In Fetal Alcohol Spectrum Disorder: Comorbidity Determines Complexity

In the forensic context, fetal alcohol spectrum disorder (FASD) affects one of every six people. Seldom is FASD diagnosed correctly, which can have serious consequences for people in forensic systems whose impairments are unrecognized. Impairments in FASD increase risk of exploitation and manipulation while in police custody (e.g., rights waivers and false/exaggerated confessions) and risk of making uninformed and impulsive decisions prior to trial (e.g., plea bargaining) and at sentencing (e.g., allocutions). Forensic systems should improve screening for FASD, and defense attorneys and prosecutors need increased awareness of FASD. Due to multiple cognitive and adaptive impairments and high rates of comorbid mental health and neurodevelopmental disorders, the negative impact of this disorder on capacity to assist at trial, understand plea options, and exercise appropriate caution at all phases of the legal system is substantial. Judges need to exercise judicial leadership in improving recognition of FASD and its effects across the legal system. This is especially important with respect to closely related (comorbid) issues of gullibility, confabulation, impaired comprehension, and attention deficits.