Navigating the System with FASDs

Reprinted with permission from the National Council of Juvenile and Family Court Judges

Summary: Because children and adults who were prenatally exposed to alcohol are at higher risk for victimization and encountering the judicial system, the juvenile and family court system has an important role to play in addressing this hidden epidemic.

Special Points of Interest

  • FASDs are 100% preventable
  • Early diagnosis, identification and intervention of the disorder is key
  • Typical disciplinary methods are not as effective for those with FASDs
  • Service plans should be modified to include emerging and evidence-based interventions for those who have FASDs
  • Courts and social workers should become knowledgeable about FASDs and locate resources in their respective communities
  • Among children with an FASDs diagnosis, 70% are or have been in foster care.
  • September 9th is International FASDs Awareness Day

Life with fetal alcohol spectrum disorders (FASDs) can be especially challenging. Children and adults who were prenatally exposed to alcohol can experience a range of issues throughout their lives and unfortunately those who are living with FASDs are at higher risk for victimization and encountering the judicial system.

People with FASDs may not understand the consequences of their behavior and actions. As a result people who suffer from FASDs may find themselves in trouble more often and in the midst of the criminal system. Fetal-alcohol exposed children may end up in the family court system either in the dependency or the juvenile justice system. This poses a special challenge because it may impact the courts’ decision on how to handle these kinds of cases. The types of services offered to those with FASDs may need to be different than the typical services offered. The juvenile and family court system has an important role to play in this hidden epidemic.

Facts about FASDs

  • Fetal alcohol spectrum disorders (FASDs) is the umbrella term for a group of conditions for anyone whose mother drank while pregnant. The effects of alcohol exposure during pregnancy can last a lifetime and include physical, behavioral, and learning problems (CDC, 2010). Fetal alcohol syndrome (FAS) is the more severe condition as a result of prenatal alcohol exposure (PAE).
  • Not all children exposed prenatally to alcohol exhibit the same characteristics due the fact that exposure factors (amount, duration and frequency) vary from case to case.
  • Population-based prevalence/incidence rates are unknown because individuals with FASDs often are not diagnosed or incorrectly diagnosed with attention deficit disorder, conduct disorder, oppositional defiant disorder, and/or emotionally disturbed.
  • Population-based estimates of FASDs vary widely. US FASDs rates are estimated between 2–5% of school children, and prevalence of FAS could be as high as 2–7 people per 1,000 (May et al., 2009).
  • Among children with an FASDs diagnosis, 70% are or have been in foster care. (Burd et al., 2011) Prevalence of FASDs in foster care is 10–15 times the rate non-foster care children and over-represented in juvenile justice (Burd et al., 2011; Malbin, 2004).
  • FASDs can cause behavioral, physical and mental disabilities.
  • Behavior issues can include: Poor judgment, impulsivity, learning problems, difficulties understanding consequences and paying attention, and hyperactivity.
  • Physical features can include: abnormal facial features, small head, shorter-than-average height, low body weight, poor coordination, vision or hearing problems, and problems with heart, kidney or bones.
  • Mental disabilities can include: low IQ, intellectual disabilities, poor memory, difficulties with math, and speech and language delays.

Diagnosis, Treatment and Interventions

Proper and Early Diagnosis:

  • FASDs is not a medical diagnosis but an umbrella term. FAS is a clinical diagnosis.
  • Identification and treatment of FASDs can be difficult because of existing barriers (e.g., no formal diagnostic criteria), but early intervention is beneficial for improved long-term outcomes (SAMHSA, 2005).
  • Severe cases of FAS are diagnosed at birth. However, most people with FASD are identified later in childhood or adulthood, if they are diagnosed at all.
  • The US Department of Health and Human Services, Substance Abuse and Mental Health Service Administration, recommends assessing the diagnosis with a team of professionals.
  • Teams can include: geneticist, developmental pediatrician, neurologist, dysmorphologist (physician who specializes in birth defects), education consultants, psychologist, psychiatrists, social workers, occupational therapists, and speech and language specialists (SAMSHA, 2005).
  • Tests include physicals, face evaluations, IQ tests, psychiatric evaluations and specific clinical tests (e.g., Conners Rating Scales, Vineland Adaptive Behavior Scale, and Children’s Memory Scale)
  • Where to go for a diagnosis in your area? The National Organization on Fetal Alcohol Syndrome (NOFAS) has listed resources state-by-state.

Treatments and Interventions:

When an individual has been diagnosed with FASDs the next step is to identify available and age-appropriate services in the community. These services can include:

  • Family interventions (e.g., Parent-Child Interaction Therapy for Children with FASDs, Families Moving Forward: A Behavioral Consultation Intervention for Families Raising Children with FASDs)
  • Educational interventions (e.g., Sociocognitive Habilitation for Children with FASDs using the Math Interactive Learning Experience (MILE) Program)
  • Behavioral interventions (e.g., Project Bruin Buddies: A Social Skills Training Program to Improve Peer Friendships for Children with FASDs)
  • Executive functioning interventions (e.g., Neurocognitive Habilitation for Children with FASDs)
  • Related FASDs treatment can include: parent support networks, self-advocacy networks, respite care, FASDs summer camps/retreats, teen groups, adult living/work arrangements, FASDs-informed mental health and substance abuse care, family/individual therapy, medications, sleep treatments, and skills based trainings (Olson, 2012). 

Additional Resources

NCJFCJ Creates Tools to Assist Those with FASDs

Recognizing the impact that fetal alcohol spectrum disorders (FASDs) have on families and children, the National Council of Juvenile and Family Court Judges (NCJFCJ) has begun working on the development of tools to assist judicial officers in identifying and serving those who come before the court with FASDs.

In early 2014, NCJFCJ will host a meeting with judicial officers from across the country to develop judicial practice tools and recommendations for courts. Once developed, these tools will be made available to judicial officers, attorneys, social workers and other stakeholders.

NCJFCJ regularly trains on cutting-edge topics in child abuse and neglect, juvenile justice and domestic violence. Practice recommendations for working with those affected by FASDs will be incorporated into the myriad of training programs that NCJFCJ offers.

NCJFCJ has developed a survey to gather information about the current level of knowledge and availability of FASDs interventions available to juvenile and family court personnel. It should only take 10–15 minutes. Your opinion is important to us. Thank you in advance for taking the time to fill out this survey.

In addition to this survey, please visit our website us for more information about FASDs, treatments, interventions, and resources.


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