Alcohol-Exposed Youth and the Alcohol-Exposed Youth and the CourtCourt

Jo Nanson, Ph. D., Judge Mary-Jo Nanson, Ph. D., Judge Mary-Ellen Turpel-Lafond, P. Blakley,M. Ellen Turpel-Lafond, P. Blakley,M.

D., Ph. D. D., Ph. D.

Key questions Key questions

Youth Criminal Justice ActYouth Criminal Justice Act, allows for mental , allows for mental health assessment of youth at any stage of health assessment of youth at any stage of proceeding (fitness, bail, sentence, review)proceeding (fitness, bail, sentence, review)

Does this youth have central nervous system Does this youth have central nervous system deficits consistent with prenatal exposure to deficits consistent with prenatal exposure to alcohol? alcohol?

Need to have assessments which follow Need to have assessments which follow accepted diagnostic protocols (Health Canada, accepted diagnostic protocols (Health Canada, IOM)IOM)

Key questions Key questions

Does the youth have the skills needed to Does the youth have the skills needed to participate in the court process? Does the youth participate in the court process? Does the youth have an understanding of the adversarial system have an understanding of the adversarial system and the players? Can the youth instruct counsel? and the players? Can the youth instruct counsel?

Even if youth understands basics of the court Even if youth understands basics of the court process, and is fit, can they provide reliable process, and is fit, can they provide reliable evidence (recall and sequencing of events)?evidence (recall and sequencing of events)?

Saskatoon Protocol Saskatoon Protocol

Courts follow the Institute of Medicine Courts follow the Institute of Medicine criteria for an FASD assessmentcriteria for an FASD assessment

All individuals receive an assessment by a All individuals receive an assessment by a dysmorphologist treated in FASDdysmorphologist treated in FASD

And a neuropsychological assessment by a And a neuropsychological assessment by a registered neuropsychologist familiar with registered neuropsychologist familiar with FASD.FASD.

Assessments are done independently Assessments are done independently

Affected Areas of the BrainAffected Areas of the Brain

Brain Behavior relationships Brain Behavior relationships

CognitionCognition AchievementAchievement AttentionAttention Memory (visual and verbal)Memory (visual and verbal) Executive functioning Executive functioning CommunicationCommunication

Guiding Principles Guiding Principles

HopeHope RespectRespect UnderstandingUnderstanding CompassionCompassion Cooperation Cooperation

Process of Assessment Process of Assessment

QuestionsQuestions Choosing the assessment measuresChoosing the assessment measures Booking the appointmentBooking the appointment Working with the youth and familyWorking with the youth and family Reports which adhere to professional standards Reports which adhere to professional standards

and guidelines (“Saskatoon protocol”) and need and guidelines (“Saskatoon protocol”) and need for information to be understood by justice for information to be understood by justice professionals professionals

Alcohol History Alcohol History

Using guiding principles Using guiding principles Ask about pregnancy planningAsk about pregnancy planning Ask about emotional stateAsk about emotional state Ask about physical healthAsk about physical health Ask about frequency, amount by trimesterAsk about frequency, amount by trimester Never ask did you drink? Never ask did you drink? Never be shocked. Never be shocked.

FASD Sample FASD Sample

12-16 years: 12 females, 32 males, mean age 14.4212-16 years: 12 females, 32 males, mean age 14.42All First Nations All First Nations 4 had previously been diagnosed as FASD4 had previously been diagnosed as FASD

16-18 years: 4 females, 14 males, mean age 16.64, 16-18 years: 4 females, 14 males, mean age 16.64,

3 Caucasian, 15 First Nations 3 Caucasian, 15 First Nations 2 had previously been diagnosed as FASD2 had previously been diagnosed as FASD

18+ years: 12 males, mean age 21.5818+ years: 12 males, mean age 21.583 Caucasian, 1 Vietnamese, 8 First Nations3 Caucasian, 1 Vietnamese, 8 First NationsNone previously diagnosed as FASDNone previously diagnosed as FASDCharges ranged from breaches and mischief to sexual Charges ranged from breaches and mischief to sexual

assault and murder. assault and murder.

FASD: AbilityFASD: Ability

-2-1.8-1.6-1.4-1.2

-1-0.8-0.6-0.4-0.2

0

12-16years

16-18years

18 andover

Verbal IQ

Performance IQ

FS IQ

FASD: AchievementFASD: Achievement

-1.8-1.6-1.4-1.2

-1-0.8-0.6-0.4-0.2

0

12-16years

16-18years

18 andover

Reading

Spelling

Math

FASD: Attention FASD: Attention

-3

-2.5

-2

-1.5

-1

-0.5

0

0.5

12-16years

16-18years

18 andover

SimpleAttention

ComplexAttention

FASD: Memory FASD: Memory

-1.6

-1.4

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0

12-16years

16-18years

18 andover

Verbal Memory

Visual Memory

GeneralMemory

FASD: Learning and CommunicationFASD: Learning and Communication

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0

12-16years

16-18years

18 andover

Verbal learning

ComplexVisual Memory

Saskatchewan ExperienceSaskatchewan Experience

In In R. v. B.D.R. v. B.D. (April 2, 2004, SPC. Judge Turpel-Lafond) found: (April 2, 2004, SPC. Judge Turpel-Lafond) found:Since 1999, approximately 150 referrals have been made for FAS Since 1999, approximately 150 referrals have been made for FAS assessments by the Youth Court. Of these youth, over 80% have been assessments by the Youth Court. Of these youth, over 80% have been diagnosed with FAS or disabilities along a spectrum related to fetal alcohol diagnosed with FAS or disabilities along a spectrum related to fetal alcohol exposure. These youth have varying degrees of organic brain damage exposure. These youth have varying degrees of organic brain damage resulting in learning problems as well as behavioural impairments and resulting in learning problems as well as behavioural impairments and secondary disabilities. Of the 150 court-ordered assessments, a small secondary disabilities. Of the 150 court-ordered assessments, a small number of these youth are returning to the Court with suggestions for number of these youth are returning to the Court with suggestions for further court-ordered assessments by neuropsychologists and child further court-ordered assessments by neuropsychologists and child psychiatrists for reasons of fitness to stand trial.psychiatrists for reasons of fitness to stand trial.

Summary Summary

Five youth under 16 have been found not fit to Five youth under 16 have been found not fit to stand trialstand trial

Placing these youth is very difficult after they Placing these youth is very difficult after they become legal adultsbecome legal adults

More sophisticated offenders might exploit the More sophisticated offenders might exploit the youth who have been found not fityouth who have been found not fit

Professionals in the criminal justice system may Professionals in the criminal justice system may have difficulty evaluating medical and have difficulty evaluating medical and psychological terminology in proceedingspsychological terminology in proceedings

Summary Summary

Younger sample is more affected than older youth Younger sample is more affected than older youth or adultsor adults

Individuals have deficits in all areas relative to Individuals have deficits in all areas relative to normal valuesnormal values

Verbal skills are weaker than nonverbal skillsVerbal skills are weaker than nonverbal skills Complex attention (multitasking is the most Complex attention (multitasking is the most

affected skill)affected skill) Most youth could not complete the classic Most youth could not complete the classic

measures of executive functioning.measures of executive functioning.