Fetal Alcohol Spectrum Disorder: What the Fire Service Needs to Know

By Jerrod Brown and Kathi Osmonson

Fetal Alcohol Spectrum Disorder (FASD) is a permanent, life-long condition resulting from exposure to alcohol while in utero. Prenatal alcohol exposure can lead to significant alterations in cognition, behavior, intellect, reasoning, and a host of other conditions. It affects between two and five percent of the United States population, so it is highly likely that fire professionals will come in contact frequently with individuals affected by an FASD.

Even though most people do not know much about FASD, it is more prevalent in our society than Autism Spectrum Disorder and Down Syndrome. This article will provide a broad spectrum overview of information related to FASD within the context of what the fire service needs to know as well as information relevant to fire professionals who may encounter such cases.

When conducting suppression tactics, investigations, inspections, public education, or youth firesetting interventions, consider that the person involved may possibly have undiagnosed FASD. It is important to be aware of FASD symptoms and consider the complexities of this disorder when interviewing and communicating with individuals who are living with the disorder.

Key Factors

Following are 12 key factors to consider when working with someone who may be affected by FASD:

• Difficult detection. Individuals with suspected or confirmed FASD may be difficult to identify; signs are not always present, and cognitive deficits are difficult to detect when using even standardized intelligence measures. The majority of those with FASD have an average IQ but continue to struggle with comprehension, decision making, and appropriate behaviors. There may be a higher number of children with FASD who are involved in the child welfare and juvenile justice systems; it is important to consider this as a possibility when working with youth firesetters involved in these systems. A small percentage of those affected by FASD have characteristic facial features including small eyes, a thin upper lip, a smooth philtrum (the vertical groove between the mouth and nose), and a small head. The great majority of those affected do not have these characteristics, and if they did as children, these features are not as recognizable as the child moves into adolescence and adulthood. So, use a reliable checklist of “red flags” to screen for FASD.
• Communication deficits. Individuals with suspected or confirmed FASD may have difficulties cooperating with fire officials because of a diminished understanding that could interfere with interviewing or assessments and their understanding of Miranda rights. People with FASD have difficulty understanding abstract language and thinking, so it is imperative that you speak using simple and concrete language. Individuals may feel scared or threatened and, because of their impulsivity and difficulty with emotional regulation, may become angry or frustrated easily.
• Superficial talkativeness. Many individuals with suspected or confirmed FASD tend to be charming and talkative, which may lead fire professionals to overestimate their level of competence and understanding. When providing youth firesetting assessments or educational interventions, a specialist should ask the juvenile to summarize a lesson to ensure understanding. It is very important to ask open-ended—rather than leading—questions.
• Misinterpretation of callousness. The apparent callous attitude of people with FASD can evoke many negative emotions in those who are speaking with them. In some cases, behaviors resulting from FASD symptoms can be mistaken for a choice rather than a result of the disorder. The social and cognitive deficits of individuals with FASD may contribute to the misinterpretation of their alleged criminal behavior as premeditated or manipulative when, in fact, neither of those things may be true. People with FASD often have difficulty expressing their emotions and demonstrating appropriate levels of remorse related to a wrongdoing. FASD is a disability, not a choice.
• Learning problems. Individuals with suspected or confirmed FASD may lack appropriate decision-making skills, which makes it difficult for them to learn from past experiences and avoid dangerous people and situations. Such deficits are often coupled with impulsiveness and an inability to think strategically about decisions. Hence, FASD can affect an individual’s ability to understand societal norms and to behave within those norms. Individuals with FASD often lack the ability to premeditate or form the specific intent to commit the crime when deciding to do so. When a person with FASD says he did not think about what he was doing at the time of the incident, he most likely was not thinking about anything beyond that moment in time—and clearly not thinking of the repercussions of his actions.
• Inappropriate sexual boundaries. Some individuals with suspected or confirmed FASD experience problems with boundary awareness that may result in inappropriate sexual encounters. Youngsters and adults with FASD tend to gravitate toward individuals who are at a similar emotional and intellectual age level because they either have a developmental/intellectual disability or are chronologically much younger. In some instances, this can result in incidents involving inappropriate sexual behaviors.
• Poor memory. Individuals with suspected or confirmed FASD have significant problems retrieving and communicating their memories, contributing to issues such as false testimony that they believe to be true and false confession. These individuals are highly suggestible and often have a wish to please others, which may result in fabricating stories or overrepresenting their abilities. This requires great care when questioning or interrogating them and in avoiding asking suggestive or leading questions. Poor memory often results in the individuals trying to fill in blanks to compensate for their lack of memory by adding information to their recollection of an event that is confabulated. It appears as if they are lying, but often they are just trying to make sense of what happened when they only have some of the information needed to tell what actually happened. They simply do not remember facts, but they do not want to appear “dumb,” so they fill in gaps with erroneous details that are not true.
• False confession. Individuals with suspected or confirmed FASD often experience social and cognitive deficits that result in a higher risk of false confession during interrogation and mistaken pleas during trial. These individuals have significant difficulty understanding their rights against self-incrimination when given to them, thus raising concerns about whether their admissions are being made knowingly, intelligently, and voluntarily.
• Executive functioning deficits. Individuals with suspected or confirmed FASD often have significant problems with attention, planning, and following social rules, resulting in a higher likelihood of contact with the criminal justice system and difficulties complying with the requirements of community supervision (e.g., probation and parole). They are likely to constantly commit the same types of offenses or crimes because of an inability to connect their past behavior with the consequences imposed for those offenses or crimes.
• Importance of structure. Individuals with suspected or confirmed FASD perform better in well-structured settings with established schedules and behavioral norms. Unfamiliar and chaotic settings with little structure often result in considerable stress. Individuals are likely to have difficulty concentrating when exposed to crowds, noise, and bright lights, which can be extremely overstimulating.
• Importance of simplicity. Individuals with suspected or confirmed FASD perform better when tackling one task at a time, especially when tasks do not involve a reliance on previous experience to complete. Consider this with any audience when providing public fire education. Present education using simple terminology, and speak/present concepts in concrete and easy-to-understand terms.
• Interdisciplinary collaboration. Interdisciplinary collaboration with law enforcement, the courts, probation, and community treatment providers is always encouraged when fire professionals encounter firesetters, especially if they suspect FASD. Likewise, if a fire victim or an arsonist presents with these symptoms, it would be wise to consult with a multidisciplinary team. If youth are involved, remember that the parent may be able to give you valuable information that will help you to more effectively interview the youth with FASD.

Because deficits in intellectual functioning can vary widely with FASD, it may be difficult for parents, teachers, and health care providers to identify the underlying cause of issues with cognitive and adaptive functioning. Many adopted children show signs of prenatal exposure, but their families may not have the birth family history needed to get a diagnosis. Alternately, many families that are raising their children with suspected FASD are reluctant to get the diagnosis because they feel guilt and shame over the damage they may have unknowingly caused their child.

Executive function deficits (e.g., impulsivity, affective dysregulation, and misperception of sensory stimuli and other information) can increase the likelihood of criminal behavior in individuals with FASD, particularly in stressful and unstructured settings. These deficits also predispose these adolescents to associate with antisocial peers. The cognitive deficits (i.e., executive control, attention, impulsivity, inability to link behaviors to consequences) of FASD may predispose these individuals to theft and other crimes. Individuals with FASD have the ability to execute a simple plan with a single goal in mind, but they may have difficulty executing such planning with memories of previous experiences and consequences for themselves and others, and thus the plans are not likely to be well thought out or sophisticated.

Remember that individuals with FASD are very vulnerable in society. They have difficulty developing appropriate friendships and will attempt to find and keep a friend despite the cost to them and to others. They are eager to please and to be accepted by others, and this often leads to the individual being manipulated into serving as a patsy by a criminal or the risk taker in a group of antisocial kids—the one who may light a fire because another child told him to. Such issues are complicated by the limited recognition of FASD and its complications in the legal system.

Individuals with FASD may be more likely to exhibit firesetting behaviors compared to individuals without FASD because of executive functioning deficits, impulse control problems, anger control issues, higher rates of substance abuse, attachment-related difficulties, and suggestibility, to name a few. However, further research needs to be conducted to verify this professional observation.

Whether you are on the fireground or conducting fire investigations, inspections, public education, and youth firesetting interventions, consider that the person with whom you are working may have (undiagnosed or confirmed) FASD. Remember the symptoms of FASD, and consider the complexities of this disorder when interviewing and communicating with individuals who have been exposed to alcohol prenatally.

JERROD BROWN, MA, MS, is the treatment director for Pathways Counseling Center, Inc., which provides programs and services benefiting individuals impacted by mental illness and addictions. Brown is also the founder and CEO of the American Institute for the Advancement of Forensic Studies and the editor in chief of Forensic Scholar Today and the Journal of Special Populations. Brown is in the dissertation phase of his doctorate degree program in psychology. He has special studies master of science degrees in cognitive disorders and forensics and a master’s degree in criminal justice from Saint Cloud (MN) State University as well as a master of arts degree in clinical counseling and psychotherapy from Adler (MN) Graduate School.

KATHI OSMONSON, BA, is the Youth Firesetting Prevention and Intervention (YFPI) program coordinator and the deputy state fire marshal for the state of Minnesota. She partners with law enforcement, mental health, justice, and social agencies to sustain a network of professionals who collaborate to provide prevention and intervention for young firesetters. Osmonson is a member of the NFPA 1035 Committee and the Minnesota Juvenile Justice Coalition, an adjunct instructor for the FEMA National Fire Academy, and a stakeholder in the Youth Fire Intervention Repository and Evaluation System and presents at national and international conferences. Osmonson developed the YFPI Specialist and Program Manager Certifications in conjunction with the Minnesota Fire Service Certification Board.

Youth Firesetting and Intellectual Disabilities