Children with Fetal Alcohol Spectrum Disorders in the Dependency Court System: Challenges and Recommendations

By Paley, Blair; Auerbach, Barbara E. | Journal of Psychiatry & Law, Winter 2010 | Go to article overview

Children with Fetal Alcohol Spectrum Disorders in the Dependency Court System: Challenges and Recommendations


Paley, Blair, Auerbach, Barbara E., Journal of Psychiatry & Law


Children with Fetal Alcohol Spectrum Disorders (FASD) are at a greatly increased risk for developmental delays, learning disabilities, and behavioral, social, and emotional problems. High rates of secondary disabilities have been reported in this population, including mental health problems, school failure, delinquency, plus alcohol and substance abuse problems. Long-term outcomes for adolescents and adults with FASD include increased risk for unemployment, suicidal ideation and behavior, and confinement in psychiatric facilities and correctional institutions. Many children impacted by prenatal alcohol exposure are raised in out-of-home placements, and thus will likely have extensive involvement with the child welfare and dependency court systems. However, child welfare agencies and dependency courts are often not well-equipped to handle cases involving these children. This article will address the challenges that children with FASD and their families face in those systems, as well as recommendations for improvements in how those systems respond to the needs of these highly vulnerable children.

Key Words: FASD, youth, courts.

Fetal Alcohol Syndrome (FAS) is a major birth defect resulting from prenatal alcohol exposure and is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system dysfunction (Jones & Smith, 1973). Numerous studies have documented the teratogenic effects of alcohol, including intellectual and learning disabilities, executive function deficits, speech and language delays, fine and gross motor problems, as well as behavioral, social, and emotional difficulties (Guerri, Bazinet, & Riley, 2009; Kodituwakku, 2009; O'Connor & Paley, 2009; Paley & O'Connor, 2007; Rasmussen & Bisanz, 2009; Riley & McGee, 2005; Streissguth, 2007). Such studies also demonstrate that there is some variability in the manifestations of in utero alcohol exposure across individuals, and consequently the term, Fetal Alcohol Spectrum Disorders (FASD) (Warren et al., 2004), has been adopted to reflect the range of effects associated with such exposure. In addition to FAS, this term also encompasses other alcohol-related conditions, including Partial FAS, Alcohol Related Neurodevelopmental Disorder, and Alcohol Related Birth Defects. These disorders are more common than previously thought, with the prevalence of the entire continuum estimated to range from 1% to 5% (May & Gossage, 2001; May et al., 2009), and more common than other more well-known developmental disabilities, yet they receive much less attention in the mental health and legal systems.

From both mental health and legal perspectives, FASD places a tremendous burden on both families and society. High rates of secondary disabilities have been reported in individuals with FASD, including comorbid psychiatric conditions, school failure, delinquency, and alcohol and substance abuse problems (Alati et al., 2008; Streissguth et al., 2004). Longterm outcomes for adolescents and adults with FASD include increased risk for unemployment, suicidal ideation and behavior, and confinement in psychiatric facilities and correctional institutions (Huggins, Grant, O'Malley, & Streissguth, 2008; Streissguth et al., 2004). Individuals with FASD are significantly overrepresented but undertreated in psychiatrie populations, the child welfare system, and juvenile detention and correctional settings (Astley, Stachowiak, Clarren, & Clausen, 2002; Burd, Selfridge, Klug, & Bakko, 2004; Fast & Conry, 2009; O'Connor, McCracken, & Best, 2006). The lifetime cost for a person with FAS is estimated to be approximately $2 million dollars, the majority of which reflects special education and medical and mental health treatment (Lupton, Burd, & Harwood, 2004).

Children with FASD in the child welfare system

According to the Adoption and Foster Care Analysis and Reporting System, approximately 424,000 children were placed in foster care in kinship and nonkinship settings as of September, 2009 (U. …

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Children with Fetal Alcohol Spectrum Disorders in the Dependency Court System: Challenges and Recommendations
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