Natalie Novick Brown

Prenatal alcohol exposure: An assessment strategy for the legal context.

Studies over the last two decades have shown that people with fetal alcohol spectrum disorders (FASD) have the kind of brain damage that increases risk of criminal behavior. Thus, it is generally accepted that FASD is likely to affect a sizable minority of individuals involved in the justice system. Most of these defendants have never been diagnosed because they lack the facial abnormalities and severe intellectual deficiency that would have improved identification and diagnosis in childhood. Despite the fact that an FASD diagnosis and associated cognitive deficits may be directly relevant to offense conduct and post-arrest capacities, screening for prenatal alcohol exposure (PAE) by legal teams remains relatively rare. This article addresses the relatively straightforward screening process with strategies that may be used singly or in combination to produce information that can establish PAE and provide a foundation for diagnostic assessment by medical and mental health experts.

Conduct-disordered adolescents with fetal alcohol spectrum disorder: intervention in secure treatment settings

Youth with fetal alcohol spectrum disorders (FASDs) are in a perilous circumstance. FASD is associated with a high rate of self-regulation problems and trouble with the law and is underdiagnosed. Standard juvenile corrections-based interventions often do not meet the needs of these vulnerable youth. This article describes what is known about conduct-disordered adolescents with FASD and the neurocognitive deficits that directly affect emotional and behavioral self-control. The authors propose guidelines for the assessment of FASD within residential treatment settings and analyze interventions that show promise for inpatient treatment of youth with FASD.

Suggestibility and Fetal Alcohol Spectrum Disorders: I'll tell you anything you want to hear

This article reviews the role of suggestibility as a psychological vulnerability in people with FASD who are arrested and questioned by police. After a review of relevant literature on suggestibility and FASD, preliminary data are presented from a small pilot study on suggestibility involving defendants with FASD in the United States who were involved in either a pre-trial or post-conviction adjudication process. Results of that study suggest that persons with FASD may be highly suggestible in interrogative situations, which appears to stem from a combination of neurologically based tendencies to acquiesce to leading questions and change responses to questions as a function of negative feedback. Interrogative suggestibility found in the FASD population, which is likely due to central nervous system dysfunction, has broad forensic implications.

A Proposed Model Standard for Forensic Assessment of Fetal Alcohol Spectrum Disorders

A model protocol is proposed for multidisciplinary assessment of Fetal Alcohol Spectrum Disorders (FASD) in the forensic context. Used effectively on both sides of the courtroom in the United States in criminal and post-conviction matters in state and federal courts, the model relies on the FASD literature and best-practice standards of care in terms of clinical as well as forensic evaluation. It is suggested that FASD diagnostic criteria for older adolescents and adults in the criminal system may need different emphasis if facial features have diminished with age and confirmation of prenatal exposure is impossible.

The Impact of Prenatal Alcohol Exposure on Addiction Treatment

Fetal alcohol spectrum disorders (FASDs) are conditions caused by prenatal alcohol exposure in amounts sufficient to cause permanent deficits in brain functioning. Extent of damage largely depends on timing, dose, frequency, and pattern of exposure. Timing is especially important because prenatal alcohol exposure during critical periods of gestation can affect brain development in ways that produce varying patterns of neurocognitive deficits and associated adaptive impairments. This article describes some of the more serious neurophysiological and neuropsychological sequelae of prenatal alcohol exposure that contribute to increased risk for substance abuse problems among people with an FASD. We discuss the unique interface between pharmacological treatment and FASD, noting that failure to consider the possibility of FASD in treatment planning may result in treatment failure and/or relapse. Finally, we present a clinical case example and recommend service accommodations to address some of the impairments in FASD that limit substance abuse treatment success.

FASD and the Concept of “Intellectual Disability Equivalence”

The term “Intellectual Disability (ID) equivalence” refers to accommodations that are made by legal and other governmental entities when they provide services, supports or protective arrangements to people who—because of brain impairment—function as if they have ID but fail to qualify for the ID label which is needed for access to many programs because their IQ scores are a few points too high. Fetal Alcohol Spectrum Disorder (FASD) is a logical candidate for such an accommodation as (a) it (like ID) involves brain impairment, (b) people with FASD have adaptive deficits and support needs that are identical to those with ID, and (c) while many people with FASD do qualify as having ID, the majority do not, because full-scale IQ scores are typically too high.

Fetal Alcohol Spectrum Disorders (FASD) and competency to stand trial (CST): Suggestions for a ‘best practices’ approach to forensic evaluation

Fetal Alcohol Spectrum Disorders (FASD), an umbrella term for neurodevelopmental conditions caused by prenatal alcohol exposure, is overrepresented in the U.S. juvenile and adult criminal justice systems. The brain damage in FASD manifests in a combination of cognitive and adaptive impairments that potentially reduce ability to function adequately during the criminal justice process, including capacity to stand trial (CST). Despite the high risk of arrest and conviction in this population, relatively little research guides CST assessment for defendants who have or may have FASD. Therefore, the purpose of this article is to describe how FASD may affect CST and suggest ways forensic professionals might modify assessment protocols to address possible effects of FASD-associated impairments on adjudicative capacity.