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Fetal Alcohol Spectrum Disorders in Mental Health
and Criminal Justice
Instructor: Dr. Dawn-Elise Snipes
Executive Director, Counseling Continuing Education
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery
– Where to begin…
– Explore the scope of the problem
– Identify the impact of the impairments across life domains
– Discuss specific issues for adolescents

– National Institute on Alcohol Abuse and Alcoholism, the prevalence of FAS in the general population ranges from 2% to 5% for the entire continuum of FASD.
– 94% of individuals with an FASD also have a mental illness
– 73-80% of children with full-blown FAS are in foster or adoptive placement
– 61% of adolescents with an FASD experienced significant school disruptions

Stats cont…
– The prevalence of FASD in the child welfare system is approximately 17 to 19 times higher than that in the general population in North America (meta-analysis published online September 9 in Pediatrics).
– 12.8 is the average age children with an FASD begin having trouble with the law. (
– 60% of people with an FASD have a history of trouble with the law

What is FASD
– FASD is not a diagnostic term, but is an umbrella term encompassing four categorical diagnostic entities:
– Fetal alcohol syndrome (FAS)
– Partial FAS
– Alcohol-related neurodevelopmental disorder
– Alcohol-related birth defects
Impact of Functional Impairment
– Problems in multiple domains interferes with treatment success, including inability to:
– Remember program rules or follow multiple instructions.
– Remember and keep appointments, or to get lost on the way there.
– Independently make appropriate decisions about treatment needs/goals.
– Appropriately interpret social cues
– Observe appropriate boundaries, either with staff or other clients.
– Attend to (and not disrupt) group activities.
– Process information readily or accurately.
– ‘Act one's age.’
– When indicators occur in any these domains (and particularly when they occur across multiple domains), it is worthwhile to apply the FASD 4-Digit Code Caregiver Interview Checklist (Astley, 2004b)
Special Considerations for Adolescents

– Evidence shows that adolescents will commonly exhibit learning and behavior challenges, especially in
– Adaptive function/getting along from day to day
– Remaining organized and regulated
– Learning information slowly (especially what is said to them)
– Tending to forget things they have recently learned
– Making the same mistakes over and over.
– Impulsivity/finding it hard to inhibit responses
– Social communication (leaving out important details/being vague).
– Suggestibility (and therefore easily influenced by others)
– Immature social skills. (too friendly/trusting,/difficulty recognizing dangerous situations.
Differential Dx
– There is some evidence for distinguishing between children with FASD and children with ADHD. Using the four-factor model of attention it has been shown that:
– children with FASD have difficulties with encoding (taking in and processing information) and shift (shifting attention (hyperfocus))
– children with ADHD have problems with focus and sustain. (Using Mirsky (1989) 4 factor model of attention)
– Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders in children: clinical guidelines Neuropsychiatr Dis Treat. 2010; 6: 509–515.

– Additional modules will focus on topics including…
– Accommodations for the clinician to prevent exasperation and burnout.
– FASD in the criminal justice system
– Case management and Unmet needs for caregivers

Video by Dr. Dawn Elise Snipes on integrative behavioral health approaches including counseling techniques and skills for improving mental health and reducing mental illness.

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