Sleep Health Issues for Children with FASD: Clinical Considerations.

This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research.

Fetal alcohol spectrum disorders and the criminal justice system.

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 disorder: Canadian guidelines for diagnosis.

The diagnosis of fetal alcohol spectrum disorder (FASD) is complex and guidelines are warranted. A subcommittee of the Public Health Agency of Canada's National Advisory Committee on Fetal Alcohol Spectrum Disorder reviewed, analysed and integrated current approaches to diagnosis to reach agreement on a standard in Canada. The purpose of this paper is to review and clarify the use of current diagnostic systems and make recommendations on their application for diagnosis of FASD-related disabilities in people of all ages. The guidelines are based on widespread consultation of expert practitioners and partners in the field. The guidelines have been organized into 7 categories: screening and referral; the physical examination and differential diagnosis; the neurobehavioural assessment; and treatment and follow-up; maternal alcohol history in pregnancy; diagnostic criteria for fetal alcohol syndrome (FAS), partial FAS and alcohol-related neurodevelopmental disorder; and harmonization of Institute of Medicine and 4-Digit Diagnostic Code approaches. The diagnosis requires a comprehensive history and physical and neurobehavioural assessments; a multidisciplinary approach is necessary. These are the first Canadian guidelines for the diagnosis of FAS and its related disabilities, developed by broad-based consultation among experts in diagnosis.

The challenge of fetal alcohol syndrome in the criminal legal system.

People with fetal alcohol spectrum disorder (FASD) present challenges to those who work in the criminal legal system. Prenatal exposure to alcohol can cause physical, neurological, and psychological impairments. It is vital to understand the individual offender in order to address the underlying reasons for criminal behavior. Individuals with FASD often come from dysfunctional backgrounds, and may have mental illnesses and substance use disorders. A comprehensive medical-legal report, prepared by a professional experienced with FASD, can help judges and lawyers understand how complex the interactions are among brain damage, genetics, and the environment. The person with FASD can be misunderstood in court, victimized in jails, and mismanaged in the transition back to the community, unless those working with the individual are aware of FASD and its implications.