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People with fetal alcohol spectrum disorder (FASD) in the criminal justice system often do not receive the support, accommodations, and rehabilitation they need, which can worsen their outcomes. Improving practice — through early screening, FASD-informed teams, and tailored approaches — can help forensic mental health professionals meet this population’s needs more effectively.
During her presentation at the International Forensic Psychiatry Lecture Series, Dr. Kaitlyn McLachlan discussed how better training can help staff adjust their practice to provide interventions that are appropriate for neurodivergent people.
What FASD Is
The Canada FASD Research Network uses this definition:
Fetal Alcohol Spectrum Disorder (FASD) is a diagnostic term used to describe impacts on the brain and body of individuals prenatally exposed to alcohol. FASD is a lifelong disability. Individuals with FASD will experience some degree of challenges in their daily living, and need support with motor skills, physical health, learning, memory, attention, communication, emotional regulation, and social skills to reach their full potential. Each individual with FASD is unique and has areas of both strengths and challenges.
(Canadian FASD Research Network, 2019, p. 3)
Developing research shows a range of strengths and protective factors for this population. Individuals are typically resilient and receptive to support. They have strong self-awareness, a willingness to change, and hope for the future. Their capacity for human connections means families and friends can provide support, structure, stable routines, and meaningful relationships.
Unfortunately, recognizing that someone may have FASD is not always easy. Many forensic mental health professionals have limited knowledge and training, which limits their ability to diagnose and create tailored accommodations and interventions.
Relevance and Challenges in the Criminal Justice System
While FASD is not a direct cause of criminality, some people with FASD may experience increased risk factors.
Mental health standards in criminal law are a poor fit for people with FASD. They may also have poor understanding of their legal rights and experience difficulties related to capacity to meaningfully take part in criminal proceedings or make important legal decisions, such as the decision to plead guilt. As well, they may be suggestible, which increase risk for false confessions.
Information about FASD is also among the most common forms of neuroscientific evidence considered in court decisions. In her team’s review of 350 published Canadian court decisions that included information about FASD over a decade, FASD was most often in sentencing decisions.
Dr. McLachlan highlighted that few cases reported current clinical diagnostic information about FASD and only half involved a formal diagnosis. The researchers also found a lack of expert testimony and information that linked the legal issue to the person’s functioning and needs.
Common themes included balancing reduced responsibility against the need for public protection and lack of treatment options, as well as rethinking what the legal definition of rehabilitation should look like for people with FASD.
Making Changes
Improving outcomes for people with FASD who become involved with the criminal justice system includes becoming better informed about FASD; screening for the FASD; tailoring practices and accommodations to meet patients’ needs; comprehensively evaluating, consulting, and referring; and improving access to services and support, including post-release.
In their research, Dr. McLachlan and her colleagues found that most international forensic psychiatrists and psychologists had FASD practice experience but felt inadequately trained and prepared for practice.
She offered tips for forensic mental health professionals who want to adjust their practice to better accommodate the needs of people with FASD.
- Plan and allow time for patients to adjust to the environment (considering whether environmental accommodations are needed for sensory challenges), the staff, and the staff’s expectations (sharing rules early and often).
- Create opportunities to discuss FASD to minimize stigma.
- Maintain a flexible and problem-solving mindset.
- Ensure patients are included in treatment planning and creative problem-solving.
- Include family and other supportive people to learn what works and what does not for the patient.
- Incorporate multiple approaches to learning.
For more details, watch the recording of Dr. McLachlan’s May 14, 2025, International Forensic Psychiatry Lecture Series presentation, “When Neurodevelopmental Disability Meets the Law: FASD in Forensic Context,” on our website.
Written by Virginia St-Denis and approved by Dr. Kaitlyn McLachlan.
