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The need to improve identification and understanding of individuals who have fetal alcohol spectrum disorder (FASD), including their strengths and challenges, is being increasingly recognized. Identification of FASD via screening is an important system-level intervention that may serve to improve early and accurate recognition of individuals who may have FASD, facilitate the provision of appropriately tailored support and interventions, and in doing so, foster healthy and positive outcomes for individuals and families. Effective and ethical implementation of FASD screening practices requires consideration of several factors for success, ensuring that resulting benefits outweigh potential harms. Using an implementation science framework, this topical review aims to provide an overview of these key considerations in order to guide further research and support practice and decision-making for service providers, organizations, and policy makers in the implementation of FASD identification and screening practices. These include prioritizing partnerships with stakeholders; taking a person-centered and ethical approach to FASD identification and screening; applying rigorous methodological research approaches to screening tool development, validation, and evaluation; increasing broader FASD awareness and response capacity at the system level; and advocating for continued policy reform and resources to enhance effective community-based support andinterventions following identification.

For many years, researchers have explored the complex challenges experienced by individuals with fetal alcohol spectrum disorder (FASD). This research has been important for documenting the brain- and body-based impacts of prenatal alcohol exposure and the psychosocial vulnerabilities and environmental adversities frequently associated with FASD. It has also supported advocacy efforts and highlighted the necessity of providing FASD services and supports. However, with the focus on deficits and needs, there is a considerable gap in the literature on the strengths and successes of individuals with FASD. The lack of strengths-based FASD research has likely perpetuated the stress and stigma experienced by individuals with FASD and their families. Thus, there is a critical need to shift the direction of the field. Here we provide a narrative review of the literature on strengths in FASD. Our goals are to: (1) understand the state of strengths-based research related to individuals with FASD across the lifespan, and (2) describe positive characteristics, talents, and abilities of individuals with FASD that may be cultivated to promote their fulfillment and well-being. We identified a total of 19 studies, most of which were conducted to explore the lived experiences of adults with FASD. This preliminary but critical body of evidence highlights the intrinsic strengths of individuals with FASD, including strong self-awareness, receptiveness to support, capacity for human connection, perseverance through challenges, and hope for the future. Despite the importance of this emerging evidence, appraisal of the literature indicates a need for more intentional, methodologically rigorous, participatory, and theory-driven research in this area. Findings from this study, including the identified gaps in the literature, can be used to inform research, practice, and policy to meaningfully advance the field of FASD and promote positive outcomes in this population.

Individuals with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disorder caused by prenatal exposure to alcohol, are overrepresented in criminal justice settings and have complex, for...

Adolescents with Fetal Alcohol Spectrum Disorder (FASD) experience a range of cognitive, behavioral, and physical difficulties, including difficulties with self-regulation. We investigated self-reg...

There is limited evidence to inform effective screening practices for identifying fetal alcohol spectrum disorder (FASD) in forensic mental health settings. This study sought to explore the potenti...

Background Prenatal alcohol exposure (PAE) is linked to alterations of cerebral white matter, including volume and nonspecific diffusion magnetic resonance imaging (MRI) indices of microstructure in humans. Some animal models of PAE have demonstrated myelination deficiencies, but myelin levels have not yet been evaluated in individuals with PAE. Multiecho T2 MRI offers a quantitative method to estimate myelin water fraction (MWF; related to myelin content) noninvasively, which was used here to evaluate brain myelination in children with PAE. Methods Participants with PAE (n = 10, 6 females, mean age 13.9 years, range 7 to 18 years) and controls (n = 14, 11 females, mean age 13.2 years, range 9 to 16 years) underwent 3T MRI of the brain. T2 images (15 minutes acquisition for 32 echoes) were used to create MWF maps from which mean MWF was measured in 12 regions of interest (ROIs) including 8 in white matter and 4 in deep gray matter. Results As expected, across the combined sample, MWF was highest for major white matter tracts such as the internal capsule and genu/splenium of the corpus callosum (10 to 18%) while the caudate and putamen had MWF less than 5%. Mean MWF was similar across 11/12 brain white and gray matter regions for the PAE and control groups (L/R internal capsule, major forceps, putamen, caudate nucleus, L minor forceps, genu and splenium of corpus callosum). In the PAE group, MWF was positively correlated with age in the genu of corpus callosum and right minor forceps, notably 2 frontal tracts. Conclusions Given comparable MRI-derived myelination fraction measures in PAE relative to controls, white matter alterations shown in other imaging studies, such as diffusion tensor imaging, may reflect microstructural anomalies related to axon caliber and density.

Background: Individuals with fetal alcohol spectrum disorder (FASD) experience a range of cognitive, affective, and physical deficits following prenatal alcohol exposure. They are thought to be overrepresented in criminal justice settings. However, limited evidence is available to inform prevalence. We sought to estimate the prevalence of FASD in a Northern Canadian correctional population. Methods: Using an active case ascertainment approach we recruited a representative sample of 80 justice-involved adults (ages 18–40, 85% male) over an 18-month period from 2013 to 2015. Participants completed interdisciplinary clinical assessments comprising medical and psychological evaluations that adhered to the 2005 Canadian FASD Diagnostic Guidelines. Results: We identified a high rate of FASD (17.5, 95% CI [9.2, 25.8%]) in this sample, and this rate could have been as high as 31.2% with confirmation of prenatal alcohol exposure. Most participants in this study presented with significant neurodevelopmental and cognitive deficits in at least two domains of functioning, irrespective of diagnosis, with only five of 80 participants (6.3%) demonstrating no cognitive impairment. Conclusions: Findings showed disproportionately high estimated FASD prevalence in this representative sample compared to general population estimates in both Canada and the U.S. (2–5%), underscoring the need for improved FASD screening and diagnosis in correctional settings, and education for clinicians working in the justice context. Strengthened health prevention and intervention efforts to support the needs of individuals with FASD outside the criminal justice context are needed.

Children with prenatal alcohol exposure (PAE) experience a range of adverse outcomes that impact multiple domains of functioning, including cognitive, physical, mental health, behavioral, social-emotional, communication, and learning. To inform tailored clinical intervention, the current study examined the relation between caregiver-reported cognitive skills (executive function; EF) and adaptive functioning. The study conducted a secondary analyses of data provided by caregivers of 87 children and adolescents (aged 5-18 years

Background Fetal alcohol spectrum disorder (FASD) is a prevalent neurodevelopmental disorder that is caused by prenatal alcohol exposure (PAE) and associated with a range of cognitive, affective, and health concerns. Although the identification of FASD can facilitate the provision of interventions and support, and plays a protective role against adverse outcomes, there are high rates of missed detection. The identification of FASD via screening may improve its recognition across settings. The current systematic review examined the available evidence on FASD screening tools and approaches across age groups and settings. Methods A systematic search was carried out for both peer-reviewed studies and gray literature sources published between January 1990 and May 2020 and was preregistered with PROSPERO (#CRD42019122077). Studies included in the review focused on human applications of FASD screening in children, adolescents, and adults. The quality of the studies was assessed using the QUADAS-2 and GRADE frameworks. Results The search yielded 20 screening tools and approaches across 45 studies, broadly characterized in 2 groups. The first group included approaches currently in use that aim to identify individuals at risk of FASD using a range of markers (n = 19) or associated sentinel dysmorphic facial features (n = 6). Another group of studies, characterized as emerging, focused on identifying promising biomarkers of PAE/FASD (n = 20). Overall, we identified limited research supporting the psychometric properties of most screening approaches. The quality review provided evidence of bias due to the common use of case-control designs and lack of adequate reference standards. Conclusions Although several FASD screening tools and approaches are available for use across a range of age groups and settings, the overall evidence base supporting their psychometric properties is weak, with most studies demonstrating significant risk of bias. Service providers should exercise caution in selecting and implementing FASD screening tools given these limitations. It is critically important to accurately identify individuals with FASD across ages and settings to support healthy outcomes. Thus, there is a pressing need for additional research in this area, particularly validation studies in large and representative samples using robust methodological approaches.

Deficits in reward decision-making are thought to contribute to criminal offending. These impairments have been measured in laboratory studies using the Iowa Gambling Task (IGT) which assesses implicit learning of different reward/punishment contingencies. This study compared IGT performance between a sample of justice-involved individuals and community-based individuals without an offending history. Participants included 100 adults from two Canadian federal correctional institutions (34% female, Mage = 39.14 ± 9.74) and a comparison group of 89 community adults with no history of offending (39% female, Mage = 37.04 ± 10.79). Responses on the IGT were analyzed for overall net score, learning across the task, and deck switching patterns. Associations between IGT performance and sentence characteristics and static factors assessment of recidivism risk were examined for the justice-involved group. The justice-involved group performed significantly worse than community adults in terms of net score. While the community group learned the advantageous strategy across the task, justice-involved participants exhibited minimal learning. This effect was moderated by recidivism risk within the justice-involved group, with individuals at low risk, but not medium/high risk, showing improvement over the blocks of the task. Finally, the justice-involved group also made greater use of an ineffective “win-stay/lose-shift” strategy. These results suggest that, compared with community participants without history of offending, incarcerated adults tend to employ maladaptive decision-making strategies that yield worse overall outcomes and the extent of impairment is associated with recidivism risk.

The purpose of this chapter is to provide an overview of the relevance of fetal alcohol spectrum disorder (FASD) in the context of adjudicative competency, from initial interactions with police at arrest through interrogation and adjudication at trial. Individuals with FASD experience contact with the criminal justice system at elevated rates and are overrepresented in forensic, legal, and correctional contexts. The complex range of functional and neurodevelopmental impairments experienced by many individuals with FASD raise concerns about their ability to competently navigate adjudicative proceedings. Growing awareness about FASD among legal professionals and courts, coupled with policy calls to more effectively address their overrepresentation in legal contexts, suggests that forensic clinicians are increasingly likely to be tasked with identifying and evaluating justice-involved individuals with FASD. However, limited FASD training, knowledge, and skill among forensic clinicians, in addition to an array of challenges identifying individuals with FASD in clinical and legal settings, render this a complex task. This chapter begins with a brief overview of adjudicative competency and FASD, followed by practical strategies to support best practices in competency evaluation for forensic clinicians.

Background. Individuals with fetal alcohol spectrum disorder (FASD) experience a range of problems in their cognitive, affective, and physical functioning following prenatal alcohol exposure (PAE), in addition to multiple complex difficulties in daily living that impact well-being. Using the Canadian National FASD Database, we sought to profile a range of difficulties in daily living, along with risk factors, in a large cross-sectional cohort of adolescents, transition-aged youth, and adults with PAE, of which a subset was ultimately diagnosed with FASD. Methods. We summarized data for 9 current difficulties in daily living reported at the time of diagnostic assessment for 726 individuals with PAE assessed at 26 FASD diagnostic clinics across Canada, including 443 adolescents (12 to 17 years), 135 transition-aged youth (18 to 24 years), and 148 adults (25 to 60 years). Difficulties included problems related to school disruption, employment, independent living needs, supportive or sheltered housing, legal problems with victimization, legal problems with offending, incarceration, alcohol misuse, and other substance misuse. Risk factors included age, gender, living placement, postnatal trauma, and neurodevelopmental impairment. Results. Across the full PAE sample, adolescents, transition-aged youth, and adults presented with high rates of difficulties in daily living, including independent living support needs (63%), alcohol misuse (38%), other substance misuse (46%), employment problems (37%), legal problems with offending (30%), assisted or sheltered housing (21%), school disruption (18%), legal problems with victimization (4%), and incarceration (3%). Difficulty rates were similar for those with FASD irrespective of diagnosis (e.g., with or without sentinel facial features), but rates greater for adults, and those with low overall intellectual functioning (IQ < 70). Controlling for age and IQ, cumulative difficulty was independently associated with gender, living placement, and neurodevelopmental impairment. Conclusions. Adolescents, transition-aged youth, and adults with FASD experienced a range of substantial and complex difficulties at the time of their diagnostic assessment, signaling a high level of service needs. These findings underscore the importance of developmentally informed assessment continued through childhood, as well as ongoing functional and needs-based service provision as youth with FASD transition to adulthood and beyond. Kids Brain Health Network; Canada FASD Research Network 2021-05-29

Objectives:A number of commonly used performance validity tests (PVTs) may be prone to high failure rates when used for individuals with severe neurocognitive deficits. This study investigated the validity of 10 PVT scores in justice-involved adults with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disability stemming from prenatal alcohol exposure and linked with severe neurocognitive deficits.Method:The sample comprised 80 justice-involved adults (ages 19–40) including 25 with confirmed or possible FASD and 55 where FASD was ruled out. Ten PVT scores were calculated, derived from Word Memory Test, Genuine Memory Impairment Profile, Advanced Clinical Solutions (Word Choice), the Wechsler Adult Intelligence Scale – Fourth Edition (Reliable Digit Span and age-corrected scaled scores (ACSS) from Digit Span, Coding, Symbol Search, Coding – Symbol Search, Vocabulary – Digit Span), and the Wechsler Memory Scale – Fourth Edition (Logical Memory II Recognition).Results:Participants with diagnosed/possible FASD were more likely to fail any single PVT, and failed a greater number of PVTs overall, compared to those without FASD. They were also more likely to fail based on Word Memory Test, Digit Span ACSS, Coding ACSS, Symbol Search ACSS, and Logical Memory II Recognition, compared to controls (35–76%). Across both groups, substantially more participants with IQ Conclusions:Results highlight the need for additional research examining the use of PVTs in justice-involved populations with FASD.

Children and adolescents with fetal alcohol spectrum disorder (FASD) experience significant impairments in cognitive functioning, though substantial within-group heterogeneity is often observed. The purpose of this study was to characterize the cognitive profile of children and adolescents with FASD with a special focus on examining moderators of functioning and cognitive strengths. Children and adolescents with FASD (n = 87) and controls (n = 110), ages 5 to 18 years completed a cognitive test battery. MANOVA was used to evaluate between-group cognitive differences, as well as the role of age and gender as potential moderators. Relative strengths were evaluated using both within-subject and between-group methods. Participants with FASD were found to show significant impairment on all cognitive tasks relative to controls, with substantial deficits evident on a measure of mathematical skill. Though neither age nor gender emerged as moderators, significant three-way interactions between age, gender, and group were evident on measures of executive functioning (inhibition), verbal memory, and word identification. Tasks measuring higher-order complex attention and visuospatial processing emerged as possible relative strengths in the FASD group. Children and adolescents with FASD had significant cognitive impairment across multiple domains confirming high need for interventions. Differences in the cognitive functioning for boys and girls with FASD at different developmental periods, along with relative strengths, may serve to inform interventions and future longitudinal research.

Aggression jeopardizes positive development in children and predicts social and academic maladjustment in school. The present study determined the relationships among anger dysregulation (a marker of emotion regulation), cortisol activity (a biomarker of stress), and peer-nominated aggression in typically developing children in their everyday classroom setting (N = 151, Mean age = 10.86, SD =.74). Salivary cortisol was collected at 09:15, 11:45, and 14:45 hr across 4 consecutive days. Children provided self-reports of anger regulation; peers reported proactive and reactive aggressive behaviors. Hierarchical linear regression analyses, followed by a bootstrapping analysis identified basal afternoon cortisol as a significant mediator between anger regulation and peer-reported aggression. More dysregulated anger significantly predicted lower afternoon cortisol, which in turn predicted increased peer-reported aggression. These results align with previous research on links among hypocortisolism, emotional regulation, and behavior, and suggest a possible meditational pathway between emotion and behavior regulation via decreased afternoon cortisol levels.

Individuals with prenatal alcohol exposure (PAE) exhibit neurological deficits associated with brain injury including smaller brain volumes. Additional risk factors such as lower socioeconomic status (SES) may also have an impact on brain development for this population. This study examined how brain volumes are related to SES in both neurotypically developing children and adolescents, and those with PAE. 3D T1-weighted MPRAGE images were acquired from 69 participants with PAE (13.0 ± 3.2 years, range 7.1–18.8 years, 49% female) and 70 neurotypical controls (12.4 ± 2.9 years, range 7.0–18.5 years, 60% female) from four scanning sites in Canada. SES scores calculated using Hollingshead’s Four-Factor Index of Social Status from current caregiver placement were not significantly different between groups, though more children with PAE had lower SES scores compared to controls. Psychometric data comprised 14 cognitive measures, including executive functioning, attention and working memory, memory, math/numerical ability, and word reading. All cognitive scores were significantly worse in children with PAE compared to controls, though SES was not correlated with cognitive scores in either group after correction for multiple comparisons. All 13 brain volumes were smaller in children with PAE compared to children in the control group. Higher SES was associated with larger hippocampus and amygdala volumes in controls, but there were no such associations in children with PAE. Direct evaluation of the interaction between SES and diagnostic group did not show a significant differential impact of SES on these structures. These findings support previous links between SES and brain volumes in neurotypically developing children, but the lack of such a relationship with SES in children with PAE may be due to the markedly smaller brain volumes resulting from the initial brain injury and postpartum brain development, regardless of later SES.

Deficits in impulse control have been linked to criminal offending, risk of recidivism, and other maladaptive behaviours relevant to the criminal justice system (e.g. substance use). Impulse control can be conceptualized as encompassing the broad domains of response inhibition and impulsive/risky decision-making. Advancements in technology have led to the development of computerized behavioural measures to assess performance in these domains, such as go/no-go and delay discounting tasks. Despite a relatively large literature examining these tasks in offenders, findings are not universally consistent. This systematic review aims to synthesize the literature using computerized neurocognitive tasks to assess two domains of impulse control in offenders: response inhibition and impulsive/risky decision-making. The review included 28 studies from diverse geographic locations, settings, and offender populations. The results largely support the general conclusion that offenders exhibit deficits in impulse control compared with non-offenders, with studies of response inhibition more consistently reporting differences than studies using impulsive and risky decision-making tasks. Findings are discussed in the context of contemporary neuroimaging research emphasizing dysfunction in prefrontal cortex as a key contributor to impulse control deficits in offenders.

It has been well-documented that individuals with FASD are over-represented in the criminal justice system. Individuals with FASD display a variety of cognitive impairments (particularly in the areas of executive functioning and memory) that likely contribute to poor functional and adaptive outcomes, and ultimately legal issues. Unfortunately, these deficits may also impact their ability to competently navigate legal adjudication. Legal experts have questioned whether justice-involved individuals with FASD experience difficulties understanding and appreciating their legal rights and the nature of adjudication from arrest and interrogation through the criminal trial process. The following chapter provides a summary of both common neurobehavioral deficits observed in individuals with FASD, as well as the manner in which they may interact to impair legal capacities relevant to adjudication.

Individuals with a diagnosis of fetal alcohol spectrum disorder (FASD) experience a range of physical, cognitive, and behavioral deficits thought to interfere with their ability to competently navigate the arrest, interrogation, and trial process. This study examined the psycholegal abilities of young offenders with FASD, including their understanding and appreciation of Miranda rights, and adjudication capacities (factual knowledge of criminal procedure, appreciation of the nature and object of the proceedings, ability to participate in a defense and communicate with counsel). Two groups of young offenders (50 with FASD and 50 without prenatal alcohol exposure) completed Grisso’s Instruments for Assessing Understanding and Appreciation of Miranda rights and the Fitness Interview Test-Revised in order to assess overall rates of impairment in youth with FASD, as well as differences between the groups. Potentially important predictors of psycholegal abilities were also evaluated. Results indicated the majority of young offenders with FASD (90%) showed impairment in at least one psycholegal ability, and rates of impairment were significantly higher than the comparison group. However, considerable within-group variability was observed. IQ and reading comprehension emerged as robust predictors of participants’ psycholegal abilities; while the FASD diagnosis differentiated participants’ scores on the FIT-R. These findings underscore the importance of individualized and comprehensive forensic assessments of psycholegal abilities in this population when warranted. Additional system level strains for this population are discussed, including problems in approaching competency remediation, and the potentially growing need for accommodation and forensic assessments in the face of limited financial and professional resources in legal settings.

This study aimed to further clarify the association between interrogative suggestibility and Miranda rights comprehension in adolescents; in particular, we examined whether intellectual ability (IQ) serves as a mediator of this relationship. Participants completed Grisso's Miranda Instruments, the Wechsler Abbreviated Scale of Intelligence, and the Gudjonsson Suggestibility Scale. Many youth demonstrated poor comprehension of their rights, particularly younger and less intellectually capable adolescents. Both yield and shift components of interrogative suggestibility were inversely related to rights comprehension; however, IQ fully mediated these relationships. Neither demographic variables (gender, ethnicity, socio-economic status after controlling for IQ, and English as a second language (ESL) status) nor previous police experience were significantly associated with rights comprehension in the present sample. The implications of these findings are discussed.

Research indicates that a sizable proportion of adolescent defendants have difficulty understanding and participating in legal proceedings against them, and may be incompetent to stand trial. To examine attorneys' experience in defending adolescents with competence-related difficulties, 214 juvenile attorneys were surveyed. Findings indicated that attorneys have doubts about the competence of approximately 10% of adolescent defendants, and that they find these cases particularly challenging to defend. Most attorneys appear to recognize that developmental factors may contribute to adolescents' competence-related difficulties, and believe that the law should accept developmental immaturity as a basis for incompetence findings. In approximately half of the cases in which attorneys had doubts about competence, attorneys did not request a competence evaluation but instead made other efforts to address competence issues, such as by teaching adolescents about legal proceedings and further involving their parents. The implications of these findings are discussed.

The purpose of this study was to: (1) Establish whether or not specific rehabilitation for mild brain injury is effective for return to work; and (2) compare the efficacy of an impairment-focused model of treatment versus an early education approach in respect to ability to return to work. Two different approaches to intervention and treatment for those with a suspected concussion from a work-related injury were utilised by an urban, interdisciplinary, outpatient rehabilitation facility. The first approach, Group Treatment (GT), provided minimal early education at time of initial intake, emphasising an extensive group-focused interdisciplinary assessment and treatment. The second approach, Individualized Education and Treatment, (IET) emphasised early education, instead coupled with specific individualised services. Both groups received employment services. Post-discharge, GT (N= 26) resulted in 46% (n= 12) of individuals returning to competitive employment, while IET (N= 23) resulted in 78% (n= 18) of individuals returning to competitive employment. An asset-oriented early individualised educational approach appears to be a more effective for employment re-engagement.

The hypothalamic-pituitary-adrenal (HPA) axis is impacted by a multitude of pre- and postnatal factors. Developmental programming of HPA axis function by prenatal alcohol exposure (PAE) has been demonstrated in animal models and in human infants, but remains understudied in older children and adolescents. Moreover, early life adversity (ELA), which occurs at higher rates in children with PAE than in non-exposed children, may also play a role in programming the stress response system. In a cohort of children and adolescents with PAE and ELA (PAE + ELA), we evaluated HPA function through assessment of diurnal cortisol activity compared to that in typically developing controls, as well as the associations among specific ELAs, adverse outcomes, protective factors, and diurnal cortisol. Morning and evening saliva samples were taken under basal conditions from 42 children and adolescents (5–18 years) with PAE + ELA and 43 typically developing controls. High rates of ELA were shown among children with PAE, and significantly higher evening cortisol levels and a flatter diurnal slope were observed in children with PAE + ELA, compared to controls. Medication use in the PAE + ELA group was associated with lower morning cortisol levels, which were comparable to controls. Complex associations were found among diurnal cortisol patterns in the PAE + ELA group and a number of ELAs and later adverse outcomes, whereas protective factors were associated with more typical diurnal rhythms. These results complement findings from research on human infants and animal models showing dysregulated HPA function following PAE, lending weight to the suggestion that PAE and ELA may interact to sensitize the developing HPA axis. The presence of protective factors may buffer altered cortisol regulation, underscoring the importance of early assessment and interventions for children with FASD, and in particular, for the many children with FASD who also have ELA.

There is a growing need for validated tools to screen children at risk of fetal alcohol spectrum disorders (FASD). The Neurobehavioral Screening Tool (NST) is one of several promising screening measures for FASD, though further evidence is needed to establish the tool's psychometric utility.To assess the predictive accuracy of the NST among children with an FASD diagnosis, with prenatal alcohol exposure (PAE) but no FASD diagnosis, and typically developing controls.The NST was completed by caregivers of children ages 6 to 17, including 48 with FASD, 22 with PAE, and 32 typically developing non-exposed controls. Predictive accuracy coefficients were calculated using Nash et al. (2006) criteria, and compared against controls. An alternative scoring scheme was also investigated to determine optimum referral thresholds using item-level total scores.The NST yielded 62.5% sensitivity for participants with FASD and 50% for PAE. Specificity values were 100% with no typically developing control scoring positive. Within the FASD group there was a trend for higher sensitivity among adolescents aged 12 to17 (70.8%) compared with children aged 6 to 11 years (54.2%), p = 0.23.The findings support a growing body of literature evidencing psychometric promise for the clinical utility of the NST as an FASD screening tool, though further research on possible age-effects is warranted. The availability of a validated clinical screening tool for FASD, such as the NST, would aid in accurately screening a large number of children and lead to a timelier diagnostic referral.

Transition from paediatric to adult health care services is fraught with challenges in multiple domains (1) including future health care use, educational and vocational trajectories, family and social life, self-fulfillment and quality of life. Significant gaps in the transition process exist (2–4) and involve both paediatric and adult health care systems. Important challenges include the lack of preparation for transition and transfer (5); adult health care providers’ lack of experience, training and expertise in traditionally paediatric diseases and conditions; loss of a longstanding, trusting relationship with the paediatrician; and suboptimal development of the adult health care physician-youth relationship and communication (5). Transition in health care is a process in which adolescents gradually prepare for and shift toward care in the adult system. In contrast, the current (albeit sparse) literature regarding perceptions of care during this period indicates that some individuals believe that they were suddenly removed from paediatric care and thrust into a foreign system for which they had not been adequately prepared (2,4). Transition challenges are likely to be greater among youth with neurodevelopmental disabilities (NDDs) because of the complexity of their health care needs and the stigma associated with physical and intellectual disability that may accompany these disorders (2,4–6). From an ethics perspective, a fundamental component of transition is whether individuals with NDDs feel respected, and how their values and autonomy are integrated, developed and supported within the transition (7). There is a paucity of literature regarding how transition programs respond to the complex needs of youth with NDDs and how they specifically respond to ethics concerns that arise during the provision of health care. Therefore, we convened a national workshop to deliberate some of the key ethics challenges for young adults with NDDs during the transition from paediatric to adult care. Our goals were: to identify and validate important ethics issues that arise during transition for youth with NDDs; to discuss how such ethics issues could be handled or addressed; to consider the barriers in implementing change; and to identify the knowledge needed to support informed practices. Building on the activities of NeuroDevNet, a Canadian Network of Centres of Excellence, we subsequently engaged in a collaborative writing process to consolidate the ideas and opinions expressed during the workshop.

Fetal Alcohol Spectrum Disorder (FASD) is a lifelong disorder with no cure and is accompanied by neurological deficits. FASD is a health concern that is increasingly gaining attention within the justice system. Research has identified an association between delinquency and prenatal alcohol exposure. This study looked at resources of resilience for young offenders and addressed questions regarding the association between enculturation and resilience, and whether offence histories differed between youth with and without a diagnosis of FASD. Ninety-four young offenders between 13 and 23 years of age participated, 47 diagnosed with FASD and 47 without. While this study was not intended to be a study on Aboriginal adolescence, given the overrepresentation of FASD among Aboriginal youth involved in justice settings, the Multigroup Ethnic Identity Measure (MEIM) was included to assess levels of enculturation among youth. The Child and Youth Resilience Measure (CYRM) was used to assess resilience. Results showed a positive association between the resilience-enhancing resources and enculturation, indicating that the two are intricately connected. Neither group differed in their rates on the resilience-enhancing resources or the enculturation measure. While the resilience measure was not significantly associated with official conviction data, it did demonstrate significant associations with self-reported offending data. Finally, no significant results emerged to suggest that FASD had an influence on the association between the resilience measure and offence history or the enculturation measure and offence history. Findings suggest the importance of incorporating cultural components into services targeted to produce resilience and positive outcomes, and that different groups may have different service needs.