1. Alcohol-Exposed Youth and the Court Jo Nanson, Ph. D., Judge Mary- Ellen Turpel-Lafond, P. Blakley,M. D., Ph. D.

2. Key questions  Youth Criminal Justice Act, allows for mental health assessment of youth at any stage of proceeding (fitness, bail, sentence, review)  Does this youth have central nervous system deficits consistent with prenatal exposure to alcohol?  Need to have assessments which follow accepted diagnostic protocols (Health Canada, IOM)

3. Key questions  Does the youth have the skills needed to participate in the court process? Does the youth have an understanding of the adversarial system and the players? Can the youth instruct counsel?  Even if youth understands basics of the court process, and is fit, can they provide reliable evidence (recall and sequencing of events)?

4. Saskatoon Protocol  Courts follow the Institute of Medicine criteria for an FASD assessment  All individuals receive an assessment by a dysmorphologist treated in FASD  And a neuropsychological assessment by a registered neuropsychologist familiar with FASD.  Assessments are done independently

5. Affected Areas of the Brain

6. Brain Behavior relationships  Cognition  Achievement  Attention  Memory (visual and verbal)  Executive functioning  Communication

7. Guiding Principles  Hope  Respect  Understanding  Compassion  Cooperation

8. Process of Assessment  Questions  Choosing the assessment measures  Booking the appointment  Working with the youth and family  Reports which adhere to professional standards and guidelines (“Saskatoon protocol”) and need for information to be understood by justice professionals

9. Alcohol History  Using guiding principles  Ask about pregnancy planning  Ask about emotional state  Ask about physical health  Ask about frequency, amount by trimester  Never ask did you drink?  Never be shocked.

10. FASD Sample 12-16 years: 12 females, 32 males, mean age 14.42 All First Nations 4 had previously been diagnosed as FASD 16-18 years: 4 females, 14 males, mean age 16.64, 3 Caucasian, 15 First Nations 2 had previously been diagnosed as FASD 18+ years: 12 males, mean age 21.58 3 Caucasian, 1 Vietnamese, 8 First Nations None previously diagnosed as FASD Charges ranged from breaches and mischief to sexual assault and murder.

11. FASD: Ability

12. FASD: Achievement

13. FASD: Attention

14. FASD: Memory

15. FASD: Learning and Communication

16. Saskatchewan Experience  In R. v. B.D. (April 2, 2004, SPC. Judge Turpel-Lafond) found: Since 1999, approximately 150 referrals have been made for FAS assessments by the Youth Court. Of these youth, over 80% have been diagnosed with FAS or disabilities along a spectrum related to fetal alcohol exposure. These youth have varying degrees of organic brain damage resulting in learning problems as well as behavioural impairments and secondary disabilities. Of the 150 court-ordered assessments, a small number of these youth are returning to the Court with suggestions for further court-ordered assessments by neuropsychologists and child psychiatrists for reasons of fitness to stand trial.

17. Summary  Five youth under 16 have been found not fit to stand trial  Placing these youth is very difficult after they become legal adults  More sophisticated offenders might exploit the youth who have been found not fit  Professionals in the criminal justice system may have difficulty evaluating medical and psychological terminology in proceedings

18. Summary  Younger sample is more affected than older youth or adults  Individuals have deficits in all areas relative to normal values  Verbal skills are weaker than nonverbal skills  Complex attention (multitasking is the most affected skill)  Most youth could not complete the classic measures of executive functioning.