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.
AbelE.L. (1988). Fetal alcohol syndrome in families. Neurotoxicology and Teratology, 10, 1–2.
2.
AlatiR.ClavarinoA.NajmanJ.M.O'CallaghanM.BorW.MamunA.A.. (2008). The developmental origin of adolescent alcohol use: Findings from the Mater University Study of Pregnancy and its outcomes. Drug and Alcohol Dependence, 98, 136–143.
3.
American Academy of Pediatrics. (2000). Developmental issues for young children in foster care. Pediatrics, 106, 1145–1150.
4.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
5.
AstleyS. J.BaileyD.TalbotC., & ClarrenS. (2000). Fetal alcohol syndrome (FAS) primary prevention through FAS diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol & Alcoholism, 35(5), 509–519.
6.
AstleyS.J.StachowiakJ.ClarrenS.K., & ClausenC. (2002). Application of the fetal alcohol syndrome facial photographic screening tool in a foster care population. Journal of Pediatrics, 141, 712–717.
7.
BassS.ShieldsM.K., & BehrmanR.E. (2007). Children, families, and foster care: Analysis and recommendations. Future Child, 14, 5–29.
8.
BertrandJ. (2009). Interventions for children with fetal alcohol spectrum disorders: Overview of findings for five innovative research projects. Research in Developmental Disabilities, 30, 986–1006.
9.
BrownJ.D.BednarL.M., & SigvaldasonN. (2007). Causes of placement breakdown for foster children affected by alcohol. Child and Adolescent Social Work Journal, 24, 313–332.
10.
BrownJ. D.SigvaldasonN., & BednarL. M. (2005). Foster parent perceptions of placement needs for children with a fetal alcohol spectrum disorder. Children and Youth Services Review, 27, 309–327.
11.
BurdL.KlugM.G.LiQKerbershianJ., & MartsolfJ.T. (2009). Diagnosis of fetal alcohol spectrum disorders: Study of the fetal alcohol syndrome checklist. Alcohol, 44, 1–10.
12.
BurdL.SelfridgeR.KlugM., & BakkoS. (2004). Fetal alcohol syndrome in the United States corrections system. Addiction Biology, 9, 177–178.
13.
BurnsB.PhillipsS.WagnerH.BarthR.KolkoD.CampbellY.. (2004). Mental health need and access to mental health services by youths involved in child welfare: A national survey. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 960–970.
14.
CaleyL.SymsC.RobinsonL.CederbaumJ.HenryM., & ShipkeyS. (2008). What human service professionals know and want to know about Fetal Alcohol Syndrome. Canadian Journal of Clinical Pharmacology, 15, e117–e123.
15.
Centers for Disease Control and Prevention. (2004). Fetal Alcohol Syndrome; Guidelines for referral and diagnosis. Washington, D.C.: Author.
16.
ChenM. L., & OlsonCarmichael H. (2008). Caregiver report of sleep problems in children with fetal alcohol spectrum disorders. American Journal of Respiratory and Critical Care Medicine, 177, A707.
17.
CoeJ.SiddersJ.RileyK.WaltermireJ., & HagermanR. (2008). A survey of medication responses in children and adolescents with fetal alcohol syndrome. Mental Health Aspects of Developmental Disability, 4, 148–155.
18.
CohenJ., & YouchaV. (2004). Zero to Three: Critical issues for the juvenile and family court. Juvenile and Family Court Journal, Spring, 2004, 15–27.
19.
ColesC. D.SmithI.FernhoffP. M., & FalekA. (1985). Neonatal neurobehavioral characteristics as correlates of maternal alcohol use during gestation. Alcoholism: Clinical and Experimental Research, 9, 454–460.
20.
ColesC.D.StricklandD.C.PadgettL., & BellmoffL. (2007). Games that “work”: Using computer games to teach alcohol-affected children about fire and street safety. Research in Developmental Disabilities, 28, 518–530.
21.
ConnorP. D.SampsonP. D.BooksteinF. L.BarrH. M., & StreissguthA. P. (2000). Direct and indirect effects of prenatal alcohol damage on executive function. Developmental Neuropsychology, 18(3), 331–354.
22.
CourtneyM.DworskyA.LeeJ., & RaapM. (2009). Midwest evaluation of the adult functioning of former foster youth: Outcomes at age23 and 24. Chicago: University of Chicago.
23.
CoxL.V.ClairmontD., & CoxS. (2008). Knowledge and attitudes of criminal justice professionals in relation to Fetal Alcohol Spectrum Disorder. Canadian Journal of Clinical Pharmacology, 15, 306–313.
24.
DavidsonH.A. (2008). ABA calls for reform in child welfare/delinquency “crossover” cases. Child Law Practice, 27, 31–32.
25.
DickerS., & GordonE. (2004). Building bridges for babies in foster care: The Babies Can't Quit initiative. Juvenile and Family Court Journal, 55(2), 29–41.
26.
DozierM. (2005). Challenges of foster care. Attachment and Human Development, 7, 27–30.
27.
DozierM.LindhiemO.LewisE.BickJ.BernardK., & PelosoE. (2009). Effects of a foster parent training program on children's attachment behaviors: Preliminary evidence from a randomized clinical trial. Child and Adolescent Social Work Journal, 26, 321–332.
28.
DozierM.PelosoE.LindhiemO.GordonM.K.ManniM.Sepúlveda (2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with infants and toddlers. Journal of Social Issues, 62, 767–785.
29.
FastD.K., & ConryJ. (2009). Fetal Alcohol Spectrum Disorders and the criminal justice system. Developmental Disabilities Research Reviews, 3, 250–257.
30.
FiermonteC., & SalyersN. S. (2006). Improving outcomes together: Court and child welfare collaboration. Child Law Practice, 26(12), 177–184.
31.
FisherP.GunnarM. R.DozierM.BruceJ., & PearsK. (2006). Effects of therapeutic interventions for foster children on behavior problems, caregiver attachment, and stress regulatory neural systems. Annals of the New York Academy of Sciences, 1094, 215–225.
32.
FloydR. L.SobellM.VelasquezM. M.IngersollK.NettlemanM.SobellL. (2007). Preventing alcohol-exposed pregnancies: A randomized controlled trial. American Journal of Preventive Medicine, 32, 1–10.
33.
GiffordA. E.FarkasK. J.JacksonL. W.MoltenoC. D.JacobsonJ. L.JacobsonS. W. (2010). Assessment of benefits of a universal screen for maternal alcohol use during pregnancy. Birth Defects Research, 88, 838–836
34.
GreenJ.H. (2007). Fetal Alcohol Spectrum Disorders: Understanding the effects of prenatal alcohol exposure and supporting students. Journal of School Health, 77, 103–108.
35.
GuerriC.BazinetA., & RileyE.P. (2009). Fetal Alcohol Spectrum Disorders and alterations in brain and behavior. Alcohol and Alcohol Research, 44, 108–114.
36.
HaleyD.W.HandmakerN.S., & LoweJ. (2006). Infant stress reactivity and prenatal alcohol exposure. Alcoholism: Clinical and Experimental Research, 30, 2055–2064.
37.
HanniganJ. H.O'Leary-MooreS. K., & BermanR. F. (2007). Postnatal environmental or experiential amelioration of neurobehavioral effects of perinatal alcohol exposure in rats. Neuroscience and Biobehavioral Review, 31, 202–211.
38.
HenryJ.SloaneM., & Black-PondC. (2007). Neurobiology and neurodevelopmental impact on childhood traumatic stress and prenatal alcohol exposure. Language, Speech, and Hearing Services in Schools, 38, 99–108.
39.
HugginsJ.GrantT.O'MalleyK., & StreissguthA.P. (2008). Suicide attempts among adults with Fetal Alcohol Spectrum Disorders: Clinical implications. Mental Health Aspects of Developmental Disabilities, 11, 33–41.
40.
HurlburtM. S.LeslieL. K., & LandsverkJ. (2004). Contextual predictors of mental health service use among children open to child welfare. Archives of General Psychiatry, 61, 1217–1224.
41.
JirikowicT.KartinD.OlsonH. C. (2008). Children with Fetal Alcohol Spectrum Disorders: A descriptive profile of adaptive function. Canadian Journal of Occupational Therapy, 75, 238–248.
42.
JohnstonM. V.IshidaA.IshidaW. N.MatushitaH. B.NishimuraA., & TsujiM. (2009). Plasticity and injury in the developing brain. Brain and Development, 31, 1–10.
43.
JonesK. (2004). Successfully raising resilient foster children with Fetal Alcohol Syndrome: What works?The Manitoba Journal of Child Welfare, 3, 1–18.
44.
JonesK. L., & SmithD. W. (1973). Recognition of the Fetal Alcohol Syndrome in early infancy. Lancet, 2, 999–1001.
45.
KableJ.A.ColesC.D., & TaddeoE. (2007). Socio-cognitive habilitation using the math interactive learning experience program for alcohol affected children. Alcoholism: Clinical and Experimental Research, 31, 1425–1434.
46.
KalbergW.O., & BuckleyD. (2007). Fetal Alcohol Spectrum Disorders: What types of intervention and rehabilitation are useful?Neuroscience and Biobehavioral Reviews, 31, 278–285.
47.
KatzL. F.SheinbergN.ClaussenA. H.BakerA., & CohenJ. B. (2006). Screening young children in dependency drug court. Child Law Practice, 25, 1–8.
48.
KodituwakkuP. W. (2009) Neurocognitive profile in children with fetal alcohol spectrum disorders. Developmental Disabilities Research Reviews, 15, 218–224.
49.
LedermanC. S., & OsofskyJ. D. (2004). Infant mental health interventions in juvenile court: Ameliorating the effects of maltreatment and deprivation. Psychology, Public Policy, and Law, 10, 162–177.
50.
Legal Center for Foster Care and Education. (2008). Special education decision making: The role of the child's attorney. Child Law Practice, 27, 138–141.
51.
LuptonC.BurdL., & HarwoodR. (2004). Cost of fetal alcohol spectrum disorders. American Journal of Medical Genetics, 127C, 42–50.
52.
MalbinD. V. (2004). Fetal Alcohol Spectrum Disorder (FASD) and the role of family court judges in improving outcomes for children and families. Juvenile and Family Court Journal, 55(2), 53–63.
53.
MarcellusL. (2010). Supporting resilience in foster families: A model for program design that supports recruitment, retention, and satisfaction of foster families who care for infants with prenatal substance exposure. Child Welfare, 89, 7–29.
54.
MayP. A., & GossageJ. P. (2001). Estimating the prevalence of Fetal Alcohol Syndrome: A summary. Alcohol Research and Health, 25, 159–167.
55.
MayP. A.GossageJ. P.KalbergW. O.RobinsonL. K.BuckleyD.ManningM. (2009). Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Developmental Disabilities Research Reviews, 15, 176–192.
56.
MekonnenR.NoonanK., & RubinD. (2009) Achieving better health care outcomes for children in foster care. Pediatric Clinics of North America, 56, 405–415.
57.
National Organization on Fetal Alcohol Syndrome. (2002). Fetal alcohol spectrum disorders: Special focus. Washington, DC: Author.
58.
National Working Group on Foster Care and Education (2007). Improving educational success for children and youth in foster care: Ensuring school stability. Child Law Practice, 26, 154–157.
59.
NiccolsA. (2008). “Right From the Start”: Randomized trial comparing an attachment group intervention to supportive home visiting. The Journal of Child Psychology and Psychiatry, 49, 754–764.
60.
O'ConnorM. J.FrankelF.PaleyB.SchonfeldA. M.CarpenterE.LaugesonE. (2006). A controlled social skills training for children with fetal alcohol spectrum disorders. Journal of Consulting and Clinical Psychology, 74, 639–648.
61.
O'ConnorM. J.KoganN., & FindlayR. (2002). Prenatal alcohol exposure and attachment behavior in children. Alcoholism: Clinical and Experimental Research, 26, 1592–1602.
62.
O'ConnorM. J.McCrackenJ., & BestA. (2006) Under recognition of prenatal alcohol exposure in a child inpatient psychiatric setting. Mental Health Aspects of Developmental Disabilities, 9, 105–108.
63.
O'ConnorM. J., & PaleyB. (2009). Psychiatric conditions associated with prenatal alcohol exposure. Developmental Disabilities Research Review, 15, 225–234.
64.
O'ConnorM. J.SigmanM., & KasariC. (1992). Attachment behavior of infants exposed prenatally to alcohol: Mediating effects of infant affect and mother-infant interaction. Development and Psychopathology, 4, 243–256.
65.
OlsonH. C.JirikovicT.KartinD., & AstleyS. (2007). Responding to the challenge of early intervention for Fetal Alcohol Spectrum Disorders. Infants and Young Children, 20, 172–189.
66.
OlsonH. C., & MontagueR. (2010). An innovative look at early intervention for children affected by prenatal alcohol exposure. In AdubatoS. & CohenD. (Eds.), Prenatal alcohol use and Fetal Alcohol Spectrum Disorders: Diagnosis, assessment and new directions in research and multimodal treatment. Oak Park, IL: Benthan Science Publishers.
67.
O'MalleyK. D., & NansonJ. (2002). Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder, Canadian Journal of Psychiatry, 47, 349–354.
68.
OsgoodD. W.FosterE. M., & CourtneyM. E. (2010). Vulnerable populations and the transition to parenthood. The Future of Children, 20, 209–229.
69.
PaleyB. (in press). Early intervention for children with Fetal Alcohol Spectrum Disorders. In Encyclopedia on Early Child Development.
70.
PaleyB. (2010, October). New approaches to treating FASD in young children. Invited presentation at the Taking the Next Step: Innovative Approaches for FASD, Atlanta, GA.
71.
PaleyB., & O'ConnorM. J. (2007). Neurocognitive and neurobehavioral impairments in individuals with fetal alcohol spectrum disorders: Recognition and assessment. International Journal on Disability and Human Development, 6, 127–142.
72.
PaleyB., & O'ConnorM. J. (2009). Interventions for individuals with Fetal Alcohol Spectrum Disorders: Treatment approaches and case management. Developmental Disabilities Research Reviews, 15, 258–267.
73.
PaleyB., & O'ConnorM. J. (In press). Behavioral interventions for children and adolescents with Fetal Alcohol Spectrum Disorders. Alcohol Research and Health.
74.
PaleyB.O'ConnorM.J.FrankelF., & MarquardtM. (2006). Predictors of stress in parents of children with Fetal Alcohol Spectrum Disorders. Journal of Developmental and Behavioral Pediatrics, 27, 396–404.
75.
PaleyB.O'ConnorM. J.KoganN., & FindlayR. (2005). Prenatal alcohol exposure, child externalizing behavior, and maternal stress. Parenting: Science and Practice, 5, 29–56.
76.
PeadonE.Rhys-JonesB.BowerC., & ElliottE. J. (2009). Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders. BMC Pediatrics, 9, 35.
77.
PecoraP. J. (2010). Why current and former recipients of foster care need high quality mental health services. Administration and Policy in Mental Health, 37, 185–190.
78.
RaghavanR.InoueM.EttnerS. L.HamiltonB. H., & LandsverkJ. (2010). A preliminary analysis of the receipt of mental health services consistent with national standards among children in the child welfare system. American Journal of Public Health, 100, 742–749.
79.
RaghavanR.ZimaB. T.AndersonR. M.LeibowitzA. A.SchusterM. A., & LandsverkJ. (2005). Psychotropic medication use in a national probability sample of children in the child welfare system. Journal of Child and Adolescent Psychopharmacology, 15, 97–106.
80.
RasmussenC., & BisanzJ. (2009). Executive functioning in children with fetal alcohol spectrum disorders: Profiles and age-related differences. Child Neuropsychology, 15, 201–215.
81.
RileyE. P., & McGeeC. L. (2005). Fetal alcohol spectrum disorders: An overview with emphasis on changes in brain and behavior. Experimental Biology and Medicine, 230, 357–365.
82.
RingeisenH.CasanuevaC.UratoM., & CrossT. (2008). Special health care needs among children in the child welfare system. Pediatrics, 122(1), E232.
83.
Risley-CurtissC., & StitesB. (2007). Improving healthcare for children entering foster care. Child Welfare, 86, 123–144.
84.
RyanJ.MarshallJ.HerzD., & HernandezP. (2008). Juvenile delinquency in child welfare: Investigating group home effects. Children and Youth Services Review, 30(9), 1088–1099.
85.
SchwartzL.L. (2008). Foster care and social services. The Journal of Psychiatry and Law, 36, 609–616.
86.
SmithD. K.JohnsonA. B.PearsK. C.FisherP. A., & DeGarmoD. S. (2007). Child maltreatment and foster care: Unpacking the effects of prenatal and postnatal parental substance use. Child Maltreatment, 12, 150–160.
87.
StahmerA. C.LeslieL. K.HurlburtM.BarthR. P.WebbM. B.LandsverkJ. (2005). Developmental and behavioral needs and service use for young children in child welfare. Pediatrics, 116, 891–900.
88.
StotlandJ.StoccoJ.DarrK., & McNaughtK. (2007). Special education decisions for children in foster care: Everyone has a role. Child Law Practice, 26, 17–25.
89.
StreissguthA. P. (2007). Offspring effects of prenatal alcohol exposure from birth to 25 years: The Seattle Prospective Longitudinal Study. Journal of Clinical Psychology in Medical Settings, 14, 81–101.
90.
StreissguthA. P.BooksteinF. L.BarrH. M.SampsonP. D.O'MalleyK., & YoungJ. K. (2004). Risk factors for adverse life outcomes in Fetal Alcohol Syndrome and Fetal Alcohol Effects. Developmental and Behavioral Pediatrics, 25, 228–238.
91.
StrattonK.HoweC., & BattagliaF. (1996). Fetal Alcohol Syndrome: Diagnosis, epidemiology, prevention, and treatment. Washington, DC: National Academy Press.
92.
Tarren-SweeneyM. (2008). Retrospective and concurrent predictors of the mental health of children in care. Children and Youth Services Review, 30, 1–25.
93.
ThomasJ. D.SatherT. M., & WhineryL. A. (2008). Voluntary exercise influences behavioral development in rats exposed to alcohol during the neonatal brain growth spurt. Behavioral Neuroscience, 122, 1264–1273.
94.
TweddleA. (2007). Youth leaving foster care: How do they fare?New Directions for Youth Development, 113, 15–31.
WarrenK.FloydL.CalhounF.StoneD.BertrandJ.StreissguthA. (2004). Consensus statement on FASD. Washington, DC: National Organization on Fetal Alcohol Syndrome.
