Parents Who Have FASD in Dependency Courts

Stephen GreenspanStephen Greenspan, PhD, Emeritus Professor of Educational Psychology, University of Connecticut
Clinical Professor of Psychiatry, University of Colorado

Summary: The author provides information for courts dealing with parents who have FASD

Adults who have fetal alcohol spectrum disorders (FASD) have a variety of behavioral traits (impulsivity, poor judgment, disorganization, failure to anticipate consequences or learn from experience, interpersonal conflict, poor perspective-taking, susceptibility to bad influences) that make it difficult for them to succeed in various adult roles (e.g., employment, community living, marital relationships) or to keep from being arrested or jailed, usually for “dumb” rather than “bad” offenses [1]. Parenting is an adult role that can also be challenging for persons with FASD, and they (along with others who have cognitive or psychiatric disorders) are at much higher than average risk for having their children removed from their custody [2], typically for neglect (inability to provide a safe or adequate environment) more than for abuse (intentional inflicting of harm on a child).

The majority of adults with FASD, including those who are parents, have alcohol related neurodevelopmental disorders (ARND) and thus lack the overt physical (facial) signs that would get the brain-based nature of their problems recognized [3]. Because the average IQ of people with ARND is in the mid or high 80’s, parents with FASD generally are not eligible for developmental disability services, and instead have typically been assigned a variety of psychiatric labels that focus on outward behavioral manifestations (impulsivity, anxiety, depression, personality disorders) rather than the underlying brain-based causes of those manifestations [4]. With the advent of a new psychiatric category of “neurodevelopmental disorder associated with prenatal alcohol exposure” (code 315.9, F88, page 86) in DSM-5 [5], it is likely that FASD will become more frequently diagnosed, including in parents (particularly mothers) who have the disorder [6].

While having one’s brain-based disorder properly labeled and recognized is generally a good thing, there is a downside for parents assigned that label, namely that child protective agencies and courts may just automatically assume that a person with FASD cannot succeed as a parent, and thus they may be quicker to terminate parental rights than would otherwise be the case [7]. This partly reflects the mistaken belief that people with brain-based disorders are globally incompetent and incapable of personal growth or learning. However, this also reflects the absence of a clear-cut definition of parenting adequacy, or of valid, systematic and comprehensive methods for evaluating parenting adequacy [8]. In the absence of objective direct evidence regarding whether a parent meets (vaguely defined) minimal standards of child care, there is a tendency for courts and child protective agencies to rely on indirect factors having little to do with parenting, such as: (a) a diagnostic label, (b) the physical condition of the living situation; and (c) whether the person meets conditions (attends classes, keeps to a visitation schedule, calls in when required to) and is sufficiently respectful of protective workers [9].

Although there is little research and few resources available specifically relating to parents who have FASD, there is much available pertaining to parents with other neurodevelopmental disorders, including intellectual disability (ID). The issues are very similar, and much of this writing [10] applies quite well to parents who have FASD. The following five lessons learned from work with parents who have ID spelled out in a publication issued by a California program called “Through the Looking Glass” [11] published by the National Center for Parents with Disabilities is fairly generic to parents with a range of neurodevelopmental disorders, and can be applied to parents who have FASD: 

  • Lesson one: Look at the person not the label. When considering termination of parental rights, look at the person, and not the label. There is a tendency to assume that parents with FASD (or ID) cannot function as parents and are so globally impaired that there is no point even trying to work with them. This, in fact, is a mistaken assumption and is responsible for improper and premature termination of parental rights [12].
  • Lesson two: Use adequate assessment and targeted interventions. It is important to gear parenting interventions to areas of specific need, rather than (as is too often the case) assigning parents to whatever courses are being offered in a particular locale. Critical to this is the use of adequate assessment methods, which are now more available than in the past [13]. It is especially important not to base decisions on psychological tests that address general abilities or traits and which have nothing to do with parenting. It is important for assessments to be repeated over a period of time, in order to see if and how parents are benefiting from interventions and supports.
  • Lesson three: Seek to create support networks. To the extent possible, parents with FASD should be encouraged to make use of supports (such as from a child’s grandparents or other extended family members) which can compensate, to some extent, for the parent’s deficits. Professionals should seek to use a “wraparound” model [14], to provide a mix of formal and informal supports as needed. As a rule, parents with FASD do better when such supports are in place. Evaluators should observe the parents in such supportive settings and should seek input from people who know the parent well rather than just relying on their own brief observations in artificial and anxiety-producing settings such as an agency office.
  • Lesson four: Use mentoring and coaching. There is some evidence that a step-by-step mentoring or coaching approach, geared to a very specific “teachable moment,” can be more effective when working with parents with cognitive impairments, including parents with FASD, [15] than is a group classroom approach where material is presented didactically, and where it is likely that the parents will not remember or assimilate the messages.
  • Lesson five: Exercise empathy and flexibility. Because parents with FASD (as well as parents with ID) are poor perspective-takers, tend to be somewhat emotionally reactive, and have difficulty remembering commitments or appointments, they do not understand the consequences of expressing anger at an evaluator or failing to appear sufficiently diligent in following directions. Some degree of flexibility, therefore, is called for when working with such parents, and protective workers and court personnel should be willing to go an extra mile. An analogy would be mental health courts [16], where judges and probation personnel are less quick to send a brain–impaired person to jail for minor mess-ups, such as occasional failure to show up for required meetings.


Author biography:

Stephen Greenspan is a developmental psychologist who specializes in neurodevelopmental disorders, particularly intellectual disability. (He was the most-cited authority in the 2010 diagnostic manual of the American Association on intellectual and developmental disability.) He is emeritus professor of educational psychology at the University of Connecticut and clinical professor of psychiatry at the University of Colorado, where he now resides. He was a featured keynote speaker at the first international conference on “supported parenting” (parents with neuro-cognitive disorders) held in Madison, Wisconsin.


[1] Edwards, W. & Greenspan, S. (2011). Adaptive behavior and fetal alcohol spectrum disorders. Journal of Psychiatry and Law. 39(4) 419-447.

[2] National Council of Disability (2012). Rocking the cradle: Ensuring the rights of parents with disabilities and their children. Washington, DC: Author.

[3] Clarke, M.E. & Gibbard, W.B. (2003). Overview of Fetal Alcohol Spectrum Disorders for mental health professionals. Canadian Child & Adolescent Psychiatry, 12 (3), 57-63.

[4] Streissguth, A.P. & O’Malley, K. (2000). Neuropsychiatric implications and long-term consequences of Fetal Alcohol Spectrum Disorders. Seminars in Clinical Neuropsychiatry, 5 (3), 177-190.

[5] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington, DC: Author.

[6] Rich, S.D. (2012, Fall-Winter). Shifting diagnostic paradigms for improved treatment and surveillance of Fetal Alcohol Spectrum Disorder in DSM-V. Child & Adolescent Psychiatry Society of Greater Washington Newsletter, pages 4, 7.

[7] Greenspan, S. and Budd, K.S. (1986). Research on mentally retarded parents. In J.J. Gallagher & P. Vietze (Eds.), Families of handicapped persons: Current research, treatment and policy issues. Baltimore: Paul Brookes & Co.

[8] Budd, K.S. and Greenspan, S. (1984). Mentally retarded mothers. In E.A. Blechman (Ed.), Behavior modification with women. New York: Guilford.

[9] DePanfilis (2006). Child neglect: A guide for prevention, assessment and intervention. Washington, DC: Children’s Bureau.

[10] Llewellyn, G., Traustadóttir, R. , McConnell, D. & Sigurjónsdóttir, H.B. (Eds.) (2010). Parents with intellectual Disabilities: Past, present and future. Chichester, UK: Wiley-Blackwell.

[11] Kirshbaum, M. (2004). Guidelines for improving practice in intervention with parents with Intellectual Disability and their children. Berkeley, CA: National Center for Parents with Disabilities and their Families.

[12] Budd, K.S. and Greenspan, S. (1985). Parameters of successful and unsuccessful interventions with parents who are mentally retarded. Mental Retardation, 23, 269-273.

[13] Feldman, M.A. & Aunos, M. (2010). Comprehensive competence-based parenting capacity assessment for parents with learning difficulties. Kingston, NY: NADD Press.

[14] Walker, J.S., Koroloff N., & Schutte, K. (2003). Implementing high-quality collaborative individualized service/ support planning: Necessary conditions, Portland OR: Research and Training Center on Family Support and Children's Mental Health.

[15] Steadman, H.J., Davidson, S. & Brown, C. (2001). Mental health courts: Their promise and unanswered questions. Psychiatric Services, 52, 457–458.


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