Fetal Alcohol Spectrum Disorders: Implications for the Juvenile Justice System

Kathryn Wosser Page, PhD
Mental Health Coordinator, Canal Alliance

Summary: Among foster children, emotional, behavioral and developmental problems are thought to be present at a rate three to six time greater than children in the general population. It is likely that FASD is a culprit in the "crossover" phenomenon.

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Fetal Alcohol Spectrum Disorders (FASD) is a wide array of behavioral, intellectual, communicative, regulatory and medical difficulties associated with damage caused by exposure to alcohol during gestation. These difficulties usually co-exist with a normal and sometimes even high IQ. Recent research suggests the prevalence of occurrence of FASD in the general population is 2–5% (1.) Across the globe, almost none of these individuals’ difficulties are even considered to stem from disability, let alone accurately diagnosed. 

This condition is largely invisible, often masquerading as simple disobedience or immaturity in children and poor character in adults. Except for the small percentage with characteristic facial features, people with FASD are usually punished and shamed for failures that are—without a little help—beyond their control.

Prenatal alcohol-related brain damage is far from evenly distributed through society, clustering instead in situations of public assistance, punishment or reform. Anne Streissguth’s seminal longitudinal study (2) outlines the following secondary disabilities of prenatal alcohol damage:

  • Mental illness: 94% (AD/HD and depression)
  • Trouble with the law: 60%
  • School dropout: 70%
  • Dependent living: 82% (over the age of 20)
  • Substance abuse 60%

Among foster children, emotional, behavioral and developmental problems are generally thought to be present at a rate three to six times greater than children in the general population (3). Twice as many foster youth fail to graduate high school as the average; 71% of females aging out of foster care become pregnant at least once before age 21; and males in foster care are four times more likely to have been arrested than a comparison group. (4)

The parallels between outcomes for foster youth and for adolescents with prenatal alcohol damage are not coincidental. Results of a University of Washington study on fetal alcohol among foster youth suggest a prevalence 10–15 times greater than among the general population. (5) Beyond being one of the central (but entirely invisible to most) factors in the dismal outcome for foster youth in general, it is likely that FASD is a major culprit in the “crossover” phenomenon. It has been said that FASD is the only disability to so frequently result in incarceration. (6) As one noted author explains it:

"Most of us can make a choice about whether or not we want to steal, or lie, or commit a crime. However, victims of  FASD experience impulses and thoughts without the neural capacity to process those thoughts or monitor the resulting behaviors—in other words, they can't make choices and they can't determine what is right and what is wrong in the moment, nor can they consider the consequences of their actions. Clearly, this type of brain damage makes them at high risk to break the law. Programs that are long term and provide employment skills, housing, parenting skills, and appropriate drug and alcohol counseling will have more likelihood of creating a successful and law abiding lifestyle for the person with FASD than any form of punitive action." (7)

Previously, multiple and group-home placement have been considered primary contributors to delinquency among foster youth. (8) It should be noted that the main reason for such disrupted placement is unmanageable behavior. Foster parents are not prepared for the complex, baffling and very difficult-to-meet needs of children with such disruptive brain damage. Evidence for FASD in multiple placements can be seen in a study in Hennepin County (9), where more than half of the children with four or more placements had a special needs problem prior to removal from the home, but only 11% with two or fewer placements. (“Special needs” in this case are a proxy for central nervous system dysfunctions of the type that prenatal alcohol can cause—learning disabilities and symptoms of autism and  AD/HD chief among them.)

The best solution to this firestorm of dysfunction is prevention, of course, and many projects are achieving a decrease in rates of exposure. If we can recognize this issue as worthy of recognition early, then supports can be put in place that will help families provide environments that maximize the chance of moving into happy, healthy, productive adulthood.

It is hoped that this very brief look at FASD in juvenile justice has sparked interest in focusing deeper on the havoc that this invisible epidemic is wreaking daily on our children and systems as a whole. A volume of the Journal of Psychiatry and the Law is currently in press which will cover this subject in much greater detail. 

  1. May, P.A., Gossage, J.P., Kalberg, W.O., Robinson, L.K., Bucley, D., Manning, M. 2009. FASD from various research methods with an emphasis on recent in-school studies. Developmental Disabilities Research Reviews 15: 176-192.
  2. Streissguth, A.P., Barr, H.M., Kogan, J., & Bookstein, F.L. (1996). Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome and fetal alcohol effects.   Final report to the Centers for Disease Control and Prevention (CDC), August, 1996 (Tech. Rep. No. 96-06). Seattle, WA: University of Washington.
  3. Marsenich, L. 2002 Evidence-based practices in mental health services for foster youth. California Institute for Mental Health. March. 
  4. Dicker, S. and Gordon, E. 2000. Connecting healthy development and permanency: A pivotal role for child welfare professionals. Permanency Planning Today, Vol. 1. pp12-15.  
  5. Astley, S. J., Stachowiak, J., Clarren, S.K., Clausen, C. 2002. Application of the fetal alcohol syndrome facial photographic screening tool in a foster care population. J Pediatr. 41:712-7. 
  6. Hagerman, R., M.D. 2002. In “What Doctors Need to Know”, video produced by Santa Clara County Department of Alcohol and Other Drug Services. 
  7. McCreight, B. 1997. Recognizing and Managing Children with Fetal Alcohol Syndrome/Fetal Alcohol Effects: A Guidebook Child Welfare League of America 
  8. Ryan, J.P., Marshall, J.M., Herz, D., Hernandez, P.M. 2008. Children and Youth Services Review.  30:9, 1088-1099.  
  9. Title IV-E Curriculum Module, Hennepin County Placement Stability/Instability Study, Center for Advanced Studies in Child Welfare, University of Minnesota, Extracted July 31, 2010 from http://www.cehd.umn.edu/SSW/cascw/research/learningModules/stability/

Editor's Note: For additional information about FASD, and the importance of early identification of it, see Kathryn Kelly's article in the February 2005 Judges' Page newsletter. 

 

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