FASD in Adult Populations: Clinical and Forensic Considerations

Abstract

Afflicting millions of individuals across the United States, Fetal Alcohol Spectrum Disorder (FASD) is a permanent disorder present from birth that results from prenatal alcohol exposure (PAE). FASD can consist of a wide range of physical (e.g., dysmorphia, sensory systems, musculoskeletal conditions), cognitive (e.g., intelligence and executive control), social (e.g., communication skills and empathy), and adaptive (e.g., independent living skills) symptoms. These impairments of FASD have important consequences across the lifespan including a predisposition to substance use issues and other co-occurring psychiatric disorders (e.g., behavioral, mood, and anxiety disorders). This complex interplay of co-occurring symptomatology complicates the identification and diagnosis of FASD, which often results in overlooked diagnosis and misdiagnosis of the disorder well into adulthood. To help familiarize clinical and forensic mental health professionals with this challenging, resource-intensive population, this chapter will provide an overview of FASD in adult populations. Red-flag indicators and common comorbid symptomatology as well as screening and intervention approaches will also be included. Further, the chapter will include a discussion of interviewing strategies and techniques that have the potential to improve screening, assessment, and treatment of the disorder, with an eye toward adult clinical and forensic mental health settings. This chapter will conclude with an examination of the current state of empirical research on FASD and identify the next steps for inquiry.