The goal of this report is to critically review research on executive functioning (EF) and working memory in individuals with fetal alcohol spectrum disorder (FASD). Individuals with FASD exhibit EF deficits in the areas of cognitive flexibility, planning and strategy use, verbal reasoning, some aspects of inhibition, set shifting, fluency, working memory, and, recently, on tests of emotion-related or hot EF. Some researchers have linked prenatal alcohol exposure to abnormalities in the development of the frontal cortex of affected individuals or animals. One common finding is that these EF deficits persist regardless of whether the individual has facial dysmorphology. Furthermore, EF deficits are not simply due to a low IQ in these individuals. More research with larger sample sizes, smaller age ranges, and consistent measurement tools is needed in this area to ameliorate some inconsistencies in the literature. Furthermore, researchers should now focus on studying the pattern of weakness in EF in individuals with FASD as well as relations among working memory and EF, which will help to identify specific areas of weakness, to enhance diagnosis, and to improve treatment. There is limited research on the development of EF in individuals with FASD, which can have important implications for understanding of how these deficits unfold from childhood through adulthood.

Executive functioning and working memory in fetal alcohol spectrum disorder.

Framework for action.

The life-long neurological impairments found in people with fetal alcohol spectrum disorders (FASDs), including learning disabilities, impulsivity, hyperactivity, social ineptness, and poor judgment, can increase susceptibility to victimization and involvement in the criminal justice system (CJS). Individuals with FASDs become involved in the CJS as complainants, witnesses, and accused. Their disabilities, resulting from the prenatal alcohol exposure, must be considered at all stages in the legal process. Adverse experiences, such as having a dysfunctional family background, mental health problems, and substance use disorders, are compounding factors. Experiencing physical, sexual, and emotional abuse also increases the risk that these individuals will become involved in the CJS. It is critical that everyone involved in the CJS receives education and training to understand FASD and the implications for the individual offender. A comprehensive medical-legal report, prepared by professionals experienced with FASD, can help judges and lawyers understand the complex interactions among brain damage, genetics and the environment. Corrections workers and probation officers need to comprehend the significance of FASD and how it affects the offender's abilities to understand and follow rules and probation orders. Caregivers and parents need to be involved whenever possible. Early recognition of the disabilities associated with FASDs may help reduce the over-representation of this group in the CJS.

Fetal Alcohol Spectrum Disorders and the Criminal Justice System.

To complement the 2005 Annual Clinical Focus on medical genomics, AFP will be publishing a series of short reviews on genetic syndromes. This series was designed to increase awareness of these diseases so that family physicians can recognize and diagnose children with these disorders and understand the kind of care they might require in the future. The second review in this series discusses fetal alcohol syndrome and fetal alcohol spectrum disorders.

Fetal alcohol spectrum disorders.

Neurobehavioural outcomes of children with fetal alcohol spectrum disorders: A Canadian perspective.

Fetal Alcohol Spectrum Disorder (FASD) is a clinically recognized disability. Persons with FASD are at a profound disadvantage within the criminal justice system. This article describes the range of deficits that characterize FASD and suggests that understanding FASD has important legal implications for the criminal justice system. Consideration is given to issues of suggestibility, witness reliability, false confessions and sentencing.

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Fetal Alcohol Spectrum Disorder (FASD): A Need for Closer Examination by the Criminal Justice System

Individuals with FASD exhibit deficits in many domains that can include memory, learning, behavioural inhibition, executive functioning, interpersonal skills, and language. These deficits have serious implications for affected persons when they become engaged in the legal system. In 2004, Moore and Green reviewed case law and psychological literature which suggested that FASD-related deficits placed affected individuals at a significant disadvantage in the justice system. According to them, this disadvantage stemmed from the limited awareness and knowledge of FASD demonstrated by key players in the justice system, as well as the scarcity of effective interventions in place to rehabilitate affected defendants. The aim of the current paper is to assess the extent to which awareness of FASD-related issues in the Canadian justice system has advanced since the publication of Moore and Green’s conclusions. First, the deficits associated with FASD and their implications for the justice system are described. Next, recent case law and psychological evidence are reviewed as we consider issues of witness reliability and false confessions. The significance of FASD for sentencing, fitness to stand trial, and the Not Criminally Responsible by Reason of Mental Disorder defence are also briefly discussed. Finally, emerging system wide responses to FASD-related issues are presented. Overall, it appears that the call for closer examination of FASD by the justice system has been answered, but a need for increased education and awareness remains.

Melvyn Green

Papers

Fetal Alcohol Spectrum Disorder (FASD): A Need for Closer Examination by the Criminal Justice System

A need for closer examination of FASD by the criminal justice system: has the call been answered?