September is FASD Awareness Month, dedicated to raising awareness around Foetal Alcohol Spectrum Disorder and the range of symptoms that people with Foetal Alcohol Spectrum Disorder can experience. The event also celebrates the achievements of people with FASD across the UK.
The National Organisation for FASD are also working with FASD UK Alliance to promote the hashtag #FASDGiveMe5: “The hashtag is designed to represent taking 5 for FASD, whether that’s taking 5 minutes to explain FASD to someone new, taking the time to learn 5 new things about FASD, or giving someone with FASD a high-five to celebrate their achievements!”
To mark the event, we’ve compiled some information about FASD, its impact on communication, its possible impacts for court users and some strategies which legal professionals can implement to support the participation of a court user with FASD…
What is Foetal Alcohol Spectrum Disorder?
Foetal Alcohol Spectrum Disorder (FASD) is an umbrella term for a range of physical, cognitive and behavioural disorders caused when someone has been exposed to alcohol before birth. As babies cannot process alcohol well, it can stay in their body for a long time and can cause damage to their brain, body, and affect their development.
FASD is a brain-based disorder and can cause a range of intellectual and behavioural differences, which may appear at any time during childhood and can be life-long. This diagnosis affects approximately 1.8% – 3.6% of the population.
How can FASD affect people?
The symptoms and their severity can depend on how often and how much alcohol was consumed during pregnancy, and the stage of development the foetus was at. It can also depend on other factors, such as the pregnant persons’ stress levels, nutrition, environmental influences and genetics. Both the pregnant person and foetus’ abilities to break down alcohol can also impact symptoms. Everyone with Foetal Alcohol Spectrum Disorder is affected differently.
A review of existing literature (Centre for Addiction and Mental Health, 2016) found that there are more than 400 conditions that can co-occur with Foetal Alcohol Spectrum Disorder. This multifaceted spectrum of disorders was described as “affecting nearly every system in the body”. Some of these conditions are caused by alcohol exposure, such as developmental and cognitive problems, however, some do not have a direct cause and effect link.
Foetal Alcohol Spectrum Disorder can cause problems with:
- Movement, balance, vision and hearing
- Learning – For example, problems with thinking, concentration and memory
- Managing emotions and developing social skills
- Hyperactivity and impulse control
- Communication – For example, difficulties with speech
- Processing information
- Following instructions
Foetal Alcohol Spectrum Disorder may also cause physical symptoms. These may look less distinctive in adults then children. Physical effects that can last into adulthood include:
- Issues with joints, muscles, bones and organs (such as the kidneys and heart)
- Short stature
- Small head size
- Differences in facial features (only present in 10% of Foetal Alcohol Spectrum Disorder cases).
- Reduced brain size
People with Foetal Alcohol Spectrum Disorder can also have multiple co-occurring diagnoses. Studies into Foetal Alcohol Spectrum Disorder populations have found higher rates of:
- Mental health issues
- Psychological disorders
- Attention Deficit Hyperactivity Disorder (ADHD).
Many people with Foetal Alcohol Spectrum Disorder go undiagnosed. It may not be detected at birth and can become more apparent later in life. It can lead individuals to have difficulties at school, mental health issues, legal issues and difficulties around independence and employment. Early diagnosis can be very important to support people with FASD to build appropriate support and strategies. It is important to note that, although some people with FASD face considerable difficulties and barriers to participation in important areas of life, many others have many strengths and lead successful lives with professional careers.
FASD and emotional management
Some of the early signs of prenatal alcohol exposure in children are intense negative moods, irritability, and sleep dysregulation.
Foetal Alcohol Spectrum Disorder can also impair a child’s executive functioning, which can impact behaviour regulation. Someone with poor behaviour regulation may have difficulties managing strong emotions and impulses. When they experience strong emotions, this can escalate quickly, and they may also be slow in calming down. Without appropriate support, children with these difficulties may be at risk of developing mental health difficulties, for example, anxiety disorders. It can also lead to them experiencing social difficulties.
Children with Foetal Alcohol Spectrum disorders may have a developmental delay in their understanding of emotions. A reduced emotional understanding can cause poor awareness of how their emotions and behaviours affect others. They can also struggle to understand the consequences of their actions. They can have difficulties with impulse control, emotional regulation and social skills.
Adults who were diagnosed with Foetal Alcohol Spectrum Disorder later in their life may be more likely to have difficulties with their emotional regulation. Teenagers and adults are at a higher risk of getting in trouble with the police and becoming involved with the justice system. This is due to difficulties managing their emotions, anticipating consequences, as well as understanding the motives of others.
Supporting people with FASD in legal proceedings
Professionals working within the courts may come into contact with people with Foetal Alcohol Spectrum Disorder, so it is important to look at what we can do to support people who may be experiencing difficulties with participation which arise from this diagnosis. In court, the condition may affect the court user’s ability to understand and effectively participate in all elements of their court proceedings. This could result in difficulties with:
- Maintaining concentration in the courtroom
- Understanding some of the ‘legal jargon’ used within court
- Providing clear and detailed instructions to counsel
Difficulties like this can make the court process more challenging, and some individuals may need additional support to participate effectively. Although every person with Foetal Alcohol Spectrum Disorder presents differently, there are some general strategies and adaptations which may assist:
- Speak slowly and clearly: This will ensure that they have time to process the information and that it is presented in the clearest way for them to understand.
- Provide regular breaks: Due to possible difficulties with concentration, it will be important to offer or implement regular breaks to allow adequate rest time from the proceedings to support attention.
- Use visual aids: To help with processing lots of verbal information or more complex concepts – to learn more about using visual aids, check out our free ‘How To’ guide on The Access Brief.
- Break information down: If information is presented in short ‘chunks’, it will be more manageable to process and retain.
- Check understanding: This can be done by asking specific comprehension-checking questions. For example, rather than asking, “Do you understand?” ask, “What did the social worker say about X?”. To learn more about checking understanding, take a look at our free ‘How To’ guide on The Access Brief.
- Ask follow up questions: Short, simple ‘wh’ style questions could help prompt the court user to add in further detail, if they are experiencing any expressive difficulties.
More information around Foetal Alcohol Spectrum Disorder can be found at:
Foetal alcohol spectrum disorder – NHS (www.nhs.uk)
Freunscht, I. and Feldmann, R., 2010. Young adults with fetal alcohol syndrome (FAS): Social, emotional and occupational development. Klinische Pädiatrie, pp.33-37