREE Safe Babies Court Team Project.

Katrine Herrick joined ZERO TO THREE in October 2010 as the Court Teams Project coordinator. She provides oversight and management of the Court Teams database by ensuring consistent, thorough, and accurate data entry, and contributing to data analysis. She also develops written products, serves as liaison with the ZERO TO THREE Policy Center, and manages the submission of progress reports. She completed a three month internship with the Court Teams Project in August 2010. She researched and reviewed resources on fetal alcohol spectrum disorders (FASD) and the relationship to the work of the Court Teams Project. She holds her MA in child and family policy from Tufts University.

Juvenile Court Judge Peggy H. Walker serves on the Executive Committee of the National Council of Juvenile and Family Court Judges (NCJFCJ). Spanning the next five years, Judge Walker will serve as NCJFCJ secretary, treasurer, president-elect, president and immediate past-president, respectively. Her election continues a notable history of Georgia juvenile court judges chosen to join the NCJFCJ’s Executive Committee.

Since 1998, Judge Walker has served as juvenile court judge in Douglas County, GA, and a member of NCJFCJ’s board of trustees since 2005. She has also served as president of the Council of Juvenile Court Judges, chair of the Georgia Commission on Family Violence and as a board member for the Georgia Court Appointed Special Advocates.

References:

Abel, E. L. (1998). Fetal alcohol abuse syndrome. New York: Plenum Press.

Badry, D. E., Bradshaw, C. M., & Public Health Agency of Canada. (2011). Assessment and diagnosis of FASD among adults: A national and international systematic review. Ottawa: Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/fasd-etcaf/index-eng.php

Bisgard, E. B., Fisher, S., Adubato, S., & Louis, M. (2010). Screening, diagnosis, and intervention with juvenile offenders. Journal of Psychiatry & Law, 38(4), 475-506. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,uid,cookie&db=psyh&AN=2011-12420-005&site=ehost-live

Burd, L. J., Carlson, C., & Kerbeshian, J. (2009). Mental health disorders comorbid with fetal alcohol spectrum disorders. In L. Sher, I. Kandel & J. Merrick (Eds.), Alcohol-related cognitive disorders: Research and clinical perspectives (pp. 111-123). New York: Nova Science Publishers, Inc.

Burd, L. J., Cotsonas-Hassler, T. M., Martsolf, J., & Kerbeshian, J. (2003). Recognition and management of fetal alcohol syndrome. Neurotoxicology and Teratology, 25(6), 681-688.

Burd, L. J., Fast, D., Conry, J., & Williams, A. (2011). Fetal alcohol spectrum disorders as a marker for increased risk of involvement with corrections systems. The Journal of Psychiatry and Law, in press

Burd, L. J., Klug, M. G., Bueling, R., Martsolf, J., Olson, M., & Kerbeshian, J. (2008). Mortality rates in subjects with fetal alcohol spectrum disorders and their siblings. Birth Defects Res.A Clin.Mol.Teratol., 82(4), 217-223.

Burd, L. J., Klug, M. G., & Martsolf, J. (2004). Increased sibling mortality in children with fetal alcohol syndrome. Addiction Biology, 9(2), 179-186.

Burd, L. J., & Wilson, H. (2004). Fetal, infant, and child mortality in a context of alcohol use. Am J Med.Genet.C Semin.Med.Genet., 127(1), 51-58.

Cohen, M., Burd, L. J., & Beyer, M. (2005). Health services for youth in juvenile justice programs. In Puisis Michael (Ed.), Correctional medicine (pp. 120-143) Moseby.

Fast, D. K., & Conry, J. (2004). The challenge of fetal alcohol syndrome in the criminal legal system. Addiction Biology, 9(2), 161-166.

Floyd, R. L., Jack, B. W., Cefalo, R., Atrash, H., Mahoney, J., Herron, A., et al. (2008). The clinical content of preconception care: Alcohol, tobacco, and illicit drug exposures. American Journal of Obstetrics and Gynecology, 199(6), S333-S339.

Floyd, R. L., & Sidhu, J. S. (2004). Monitoring prenatal alcohol exposure. American Journal of Medical Genetics.Part C, Seminars in Medical Genetics, 127C(1), 3-9. doi:10.1002/ajmg.c.30010

Jones, K. L., & Smith, D. W. (1973). Recognition of the fetal alcohol syndrome in early infancy. Lancet, 2, 999-1001.

Lupton, C., Burd, L. J., & Harwood, R. (2004). Cost of fetal alcohol spectrum disorders. Am J Med Genet C Semin Med Genet, 127C(1), 42-50.

Popova, S., Lange, S., Bekmuradov, D., Mihic, A., & Rehm, J. (2011). Fetal alcohol spectrum disorder prevalence estimates in correctional systems: A systematic literature review. Canadian Journal of Public Health, 102(5), 336-340.

Stade, B., Ungar, W. J., Stevens, B., Beyen, J., & Koren, G. (2007). Cost of fetal alcohol spectrum disorder in canada. Canadian Family Physician Medecin De Famille Canadien, 53(8), 1303-1304.

Stratton, K. R., Howe, C. J., Battaglia, F. C., & Institute of Medicine. (1996). Fetal alcohol syndrome-diagnosis, epidemiology, prevention, and treatment. Washington, D.C: National Academy Press.

Streissguth, A. P., Barr, H. M., Koga, J., & Bookstein, F. L. (1996). Understanding the occurrence of secondary disabilities in clients with FAS and FAE No. 96-0). Seattle: University of Washington Fetal Alcohol and Drug Unit.

Sullivan, W. C. (1899). A note on the influence of maternal inebriety on the offspring. Journal of Mental Science, 45, 489-507.

Thanh, N. X., & Jonsson, E. (2009). Costs of fetal alcohol spectrum disorder in alberta, canada. Can J Clin Pharmcol, 16(1), e80-e90.

Author biographies:

Dr. Larry Burd is a professor in the Department of Pediatrics at the University of North Dakota School of Medicine and Director of the North Dakota Fetal Alcohol Syndrome Center and FAS Clinic. Dr. Burd has been with the Pediatric Therapy Program for 31 years, where he has evaluated over 15,000 children with birth defects, developmental disorders and mental illness. He has ongoing longitudinal studies of linked cohorts of subjects with Tourette syndrome, autism, fetal alcohol syndrome and infant mortality risk that are in their 26th year of data collection. He published over 130 professional papers on topics dealing with development and behavior in children and adolescents. Dr. Burd is a consultant for the ZERO TO THREE Safe Babies Court Team Project.

Katrine Herrick joined ZERO TO THREE in October 2010 as the Court Teams Project coordinator. She provides oversight and management of the Court Teams database by ensuring consistent, thorough, and accurate data entry, and contributing to data analysis. She also develops written products, serves as liaison with the ZERO TO THREE Policy Center, and manages the submission of progress reports. She completed a three month internship with the Court Teams Project in August 2010. She researched and reviewed resources on fetal alcohol spectrum disorders (FASD) and the relationship to the work of the Court Teams Project. She holds her MA in child and family policy from Tufts University.

Juvenile Court Judge Peggy H. Walker serves on the Executive Committee of the National Council of Juvenile and Family Court Judges (NCJFCJ). Spanning the next five years, Judge Walker will serve as NCJFCJ secretary, treasurer, president-elect, president and immediate past-president, respectively. Her election continues a notable history of Georgia juvenile court judges chosen to join the NCJFCJ’s Executive Committee.

Since 1998, Judge Walker has served as juvenile court judge in Douglas County, GA, and a member of NCJFCJ’s board of trustees since 2005. She has also served as president of the Council of Juvenile Court Judges, chair of the Georgia Commission on Family Violence and as a board member for the Georgia Court Appointed Special Advocates.

 

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