1. Fetal Alcohol Spectrum Disorders: And Drug Courts

2. Summary of the Class FASD Terminology Cause of the Disorder Physical and Behavioral Effects Diagnoses Prognosis/Effect on Society Legal Issues Intervention Basics FASD In the Courts

3. Fetal Alcohol Spectrum Disorders (FASD): The Basics

4. Fetal Alcohol Syndrome (FAS) A medical diagnosis that requires: –Small size or slow growth –Specific facial features –Cognitive deficits in multiple areas –Proof of prenatal alcohol exposure

5. Descriptive Term for the Whole Spectrum (FASD) Fetal Alcohol Spectrum Disorders Describes the whole range of disorders caused by maternal alcohol used during gestation. FASD is not a diagnosis.

6. What happens when a Pregnant Woman Drinks?

7. Mom & baby both drink

9. Effect on the Brain Typical InfantInfant with FAS

10. Every Individual is Different Some Have Many Effects, Some Have Fewer or None

11. Alcohol Can Cause Irreversible Damage Before the Mother Knows She is Pregnant

12. Physical Effects Premature birth Small size/slow growth Vision, hearing deficits Heart problems Problems with other organs Improper bone development Dyslexia Lower IQ

14. Cognitive Effects Difficulty Making Decisions –Don’t understand cause and effect or behavior and consequences –Impulsive Memory Problems –Poor short-term memory –Memory comes and goes –Can’t follow directions

15. Cognitive Effects Can’t Think Abstractly –Don’t understand time –Can’t handle money Wide Differences in Abilities –May say more than they understand –May know things that they can’t express –May think slowly and therefore miss part of what is said – mis-interpret

16. Cognitive Effects Disorganized Mind –Therefore can’t organize their life Distractible - may have trouble paying attention Have a difficult time with any kind of change

17. Sensory Issues Over or Under Sensitive to: –Touch –Things they see –Things they hear –Smells –Taste/food texture –Gravity/their space in the world

18. Red Flags in Children Slow to talk Poor muscle tone Trouble relating to same-age peers May behave like a much younger child May not be able to adjust to middle school and above May not reach adult maturity until 25 or 30, if ever

19. Learned Behaviors Because of the Way They See the World Angry/Violent Avoidance –Shut people out –Isolate/Run away –Drug & alcohol use Bossiness/bullying Anxiety, fear, somatic complaints Depression

20. Mental Health Diagnoses ADHD/ADD Reactive Attachment Disorder Depression Sensory Integration Disorder Conduct Disorder Bi-Polar Disorder

21. Life Issues Faced by Those with FASDs 94% will require Mental Health services 60% will have school problems 60% will be arrested 50% will be incarcerated or confined in a mental institution or in-patient drug program. 80% will be unable to hold down a job 80% will be unable to live independently Streissguth 1996

22. The Effect on Society At least 1 in 100 children born in America have an FASD 43,000 per year in the United States 708 per year in Colorado (2007) Studies estimate that each child born with an FASD will average well over $2,000,000 in services over a lifetime. $1.4 Billion per year for babies born in Colorado (based upon 2007 census) –These costs do NOT count the cost of incarceration

23. These Outcomes Can Be Changed with Recognition, Diagnosis, and Intervention

24. The Children of Any Woman in a Drug Court Are at Risk of Having Been Prenatally Exposed Once Identified, They Can Be Helped!

25. 17 th Judicial Preliminary Statistics – D&N 2.4 years of screening 3-5 year olds removed from parents because of mother’s substance abuse [and other children referred]. –63% prenatally exposed by interview –65% of those sent for diagnosis have cognitive deficits

26. Children Are Not The Only Concern

27. Individuals With FASDs Have Higher Odds of Being Arrested If Their Disabilities are Identified, They May Be Better Able to Successfully Complete Their Program and Stay Drug/Alcohol Free

28. 17 th Judicial Preliminary Statistics - Probation 2.7 years of screening all juveniles on probation (or at PSI): –24% (73)determined to be prenatally exposed to alcohol by interview of mother –67% (28)of those diagnosed with cognitive deficits –Nearly 16% of all those on probation diagnosed with cognitive deficits after mother acknowledged prenatal exposure

29. FASD – Legal Issues Impulsive crimes - unlikely to premeditate “Stupid crimes” Crimes that would be normal for someone their developmental age May miss UA’s, appointments, court, curfew – otherwise violate Probation

30. FASD – Legal Issues Confessions - suggestible, eager to please authority figures – may admit to things they didn’t do Poor witnesses – don’t understand, can’t remember Competency to stand trial Vulnerable victim

31. Sentencing May not understand why they’re being punished May be less culpable –Impulsive crimes –Tend not to take a leadership role in an offense Easily victimized in prison Benefit from a structured, community based sentence, not incarceration

32. Children and Youth with FASD’s Who Are the Subject of D&N’s, are Truant, or are Delinquent, if unidentified, have a high chance of re-entering the system as adults

33. Adults in the Criminal or Family Drug Court May Have FASDs Themselves They Can Be Helped As Well

34. How Do We Stop This Cycle?

35. Screening Interview Mother or Other Family Member –Discuss the pregnancy, including asking how far along she was when she found out she was pregnant. –Discuss alcohol use pattern – a couple of beers on the weekends, wine or champagne on special occasions, etc. –Ask if that pattern continued until she found out that she was pregnant. That is enough to affect the child

36. Diagnosis A diagnosis is required in order to know if an individual is affected by an FASD Few courts recognize FASD as a factor Early Identification is ideal – but identification at any point is helpful

37. Basics of FASD Behavior Management Determine whether each behavior is primary (because of brain differences) or secondary (learned) Distinguish Between CAN’T and WON’T

38. Basics of FASD Behavior Management If the child CAN’T do what’s asked, Modify the Environment Work with what he/she CAN DO Modify Your Expectations

39. Intervention Basics Test for Functioning Focus on each area of processing – not just overall cognitive ability Get a Diagnosis –Children - Sewell Center - 303-399-1800 –Children - D & E Clinics around the state –Get your local Mental Health Center to develop a team –Adolescents and Adults – Neuropsychological Evaluation

40. Intervention Basics Understand how the person thinks & learns Realize the individual may not understand cause and effect –Therefore may not take responsibility for actions Accept the person’s condition as a medical disability Identify strengths, skill and interests Create chances for success; limit failure

41. Intervention Basics Be prepared to work with an individual with poor memory –Remind of appointments –Write down directions Understand concrete thinking –Use simple, straightforward language –Avoid teasing, jokes

42. Intervention Basics Break down required tasks into simple steps – in writing Talk slowly and give time for response Understand that the individual may be able to say things that they can’t do Double check to try to assure understanding Be specific – say exactly what you want

43. TAKE “DON’T” OUT OF YOUR VOCABULARY

44. Remember: The Person’s Brain Is Different Behavior Management Cannot Remove Brain Differences

45. Where To Start

46. Individuals in Drug Court should be screened for FASDs And So Should Their Children

47. Incorporating FASD Awareness in the Criminal Court Probation Officers Screen at Intake Those who Screen Positive are Referred for Diagnosis Terms and Conditions of Probation Are Modified to Fit Individual’s Abilities Educational Plans Are Modified for Youth Caretakers are Helped to Understand the Individual

48. Incorporating FASD Awareness in the D&N Court Intake Workers Should Ask About Prenatal Exposure (Screen) Developmental Testing for Pre-schoolers is Required by Law After a Founded Investigation Children Who Were Exposed and are Behind Developmentally Should be Referred for Diagnosis Occupational, Physical, Speech Therapy Can be Accessed as Needed Caregivers Can Receive Support and FASD Education from NOFAS Colorado

49. Goals of the 17 th Judicial FASD Project Limit Restrictive Placements Improve School Performance Successful Probation Completion Limit Future Criminal Activity Improve Quality of Life

50. Colorado Resources NOFAS Colorado, April Montgomery 303-692- 2620 www.nofascolorado.org North Metro and Colorado Springs Parent Support Groups, (call Eileen Bisgard 303-654- 3246) 17 th Judicial District FASD Project and NOFAS Colorado, Eileen Bisgard – eileen.bisgard@judicial.state.co.us 303-654- 3246 eileen.bisgard@judicial.state.co.us Fetal Alcohol Prevention & Outreach Project – Pamela Gillen, RN, ND 303-724-0327