Name of Expert: Natalie Novick Brown, Ph.D., SOTP 

Area of Expertise: Psychiatry & Psychology >> Psychology 

Area of Expertise: Psychiatry & Psychology >> Forensics 

Area of Expertise: Psychiatry & Psychology >> Psychiatry 

Representing: Defendant 

Jurisdiction: S.D.Tex. 

I, NATALIE NOVICK BROWN, PhD, hereby declare, under oath, as follows: 

1. I am over the age of eighteen and mentally competent, and I make this declaration based on my own personal knowledge. 2. Defense counsel requested that I submit this declaration. 

3. I am a psychologist and Program Director of FASDExperts, a multidisciplinary assessment group that conducts forensic evaluations consistent with well-20 accepted, published diagnostic guidelines in cases of suspected Fetal Alcohol Spectrum Disorders (FASD). 

4. Our multidisciplinary assessment group consists of three specialists as recommended under federal guidelines for clinically consistent FASD diagnosis: Paul Connor, PhD (neuropsychologist), Richard Adler, MD (psychiatrist), and Natalie Novick Brown, PhD (psychologist and functional specialist in FASD). 

5. Each member of our multidisciplinary team holds a faculty appointment at the University of Washington School of Medicine in the Department of Psychiatry and Behavioral Sciences. Resumes are available at our website: www.FASDExperts.com. All three members of our team have training and experience relevant to our individual specialties in FASD. 

a. Dr. Connor is a neuropsychologist and licensed Psychologist in the State of Washington. He completed his doctoral degree in psychology and neuropsychology at Brigham Young University and a post-doctoral fellowship in the Fetal Alcohol and Drug Unit at the University of Washington. He subsequently was a faculty member of the Fetal Alcohol and Drug Unit for nearly 13 years, conducting research on the neuropsychological, neuroimaging, and mental health impairments associated with FASD. Currently, he is in private practice, specializing in clinical and forensic assessment of FASD. He is the Neuropsychological Director of FASDExperts. 

b. Dr. Adler is a medical doctor and licensed Psychiatrist in the State of Washington. He obtained two postdoctoral degrees in Psychiatry from Harvard University and completed a Fellowship in Forensic Psychiatry at the University of Washington School of Medicine. He is Board certified in Child and Adolescent Psychiatry and Board certified in Adult Psychiatry. He maintains an active clinical practice in child, adolescent and adult psychiatry. He is the Medical Director of FASDExperts. 

c. Dr. Brown obtained her undergraduate degree from UCLA and her doctoral degree in clinical psychology from the University of Washington, where she also completed a post-doctoral fellowship in the Fetal Alcohol and Drug Unit. She is licensed as a Psychologist in Washington and Florida and also is certified to conduct assessments by the Division of Developmental Disabilities, Department of Corrections, and Department of Social and Health Services in Washington State. Since 1995, Dr. Brown has specialized in forensic evaluation of FASD and in community-based treatment of individuals with FASD (particularly those with sex offenses and other felony convictions). 

6. FASDExperts has provided reports, depositions, and/or testimony regarding FASD in over 50 forensic cases, including State of Washington v. Johnson, State of South Carolina v. Binney, State of California v. Hamilton, State of Washington v. Benedict, State of Washington v. John Doe (Juvenile Matter), Ernest Johnson v. State of Missouri, Texas v. Joseph T. Estrada, Jr., Nevada v. Eugene Nunnery. We have worked as a forensic assessment team in multiple forensic contexts including pre-trial, post conviction, and civil/administrative matters as well. 

7. We have participated as invited speakers in many trainings and workshops for legal and mental health professionals, government officials, and the lay public. We also have provided national and international training regarding our assessment protocol to medical and mental health groups. 

8. Our group presented its Model Standard for forensic evaluation of FASD at the FAS International Conference in Victoria, B.C. on March 11, 2009. 

9. FASDExperts was contacted by Defense co-counsel on January 6, 2011, who provided us with preliminary information and materials relevant to this matter. I reviewed those materials on January 7, 2011. 

10. Based upon my review of several case documents, I have concluded that there is basis for further evaluation to determine definitively whether FASD is present. The basis for this opinion is the following: 

a. A sworn affidavit from birth mother Joe Mae Brown and statement describing her interview by Mitigation Specialist Lisa Milstein confirm prenatal alcohol exposure (i.e., according to the Centers for Disease Control ¹, self-reported drinking by a birth mother constitutes definitive evidence of prenatal exposure). The fact that family members corroborated the birth mother's report in their interviews with Lisa Milstein provides convergent evidence of its reliability. Specifically, the birth mother reported that she consumed a pint of “boot leg” alcohol on Friday, Saturday, and Sunday of each week during the 4 index pregnancy. Regular alcohol consumption in this amount well exceeds levels known to cause brain damage in FASD. A pint of liquor contains 16 shots of alcohol (i.e., 16 drinks of 1.25 ounces each). According to Sterling 7 Clarren ² , risk for “severe” FASD increases substantially when pregnant women reach a blood alcohol level or BAC in the 125-150 mg/dL range and attain such levels at least weekly. (A range of 125-150 mg/dL is equivalent to a BAC of 0.125-0.150 percent.) The exact amount of drinking it takes for an individual woman to reach a BAC of 0.125 to 0.150 percent is complex and based on many factors (e.g., her size, her ponderal index, the rapidity of her drinking, whether alcohol is consumed alone or with food and what types of Bertrand, J., Floyd, R. L., Weber, M. K., O'Connor, M. J., Riley, E. P., Johnson, K. A., ... National Task Force on FAS/FAE. (2004). Food, and other factors). In general, an average-sized woman (i.e., 120-150 pounds) reaches a BAC of 0.10 after 3 drinks and a BAC of 0.15 after 4-5 drinks. (The latter is considered “binge” drinking and is associated with the most severe deficits in FASD.) In summary, the birth mother's report that she consumed the equivalent of 10 shots of alcohol at least three nights per week throughout the pregnancy indicates a massive amount of binge drinking throughout pregnancy that is almost certainly going to produce FASD. 

b. School records established that Arthur Brown had a childhood history consistent with FASD (e.g., designated as “Learning Disabled” in third grade and subsequently placed in Special Education, standardized testing throughout school indicating significant learning deficits in basic academic subjects, severe auditory comprehension/receptive language deficits). Such developmental problems are found in almost all children with FASD. 

c. School psychology reports reflected IQ scores from the mild mental retardation range (i.e., full scale IQ of 70 at age 8) to the low average range (i.e., full scale IQ of 87 at age 15), with a significant “split” between Verbal (VIQ=81) and Nonverbal (PIQ=96) performance in the latter test. Variable performance on standardized tests as well as a significant verbal/nonverbal IQ difference are consistent with the uneven, diffuse, “patchy” brain damage in FASD. ³ 

11. In summary, there is abundant preliminary information to support a conclusion that an FASD diagnosis is LIKELY and that a multidisciplinary diagnostic assessment to address this issue should be undertaken. As forensic FASD assessment relies on complete information about a respondent's life history and instant offense conduct, thorough mitigation investigation is essential to our work. 

12. It is well-accepted that FASD is under-diagnosed. In seminal research by Streissguth and colleagues ⁴, it was found that a significant risk factor for negative life course consequences in FASD was the failure to have the condition diagnosed before age six so that case management and appropriate treatments could be administered throughout childhood. FASD is often referred to in the literature as a “hidden disability” because of a common but inaccurate lay perception that if IQ is unimpaired, there are no cognitive deficits of note. Consequently, an ironic and lamentable consequence of mitigation efforts in Capital Murder cases is that in many instances, it is only in the context of such a serious penalty that an appropriately-thorough analysis undertaken. That analysis begins with thorough mitigation investigation by defense counsel and culminates with equally thorough assessment conducted by FASDExperts, which relies on the mitigation investigation. 

13. Based on the limited document review I have conducted, it is likely that Arthur Brown's lifelong history, including his offense conduct, will reveal the very kind of neurocognitive impairments that are associated with FASD - impairments that produce a cognitive disorder (i.e., mental defect) and affect self-regulation across the lifespan, particularly in unstructured and high stress situations. During trial and sentencing in 1993, appeal in 1996, and habeas appeal in 2008, the Court did not have the benefit of hearing any testimony about the impact of FASD on Mr. Brown's life history or, more specifically, on his instant offense behavior. At the time of his trial, sentencing, and appeal in the early 1990s, FASD was definitely not a new or novel concept to medicine or psychology and had been recognized for many years as a major known cause of developmental disabilities, with the lifelong implications of these disabilities known for several years. By the time of his habeas appeal in 2008, it was well recognized that FASD caused “secondary disabilities,” most relevant of which is “Trouble with the Law.” However, when Mr. Brown was born in 1970, no one knew about the damage and long-term effects that prenatal alcohol exposure could cause. For example, in 1989, long after his mother was pregnant, Congress passed legislation to mandate labels on all alcohol beverage containers sold in the United States that warned against drinking alcohol during pregnancy. This event, which occurred during the pre-trial investigation stage in Mr. Brown's case, evoked widespread television and newspaper publicity across the nation. Consequently, by the time of his trial and sentencing in 1993 and initial appeal in 1996, knowledge about FASD was widespread in the lay population as well as the scientific community. At any point in the legal process, including at Mr. Brown's federal habeas appeal in 2008, any expert with knowledge about FASD could have testified not only about the diagnosis if it had been obtained but also about the long- term behavioral ramifications of the condition on his ability to self-regulate in general and on his offense conduct in particular. 

14. An FASD diagnosis, if found, involves significant, permanent brain damage that affects executive functioning and adaptive behavior (e.g., judgment, decision making, impulse control). Therefore, an FASD diagnosis, if found, would be highly relevant to the legal outcome in Mr. Brown's case. According to counsel's review of the State Habeas Court's findings of fact, the Court found that “counsel did not call the applicant's special education teacher as a matter of trial strategy, because there was no information indicating that the applicant's IQ affected his ability to determine right from wrong.” (Finding No. 52). Evidence of FASD has mitigating potential beyond a person's ability to determine right from wrong. In particular, FASD substantially impairs an individual's ability to deliberate and reflect as well as self-regulate. In the last 15 years, awareness that FASD involves birth defects caused by maternal alcohol use has led to increasing awareness in the legal profession that a different level of attribution is warranted for individuals with fetal alcohol impairment. Rather than assuming that these individuals become unmotivated, manipulative, antisocial, and/or self-defeating solely because of poor parenting experiences and free will, research over the last two decades has shown consistently that untreated neurocognitive disabilities are the basis for maladaptive behaviors. Notwithstanding the fact that environmental influences can and do play a significant role in the expression of secondary disabilities seen in FASD such as Trouble with the Law, it also has been established in the scientific research over the past 20 years that individuals with FASD have structural brain damage that makes it highly unlikely they will be able to withstand the negative influence of environmental risk factors without appropriate diagnosis and treatment. The relevance of FASD in the judicial process is well known: 

a. While many persons with FASD do not have IQs in the intellectual disability range, they function adaptively as if they are intellectually disabled due to their executive function deficits: “The use of IQ scores (is) an attempt to create an illusion of scientific certainty in identifying a disorder whose causes and manifestation are often hidden and subtle....The problem is that when the artificial number fails to fit with the disability as it is experienced and documented by others, which criterion should be used? Typically, clinicians and government entities find it easier to go ‘by the book,’ but there are times when that results in a wrong and, possibly, unjust decision.” ⁵ 

b. Due to their mental defect, persons with FASD tend to be highly suggestible and prone to waiving their rights: “When giving statements, they may not understand concepts such as waiving rights to counsel, lawyer-client privilege, and the implications of their plea. They are vulnerable to making false confessions.” ⁶ 

c. Due to their mental defect and suggestibility, persons with FASD tend to be poor historians: The tendency for individuals with FASD to lie and confabulate similar to others with developmental deficits ⁷ is likely not intentional but rather a result of cognitive deficits such as difficulty with the interpretation and understanding of information. ⁸ 

d. Due to their mental defect, persons with FASD often lack the biological capacity to premeditate, reflect, appreciate the wrongfulness of their actions, and control their aggressive impulses: “FASD may negate the ‘guilty mind’ requirement essential to establishing legal culpability....How can a defendant form the requisite intent for the criminal offense if he or she does not appreciate the wrongfulness of the act due to learning and memory difficulties? Or, where an act requires a specific intent... does an individual with FAS have that kind of forward thinking and planning ability?” ⁹ 

e. The United States government has recognized that FASD is directly relevant in the legal context: “Individuals with FASD typically are impulsive and have trouble foreseeing the consequences of their actions.... (This) presents challenges throughout the judicial process - from questioning through arrest, hearings, sentencing, and detention.” ¹

f. Courts have recognized that FASD is relevant throughout the judicial process: “Evidence concerning certain alcohol-related conditions has long been admissible during the guilt phase of criminal proceedings to show lack of specific intent .... (I)f evidence of a self-induced condition such as voluntary intoxication is admissible, then so too should be evidence of other commonly understood conditions that are beyond one's control, such as epilepsy... Just as the harmful effect of alcohol on the mature brain of an adult imbiber is a matter within the common understanding, so too is the detrimental effect of this intoxicant on the delicate, evolving brain of a fetus held in utero. As with ‘epilepsy, infancy or senility'...we can envision few things more certainly beyond one's control than the drinking habits of a parent prior to one's birth.” ¹¹ 

15. FASDExperts has been asked to provide a cost estimate for multidisciplinary assessment of Arthur Brown to determine if he meets criteria for an FASD. In the interests of cost-effectiveness, our evaluative model reflects a step-wise approach: 

a. Step 1: Dr. Connor, our team's Neuropsychological Director, reviews the defendant's prior psychological testing and advises regarding the need for further testing and the nature of same. Dr. Connor administers a battery of tests to the defendant in order to determine if there are neuropsychological deficits consistent with FASD. He prepares a graphic representation of the test results for use as an exhibit in court. If the results of neuropsychological testing show deficits in a pattern consistent with FASD, counsel are advised that it is appropriate to pursue additional FASD evaluation, as below. 

b. Step 2: After reviewing results of neuropsychological testing, Dr. Adler undertakes the second (and diagnostic) step in the evaluation, which may be conducted in tandem with Dr. Brown (especially when time is of the essence). Dr. Adler reviews records, conducts a complete medical examination, takes digital facial photographs to analyze for FASD abnormalities, and conducts a psychiatric interview to address whether an FASD medical diagnosis is warranted. In addition, it is not unusual that the medical evaluation of FASD will require neuroanatomical testing such as Magnetic Resonance Imaging (MRI) and specialized analysis of the MRI via one or more of the following: (1) Diffusion Tensor Imaging, (2) Morphometric (Shape) Analysis, and/or (3) Volumetric measurements. In addition, Dr. Adler reviews the MRI images with his own Neuroradiology consultant at the University of Washington and does not rely on what is often a rudimentary reading of the study by a local (clinical and non-specialized) radiologist. 

c. Step 3: If the defendant is diagnosed with an FASD, Dr. Brown reviews case records, examines and administers forensic psychological tests to the defendant, and conducts lifelong functional assessment for the purpose of determining whether there is adequate evidence of persistent deficits in functioning across the defendant's lifespan, which would be consistent with FASD. If counsel requests, she also analyzes the defendant's criminal history, including instant offense, to determine if the behavior depicted in that history is consistent with FASD (i.e., a “nexus” analysis). 

16. An estimate of fees associated with our work is the following: 

a. Dr. Connor bills at an hourly rate of $250. Neuropsychological testing involves 24 hours of time ($6000), which includes document review, face-to-16 face testing, consultation with FASDExperts colleagues, travel time, and report. 

b. Dr. Adler bills at an hourly rate of $350. His medical assessment involves 30 hours ($10,500), which includes record review, consultation with FASDExperts colleagues, face-to-face medical examination, analysis of the FAS Facial Photographic data, coordination of neuroradiological testing, travel time, and report. The cost for neuroradiological testing (paid directly to the facility and/or vendor experts) is typically in the range of $2,500. 

c. Dr. Brown bills at an hourly rate of $250. Her lifelong/nexus assessment involves 42 hours ($10,500), which includes document review, consultation with FASDExperts colleagues, face-to-face interview/testing, travel time, and report. In post- conviction cases involving an extensive record, Dr. Brown's fee estimate may increase by an additional 8 hours for review of trial testimony. 

d. Travel time for each expert (during which case work is conducted while enroute) is estimated at 4 hours each way, which is subject to change based on the location of the case. Travel expenses (e.g., airline/grand transportation, hotel) are billed separately from the aforementioned fee estimates. 

I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. 

Footnotes 

1 Fetal alcohol syndrome: Guidelines for referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention. 

2 Clarren, S. (2003). Fetal alcohol syndrome. In M. Wolraich (Ed.), Disorders of development and learning, Vol. 1. Hamilton, Ontario: B.C. Decker. 

3 O'Malley, K. (2007). ADHD and fetal alcohol spectrum disorders (FASD). New York: Nova Science Pub. 

4 “Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE): Final Report to the Centers for Disease Control on Grant No. RO4/CCR008515 (Tech. Report No. 96-16).” Seattle: University of Washington, Fetal Alcohol and Drug Unit, 1996. 

5 Hearn v. Quarterman, #3:04-CV-0450-D, U.S. District Court, Northern District of Texas, Dallas Division 

6 Fast, D. K., Conry, J., & Loock, C. (1999). Identifying fetal alcohol syndrome among youth in the criminal justice system. Journal of Developmental and Behavioral Pediatrics, 20(5), 370-372. 

7 Nash, K., Rovet, J., Greenbaum, R., Fantus, E., Nulman, I., & Koren, G. (2006). Identifying the behavioral phenotype in Fetal Alcohol Spectrum Disorder: sensitivity, specificity and screening potential. Archives of Women's Mental Health, 9, 181-186. 

8 Streissguth, A., & Kanter, J. (1997). The challenge offetal alcohol syndrome: Overcoming secondary disabilities. Seattle, WA: University of Washington Press. 

9 Dagher-Margosian, J. (1997). Representing the FAS client in a criminal case. In Streissguth, A.P. & Kanter, J. (Eds.). The challenge of fetal alcohol syndrome: Overcoming secondary disabilities (pp. 125-133). Seattle: University of Washington Press. 

10 www.samhsa.gov 

¹¹ Dillbeck v. State, 643 So. 2 ^nd 1027 (Fla.)

Summary

1. I, Natalie Novick Brown, PhD, being duly sworn, depose and state as follows:

2. I submit this declaration at the request of defense counsel.

3. I am a licensed psychologist and the Program Director of FASDExperts, a multidisciplinary group specializing in forensic evaluations for Fetal Alcohol Spectrum Disorders (FASD). We adhere to established diagnostic guidelines in our assessments.

4. Our team comprises three specialists, adhering to federal guidelines for FASD diagnosis: Paul Connor, PhD (neuropsychologist), Richard Adler, MD (psychiatrist), and myself, Natalie Novick Brown, PhD (psychologist specializing in FASD).

5. Each team member holds a faculty appointment at the University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences. Resumes are available at our website: www.FASDExperts.com. Our team possesses extensive training and experience in FASD, specific to our disciplines.

• a. Dr. Connor, a Washington State-licensed neuropsychologist, earned his doctorate in psychology and neuropsychology from Brigham Young University. After a post-doctoral fellowship at the University of Washington's Fetal Alcohol and Drug Unit, he served as faculty for 13 years, researching neuropsychological, neuroimaging, and mental health impacts of FASD. Currently, he specializes in clinical and forensic FASD assessments in private practice and serves as FASDExperts' Neuropsychological Director.

• b. Dr. Adler, a Washington State-licensed psychiatrist, holds two postdoctoral degrees in Psychiatry from Harvard University and completed a Forensic Psychiatry fellowship at the University of Washington School of Medicine. He is board-certified in Child and Adolescent Psychiatry and Adult Psychiatry, maintaining an active clinical practice. He is the Medical Director of FASDExperts.

• c. I received my undergraduate degree from UCLA and my doctorate in clinical psychology from the University of Washington. My post-doctoral fellowship was completed at the University of Washington's Fetal Alcohol and Drug Unit. I am a licensed psychologist in Washington and Florida, certified to conduct assessments by Washington State's Division of Developmental Disabilities, Department of Corrections, and Department of Social and Health Services. Since 1995, my work has focused on forensic FASD evaluation and community-based treatment for individuals with FASD, particularly those involved in sex offenses and other felonies.

6. FASDExperts has provided reports, depositions, and/or testimony regarding FASD in over 50 forensic cases, including State of Washington v. Johnson, State of South Carolina v. Binney, State of California v. Hamilton, State of Washington v. Benedict, State of Washington v. John Doe (Juvenile Matter), Ernest Johnson v. State of Missouri, Texas v. Joseph T. Estrada, Jr., Nevada v. Eugene Nunnery. Our team has experience in pre-trial, post-conviction, and civil/administrative contexts.

7. We frequently present at trainings and workshops on FASD for legal professionals, mental health professionals, government officials, and the public. We also provide national and international training on our assessment protocol to medical and mental health groups.

8. Our group presented our Model Standard for forensic evaluation of FASD at the FAS International Conference in Victoria, B.C., on March 11, 2009.

9. On January 6, 2011, defense co-counsel contacted FASDExperts, providing preliminary information and materials regarding this matter. I reviewed these materials on January 7, 2011.

10. Based on my review of the case documents, further evaluation is warranted to definitively determine the presence of FASD. This opinion is based on the following:

• a. The sworn affidavit of birth mother Joe Mae Brown and the statement describing Mitigation Specialist Lisa Milstein's interview with her confirm prenatal alcohol exposure. The Centers for Disease Control recognizes self-reported maternal alcohol consumption as definitive evidence of prenatal exposure. Family member corroboration of Ms. Brown's report during Ms. Milstein's interviews strengthens its reliability. Ms. Brown reported consuming a pint of "bootleg" alcohol every Friday, Saturday, and Sunday throughout her pregnancy with the defendant. This amount and frequency of alcohol consumption significantly exceed levels known to cause brain damage in FASD. A pint of liquor contains 16 shots (1.25 ounces each). Sterling and Clarren (2003) suggest that "severe" FASD risk significantly increases when pregnant women reach a Blood Alcohol Content (BAC) of 125-150 mg/dL at least weekly (equivalent to 0.125-0.150%). Factors like body size, weight, rate of consumption, and food intake impact an individual's BAC. Generally, a woman of average size (120-150 pounds) will reach a BAC of 0.10 after three drinks and 0.15 after 4-5 drinks (considered "binge" drinking and associated with the most severe FASD deficits). The birth mother's reported consumption of 10 shots of alcohol at least three times per week throughout her pregnancy indicates a substantial amount of binge drinking, making FASD highly probable.

• b. Arthur Brown's school records demonstrate a history consistent with FASD. This includes a "Learning Disabled" designation in third grade, subsequent placement in Special Education, consistent indications of significant learning deficits in core academic subjects on standardized tests, and severe auditory comprehension/receptive language deficits. These developmental challenges are prevalent in children with FASD.

• c. School psychology reports reveal fluctuating IQ scores ranging from mild mental retardation (full-scale IQ of 70 at age 8) to low average (full-scale IQ of 87 at age 15). Notably, his later test showed a significant difference between Verbal IQ (VIQ=81) and Performance IQ (PIQ=96). Such variability in standardized test performance and a significant verbal/nonverbal IQ discrepancy align with the uneven, diffuse, and "patchy" brain damage characteristic of FASD (O'Malley, 2007).

11. In summary, substantial preliminary information suggests a high likelihood of an FASD diagnosis. A comprehensive multidisciplinary diagnostic assessment is strongly recommended. As forensic FASD assessments rely on complete life history and offense-related conduct information, thorough mitigation investigation by defense counsel is critical to our work.

12. FASD is widely recognized as an underdiagnosed condition. Research by Streissguth et al. (1996) identified the failure to diagnose FASD before age six as a significant risk factor for negative life outcomes. This delay hinders the timely implementation of case management and appropriate treatments throughout childhood. The common misperception that unimpaired IQ negates significant cognitive deficits contributes to FASD being labeled a "hidden disability." Consequently, a poignant irony arises in Capital Murder cases: only under the shadow of such severe consequences is a sufficiently thorough analysis often undertaken. This analysis hinges on comprehensive mitigation investigation by defense counsel, culminating in an equally meticulous assessment by FASDExperts.

13. Based on my limited review of the available documents, it is probable that a closer examination of Arthur Brown's life history, including his offense conduct, will reveal neurocognitive impairments consistent with FASD. These impairments manifest as a cognitive disorder (i.e., mental defect) and impact self-regulation throughout the lifespan, particularly in unstructured and high-stress situations. During his 1993 trial and sentencing, 1996 appeal, and 2008 habeas appeal, the Court did not have the benefit of expert testimony regarding the impact of FASD on Mr. Brown's life or, more specifically, on his actions related to the instant offense. While FASD was not a new concept in medicine or psychology at the time of his trial, sentencing, and appeal in the early 1990s, its significance as a major cause of developmental disabilities, with lifelong consequences, was not as widely understood. By his 2008 habeas appeal, the concept of "secondary disabilities" in FASD, notably "Trouble with the Law," was well-established. However, at the time of Mr. Brown's birth in 1970, the detrimental and lasting effects of prenatal alcohol exposure were unknown. For instance, it wasn't until 1989, long after Mr. Brown's birth, that Congress mandated warning labels on alcoholic beverages sold in the United States, cautioning against alcohol consumption during pregnancy. This event, occurring during the pre-trial investigation in Mr. Brown's case, generated significant media attention nationwide. Consequently, by his 1993 trial and sentencing and his 1996 appeal, awareness of FASD was widespread among both the public and the scientific community. At any point in the legal process, including Mr. Brown's 2008 federal habeas appeal, an expert knowledgeable about FASD could have provided valuable testimony. This testimony could have addressed not only the potential diagnosis itself but also the long-term behavioral consequences of the condition. This includes its impact on his self-regulation abilities in general and its potential influence on his offense-related conduct specifically.

14. An FASD diagnosis, if established, signifies significant and permanent brain damage that impacts executive functioning and adaptive behaviors such as judgment, decision-making, and impulse control. Therefore, such a diagnosis holds substantial relevance to the legal outcome in Mr. Brown's case. According to counsel's review of the State Habeas Court's findings of fact, the Court determined that "counsel did not call the applicant's special education teacher as a matter of trial strategy, because there was no information indicating that the applicant's IQ affected his ability to determine right from wrong" (Finding No. 52). It is crucial to recognize that evidence of FASD extends beyond an individual's capacity to discern right from wrong. FASD profoundly impairs an individual's abilities in deliberation, reflection, and self-regulation. Over the past 15 years, the understanding of FASD as a consequence of birth defects caused by maternal alcohol consumption has prompted a growing recognition within the legal profession that a different standard of attribution is necessary for individuals with fetal alcohol-related impairments. Rather than assuming that maladaptive behaviors in these individuals are solely due to poor parenting or free will, research over the last two decades consistently points to untreated neurocognitive disabilities as the underlying cause. While environmental influences undoubtedly play a role in the manifestation of secondary disabilities like "Trouble with the Law," research consistently demonstrates that individuals with FASD have structural brain damage. This damage makes them highly susceptible to the negative influences of environmental risk factors in the absence of appropriate diagnosis and treatment. The legal relevance of FASD is well documented:

• a. Although many individuals with FASD do not meet the criteria for intellectual disability based solely on IQ scores, their adaptive functioning often mirrors that of individuals with intellectual disabilities due to executive function deficits. "The use of IQ scores (is) an attempt to create an illusion of scientific certainty in identifying a disorder whose causes and manifestation are often hidden and subtle....The problem is that when the artificial number fails to fit with the disability as it is experienced and documented by others, which criterion should be used? Typically, clinicians and government entities find it easier to go ‘by the book,’ but there are times when that results in a wrong and, possibly, unjust decision." (Hearn v. Quarterman, #3:04-CV-0450-D, U.S. District Court, Northern District of Texas, Dallas Division)

• b. The mental defect inherent in FASD often leads to increased suggestibility and a higher likelihood of waiving rights. "When giving statements, they may not understand concepts such as waiving rights to counsel, lawyer-client privilege, and the implications of their plea. They are vulnerable to making false confessions." (Fast, Conry, & Loock, 1999)

• c. Due to the combined effects of mental defects and suggestibility, individuals with FASD are often unreliable historians. While they may exhibit a tendency to lie or confabulate similar to others with developmental deficits (Nash et al., 2006), these behaviors are likely unintentional, stemming from cognitive impairments such as difficulty interpreting and understanding information (Streissguth & Kanter, 1997).

• d. The mental defect associated with FASD can impair the biological capacity for premeditation, reflection, appreciation of wrongdoing, and impulse control. "FASD may negate the ‘guilty mind’ requirement essential to establishing legal culpability....How can a defendant form the requisite intent for the criminal offense if he or she does not appreciate the wrongfulness of the act due to learning and memory difficulties? Or, where an act requires a specific intent... does an individual with FAS have that kind of forward thinking and planning ability?" (Dagher-Margosian, 1997)

• e. The United States government acknowledges the direct relevance of FASD within the legal context: "Individuals with FASD typically are impulsive and have trouble foreseeing the consequences of their actions.... (This) presents challenges throughout the judicial process - from questioning through arrest, hearings, sentencing, and detention." (www.samhsa.gov)

• f. Courts have increasingly recognized the significance of FASD throughout the judicial process: “Evidence concerning certain alcohol-related conditions has long been admissible during the guilt phase of criminal proceedings to show lack of specific intent .... (I)f evidence of a self-induced condition such as voluntary intoxication is admissible, then so too should be evidence of other commonly understood conditions that are beyond one's control, such as epilepsy... Just as the harmful effect of alcohol on the mature brain of an adult imbiber is a matter within the common understanding, so too is the detrimental effect of this intoxicant on the delicate, evolving brain of a fetus held in utero. As with ‘epilepsy, infancy or senility'...we can envision few things more certainly beyond one's control than the drinking habits of a parent prior to one's birth.” (Dillbeck v. State, 643 So.2nd 1027 (Fla.))

15. FASDExperts has been tasked with providing a cost estimate for a multidisciplinary assessment of Arthur Brown to determine whether he meets the diagnostic criteria for FASD. Our evaluative model adopts a stepwise approach to ensure cost-effectiveness:

• a. Step 1: Dr. Connor, our team's neuropsychological expert, will review the defendant's existing psychological testing records. Based on his analysis, he will advise on the necessity and specific nature of further neuropsychological testing. Dr. Connor will then administer a battery of tests to the defendant, aiming to identify any neuropsychological deficits consistent with FASD. He will then prepare a graphic representation of the test results for potential use as a court exhibit. If the neuropsychological testing reveals a pattern of deficits consistent with FASD, counsel will be advised to proceed with additional FASD-specific evaluations as detailed below.

• b. Step 2: Following the review of the neuropsychological testing results, Dr. Adler will undertake the second and diagnostic phase of the evaluation. This phase may be conducted concurrently with Dr. Brown's assessment, particularly when time constraints are a factor. Dr. Adler will review records, conduct a comprehensive medical examination, obtain digital facial photographs to assess for FASD-related facial dysmorphology, and conduct a psychiatric interview. These steps aim to determine whether a formal medical diagnosis of FASD is warranted. Additionally, it is not uncommon for the medical evaluation for FASD to necessitate neuroanatomical testing, such as Magnetic Resonance Imaging (MRI). This may involve specialized analyses of the MRI data, including Diffusion Tensor Imaging, morphometric (shape) analysis, and/or volumetric measurements. Dr. Adler will personally review the MRI images in consultation with his neuroradiology colleagues at the University of Washington. This ensures a thorough and expert interpretation of the neuroimaging findings, going beyond the often limited scope of a standard reading by a general radiologist.

• c. Step 3: If the defendant receives an FASD diagnosis, I will conduct a comprehensive review of case records, administer and interpret relevant forensic psychological tests, and conduct a lifelong functional assessment. This comprehensive assessment will focus on identifying evidence of persistent functional impairments across the defendant's lifespan, a hallmark characteristic of FASD. At the request of counsel, I can also analyze the defendant's criminal history, including the instant offense, to determine if the behavioral patterns observed align with those commonly associated with FASD. This analysis, often referred to as a "nexus" analysis, aims to establish a potential link between the diagnosed condition and the behaviors in question.

16. Below is an estimate of the fees associated with our services:

• a. Dr. Connor's hourly rate is $250. The estimated time for neuropsychological testing is 24 hours ($6,000). This includes document review, face-to-face testing, consultation with FASDExperts colleagues, travel time, and report preparation.

• b. Dr. Adler's hourly rate is $350. His medical assessment requires an estimated 30 hours ($10,500), encompassing record review, consultations with FASDExperts colleagues, a comprehensive medical examination, analysis of facial photographic data, coordination of neuroradiological testing, travel time, and report writing. Neuroradiological testing costs, typically ranging around $2,500, are billed separately and paid directly to the facility or expert vendor.

• c. My hourly rate is $250. The estimated time for the lifelong/nexus assessment is 42 hours ($10,500). This includes document review, consultation with FASDExperts colleagues, face-to-face interviews and testing, travel time, and report preparation. In post-conviction cases with extensive records, an additional 8 hours may be required for a thorough review of trial transcripts, potentially increasing the total fee.

• d. Travel time, during which case-related work is conducted, is estimated at 4 hours each way per expert. This estimate is subject to change based on the case's location. Travel expenses (e.g., airfare, ground transportation, hotel accommodations) are billed separately from the fee estimates outlined above.

I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

Summary

1. I, Natalie Novick Brown, PhD, swear under oath that the following information is true and based on my personal knowledge.

2. I am submitting this declaration at the request of the defense attorney.

3. I am a psychologist and the Program Director of FASDExperts. We are a group of specialists who conduct forensic evaluations for possible Fetal Alcohol Spectrum Disorders (FASD) using established and recognized diagnostic guidelines.

4. Our team consists of three specialists, which is the recommended team structure according to federal guidelines for diagnosing FASD: Dr. Paul Connor (neuropsychologist), Dr. Richard Adler (psychiatrist), and myself, Dr. Natalie Novick Brown (psychologist specializing in FASD).

5. Each member of our team is a faculty member at the University of Washington School of Medicine in the Department of Psychiatry and Behavioral Sciences. You can find our resumes on our website: www.FASDExperts.com. We each have training and experience related to FASD in our respective areas:

• a. Dr. Connor is a neuropsychologist licensed in Washington State. He holds a doctorate in psychology and neuropsychology from Brigham Young University and completed a post-doctoral fellowship at the University of Washington's Fetal Alcohol and Drug Unit. He worked as faculty in that unit for almost 13 years, researching how FASD affects neuropsychology, brain imaging, and mental health. He now has a private practice focusing on clinical and forensic assessments for FASD. He is the Neuropsychological Director of FASDExperts.

• b. Dr. Adler is a medical doctor and licensed psychiatrist in Washington State. He completed two postdoctoral degrees in Psychiatry at Harvard University and a Forensic Psychiatry Fellowship at the University of Washington School of Medicine. He is board-certified in both Child and Adolescent Psychiatry and Adult Psychiatry and maintains an active practice working with children, adolescents, and adults. He is FASDExperts’ Medical Director.

• c. I (Dr. Brown) graduated from UCLA and earned my doctorate in clinical psychology from the University of Washington. I also completed a post-doctoral fellowship at the University of Washington's Fetal Alcohol and Drug Unit. I am a licensed psychologist in Washington and Florida and certified to conduct assessments for the Division of Developmental Disabilities, Department of Corrections, and Department of Social and Health Services in Washington State. Since 1995, I have focused on forensic evaluations for FASD and community-based treatment for individuals with FASD, especially those convicted of sex offenses or other felonies.

6. FASDExperts has provided reports, depositions, and/or expert testimony regarding FASD in over 50 forensic cases. These include State of Washington v. Johnson, State of South Carolina v. Binney, State of California v. Hamilton, State of Washington v. Benedict, State of Washington v. John Doe (Juvenile Matter), Ernest Johnson v. State of Missouri, Texas v. Joseph T. Estrada, Jr., and Nevada v. Eugene Nunnery. We have worked as a team in various legal settings, including pre-trial, post-conviction, and civil/administrative cases.

7. We have been invited to speak at numerous training sessions and workshops for legal professionals, mental health professionals, government officials, and the public. We've also provided training on our assessment protocol to medical and mental health groups nationally and internationally.

8. Our group presented our Model Standard for forensic evaluation of FASD at the FAS International Conference in Victoria, British Columbia, on March 11, 2009.

9. The defense co-counsel contacted FASDExperts on January 6, 2011, providing us with initial information and documents about this case. I reviewed those materials on January 7, 2011.

10. My review of several case documents indicates a basis for further evaluation to definitively determine the presence of FASD. This opinion is based on the following:

• a. A sworn statement from the birth mother, Joe Mae Brown, and an interview summary from Mitigation Specialist Lisa Milstein confirm prenatal alcohol exposure (according to the Centers for Disease Control, self-reported drinking by a birth mother is definitive evidence). Family members corroborated the birth mother’s report in their interviews with Lisa Milstein, supporting the report's reliability. The birth mother stated she consumed a pint of “bootleg” alcohol every Friday, Saturday, and Sunday during her pregnancy with Arthur. This amount and regularity of alcohol consumption exceed levels known to cause brain damage in FASD. A pint of liquor contains 16 shots (1.25 ounces each). According to research, the risk for “severe” FASD significantly increases when pregnant women reach a blood alcohol concentration (BAC) of 0.125-0.150% at least weekly. Many factors influence how much a woman needs to drink to reach a specific BAC (e.g., body size, how quickly she drinks, if she drinks with food, and the type of alcohol). Generally, a woman of average size (120-150 pounds) will reach a BAC of 0.10% after three drinks and 0.15% after 4-5 drinks. (This is considered "binge" drinking and is linked to the most severe FASD deficits.) The birth mother’s self-reported consumption of the equivalent of 10 shots at least three times a week throughout her pregnancy constitutes a massive amount of binge drinking highly likely to cause FASD.

• b. Arthur Brown's school records reveal a history consistent with FASD. He was labeled "Learning Disabled" in third grade and placed in Special Education. Standardized tests throughout school showed significant learning difficulties in core subjects and severe issues with auditory comprehension and receptive language. These developmental problems are prevalent in children with FASD.

• c. School psychology reports show a range of IQ scores from mild mental retardation (full-scale IQ of 70 at age 8) to low average (full-scale IQ of 87 at age 15), with a significant difference between his Verbal IQ (81) and Nonverbal IQ (96) on the latter test. This variability in test performance and the significant difference between verbal and nonverbal abilities align with the uneven, diffuse, "patchy" brain damage characteristic of FASD.

11. The preliminary information strongly suggests that Arthur Brown is LIKELY to be diagnosed with FASD. A thorough multidisciplinary diagnostic assessment is recommended. Forensic FASD assessment requires complete information about an individual's life history and the circumstances of their alleged offense. Therefore, thorough mitigation investigation by the defense counsel is essential to our work.

12. FASD frequently goes undiagnosed. Landmark research by Streissguth and colleagues found that a significant risk factor for negative life outcomes in individuals with FASD was the failure to diagnose the condition before age six. Early diagnosis allows for case management and appropriate treatment throughout childhood. FASD is often called a “hidden disability” because of the mistaken belief that if a person's IQ is within the normal range, there are no significant cognitive deficits. Ironically, it is often only during serious legal proceedings like Capital Murder cases that a comprehensive analysis is undertaken. This analysis begins with thorough investigation by the defense and concludes with an equally thorough assessment by FASDExperts, relying heavily on the information gathered during the investigation.

13. Based on the limited document review I have conducted, Arthur Brown's life history, including his alleged offense, may reveal neurocognitive impairments consistent with FASD. These impairments can lead to cognitive disorders (i.e., mental defects) and affect self-regulation throughout life, especially in unstructured and stressful situations. During his trial and sentencing in 1993, appeal in 1996, and habeas appeal in 2008, the Court did not have the opportunity to hear testimony about the impact of FASD on Mr. Brown's life or his alleged offense. Although not new to medicine or psychology during his trial, sentencing, and appeal in the early 1990s, FASD was not widely recognized then as a significant cause of developmental disabilities with lifelong implications. By his 2008 habeas appeal, it was widely understood that FASD could cause "secondary disabilities," particularly "Trouble with the Law." However, when Mr. Brown was born in 1970, the damage and long-term effects of prenatal alcohol exposure were unknown. For example, in 1989, well after his birth, Congress mandated warning labels on alcoholic beverages sold in the United States, cautioning against drinking during pregnancy. This event, occurring during the pre-trial investigation phase of Mr. Brown’s case, brought national attention to the issue through television and newspapers. As a result, public and scientific awareness of FASD was widespread by his trial and sentencing in 1993 and his initial appeal in 1996. Throughout the legal process, even during his 2008 federal habeas appeal, an expert with FASD knowledge could have testified about the diagnosis and its long-term behavioral ramifications on self-regulation and, more specifically, on his alleged offense.

14. A diagnosis of FASD indicates permanent brain damage affecting executive functioning and adaptive behaviors like judgment, decision-making, and impulse control. Therefore, a potential FASD diagnosis is highly relevant to the legal outcome in Mr. Brown's case. According to the defense counsel's review of the State Habeas Court's findings, “counsel did not call the applicant's special education teacher as a trial strategy because no information indicated that the applicant's IQ affected his ability to determine right from wrong” (Finding No. 52). However, evidence of FASD has mitigating potential beyond a person's ability to determine right from wrong. It significantly impairs an individual's capacity for deliberation, reflection, and self-regulation. Over the last 15 years, the understanding that FASD involves birth defects caused by maternal alcohol use has led to a growing recognition within the legal profession that a different level of culpability might be warranted for individuals with fetal alcohol impairment. Rather than assuming these individuals are unmotivated, manipulative, antisocial, or self-defeating solely due to poor parenting or personal choices, research over the past two decades consistently shows that untreated neurocognitive disabilities contribute significantly to their maladaptive behaviors. While environmental influences undeniably play a role in the secondary disabilities observed in FASD, research also demonstrates that individuals with FASD have structural brain damage that makes them particularly vulnerable to the negative impacts of environmental risk factors without proper diagnosis and treatment. The relevance of FASD within the judicial process is well established:

• a. Many individuals with FASD do not have low IQ scores but function as if they have intellectual disabilities because of deficits in executive functioning: "The reliance on IQ scores (is) an attempt to create an illusion of scientific certainty in identifying a disorder whose causes and manifestations are often hidden and subtle....The problem arises when the arbitrary number fails to align with the lived experience and documented observations of the disability – which criterion should prevail? Typically, clinicians and government entities choose the easier path of 'following the rules.' However, this can sometimes lead to incorrect and potentially unjust outcomes." (Hearn v. Quarterman, #3:04-CV-0450-D, U.S. District Court, Northern District of Texas, Dallas Division).

• b. Due to their mental defects, individuals with FASD may be highly suggestible and more likely to waive their rights: "When giving statements, they may not fully grasp concepts such as waiving the right to counsel, lawyer-client privilege, or the implications of pleading guilty. This makes them vulnerable to making false confessions." (Fast, Conry, & Loock, 1999).

• c. The mental defects and suggestibility associated with FASD can make those affected unreliable historians: "While individuals with FASD might lie or confabulate similar to others with developmental deficits, this is often unintentional. Instead, it likely stems from cognitive difficulties such as problems with interpreting and understanding information." (Nash et al., 2006; Streissguth & Kanter, 1997).

• d. Due to their mental defects, individuals with FASD may lack the biological capacity to premeditate, reflect on their actions, understand the wrongfulness of their behavior, or control their impulses: "The presence of FASD can challenge the ‘guilty mind’ requirement essential for establishing legal culpability....Can a defendant truly form the necessary intent for a criminal offense if they struggle to grasp the wrongfulness of their actions due to learning and memory difficulties? Moreover, when an act requires specific intent...does an individual with FAS possess the capacity for such forward thinking and planning?" (Dagher-Margosian, 1997).

• e. The United States government acknowledges the relevance of FASD in legal proceedings: "Individuals with FASD are often impulsive and have difficulty anticipating the consequences of their actions.... (This) creates significant challenges throughout the judicial process, from the initial questioning and arrest to hearings, sentencing, and detention." (www.samhsa.gov).

• f. Courts recognize the relevance of FASD throughout the judicial process: "Evidence of alcohol-related conditions has long been admissible in the guilt phase of criminal trials to demonstrate a lack of specific intent....If evidence of self-induced conditions like voluntary intoxication is permissible, then evidence of other widely recognized conditions outside a person's control, such as epilepsy, should be as well.... Just as alcohol's damaging effect on a mature adult brain is common knowledge, so is its detrimental impact on the developing brain of a fetus. Like 'epilepsy, infancy, or senility'...few things are more clearly beyond an individual's control than their parent's drinking habits before their birth." (Dillbeck v. State, 643 So. 2d 1027 (Fla.)).

15. FASDExperts has been asked to provide a cost estimate for a multidisciplinary assessment of Arthur Brown to determine if he meets the criteria for an FASD diagnosis. For cost-effectiveness, our evaluation follows a step-wise approach:

• a. Step 1: Dr. Connor, our Neuropsychological Director, will review the defendant's previous psychological testing to advise on the need for further testing and its nature. He will then administer a series of tests to assess for neuropsychological deficits consistent with FASD and prepare a visual representation of the results for potential court presentation. If these tests reveal deficits aligning with FASD, we recommend proceeding with a comprehensive FASD evaluation, as outlined below.

• b. Step 2: After reviewing the neuropsychological testing results, Dr. Adler will lead the second (diagnostic) phase of the evaluation, possibly concurrently with Dr. Brown, especially when time is limited. Dr. Adler will review records, conduct a full medical examination, take digital facial photographs to analyze for FASD-related physical features, and conduct a psychiatric interview to determine if an FASD medical diagnosis is warranted. The medical evaluation for FASD may necessitate neuroanatomical testing, such as Magnetic Resonance Imaging (MRI), and specialized analysis of the MRI, which may include Diffusion Tensor Imaging, Morphometric (Shape) Analysis, and/or Volumetric measurements. Importantly, Dr. Adler will review the MRI images with his Neuroradiology consultant at the University of Washington. He does not rely on what is often a basic reading of the study by a local (clinical and non-specialized) radiologist.

• c. Step 3: If the defendant receives an FASD diagnosis, I (Dr. Brown) will review case records, administer and interpret forensic psychological tests, and conduct a lifelong functional assessment to determine if there's sufficient evidence of persistent functional impairments throughout the defendant's life, consistent with FASD. At the counsel's request, I can also analyze the defendant’s criminal history, including the instant offense, to evaluate if the behaviors are consistent with FASD (i.e., a “nexus” analysis).

16. The estimated fees for our services are as follows:

• a. Dr. Connor charges an hourly rate of $250. The neuropsychological testing, including document review, in-person testing, consultations with FASDExperts colleagues, travel, and report writing, will require approximately 24 hours ($6,000).

• b. Dr. Adler's hourly rate is $350. His medical assessment, including document review, consultations with the FASDExperts team, in-person medical examination, analysis of facial photographs, coordination of neuroimaging, travel, and report writing, will take approximately 30 hours ($10,500). Neuroradiological testing costs (paid directly to the facility or expert) are typically around $2,500.

• c. I (Dr. Brown) charge $250 per hour. The lifelong/nexus assessment, encompassing document review, consultations with FASDExperts colleagues, in-person interview/testing, travel, and report writing, will take approximately 42 hours ($10,500). In post-conviction cases with extensive records, an additional 8 hours may be necessary for reviewing trial transcripts.

• d. Travel time for each expert (during which casework is conducted) is estimated at 4 hours each way but may vary depending on the case location. Travel expenses (airfare, ground transportation, hotel) are billed separately from the above professional fees.

I declare under penalty of perjury under the laws of Washington State that the information provided is true and accurate.

Summary

About Me and My Team

1. My name is Natalie Novick Brown, and I'm a psychologist. I'm writing this statement for a court case.

2. I lead a group called FASDExperts. We're a team of specialists who figure out if someone has Fetal Alcohol Spectrum Disorders (FASD). FASD happens when a mother drinks alcohol while pregnant.

3. Our team has three experts:

   • Dr. Paul Connor: A brain and learning expert. He's really good at figuring out how FASD affects the brain.

   • Dr. Richard Adler: A psychiatrist, which is a doctor who focuses on mental health. He's an expert in diagnosing FASD.

   • Me (Dr. Brown): I'm a psychologist who specializes in how FASD affects people's lives and how they act.

4. We all work at the University of Washington School of Medicine. We've worked on over 50 court cases involving FASD and have even trained other professionals about it.

Why We Might Be Needed for This Case

1. The defendant's lawyers contacted us about a case.

2. Based on what we've read, we think the defendant might have FASD. Here's why:

   • The defendant's mother said she drank a lot of alcohol during pregnancy. This is very likely to cause FASD.

   • The defendant had trouble in school, especially with learning. This is common in kids with FASD.

   • The defendant's IQ scores were inconsistent. This is another sign of how FASD can affect the brain.

3. Because of this, we believe a full evaluation is needed to see if the defendant has FASD.

What is FASD and Why Does it Matter in Court?

1. Many people don't know they have FASD. This is a problem because if it's not diagnosed early, people don't get the help they need. FASD is a "hidden disability" because you can't always tell someone has it just by looking at them.

2. FASD can cause serious problems that last a lifetime, like difficulty making good decisions, controlling impulses, and understanding consequences. This is important for court cases because it can explain why someone might commit a crime. It's possible that no one considered FASD in the defendant's previous trials or appeals, even though it was a known condition.

3. If someone has FASD, it doesn't mean they don't know right from wrong. But it does mean their brain works differently. Here's how FASD is important for the legal system:

How We Would Evaluate the Defendant

1. We would evaluate the defendant in three steps:

• Step 1 (Dr. Connor): Review existing records and do some brain-based testing to look for signs of FASD.

• Step 2 (Dr. Adler): If Step 1 suggests FASD, he would do a medical exam, take special pictures of the face (which can show FASD signs), and maybe order brain scans.

• Step 3 (Dr. Brown): If FASD is diagnosed, I would look at the defendant's life history and criminal record to see if their actions align with how someone with FASD might behave.

1. Our fees would depend on how much time each step takes. We would also bill for travel expenses.

I swear that everything I've said here is true.

Summary

About Dr. Brown: I am a psychologist! That means I study how people think and behave. I am the director of a group called FASDExperts. We are a team of specialists who are really good at figuring out if someone has Fetal Alcohol Spectrum Disorders (FASD).

What is FASD? FASD happens when a baby's mother drinks alcohol while pregnant. Alcohol can hurt the baby's brain while it is still growing. This can cause problems with learning, behavior, and understanding things.

Why is Dr. Brown writing this? A lawyer asked me to look at information about a man named Arthur Brown. The lawyer wants to know if Arthur Brown might have FASD.

What does Dr. Brown know?

1. Arthur Brown's mom drank alcohol when she was pregnant with him. She drank a lot of alcohol, almost every day. This is very dangerous for a baby's brain.

2. Arthur Brown had trouble in school. He was in special education classes and had trouble learning. This can be a sign of FASD.

3. Arthur Brown's IQ tests showed different scores at different times. This uneven pattern of thinking skills is also common in people with FASD.

What does Dr. Brown think? It seems very possible that Arthur Brown has FASD. To know for sure, he needs to have some special tests.

Why are these tests important?

• FASD is hard to see. It's like a hidden disability. Many people with FASD don't get diagnosed until they are adults, even though the damage happened before they were born.

• People with FASD often have trouble making good decisions and controlling their behavior. They might do things without thinking, especially in stressful situations.

• It's important for judges and juries to know if someone has FASD. This information can help them understand why someone might have broken the law.

What will the tests involve?

• Step 1: An expert will look at Arthur Brown's old test scores and maybe give him some new tests. These tests check how well his brain works.

• Step 2: A doctor will examine Arthur Brown and take pictures of his face. The doctor will also look at pictures of Arthur Brown's brain. This helps them see if his brain looks different than other people's brains.

• Step 3: Dr. Brown will talk to Arthur Brown and give him some more tests. This will help her understand how well he can do everyday things.

Can FASD be cured? No, but people with FASD can still learn and grow. With the right help, they can have happier and healthier lives.