State of Nevada

Board of Pardons
________________________________________________________________________
Application for Commutation of Death Sentence
ZANE MICHAEL FLOYD

Submitted by:
BRAD D. LEVENSON
Assistant Federal Public Defender
[email protected]
Nevada Bar No. 13804C
411 E. Bonneville Avenue, Suite 250
Las Vegas, NV 89101
(702) 388-6577
(702) 388-6261 (Fax)
Attorney for Applicant
Application for Clemency
To the Nevada State Board of Pardons Commissioners

Zane Michael Floyd hereby requests you to:

1. File this application for clemency
2. Place Mr. Floyd’s case on the September 21, 2021 Pardons Board
Agenda,
3. Grant a stay of Mr. Floyd’s execution under Nev. Rev. Stat. §
176.415(1) until his case can be placed on the September 21, 2021
Pardons Board meeting, and
4. Thereafter commute Mr. Floyd’s death sentences to sentences of
life imprisonment without the possibility of parole
 BOARD OF PARDONS
Application for Commutation of Sentence - Page 1 of 2

Name: ----------
Zane Floyd Location: --------
Ely State Prison 66514 _
NDOC# ____
This application is designed for inmates currently serving a sentence imposed by a Nevada Court. Applications that
are not complete may be rejected. After completing the application, return it to your caseworker or to the Warden of
the institution where you are housed. Wardens will forward the application to the Director of Corrections.
Applications must be received by the Warden by 5:00 P.M. on November 20, 2020. Inmates housed outside of the
NDOC must submit their application no later than 5:00 P.M. November 25, 2020 to the NDOC Director at: PO Box
7011, Carson City, NV 89702 or 5500 Snyder Ave, Building l 7, Carson City, NV 89701.
NOTE: Submit only .ONE application.
Please indicate your answer bv checking the YES or NO box after each guestion YES NO
Have you been housed in disciplinary segregation for any period of time within the
past 36 months? X

Have you been found guilty of a major disciplinary infraction within the past 24
months or do you have a major disciplinary charge pending? X

Have you been found guilty of three or more minor/general disciplinary infractions X
within the past 18 months?

Are you eligible for release on parole to the communit:1£ prior to March 31, 2022? X

Were you revoked on your current sentence m: are you serving a single sentence that
you received while you were on parole? X

Have you been denied release on parole to the communi� on your current sentence? X
Do you have any unresolved criminal charges? X

Is your case under appeal in a Nevada or Federal Court,,ru: do you have plans to X
appeal your case in the future?

Was a victim injured during the commission of the crime? X

Are you projected to discharge from prison before March 31, 2022? X

Do you have any consecutive sentences still to be served? X

Are you currently validated by the NDOC as a member of a street or prison-based

gang? X

Were there any co-defendants in this case? If so, please provide their names:
X

Ifvou are serving a sentence of Death or Life Without, l!lease answer the following:

I
What year did you commit the offense that resulted in the sentence of Death or Life
1999
Without?
 Zane Floyd 66514

8th JD
Ely State Prison
45 24

N/A

Please see attached sheet.

None.

Commutation of death sentence to life without parole on all counts.

Please see attached clemency application.

Zane Floyd Clemency Application

Convictions and punishments

Count I - Burglary while in possession of a firearm: 72 – 180 months.

Counts II, III, IV, V – First-degree murder w/ use of a deadly weapon: death by lethal
injection.

Count VI – Attempt murder w/ use of a deadly weapon: 96 – 240 months plus equal and
consecutive enhancement.

Count VII – First degree kidnapping w/ use of a deadly weapon: life with parole eligibility
after 60 months.

Counts VIII, IX, X, and XI – Sexual assault w/ use of deadly weapon: life with parole
eligibility after 120 months to run consecutively with an additional life sentence of 120
months.

Sentence Structure

Counts VI and VII are served consecutive to Count VIII.

Count IV served consecutive to Count VIII.

Count X served consecutive to Count IX.

Count XI served consecutive to count X.

Introduction

“Each of us is more than the worst thing we’ve ever done.” (Bryan
Stevenson, Just Mercy). And the same is true for Zane Floyd. Zane is a
United States Military Veteran, a loyal son, and an individual who is
described as a good and decent person who cared about friends and family
members. But Zane Floyd is also an individual who was born with brain
damage caused by his mother’s prenatal consumption of alcohol. 1
Zane also endured a childhood full of physical, mental, and verbal
violence from his stepfather, which created feelings of inadequacy and lack of
self-worth and confidence.
At an early age Zane was sent to doctors for neurological and
psychological evaluations. It was determined Zane was in need of special
education classes, but his stepfather denied Zane the opportunity to attend
such classes because he believed he could “toughen” up Zane and “fix” him.
In school, Zane was socially awkward and bullied, which led him to
spend a lot of his time alone. Zane has always felt that he was in a constant
battle with himself. While trying to live up to his stepfather and
grandfather’s “macho” expectations, as an only child Zane worked to keep the
peace between his alcoholic parents. And, at the same time, always feeling
that the bottom was going to drop out of his life at any time, Zane navigated
his young life as well as he was able. He did not have a father or other male
role model to mentor or guide him, only males who disregarded him.
As a result of his lengthy childhood trauma, resulting post-traumatic
stress disorder (PTSD), as well as a pre-genetic disposition for addiction due
to his FASD and multi-generational history of addiction, Zane began abusing
drugs and alcohol as a method of self-medication while a teenager.

1 Zane has since been diagnosed with fetal alcohol spectrum disorder (FASD).
1
 Zane joined the United States Marine Corps at age 18 in order to
escape his stepfather, and to prove his worth to others, and after basic
training was sent to Guantanamo Bay, Cuba (Gitmo) where he served in a
combat like setting, exacerbating his PTSD and psychiatric disorders. For
those stationed at Gitmo, drinking was a way of life and Zane’s drinking
became worse. After serving four years, Zane left the military in 1998 with an
honorable discharge and various medals and accommodations. Zane tried but
failed to successfully transition back into civilian life.
Unable to find gainful employment, Zane moved back into his parents’
home, where he lacked the structure offered by the military, and again
turned to drugs and alcohol. In a military mindset, and suffering from a
psychotic break due to methamphetamine use, Zane loaded his weapon, put
on his military uniform, walked to a nearby grocery store, and killed four
individuals and wounded a fifth.
While Zane committed an unspeakable act, he is not an irredeemable
person. He did not choose to be born with FASD, he did not choose to be
mentally and physically abused by his parents, nor did he choose to suffer
from PTSD.
In fact, prior to the events of June 1999, Zane had never been arrested
or in trouble with the law other than one driving under the influence charge
in the military. Individuals from Zane’s past describe him as a good and
decent person, eager to make people laugh, and willing to help anyone in
need.
The jury at Zane’s trial did not hear the majority of this significant
mitigating evidence before sentencing Zane to death. The jury also did not
have the information that has been proffered to the Board regarding Zane’s
exemplary institutional history over the last twenty years.

2
 As will be discussed in this clemency application, to understand Zane’s
life trajectory is to understand that he is not a danger to others, he has great
remorse for his actions, he proudly served our country as a United States
Marine, and that serving a life term in prison is the appropriate sentence
that should be imposed here. These are compelling reasons why this Board
should grant commutation of Zane’s sentences to life without the possibility
of parole.

Zane Floyd was born to a mother who drank and took drugs.
Zane’s mother, Valerie Floyd, was a troubled woman. From an early
age she abused drugs and alcohol, and at one point in her early twenties, was
homeless and suffered a mental breakdown after escaping her parents’ home.
Valerie returned to her parents’ house where she was admitted to a
psychiatric hospital and underwent electroshock therapy. Decl. of K. Hodson
at 3, 2 ¶¶2-3. Escaping her parents’ home a second time, Valerie moved to
Kodiak, Alaska, where she met Jim Cobis, Zane’s biological father. Decl. of K.
Hodson at 3, ¶3; Decl. of J. Cobis at 93, ¶3.
Cobis, who met Valerie in a nightclub, did not realize she was severely
addicted to alcohol. Decl. of J. Cobis at 93, ¶2. The two married and were
together for three years. During that time, Valerie went out drinking four to
five nights a week, frequenting bars that were open 24 hours a day. She
drank morning and night and ran up large tabs at the local bars. Decl. of J.
Cobis at 93, ¶4.

2These references are to the bates number at the bottom of each declaration and
report that are included as exhibits.
3
 After the death of their first son, Francisco, from sudden infant death
syndrome, 3 Valerie sunk into a deep depression and her drinking became
even more severe. She also developed an addiction to Valium and became
involved in illegal drug transactions. Decl. of J. Cobis at 93-94, ¶¶6-7.
It was in this dysfunctional environment, a woman addicted to drugs
and alcohol who had received electroshock therapy for psychological issues,
that Zane was conceived. During the early months of her pregnancy, Valerie
continued drinking, smoked cigarettes and marijuana, and abused cocaine
and possibly other drugs. Decl. of J. Cobis at 94, ¶9.
Valerie and James Cobis ended their relationship during Valerie’s first
trimester of pregnancy. Valerie first moved into the home of a drinking buddy
in Kodiak, and then returned to Colorado to her parents’ home. Decl. of J.
Cobis at 94, ¶¶10-11. Back in Colorado, Valerie continued to drink (five days
out of seven) and abuse drugs (marijuana and possibly cocaine) during her
entire pregnancy. Decl. of J. Cobis at 94, ¶11; Decl. of K. Hodson at 3, ¶5.
On September 23, 1975, Zane Floyd was born. He was one and a half
months premature and weighed less than five pounds. Zane was transported
by helicopter from the local hospital to one in Denver where he spent time in
an incubator requiring oxygen. Report of Dr. Mack at 183. Zane was born
with FASD, which was undiagnosed most of his life. Report of Dr. Brown at
101, 119-21; Report of Dr. Cardle at 234.

Fetal Alcohol Spectrum Disorder

FASD is a mental disorder found in the Diagnostic and Statistical
Manual of Mental Health Disorders, Fifth Edition (DSM-5). Under the DSM-

3Valerie drank and abused substances during her pregnancy with her first child.
Decl. of J. Cobis at 93, ¶6; Decl. of K. Hodson at 3, ¶4.
4
5, the term FASD also includes the diagnosis for the Central Nervous System
(CNS) dysfunction due to prenatal alcohol exposure: neurodevelopmental
disorder associated with prenatal alcohol exposure (ND-PAE/FASD). Report
of Dr. Brown at 104. This diagnosis requires evidence of prenatal alcohol
exposure, at least one impairment in neurocognitive functioning, at least one
impairment in self-regulation, and at least two domains of adaptive
impairment. Id. ND-PAE/FASD is a brain-based, congenital lifelong
impactful disorder with pervasive and long-standing neurodevelopmental
effects. Report of Dr. Brown at 103.
A fetus is susceptible to damage from alcohol exposure throughout the
mother’s pregnancy. And the first few weeks of the pregnancy, when brain
cells are developing and forming structures, are especially vulnerable to
alcohol’s poisonous effects. Prenatal alcohol exposure typically causes
widespread structural damage to the brain. Report of Dr. Brown at 104.
The toxic effects of prenatal alcohol exposure appear to be widespread
throughout the entire brain, causing subtle but potent irregularities in brain
structure that compromise brain function and directly impact cognition and
behavior. Report of Dr. Brown at 106.
Organic brain damage in FASD directly impairs the cognitive skills
needed to think adequately and self-regulate one’s behavior. Report of Dr.
Brown at 113. In turn, cognitive dysfunction in FASD impairs adaptive
functioning in the community. Id. Of the many possible cognitive
impairments in FASD, executive dysfunction is the most serious because the
executive system controls self-regulation, conscious decision-making, and
everyday adaptive behavior. Report of Dr. Brown at 106-07. Prenatal alcohol
exposure creates hypersensitivity to stress via faulty neurological hard-
wiring of the hypothalamic-pituitary-adrenal system which causes chronic

5
overreaction to stressful events. Id at 107. But because of the executive
functioning deficits, individuals with FASD lack the top-down moderating
influence of a fully functioning prefrontal cortex. Id. As a result, those with
FASD are prone to act out their emotions, particularly in high stress
everyday situations. Id.
It is not surprising then that a deficient adaptive profile is a universal
finding in persons with FASD. The DSM-5 defines adaptive functioning as
everyday behavior that meets developmental and sociocultural standards for
personal independence and social responsibility. Report of Dr. Brown at 108.
Zane’s mother drank heavily from the very beginning of her pregnancy
to the end, causing widespread damage to Zane’s brain, in utero. Evidence of
such damage became apparent almost immediately.

Valerie meets Mike Floyd; Zane’s early years uncover problems, now
known to be associated with FASD.
Valerie was always seeking approval of the men in her life. And once
Zane was born, Valerie wanted desperately for Zane to have a father. This led
Valerie to marry a mechanic, Gary Poprocki, when Zane was about two years
old. But Valerie fled that marriage a brief six weeks after marrying, when
her new husband began physically abusing her. Decl. of K. Hodson at 3, ¶6.
Valerie met Mike Floyd in 1979, a short time after her brief failed
marriage to Poprocki. Zane was already three years old at the time. Valerie
and Mike married within three months. Mike adopted Zane when Zane was
about five years old.
Mike thought Zane was a good kid but recognized early on that Zane
had constant problems. Mike believed that many of these problems stemmed

6
from Valerie’s drinking while she was pregnant with Zane. Valerie admitted
to Mike that she drank, abused drugs, and smoked cigarettes while pregnant.
Zane had many delayed developmental milestones including walking
and talking. Zane also had difficulty with tremors and fine motor skills.
Report of Dr. Mack at 183.
Deficits in cognitive functioning often become evident in elementary
school, as was the case with Zane.
By the second grade Zane was prescribed Ritalin for his diagnosed
attention deficit disorder (ADD). Report of Dr. Mack at 183; Report of Dr.
Cardle at 234. Zane had a short attention span and was hyperactive. Decl. of
T. Delagardelle at 91, ¶4. But even with the Ritalin, Zane still struggled in
school.
By the third grade Zane was already behind other students, failing
arithmetic, reading, language/phonics, and social studies. Zane’s struggles in
school continued both in middle school and high school. Report of Dr. Mack at
181-82.
Due to Mike’s job, Zane’s family moved approximately ten times during
Zane’s elementary school years, which created further stress for both Zane
and his family. Report of Dr. Cardle at 234.
Zane was referred by his middle school for both a neurological and
psychological evaluation due to very poor attention span, fine motor skills
problems, immaturity, and poor frustration tolerance. A child psychiatrist
prescribed Zane imipramine, an anti-depressant. And a psychologist noted
significant deficiency in cognitive functioning based on his performance skills.
Report of Dr. Cardle at 234-38. Based upon the referrals, it was
recommended that Zane attend special education classes. Instead, Mike
sought to toughen Zane into shape. Decl. of C. Hodson at 1, ¶9. Mike would

7
not accept that Zane had special needs requiring intervention and systems of
support. Decl. of K. Hodson at 103-04, ¶8.
Most likely due to his FASD and adaptive functioning deficits, Zane
was socially awkward and spent a lot of time alone. Decl. of M. Hall at 97, ¶4;
Decl. of J. Hall at 88, ¶7. Zane also lacked self-confidence, which might have
been connected to his learning difficulties. Decl. of M. Hall at 97, ¶4; Decl. of
C. Hodson at 1, ¶4. Zane further dealt with a recurring problem of how others
saw him. Decl. of M. Hall at 97, ¶4; Decl. of C. Hodson at 2, ¶14. Zane
desperately sought approval from friends and family but never seemed to
achieve that goal. Decl. of K. Hodson at 3, ¶7; Decl. of C. Hodson at 1, ¶7.
Zane met his best friend, Robert “Jay” Hall, around the sixth grade
when they were both eleven. The two lived in the same neighborhood and
attended the same schools over the next ten years. The two also spent a great
deal of time in each other’s homes. Zane was loved by the Hall family and
became a de facto Hall family member. Decl. of J. Hall at 88, ¶3; Decl. of M.
Hall at 97, ¶2; Decl. of T. Delagardelle at 91, ¶2; Decl. of C. Hodson at 1, ¶6;
Decl. of A. Hall at 86, ¶2.
Jay remembers that in the sixth grade, Zane would sit in the back of
the classroom and crack jokes and do whatever he could to make people
laugh. Most of the jokes were self-deprecating and at his own expense. Many
of the kids in the class laughed, but Zane did not realize they were laughing
at him. Decl. of J. Hall at 88, ¶4.
Zane was also bullied in school because the other kids thought he was
“weird.” Sometimes kids waited outside the school for Zane. Jay walked Zane
home to make sure no one picked on him or beat him up. Decl. of J. Hall at
88, ¶5. Zane never achieved popularity at school.

8
 Zane’s father Mike was a good little league and high school baseball
player and briefly played baseball in the military. Mike wanted Zane to do
well in baseball too, but Zane was not the best athlete and struggled. Decl. of
M. Eoff at 99, ¶5.
At age 13, Michael Eoff became Zane’s little league baseball coach for
two seasons. Eoff used to pick up Zane from his home and drive him to
practice, and then back home again. The two talked baseball nonstop during
these trips. Eoff found Zane to be a good and respectful kid. Decl. of M. Eoff
at 99, ¶2.
Zane, who showed up at every game, played catcher. And while Zane
was not a natural athlete, he tried hard and ultimately became better by the
time he turned 15. Decl. of M. Eoff at 99, ¶4.
Coach Eoff only saw Zane angry one time. During the first season, Eoff
brought in another batter to replace Zane. Zane threw his bat and used
profanity. Eoff was surprised by this behavior because it was so out of
character for Zane. Valerie told the coach that Zane was experiencing side
effects from a medication he was taking, which caused mood swings. Decl. of
M. Eoff at 99, ¶7. This was around the time Zane was prescribed the anti-
depressant, imipramine. Report of Dr. Mack at 183.
While Mike Floyd completely missed his son’s first season of play, he
attended each of the games the second season. He sat behind the dugout
screaming at Zane. Coach Eoff could tell that Zane was emotionally impacted
by Mike’s behavior. Eoff asked Mike to stop yelling at Zane and to move to
another area, but Mike ignored the request. Decl. of M. Eoff at 99, ¶5.
Zane’s FASD is a cause-and-effect condition that not only explains his
learning disabilities, attention deficits, and hyperactive behavior in

9
childhood, but explains all of his behavior across his entire lifespan including
his social awkwardness, and struggle with self-doubt and lack of confidence.

Zane’s abusive relationship with his stepfather.

Mike and Zane’s relationship was complicated as Mike was a terrifying
parental figure. Zane knew his father loved him, but he also knew Mike acted
in ways that showed the opposite.
Mike was extremely hard on Zane and became emotionally and
physically abusive. Decl. of C. Hodson at 1, ¶8; Decl. of K. Hodson at 4, ¶8.
Mike also controlled Zane by intimidation, fear, and violence. Decl. of J. Hall
at 88, ¶9.
Zane’s Aunt Sue remembers a time when the Floyds were visiting the
family ranch in Colorado. Zane was about 5 years old. One night, when
everyone was eating dinner, Mike was yelling so much at Zane, that Zane
was shaking and unable to eat. Zane appeared terrified of Mike. Decl. of K.
Hodson at 4, ¶9.
When Zane was growing up, Mike’s job kept him away from the family
home about half the time. When Mike was gone, Zane felt relaxed and safe.
But as the time approached for Mike to come back home, Zane would get in
countdown mode and become tense and nervous. Zane did not have the tools
to deal with his father. Zane’s mother also did not have the tools to be able to
protect Zane.
Carolyn and Herbert Smith lived across the hall from the Floyd family
when they moved into a Las Vegas apartment complex in 1988. The two
couples socialized almost daily. Zane was 8 or 9 years old at the time.
Carolyn, who was a social worker, saw things in Zane that others did not.
Decl. of C. Smith at 240, ¶¶3-4. Carolyn and Zane became close, and Zane

10
referred to her as his “godmother.” Zane was like a son to Carolyn. Decl. of C.
Smith at 240, ¶4.
Carolyn often spoke to Zane when he was feeling down. Zane trusted
Carolyn and confided in her. Decl. of C. Smith at 240, ¶7.
Often times Mike was the source of Zane’s bad feelings. Mike was a
macho man who thought that Zane was “soft.” Mike wanted Zane to be more
like him—tough and good at sports. But Zane had a hard time living up to
Mike’s expectations. This caused Zane to suffer from self-doubt, a lack of
confidence, and a poor self-image. Decl. of C. Smith at 240, ¶8.
When Mike yelled at Zane, Zane would often tremble and visibly
shrink. Zane just could not live up to Mike’s expectations. Decl. of C. Hodson
at 1, ¶8; Decl. of C. Smith at 240, ¶8.
Zane’s maternal cousin Cole grew up with Zane in Las Vegas. Decl. of
C. Hodson at 1, ¶¶1-3. Cole remembers an incident when Zane was terrified
of his father. Zane, Mike, and Cole were riding in Mike’s car during a hot Las
Vegas summer day. Mike did not like to run the car’s air-conditioner, nor did
he like to roll down the windows. When Cole reached over to roll down the
window closest to him, Zane placed his hand on Cole’s arm and nervously
pleaded with him not to do it saying, “it would be bad.” Zane looked terrified
and Cole did not know why. Then one day Zane rolled down the car window
by mistake. Mike yelled at the top of his lungs and hit Zane. Cole was
shocked but then understood why Zane was so fearful of Mike. Decl. of C.
Hodson at 1, ¶10.
Jay Hall saw many episodes where Mike abused Zane. When Zane was
around 14 or 15, Mike allowed Zane and Jay to drink with him. On one
occasion, they all got drunk, and Mike started talking trash about Zane living
under his roof and having to follow his rules. Without warning, Mike punched

11
Zane very hard in the jaw. Zane fell backwards and started crying. Decl. of J.
Hall at 88, ¶9.
On another occasion, Mike had purchased a season pass for the Wet N’
Wild water park. Zane accidentally lost his season pass and when Zane
confessed to his father, Mike picked him up by the hair and threw him
against the window of the car. Decl. of J. Hall at 89, ¶10.
Zane’s relationship with his father was not his only source of anguish.
Zane’s maternal grandfather, Wayne Cool Hodson, was retired from the
Navy. People described the grandfather as a John Wayne personality type.
Zane deeply admired his grandfather and sought his approval. But his
grandfather did not return the affection and did not show Zane much
attention or respect. This hurt Zane especially because his grandfather
favored some of his other grandchildren. This reinforced Zane’s self-doubts
and inferiority complex. Decl. of C. Hodson at 2, ¶11; Decl. of J. Hall at 89,
¶11.

Familial drinking and drugs.

Mike and Valerie were social drinkers. Decl. of C. Smith at 240, ¶10.
But they were also alcoholics. Decl. of J. Hall at 88, ¶8. When Mike drank, he
became aggressive. When Valerie drank, she became dismissive of Zane and
socially inappropriate.
Mike’s physical abuse of Zane was particularly bad when he drank.
Valerie would call friends and ask if Zane could come to their house because
she was afraid Mike would hurt Zane. Decl. of M. Hall at 97, ¶6; Decl. of C.
Smith at 241, ¶12. Sometimes Valerie fled with Zane for her own safety. Decl.
of M. Hall at 97, ¶6. On one occasion Valerie called Carolyn and Herbert
Smith and asked Herbert to come over and speak with Mike. Mike had hit

12
Valerie on the head and the police were called. Decl. of C. Smith at 240, ¶11.
Herbert often had to go to the Floyd home to calm Mike and the situation.
Decl. of C. Smith at 241, ¶12.
Mike also had no boundaries about underage drinking. When Zane had
his 16th birthday, he invited some school mates over to celebrate. Mike
served all the kids alcohol, even though they were under legal age. When the
parents of the kids came to retrieve them, they found their children under the
influence. Many of the parents refused to let their children socialize with
Zane again. Decl. of K. Hodson at 4, ¶11.
Valerie’s drinking intensified at social gatherings. She would often pass
out before the evening was over. Valerie also became verbally abusive to Zane
when she drank too much. Decl. of J. Hall at 88, ¶8.

Zane had positive attributes notwithstanding his deficits.

Despite his being born with brain damage due to his mother’s drinking,
despite the physical and emotional abuse he suffered at the hands of his
stepfather, and despite the alcoholism of his parents, Zane was a good person.
When interviewed, people used the following terms to describe Zane: a good
and easygoing kid; a big teddy bear; well behaved and polite; respectful; good
hearted; peaceful; kind; well-mannered; sweet; polite; quiet; and never rude.
And people noted that Zane was wonderfully kind to individuals he did not
even know and treated everyone like a gentleman. Decl. of J. Hall at 88, ¶6;
Decl. of R. Floyd at 85, ¶3; Decl. of T. Delagardelle at 91, ¶3; Decl. of M. Eoff
at 99, ¶2; Decl. of C. Smith at 240, ¶¶5-6; Decl. of C. Hodson at 1, ¶4; Decl. of
M. Hall at 97, ¶3; Decl. of A. Hall at 86, ¶3.
Carolyn Smith’s daughter Brittany thought of Zane as a big brother
and protector. Decl. of C. Smith at 240, ¶4. Zane’s cousins Steven and Josh

13
felt the same. Zane was also protective of his young cousin Cole and did not
let anyone bully Cole. Decl. of C. Hodson at 1, ¶5.
Carolyn even trusted Zane to babysit her daughter. And Jay’s mother
Tracey trusted Zane to take her daughter Aubra to the prom. Decl. of T.
Delagardelle at 91, ¶3; Decl. of A. Hall at 86, ¶3.
Zane is also described as someone who was not mean-spirited or a
troublemaker, non-threatening, and did not get into fights with others or
become violent, even when he was bullied. Decl. of T. Delagardelle at 91, ¶3;
Decl. of R. Floyd at 85, ¶3; Decl. of J. Hall at 88, ¶6; Decl. of C. Smith at 240,
¶6.

Zane’s genetic predisposition to addiction.

Zane came from a multi-generational family of alcoholics and drug
users.
Zane’s mother, an alcoholic herself, came from a family of alcoholics.
And Zane’s biological father also struggled with alcohol and marijuana abuse
as did his father, his brothers and sisters, and his first cousin. Decl. of J.
Cobis at 94, ¶¶14-15.
Persons with FASD have a predisposition to addiction. Based on his
own multi-generational history of addiction, and due to his FASD, it is no
surprise that Zane turned to alcohol and drugs.
Zane experimented with beer at the age of 5. By the age of 14 to 15, he
was drinking beer and alcohol on a weekly basis. At the height of his
consumption, he was drinking a fifth of Jack Daniel’s every day. Zane would
on occasion drink until he blacked out.
Drugs were prevalent in the Las Vegas neighborhood where Zane grew
up. There was a drug house nearby that many of the kids went to get high. A

14
neighbor of Zane’s, and a fellow classmate, became addicted to crack cocaine
and later died.
Zane’s own addiction to drugs, mainly marijuana, escalated when he
switched from a religious school to a public high school. He then began using
methamphetamine, cocaine, and occasionally acid.
By the time he joined the military, Zane was drinking a lot and his life
seemed to lack direction. Decl. of J. Hall at 89, ¶12.

Zane joins the United States Marines to serve his country.

There are various theories why Zane joined the Marines at age 18.
Some believe that Zane was trying to prove his “manliness.” Decl. of M. Hall
at 97, ¶7; Decl. of C. Hodson at 2, ¶12. Others believed he joined the military
to please his father, his grandfather, and virtually all the men in his family.
Decl. of C. Smith at 241, ¶13. In reflection, Zane says he joined the military
to escape his father.
No matter the reason, most people who knew Zane were surprised he
joined the military, not to mention the Marines, known to be the toughest
branch of the military.
When Zane told his father of his interest in joining the Marines, Mike
tried to convince him to join another branch instead, like the Navy or Air
Force. Mike did not feel that Zane was cut out for the Marines because of the
strenuous physicality and psychological stress involved. This fortified Zane’s
intent to join the Marines and prove that he was the toughest of men.
Jay Hall too was surprised about Zane’s decision to join the Marines.
To Jay, Zane did not seem to be the Marine type. Decl. of J. Hall at 89, ¶12.
However, Zane was determined to enlist in the Marines and do well
there. Decl. of M. Hall at 97, ¶7.

15
Life at Guantanamo Bay (Gitmo): 1995 to 1996.
Highly stressful Gitmo conditions.
Following bootcamp, Zane’s first assignment as a Marine infantryman
was Naval Station Guantanamo Bay, Cuba (Gitmo), where he served a one-
year tour of duty.
Zane’s military commander while at Gitmo was Captain Robert
Salasko. Decl. of R. Salasko at 152, ¶¶2-3. Serving with Zane was fellow
infantryman Scott Rollenhagen. Decl. of S. Rollenhagen at 155, ¶¶2-3.
There was a lack of popular knowledge, even in the Marines, regarding
the difficulty of the environment at Gitmo. Salasko, a 30-year veteran of the
Marine Corps., who served a tour of duty in Iraq, described Gitmo as intense
and stressful, not an easy tour, and something one lived 24 hours a day while
there. Decl. of R. Salasko at 152, ¶4.
According to Salasko, the level of conditioning and readiness at Gitmo
was like those hostile combat assignments in Iraq and Afghanistan. To that
end, the Cubans and the American troops fired at one another, there were
perimeter breaches, and riots occurred in the refugee camps where Cubans
and Haitians were kept. Anything could happen at any moment, so the troops
were not allowed to let down their guard. Decl. of R. Salasko at 152, ¶5.
Marines based at Gitmo had multiple missions including patrolling the
fence line separating the Cuban zone from the American zone and serving as
a contingency force in the event of refugee riots. Decl. of R. Salasko at 152,
¶6; Decl. of S. Rollenhagen at 155-56, ¶9.
When Marines were not out patrolling, they lived in hardstand four
story buildings like those on a typical Marine base. When Marines went on
patrol, they lived in tents. Decl. of R. Salasko at 152, ¶7.

16
 Marines at Gitmo worked a two-week cycle: a week of patrolling,
keeping an eye on the Cuban Frontier Brigade (the enemy), and then one
week of barracks time where one would train in weapon and mortar firing,
clean weapons, and serve as a contingency force. Marines went on roving
patrols as well as worked the guard towers using night vision goggles and
thermal sites to surveil. Marines routinely went on patrols with live
ammunition in their M-16 rifles. Gitmo was an operational environment as
opposed to a training environment. Troops would work 12-hour shifts at the
fence line. The armed Cuban soldiers were only 100 feet away. At times one
could hear the Cubans because they were so close. Decl. of R. Salasko at 152,
¶6; Decl. of S. Rollenhagen at 155-56, ¶9.
Rollenhagen remembers that the tour of duty at Gitmo for an enlisted
person, like him and Zane, was a difficult assignment. Once a new infantry
person arrived at Gitmo, he would receive training on how to respond and
handle riots on the island and would be forced to keep riot gear at the ready.
Decl. of S. Rollenhagen at 155, ¶8. An ever-present danger was the possibility
that refugees would riot and overrun the base. Decl. of S. Rollenhagen at 155,
¶¶8-9.
The primary interaction with refugees was riot suppression. When
refugees would riot and head toward the “critical infrastructure areas” of the
Navy base, Marines would take up a blocking position: weapons on safe but
fixed bayonets to project a show of strength to deter the refugees from moving
towards the American base. In one instance, a Marine bayoneted a charging
refugee. There were a few times when refugees attempted to grab Marine
weapons. Decl. of R. Salasko at 153, ¶10. Zane experienced this.
There was a Cuban mine field between the American side and the
Cuban side. The Cubans had planted anti-personnel mines on their side and

17
the field was not well marked. The Cuban mines would maim as opposed to
kill an individual. Once a victim had detonated a mine, his friends who came
to rescue him would also encounter mines inflicting further casualties.
Despite warnings not to do so, several brave Marines entered the Cuban
minefield to rescue a Cuban resulting in a detonation causing the loss of a
Marine’s leg from the knee down. There were an estimated 300,000 mines
planted in the aftermath of the Bay of Pigs invasion. Decl. of S. Rollenhagen
at 156, ¶10; Decl. of R. Salasko at 153, ¶13.
There were weekly detonations on the Cuban side when Zane and
Rollenhagen were stationed there. Decl. of S. Rollenhagen at 156, ¶10.
Salasko recalled an incident where a Cuban, who had lost his leg because of a
detonation, was crawling towards the American fence line. Eventually the
Americans cut a hole in the fence and went out and got the Cuban and
brought him to the American side. Marines were aware that asylum seekers
would frequently be shot by Cubans attempting to get to the base. Decl. of R.
Salasko at 153, ¶14.
The American minefield on the other hand was well marked and
consisted of anti-tank mines designed to stop Russian made tanks used by
the Cubans. If a person stepped on a mine, they would meet certain death.
Decl. of R. Salasko at 153, ¶12.
Rollenhagen remembered a situation where the Cuban forces used
spotlights and detected a Cuban asylum seeker swimming in the Bay. The
Cuban soldiers pulled the swimmer from the water, took him to the shore,
kicked and beat him, and then threw him in the back of a truck and drove
him away. Decl. of S. Rollenhagen at 156, ¶12; Decl. of R. Salasko at 153,
¶14.

18
 Salasko remembers a swimming Cuban family was literally harpooned
and brought into a Cuban patrol boat and beaten. Decl. of R. Salasko at 153,
¶11.
The average Gitmo Marine, including Zane, saw something like this at
least once but was powerless to help these people whose only crime was
seeking freedom. Decl. of S. Rollenhagen at 156, ¶12.
The Cuban and Haitian refugees, who numbered between 30,000 and
40,000, lived in tents either on the golf course or near the beach. This
population greatly outnumbered the military troops who numbered at most
about 1,000. Decl. of R. Salasko at 152, ¶8; Decl. of S. Rollenhagen at 155, ¶7.
Zane called his father in the middle of the night while at Gitmo to
discuss some of the things that he was going through. Zane told Mike that his
greatest concern was that the Cuban soldiers would point their weapons at
the American soldiers, but the Americans were not permitted to point back or
respond in any way. Zane developed anxiety over the constant threat of being
shot, having to stay on guard all the time, and felt completely helpless. Decl.
of R. Floyd at 85, ¶5. Zane also told his father about seeing people blown up
on the mine fields and other traumatic experiences.
Zane also called his cousin Steven while the two were both serving in
the military (Steven was in the Navy). Zane told Steven about his traumatic
experiences in Gitmo including seeing people blown up in the mine fields.
Even though the two were talking by phone, Steven could tell that Zane was
deeply impacted by his experiences there.
Mental health problems and drinking at Gitmo.
Drinking, depression, PTSD, and suicide were problems for those
serving our country at Gitmo.

19
 There was a lot of drinking mainly because there was little to do when
not on patrol. And drinking also took the edge off the stress troops were
experiencing. It was not uncommon for Marines at Gitmo to drink the entire
weekend until Monday rolled around. As Rollenhagen admits, “it was not the
healthiest pastime but there was not much else to do to relieve the tension.”
Decl. of S. Rollenhagen at 156, ¶13.
There were also PTSD issues among the troops. This led to alcoholism,
as well as depression and suicides. Decl. of R. Salasko at 153, ¶15.
There was no extra mental health screening before troops were
assigned to Gitmo. The military was so desperate for troops at the time that
there was a rush to get men on the ground. Decl. of R. Salasko at 153, ¶16.
There were no mental health resources in Gitmo other than a base Chaplain.
In the event of a suicide, a counselor would be flown in. Decl. of R. Salasko at
153-54, ¶17.

Floyd receives accommodations and medals while serving his

country.
At the conclusion of his tour of duty at Gitmo, Captain Salasko
composed a “Letter to Gaining Command” introducing each Marine who
served under him to their new commander. Salasko wrote such a letter on
behalf of Zane. The letter stated the following:
Zane had served in a real-world screening and recognizant
operations against the First Cuban Frontier Brigade; Zane had
demonstrated astute proficiency and meticulous attention to detail
in the rules of engagement application and the employment of
deadly force; Zane had personally conducted over 120 live patrols
against an adversarial force armed with small arms and anti-
personnel mines, and that he personally led over forty real world
patrols with fifty percent of his squad under one year of service;
Zane was responsible for patrol preparation, patrol execution, and

20
 the recommendation of future operations; and that Zane was in a
compound filled with 40,000 Haitian and Cuban refugees who were
seeking US asylum and had expertise in riot control.

Decl. or R. Salasko at 154, ¶19.

During his service as a Marine, Zane was awarded the following
decorations, medals, badges, citations, and campaign ribbons:

21
1. National Defense Services Medal
The National Defense Service Medal is a service award of the
United States Armed Forces established by President Dwight D.
Eisenhower in 1953. It is awarded to every member of the US Armed
Forces who has served during any one of four specified periods of armed
conflict or national emergency from 1950 to the present.

2. Joint Meritorious Unit Commendation

Authorized by the Secretary of Defense on June 10, 1981,
this award was originally called the Department of
Defense Meritorious Unit Award. It is awarded in the name of the
Secretary of Defense to joint activities for meritorious achievement or
service, superior to that which is normally expected, for actions in the
following situations: combat with an armed enemy of the United States,
a declared national emergency, or under extraordinary circumstances
that involve national interests.

3. Humanitarian Service Medal

The Humanitarian Service Medal (HSM) is a military service
medal of the United States Armed Forces which was created
on January 19, 1977 by President Gerald Ford. The medal may be
awarded to any member of the United States military who
distinguishes himself or herself by meritorious participation in
specified military acts or operations of a humanitarian nature.

22
4. Overseas Ribbon
An Overseas Service Ribbon is a service military award of
the United States military which recognizes those service members
who have performed military tours outside the borders of the United
States of America.

5. Coast Guard Meritorious Unit Commendation

The Meritorious Unit Commendation is awarded to units
for exceptionally meritorious conduct in performance of outstanding
service for at least six continuous months during the period of military
operations against an armed enemy occurring on or after 1 January
1944.

6. Meritorious Unit Commendation

The Meritorious Unit Commendation (MUC; pronounced
muck) is a mid-level unit award of the United States Armed Forces.
The U.S. Marine Corps awards Navy MUC for valorous or meritorious
achievement or service in combat or non-combat.

7. Good Conduct Medal

The Good Conduct Medal is one of the oldest military awards of
the United States Armed Forces. The Marine Corps Good
Conduct Medal was established on 20 July 1896. Members of
the Marine Corps must have three consecutive years of honorable and
faithful service to be eligible for the medal.

23
 8. Rifle Marksman Badge
A marksmanship badge is a U.S. military badge or a civilian
badge which is awarded to personnel upon successful
completion of a weapons qualification course (known as marksmanship
qualification badges) or high achievement in an official marksmanship
competition (known as marksmanship competition badges). The U.S.
Army and the U.S. Marine Corps are the only military services that
award marksmanship qualification badges.

(Zane’s father threw away his medals and accommodations. The

photograph above is a recreation of Zane’s actual awards.)

24
Zane’s alcohol use in the military.
With the exception of two alcohol-related incidents, Zane’s service in
the Marines was exemplary.
The first alcohol-related incident occurred in June 1996, while Zane
was stationed at Gitmo and involved drinking while on duty. From his
military records, it appeared Zane was drinking in the barracks, which was
considered “on duty,” but at the time it occurred, Zane was “off duty.” Other
marines in the barracks were also drinking, including higher ranking
Marines. Yet Zane, then a mere Private, was the only one reported for the
offense. Report of Dr. Castro at 7-8. Zane did not implicate anyone else in this
drinking incident and alone accepted his punishment. This behavior is in
keeping with military culture of not “ratting out” a fellow Marine. There does
not appear to be any other adverse actions taken against Zane for this
incident, and Zane completed the remainder of his tour at Gitmo without
incident. Report of Dr. Castro at 8.
Ideally, Zane should have received alcohol counseling and treatment for
his drinking problem while stationed at Gitmo. Most likely, though, the
Marine Corps simply did not take seriously incidents like drinking in the
barracks. Report of Dr. Castro at 8-9. A tour of duty at Gitmo was stressful
and leadership at Gitmo might have simply permitted Marines, like Zane, to
use alcohol as a means to cope and destress from their duties, while ignoring
the short- and long-term behavioral health consequences. It is also possible
there was no alcohol treatment program at Gitmo at that time.
Less than a year later, in May 1997 while stationed at Camp Pendleton
as a firearms instructor, Zane received a second write-up for alcohol use, this
time for driving under the influence (DUI). This incident led to Zane
participating in a 12-week alcohol use treatment program. However, due to

25
this second alcohol-related incident, Zane was told by his commanding officer
that he would not be approved to re-enlist. Just a year after this incident,
Zane left the military with an honorable discharge on July 4, 1998, and
returned to Las Vegas. Report of Dr. Castro at 8.
Alcohol use in the Marines is a serious problem. Zane’s use of alcohol as
a means to alleviate stress and boredom is typical. Many Marines are no
doubt high functioning alcoholics, yet alcohol use tends to be tolerated, as
long as it does not lead to serious incidents. Zane should have received help
for his alcohol problem, and the absence of such was a failure in military
leadership. Report of Dr. Castro at 9-10.

The lack of transition resources for Marines separating from

military service.
Marines with emotional and psychological struggles were not provided
re-entry resources to transition back to civilian life. And those who reenlisted
were often sent to their next assignment without being provided a chance to
decompress or process the traumatic experiences they endured at Gitmo.
Decl. of R. Salasko at 154, ¶18. Zane was one of those Marines who would
have benefited from re-entry resources.
Transitioning from the military to civilian life is difficult. Three
quarters of all service members leaving the military are faced with numerous
challenges not faced before, like locating a place to live and finding a job. And
with respect to employment, veterans struggle to find a job that provides
them with the same pay and benefits that the military provided them.
Veterans also have to start paying for things that were provided to them in
the military like food, utilities, and medical and dental care. Most veterans
have little life experience living in a civilian world, especially if they joined

26
the military while still living with their parents, as was the case with Zane.
Report of Dr. Castro at 10.
When Zane returned to civilian life, he could not find a good paying job
and eventually had to move back in with his parents. Zane saw himself as a
failure for losing the prestige associated with being a Marine and for having
to struggle working odd low-paying jobs. Decl. of J. Hall at 89, ¶18; Decl. of A.
Hall at 86, ¶5; Report of Dr. Castro at 13.
While there are many jobs in the military that translate to civilian jobs,
Zane did not have one of those jobs. He was a weapons specialist trainer and
there are not many jobs in the civilian world for weapons specialist trainers,
especially for someone who was relatively junior and at such a low rank.
Report of Dr. Castro report at 12.
In the 1990s, the only program in place to assist military personnel
transitioning from active duty back to civilian life was the Transition
Assistance Program (TAP). This program assisted retiring service members
find meaningful and well-paid employment and required a comprehensive
physical and mental health examination before separation. However, at the
time Zane separated from the military, most units would not permit Marines
to attend these courses as the military wanted servicemembers to work up
until the last day before they separated. The culture during that time was to
get every last bit of work out of those leaving the military. In some sense, the
Marines were being “punished” for leaving the military, and attending TAP
classes was considered “shaming.” Like so many of his fellow Marines, Zane
did not have the advantage of the TAP program. Report of Dr. Castro at 11.
Many veterans also leave the military with significant physical and
psychological issues that have not be diagnosed or treated. Zane experienced
this challenge as well. Report of Dr. Castro at 13.

27
 The Marine Corps is also a hypermasculine, combat focused branch of
the military. Marines pride themselves on being the Nation’s rapid reaction
force. Junior enlisted service members, like Zane, have the most difficult time
transitioning back to civilian life. These service members whose military
occupation was combat arms, such as Zane’s, also have greater difficulty
transitioning back to their civilian communities. Report of Dr. Castro at 14.
Today, veterans enjoy many more benefits and have many more
programs to access when they leave the military than were available to
Zane’s generation of veterans. First, since the wars in Iraq and Afghanistan,
all separating service members must attend TAP. And second, the federal,
state, and local governments provide much more support for veterans,
especially in the employment area. There are also hundreds of non-profit
agencies that are specifically focused on helping veterans transition back to
their communities. Report of Dr. Castro at 11, 13.

Zane’s rocky reentry back to civilian life and downward spiral.

Everyone who knew Zane saw a marked difference in his personality
and behavior when he came home from the Marines. People described him as
a different person who clearly had been negatively impacted by his service.
When he returned to civilian life, Zane seemed lost; he could not figure
out who he was or what he wanted to do. And while Zane did well in the
structured environment of the military, he was lost when he was left to his
own devices in his new civilian role. Mike Floyd noticed that Zane had no
direction. Mike also noted that Zane kept to himself and was less outgoing
when he got home.
Zane’s best friend Jay realized that Zane’s entire personality had
changed. Zane was unhappy, more introverted, and lacked his normal joking

28
humor. His overall demeanor was somber and serious. Zane also seemed less
joyful and was not the bubbly person that he was prior to his military service.
Decl. of J. Hall at 89, ¶17. Jay’s sister Aubra saw similar problems. Decl. of
A. Hall at 86, ¶4.
Zane spoke to Jay about his experiences at Gitmo. Zane told Jay about
seeing people being blown up in the mine fields. Decl. of J. Hall at 89, ¶13.
Zane also spoke about a bayonetting of a Cuban civilian who ran up to Zane’s
company in a threatening manner. Decl. of J. Hall at 89, ¶14.
Zane also spoke to Jay about how the Cuban and Haitian refugees were
trying to flee their desperate circumstances, but Zane and his fellow troops
had to round them up into detention camps. Zane wanted to help the refugees
but felt completely powerless to do so. Decl. of J. Hall at 89, ¶15.
Carolyn Smith, Zane’s “godmother,” is a Clinical Social Worker by
profession and has a foundational knowledge of mental health assessments.
She also noticed an overall change in Zane’s demeanor and emotional affect.
Prior to his military service Zane was always laughing, smiling, and
displaying a joyful spirit. But when he came home it seemed like the joy was
gone. He no longer laughed or smiled, and he was much more serious. Decl. of
C. Smith at 241, ¶14. It was clear to Carolyn that Zane needed counseling to
help him transition back to civilian life. Instead, he was left on his own to
figure things out. Carolyn was very concerned about his wellbeing. Decl. of C.
Smith at 241, ¶16.
Zane’s cousin Cole and Aunt Sue noted that Zane returned from the
military more aggressive. Decl. of C. Hodson at 2, ¶13; Decl. of K. Hodson at
4, ¶12.
Zane also seemed distracted and had a habit of silently sitting and
staring off into the distance. When Carolyn asked Zane what he was thinking

29
about, Zane would talk about his military service including the stress he felt
during his time at Gitmo. Decl. of C. Smith at 241, ¶15. Zane also told Cole
and Sue Hodson about the things he saw and did while at Gitmo. Decl. of K.
Hodson at 4, ¶12; Decl. of C. Hodson at 2, ¶13.
When Zane spoke about his military experiences, Carolyn saw that he
had a strange look on his face as if he was transported back in time and
reliving the experiences. Decl. of C. Smith at 241, ¶16.
Zane talked with Mike Hall about some of the bad things he
experienced while stationed in Gitmo. Mike, who was a retired Marine,
realized that Zane had been negatively impacted by what he experienced.
Decl. of M. Hall at 97, ¶8. Zane also told his mother about the negative things
he saw at Gitmo. Decl. of R. Floyd at 85, ¶5.
Cole and Sue Hodson remember Zane’s first Thanksgiving home from
military service. Zane did not seem comfortable at the gathering. Zane left
early to avoid being around people. Zane said something to the effect that no
one wanted him around anyway. Decl. of K. Hodson at 4, ¶12; Decl. of C.
Hodson at 2, ¶13.
Many of those around him noticed that Zane would speak for hours
about weapons training. Zane also talked a lot about how guns worked and
fired. Before the military Zane was not fixated on weaponry. Decl. of C. Smith
at 241, ¶¶15-16; Decl. of K. Hodson at 4, ¶12; Decl. of C. Hodson at 2, ¶13;
Decl. of J. Hall at 89, ¶19; Decl. of A. Hall at 86, ¶6. As becoming a U.S.
Marine was Zane’s greatest accomplishment, it appeared he had nothing else
to talk about.
Tragically, Zane’s first several months after leaving the military were
not that unusual. Serving in the military provides a job in which there is real
meaning. The mission of the military is viewed by society as honorable and

30
worthy, and Zane was extremely proud to be a Marine. Report of Dr. Castro
at 12.

The day of the incident.

On the morning of the shooting, Zane ingested methamphetamine and
experienced a methamphetamine-induced psychosis (MIP). Report of Dr.
Castro at 14.
The most common features of MIP include flat affect, impulsivity, and
dissociation, which may be accompanied by violent behavior. An individual
undergoing a MIP episode can be highly suicidal. Report of Dr. Castro at 15.
During a MIP, the individual is not in control and does not perceive what is
happening as real. MIP episodes may occur long after the drug use ceases yet
recur with re-exposure or repeated stressful life events. Report of Dr. Castro
at 15, 18.
While typically psychotic breaks and the associated dissociative state
are accompanied by significant physical incapacitation, here Zane was able to
perform numerous highly complex and coordinated actions which he was able
to do based upon his Marine training and experiences. Report of Dr. Castro at
18.
Training in the Marine Corps consists of learning a task by performing
a series of actions in a specific order over and over until performing that task
becomes automatic. It is very common for Marines who were engaged in
combat to describe their subsequent behavior where they returned fire,
maneuvered on the battlefield, and killed numerous insurgents as “going on
autopilot.” These Marines while in combat were clinically in a “dissociative”
state; they were doing what they were trained to do. And often they do not
remember all the actions they performed.

31
 For Zane, the entire episode can be accounted for by the training that
he underwent while a Marine. Getting dressed in the military gear, the
camouflaging of his shotgun with the bathrobe, the route he took to the
grocery store, the loading and firing of the shot gun, his movements through
the store, and acquiring “targets” were all acts that would have been second
nature to Zane based on his military training. These acts were likely
performed while he was “on autopilot,” while experiencing a MIP. Report of
Dr. Castro at 19.
It is doubtful that Zane will ever be able to fully recount what
happened given his mental state at the time. Nevertheless, all the available
evidence indicates that Mr. Floyd was in a methamphetamine-induced
psychotic state. Report of Dr. Castro at 21.

Suicide by proxy.
Suicidal thoughts are heightened during MIP and Zane possessed
numerous risk factors for dying by suicide: he lost his job, he lost all his
money gambling at blackjack, his girlfriend broke up with him, and he was
forced to move back in with his parents because he couldn’t pay his rent. To
Zane, his prospects and future were bleak, and he viewed himself as a “loser.”
Zane was actively suicidal. Report of Dr. Castro at 20.

After the incident.

After the shooting, Zane was still experiencing a MIP. Report of Dr.
Castro at 14. Almost everyone who saw the news the morning of the shooting
did not recognize Zane.
When Carolyn Smith saw the news coverage, she had a difficult time
recognizing Zane. He had an empty look on his face that Carolyn had never

32
seen before. It was clear to her that Zane was not in his right mind. Decl. of
C. Smith at 241, ¶18.
Jay and Aubra saw the news footage of Zane being arrested and
thought that Zane did not look like himself. He had a distant and empty
expression on his face like he was not there. Jay and Aubra had never seen
Zane in that state in all the years they had known each another. Decl. of J.
Hall at 88, ¶20; Decl. of A. Hall at 86, ¶9. Jay and Aubra were shocked by the
crime because it was completely out of character for Zane. Zane had led a life
free of violence and criminality. Decl. of J. Hall at 90, ¶21; Decl. of A. Hall at
87, ¶10.
Jay’s mother Tracey also watched the news coverage and thought that
Zane was unrecognizable. Tracey only knew it was Zane because his name
appeared on the screen. She had to look at the news coverage for a while
before she was able to tell it was Zane. His face looked distant and empty. It
was clear to Tracey that Zane was not all there. Decl. of T. Delagardelle at
91, ¶8.
Zane’s father was completely shocked by the incident because never in
a million years could he have imagined Zane being capable of doing this act.
Zane’s Uncle Randy agreed. The shooting was completely out of character for
the Zane he knew. Zane was a kind and gentle person, not a killer. Randy
believed that Zane must have been out of his mind at the time. Decl. of R.
Floyd at 85, ¶6.
Zane’s cousin Cole also believed the incident was out of character for
Zane and believed that drug use must have been involved. Decl. of C. Hodson
at 2, ¶15.
Coach Eoff heard about the shootings and turned on the television. He
did not recognize Zane as the boy he had coached. Decl. of M. Eoff at 99, ¶8.

33
 Mike Floyd, Ted King, and Carolyn Smith remember Zane’s closet after
he was arrested. The only outfits Zane kept in his closet after returning from
the Marines were his military uniforms. Each uniform had been meticulously
pressed and equally spaced on hangers as if he measured them. It was clear
Zane was still stuck in a military mindset. This clearly was not normal
behavior. Decl. of C. Smith at 241, ¶17.

(This photo has been recreated)

Post-arrest statements.
Zane’s post-arrest statements can best be described as confused. He
was constantly searching for answers as to why he shot the people in the
grocery store. Zane repeatedly said, “I don’t know why!,” when asked by the
police, “Why did you do it?” When listening to his post-arrest statements, the
tone and pitch of Zane’s voice and speech presents as if he is still in a

34
psychotic state: his speech is slurred, almost as if he is out of breath. Report
of Dr. Castro at 20.
At one point Zane said, “I am thinking what’s it going to be like to shoot
somebody?” However, this is not a declarative answer to the question, “Why
did you do it?” Nor is it a definitive statement of his motivation. It is a
searching question that he is asking of himself and is not meant to avoid
responsibility but to understand himself. Report of Dr. Castro at 20-21.
The only definitive statement that Zane made involves the uncertainty
about his own mental sanity, “I don't know what's wrong with me!” This was
a cry for help, a statement of desperation. Report of Dr. Castro at 20.

Other considerations deserving of the Board’s consideration in favor

of commutation: FASD, Intellectual Disability (ID), and Juvenile
Brain Development.

Zane suffers from neurodevelopmental disorder associated

with prenatal alcohol exposure (ND-PAE/FASD).
As mentioned earlier, Zane meets the diagnostic criteria under the
DSM-5 for the CNS impairment in FASD. Report of Dr. Brown at 119-21.
First, Zane’s mother has a well-documented history of drinking while
pregnant. Report of Dr. Brown at 119. Second, psychological testing from
1989, 2000, and 2006 demonstrate that Zane suffers from neurocognitive
impairments including intellectual deficiencies, memory deficits, and
academic learning disabilities. Report of Dr. Brown at 113-20. Third, Zane
suffers from impairments in three areas of self-regulation: attention, impulse
control, and problem solving. Report of Dr. Brown at 119-20. And fourth,
Zane suffers from adaptive impairments in four areas: communication, daily

35
living skills, socialization, and motor coordination. Report of Dr. Brown at
110-13, 119-20.
Further, Zane’s FASD is long standing from infancy, and his FASD
causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning. Report of Dr. Brown at 119-20.
Zane also suffers from secondary disabilities from his FASD. According
to studies, children with FASD are at a very high risk of negative
developmental outcomes. Report of Dr. Brown at 116-18. In Zane’s case, the
secondary disabilities include disrupted education, mental health problems,
substance abuse, employment problems, and dependent living. Id.
FASD is Intellectual Disability (ID) Equivalent from the
perspective of Zane’s moral culpability.
FASD and Intellectual Disability (ID) 4 are both classified by the DSM-5
as neurodevelopmental disorders meaning both disorders typically: (1)
manifest early in development, often before grade school; (2) are
characterized by developmental deficits that produce impairments of
personal, social, academic, or occupational functioning; and (3) involve a
range of developmental deficits that vary from the very specific limitations of
learning or control of executive functions to global impairments of social
skills or intelligence. Report of Dr. Brown at 120-21.
DSM-5 diagnoses can be classified by disability severity. One way to
measure disability severity is by definitional complexity, i.e., the number of
domains that must be impaired under the DSM-5 to meet the diagnostic
criteria. ID and FASD are similar in that both require the following
diagnostic elements: neurocognitive deficit (executive function); adaptive

4 Intellectual disability was formerly referred to as mental retardation.

36
function deficits; deficits that significantly interfere with functioning; and
deficits that constitute a lifelong disorder. Report of Dr. Brown at 122-26.
The adaptive functioning component is a more stringent requirement
for FASD (impairments in two categories) while ID only requires one
impaired adaptive domain. Id.
FASD impairs nineteen domains of functional capacity while ID
impairs twenty-one. Both are similar in terms of widespread functional
deficiency in both cognition and adaptive functioning in the community.
Report of Dr. Brown at 122-26.
Another way of comparing the two diagnoses is the risk of adverse
developmental outcomes, including secondary disabilities. Individuals with
FASD are at a much greater risk of a negative developmental trajectory than
those with ID: FASD has negative developmental outcomes in nineteen areas
while ID has negative developmental outcomes in only nine areas. Report of
Dr. Brown at 122-26. ID is a mild severity disability compared to FASD in
terms of negative life course outcomes. Id. However, most people with FASD
and ID cannot live independently in society as adults. Id.
Whether measured by definitional complexity, functional capacity, or
outcome risk, FASD is equal to and in some cases a more severe disorder
than ID. Thus, FASD is deserving of being viewed under the category of “ID
Equivalence.” Report of Dr. Brown at 127.
Both ID and FASD stem from permanent structural brain damage.
Report of Dr. Brown at 127. Typically, ID is diagnosed by a single provider
(mental health provider or pediatrician) and requires relatively minimal
testing (IQ and adaptive assessment). Id. FASD on the other hand is
diagnosed by a multidisciplinary team comprised of a neuropsychologist,

37
adaptive functioning specialist, and a medical doctor to identify physical
indicia of FASD. Thus, FASD requires more resources to diagnose. Id.
While IQ distinguishes ID from FASD in the majority of FASD
individuals, executive and everyday functioning in both conditions tends to be
identical. Significant discrepancies in IQ domains are seen frequently in
persons with FASD, as is the case with Zane, which makes full scale IQ an
inaccurate way to classify functional deficiency in FASD. Report of Dr. Brown
at 113-15, 127. Full scale IQ also has become less important in ID, according
to the DSM-5, as “intellectual deficiency now is defined as a broad array of
mixed impairments that mostly involve executive dysfunction.” Id. Further,
executive functioning tends to be universally impaired in FASD as well as ID.
Id.
Both ID and FASD have an adaptive-impairment diagnostic criteria in
the DSM-5 (one deficient domain for ID and two deficient domains for FASD),
making individuals with FASD and ID indistinguishable in terms of everyday
behavior. Report of Dr. Brown at 128.
Of particular interest is that FASD is the leading cause of ID and is
misdiagnosed or undiagnosed more than ID. Report of Dr. Brown at 129. In
children with FASD, average or low-average IQs in the context of learning
disabilities, self-regulation problems, social deficits, and interpersonal
difficulties often lead teachers and providers to attribute the difficulties to
parenting deficiency. Id. Thus FASD is very much a hidden disability. Id.
Symptom manifestation in both FASD and ID is lifelong and
permanent. Report of Dr. Brown at 129. With regard to ID, symptom course
remains relatively stable over the developmental years into adulthood, but
FASD symptoms become more complex and debilitating, leading to greater
adaptive severity into adulthood. Id.

38
 Zane’s death sentence should be commuted to life without
parole.
Zane Floyd’s FASD is similar to ID with broad ramifications that have
affected all important functional domains in his life. Report of Dr. Brown at
130-31. The litany of deficits suffered by Zane are akin to those identified by
the United States Supreme Court in Atkins v. Virginia, 536 U.S. 304, 318,
320–21 (2002), and require his exclusion from the class of persons that
demonstrate a sufficient level of culpability to be executed.
Thus, like the categorical exclusion of an individual with ID to capital
punishment, Atkins, 536 U.S. at 320–21, here, Floyd’s FASD too should make
him ineligible for the death penalty.
Due to Zane’s pre-existing FASD and PTSD, he suffered
psychological injury while serving in the military.
As discussed, FASD can result in significant and life-long changes in
individuals. Without question additional traumatic experiences associated
with military service can exacerbate the effects of pre-existing FASD and
PTSD. Report of Dr. Castro at 6.
And while the military is a highly structured environment, one in
which Zane was able to function, he most likely suffered from a phenomenon
called “suffering while functioning.” This is highly prevalent within the
military due to the mental health stigma which exists that impedes Marines
from seeking and receiving the mental and behavioral health care services
needed. Report of Dr. Castro at 6.
Zane should be granted clemency because of his age at the time
of the incident.
In Roper v. Simmons, 543 U.S. 551, 578 (2005), the Supreme Court
established a categorical rule forbidding the execution of offenders under the

39
age of eighteen when their crimes were committed. The Court relied in large
part on three “general differences” between juveniles under eighteen and
adults, “demonstrat[ing] that juvenile offenders cannot with reliability be
classified among the worst offenders.” Id. at 569. Pointing to scientific and
sociological studies, the Court noted that juveniles exhibit a “‘lack of maturity
and an underdeveloped sense of responsibility,’” which “‘often result in
impetuous and ill-considered actions and decisions.’” Id.
The Court in Roper also recognized juveniles are “more vulnerable or
susceptible to negative influences and outside pressures, including peer
pressure.” Id. Finally, the Court explained “the character of a juvenile is not
as well formed as that of an adult.” Id. at 570 (personality traits of juveniles
more transitory, less fixed). Noting “the death penalty is reserved for a
narrow category of crimes and offenders,” the Court concluded that juveniles
under the age of eighteen simply “cannot with reliability be classified among
the worst offenders.” Id. at 568-69.
The reasoning in Roper should be extended to Zane, who committed the
offense at age twenty-three. Although Roper drew a cut-off at age eighteen,
the rationale of Roper extends to individuals like Zane at age twenty-three
because the human brain continues to develop beyond the age of eighteen.
Even Roper recognized “[t]he qualities that distinguish juveniles from adults
do not disappear when an individual turns 18.” Roper, 543 U.S. at 574. This
reasoning is particularly applicable to individuals like Zane whose cognitive
functioning is actually below that of their chronological age. Report of Dr.
Brown at 136.
Moreover, people with FASD exhibit abnormal and delayed brain
maturation across the developmental years. Report of Dr. Brown at 134.
Studies have found significant maturation alterations and delays in the

40
prefrontal cortex and its microstructure in children, adolescents, and adults
with prenatal alcohol exposure compared to normally developing age peers.
Id. Compared with normal changes in brain structure during adolescence
that improve speed and efficiency of neurochemical communication, research
finds that individuals with prenatal alcohol exposure have significantly
impaired: global network efficiency, speed of information processing, and
executive self-regulation. Id.
Given the normally developing adolescent brain does not have mature
executive control capacity until at least the age of twenty-five, and brain
development in young adults with FASD lag many years behind rates seen in
neurotypical age peers, it is likely that Zane’s brain was not fully developed
at the time of the offense due to his ND-PAE/FASD, which would have had
an additive and cumulative effect on the brain damage with which he was
born. Report of Dr. Brown at 136.

Zane has always been remorseful for his actions.

Since his arrest, Zane has always taken responsibility for his actions
and has been remorseful.
Mike Floyd saw Zane soon after his arrest. Zane had a difficult time
remembering the events but was very remorseful. Zane also became
withdrawn following the shootings.
Jay’s mother, Tracey, and her daughter Aubra also went to see Zane
soon after his arrest. At first Zane was not coherent. It took about a week
before he seemed more like himself. But Zane took responsibility for his
actions and was very remorseful from the start. Decl. of T. Delagardelle at 91,
¶9; Decl. of A. Hall at 87, ¶11; Decl. of J. Hall at 90, ¶22.

41
 Carolyn Smith also visited with Zane after his arrest. While Zane did
not have much memory of his actions and could not explain what was going
through his mind at the time, he was deeply remorseful, ashamed, and
horrified by his actions. Zane took responsibility and felt terrible for the harm
he caused the victims and their families. Decl. of C. Smith at 241, ¶18.

Zane Floyd is deserving of commutation of his death sentence by the

Board.
Zane Floyd committed an unspeakable act and took the lives of
innocent people while severely injuring others. Impaired by his FASD, and
indoctrinated by his father and grandfather that alcohol, weapons, and
heroism were indispensable to male life, Zane transformed his military
training and experiences into binge drinking, target practice, and weapons
cleaning and disassembling. On the morning of the Albertson’s shooting,
Zane replayed this routine to a tragic end.
But Zane is not the “worst of the worst.” 5 Nor is he “evil” or a “natural
born killer.” Rather, he is a person who was born with—and is still suffering
from—pre-natal exposure to alcohol, which caused brain damage which has
affected his entire life trajectory. Further, his traumatic upbringing led to
PTSD, which became worse during his service to the country while an
enlisted Marine.
Zane also abused drugs and alcohol. This addiction was caused by a
psychological need to self-medicate to deal with the stressors in his life. His
addiction was also a result of a genetic predisposition to addiction caused by a
history of familial abuse and by his FASD.

5
The United States Supreme Court has recognized that the death penalty is
reserved for those defendants who are “the worst of the worst.” Kansas v.
Marsh, 548 U.S. 163, 206 (2006).
42
 Importantly, Zane did not choose any of these insults, nor did he have
control over them. Instead, he was born with these issues, due to no fault of
his own.
Zane Floyd has many positive traits, as discussed above. Other than
this one senseless act, Zane is known to those who love him as a gentle,
loving, and kind person who would do anything for anyone. Further, Zane
served his country in the Marines, the toughest branch of the military, and
was awarded a multitude of awards and medals for that service.
Zane’s own father Mike, who has always been a supporter of the death
penalty, acknowledges that what Zane did was terrible. But Mike still
believes his son’s life should be spared, because Zane was not in his right
mind at the time of the incident, and he had never been in trouble with the
law before (other than a DUI). See NRS 200.033(1) (capital offense mitigated
by absence of significant criminal history). Also, Zane was not a violent
person, nor had he ever been violent before this offense.
Jay Hall’s mother Tracey is a very conservative person and has always
supported the death penalty. But she too does not believe that Zane should be
executed. He was a good kid who did something terrible, but that one act does
not define who he was or is as a person. Zane has redeeming qualities and
Tracey truly believes that this one incident would not have happened had
Zane not been on drugs and not in his right mind. Zane also took
responsibility for his actions and showed sincere remorse from the start. Decl.
of T. Delagardelle at 92, ¶10. Tracey’s daughter echoes similar thoughts
about Zane saying that those who know him best understand this his life has
so many positive dimensions. Decl. of A. Hall at 87, ¶12.
Zane’s cousin, Steven King, is himself a military PTSD survivor and
believes that Zane’s PTSD is a reason to spare his life. Steven’s PTSD stems

43
from his being deployed to provide humanitarian relief after a great tsunami
hit off the Indian Ocean. Steven saw countless dead bodies floating in the
ocean. This traumatic experience led to his experiencing nightmares,
insomnia, anxiety, and hallucinations. Steven believes that non-combat
related PTSD is a larger problem of which most people are not aware. Steven
also believes that Zane would not have committed the offense if Zane had
received the support he needed for his issues.
Steven describes Zane as a gentle teddy bear who protected people and
was never a bully. To Steven, Zane is quintessentially a good person and the
incident for which he was convicted does not represent the person he is or
was. Steven’s entire family loves Zane very much and they all would be
negatively impacted by his death.
Zane also does not present a danger to others. He has spent over
twenty years in prison and his institutional record has been exemplary.
There has never been any suggestion that Zane poses any danger to staff or
other inmates while in custody. He is not a threat to the community nor a
threat to other prisoners or correctional staff.
Zane has always done well in a structured setting, and even thrives on
it, as shown by his military service.
Zane has also learned to control his behavioral issues and by
maturation, has aged out of others.
Zane has also been properly diagnosed and he understands his illness
and how to adapt to his current setting. While serving a life sentence without
the possibility of parole is a harsh consequence for his acts, prison is the best
place for Zane Floyd. There is no need to execute him.

44
The Pardons Board should commute Zane Floyd’s death sentence as
all of the factors militating in favor of granting clemency are present
in his case.
This Board is authorized to commute Zane Floyd’s death sentences to
sentences of life imprisonment without possibility of parole, under state law.
In pertinent part, the Nevada Constitution provides that:
The State Board of Pardons Commissioners may, upon
such conditions and with such limitations and
restrictions as they may think proper, remit fines and
forfeitures, commute punishments . . . and grant
pardons, after convictions, in all cases, except treason
and impeachments. . . .

Nev. Const. Art. 5 Sect. 14 (1); see Nev. Rev. Stat. § 213.080 (commutation of
death sentence).
Clemency is “an act of grace, proceeding from the power entrusted with
the execution of the laws, which exempts the individual on whom it is
bestowed from the punishment the law inflicts from a crime he has
committed.” United States v. Wilson, 32 U.S. 150, 160 (1833). As an act of
grace, it may be, and normally is, bestowed on grounds other than the issue
of guilt or innocence of the applicant, or the legality of the procedures by
which he or she was convicted. In Herrera v. Collins, 506 U.S. 390 (1993),
Chief Justice Rehnquist noted that “[c]lemency is deeply rooted in our Anglo-
American tradition of law and is an historic remedy for preventing
miscarriages of justice where the judicial process has been exhausted.”
Herrera, at 411-12. In the same opinion, the Chief Justice noted that
clemency is “the fail-safe” in our criminal justice process. Id. at 415.
The clemency power is a “broad discretionary power to temper
retribution with mercy, to correct error and to do justice where the rigorous
inflexibility of the judicial system has not adjusted to compelling social

45
needs.” Caleb Foote, Pardon Policy in a Modern State, 39 Prison J. 3 (April,
1959). Clemency has also been described as “society’s last chance to be sure
that the person sentenced to death is one truly deserving of the death penalty
because there may be new evidence mitigating the crime or factors pointing
away from the guilt of the defendant.” George Kostolampros, Article 905.2 (B)
and State v. Loyd: Introducing an Unnecessary Consideration in the
Imposition of the Death Penalty by Informing the Jury of the Governor’s
Power to Grant Clemency, 8 Widener J. Pub. L. 149, 159 (1998).
What becomes evident from a brief review of the
executive’s power to grant clemency is that it is a
power deeply rooted in our American tradition of
separation of powers. The executive’s decision in
granting clemency is an act of grace, but it is an act of
grace that is political in nature. Therefore, the
executive’s power to grant clemency is quite different
than an acquittal by a jury because the executive’s
decision is based on factors that the jury cannot
consider.

Id. at 158-59.

The United States Supreme Court has also recognized that

fundamental considerations of due process are inherent in the clemency
process. Ohio Adult Parole Authority v. Woodard, 523 U.S. 272, 280-81 (1998)
(recognizing that “the heart of executive clemency” is to “grant clemency as a
matter of grace, thus allowing the executive to consider a wide range of
factors not comprehended by earlier judicial proceedings and sentencing
determinations.”); see Wilson v. United States District Court, 161 F.3d 1185,
1187 (9th Cir. 1998).
This Board must consider all the factors presented in this application
and the accompanying exhibits. The Board should look beyond the fact of the
conviction and sentence and recognize that, in conscience and mercy, Zane

46
Floyd’s death sentence should be commuted to life without the possibility of
parole.
Dated this 27th day of May, 2021.

Respectfully submitted,

RENE VALLADARES
Federal Public Defender
For the District of Nevada

Brad D. Levenson
_______________________
Brad D. Levenson
Assistant Federal Public Defender

Attorneys for Applicant

47
 ZANE FLOYD
Index of Exhibits in Support of Application
For Commutation of Sentence

No. Document Bates No.

1 Declaration of Cole Calloway-Hodson, dated May 3, 2021 1-2

2 Declaration of Kathleen Susan Hodson, dated May 3, 2021 3-4

3 Report of Dr. Carl Castro, dated April 26, 2021; CV 5-84

4 Declaration of Randy Dale Floyd, dated April 26, 2021 85

5 Declaration of Aubra Hall-Smithson, dated April 23, 2021 86-87

6 Declaration of Robert Jay Hall, dated April 23, 2021 88-90

7 Declaration of Tracy Delagardelle, dated April 22, 2021 91-92

8 Declaration of James Cobis, dated April 19, 2021 93-95

9 Declaration of Rosalie Ann Cobis, dated April 18, 2021 96

10 Declaration of Michael Hall, dated April 13, 2021 97-98

11 Declaration of Michael Eoff, dated April 1, 2021 99-100

12 Declaration of Dr. Natalie Novick Brown, Ph.D., dated 101-151

February 24, 2021; CV

13 Declaration of Col. Robert Salasko, dated February 16, 152-154

2021

14 Declaration of Scott Rollenhagen, dated January 29, 2021 155-156

15 Report of Dr. Brown, dated October 17, 2006 157-179

16 Report of Jonathan Mack, dated October 13, 2006 180-233

17 Report of Dr. Maria Cardle, dated April 30, 1989 234-239

18 Declaration of Carolyn Smith, dated May 5, 2021 240-242

 Declaration oLC ole C alloway-Hodson

I, Cole Calloway-Hodson, hereby declare as follows:

1. My name is Cole Calloway-Hodson. I am thirty-nine years old and currently reside in

n^^,1 ^l^L-^-----,. rr:^^^---i
rvliSsUUji. rr-.-,-^r1-^.-:.-ll ( .3U5aiii i. c-.^..--
I\i{ilU(rtpii \-Utiiii}. ^.1^{^^--c---^-rf
ivi-1' ltKiiiltrl tS I\atiilt:€li ^l^---l.6.-^^--.r\
)USaii fiUU;UIt JUiali -,.^--I-^
iVaS tiig
sister of Valerie F1oyd, Zane Floyd's mother. Valerie passed away in 2005.

2. I am the Pastor of the Redeemer Church of Moberly, in Mober$, MO.

3. Zane is six years older than me, but we grew up together . Zare used to stay with me and my
Colorado family during summers and holidays, and I would stay with Zane and his parents,
t! !
vaiet'te ! ai:! ,! : r!- I
airo lvilKe. on oii:iel ocuitstui]s. iviy moilicl'arlo
- -
I! aL\o
!-, !: !
ilveu :
lit ! - !I-
Las vegas lor
C
a yeiil'
and stayed with Zane's family in their guest house on Oakey.

4. Zane wx
socially awkward and did not have many friend s. Zane also lacked self-confidene
---l-i^l- l----- - l-^^- .l r^ Li- l^^--1,^^ -tl^^L'-.l'-t-. 7^-^^ l-^^t-)
wiilrli uil8rrr uarvs
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^J
PEls{Jil
who was wonderfully kind, even to people he did not know.

5. Zane was good to me and was very protective. Zane did not allow anyone in the neighborhood
. 1 7 t rl
iu prch on ol Duil)i
'lle.

6. Zane was constantly with his best friend, Jay Hall. There were a couple of other friends that
n--- ^ t---r Ll-^-- Ll---^^ ^- C^---
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uyuigu iiiiLiuBii ---:Ll-
wriii r'.diiu, ----,-^
riui iiiuiu
uui --^ tiiaii r,ligg Lu iuul., T C^----J a^,--r-
iuuliu Lallre J Ci--- J- r^ L-
lriEiiuS -.^
iu ug ifs
socially awkward as Zane. I also believe the Zane kept his circle of friends small so as to
protect himself.

7. Zane desperately sought approval from friends and family but never seemed to achieve this
goal.

8. It was apparent to me that Mike and, Zane loved one another and had a real father-son
relationship. But Mike could not give Zane the type of love and encouragement thatZane so
.-l tl/l tl'l r a- - 7 .... I,l-J .lt-
ieiicu di Laiic- aaiie (iircll LrcillDlrru allu \Isliaiiy siilalll{. lt
I - - -l-, - - -ll-l - -.f'., - -l -' 1 --1. l.
{Jtr}peraltriy litririJ9u.. wiitsil iviij(c
seemed like Zane never lived up to Mike's expectations.

9. Mike did not recognize tbatZane was a child with special needs. Instead he acted as if he could
car . ,- !-r-,l--,,
ruuBfi
-1,7)n z.ailv-
ulru sriirpts.

10. I recall riding in Mike's car with Zane one hot summer day. Mike did not like to run the car
!lJ! .-,t-.!
-..li.l-,
dil uuliurtlutlgr ilut
--
uru ilt t:lrtKc ,urillrB
-tt: l
uuw'il rl l=1.-.,, 11/1.-! - !'! !-...-,
LilE wilruuws. Yvrrtril r rtraLlluu uvtr ru tulr uuwil
my window to get some fresh air, Zaneplaced his hand on my arm and nervously pleaded with
me not do it saying "it would be bad." Zane looked terrified and I did not know why until Zane
roiiuri dowt iris wintiow-b-y raistake one day- iviike yeiled irruriiy* and Zane was scare+i. i thm
understood why Zane was so fearful.

001
ll. Zane deeply admired our grandfather, Wayne Cool Hodson, and sought his approval, but our
grillu.rc..l. . ._1-- --t-__. -.... -t. _,.--,.:_-- . r .. -_1 f,_.at--..r_ c_ - -:-_
i arIiEf i icv ur- si iUW EU z,iiIiu ill-uali at atrI] i itrIi rrf r'especa. I W a5.UUr- St-4iiu iaii]El' i i av Ofitu
,l
dilU
Zane sometimes mentioned this to me in an envious manner, buthe never mistreated orblamed
me forthe circumstances. Zane was more hurt than anything else.

12. Zane tried to prove to himself and others that he was "man enough" but he often fell short of
expectations. I believe thatZane's desire to prove his "manliness" was part of his motivation
tujuii-r itis iiitirirrus. i aisu bciicvc iic itiigiii liavc-iuiiicri iiicliiaiinsr iui-cinvuri i,iinrcif.

1 3. I noticed a big chang e in Zane's personality when he came home from the Marines. He was
.-- -.-- --^-a:,.- --- I --tr--, I^. ^"- I .1- - .I-j-- -.. l- - - ---- ---I J:l
lilutu as5ilitivE allu tiiil\,uu a lui duiJlit
-l- gi.tiis- aliu idc.itiiilgs ltL sa\y aliu rliu \l,ilita :,-
---r^jI-
iil
Guantanamo Bay, Cuba. I recall Zane's first Thanksgiving shortly afterhe returned home in
the months leading up to the inciderit. Zane did not seem comfortable at the gathering. We
fu'rcw ihat Zaiic ctrtrid nui reciilisi arrti.rur grarr.ifatlicr, a decot'a{etl rriilitary vcicrari, slruLc in
a way that was critical of Zane. Zane still sought our grandtbther's approval, but it was
obvious that our grandfatherwas disappointed in Zane. Zane left the gathering early to avoid
treilrg zu'ound ci'etytirre. Zarrc sairi somethirrg to tire eifeci ilrai nu orrc ivante<i irir:r ar-ruirrj
anyway.

14. I believe one of the reoccurring problems in Zane's perception of how others saw and treated
!.:* L^ L-l:--.-J
wds rL^+
ttuil -.^- ur111 riu utiluvuu PUUIJiu
-^^-l- f--^..^-*l-. -J L:^
itirLiuurrir) r{uusLii-hiuu
--^^t2^- rirr *^-L^^J ^^J Lj^
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iiiiiiriiuuu iiliutlis
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}c;{uaJlly. iiiis
included his father Mike, his grandfather, neighborhood kids, and his classmates at school. i
suspected thatZane may have been gay, but this was never something that I could bring up in
^*:--- !- ! l:l - ! !:
a uurlversarlon Decause t oto ilol waitl -Io n-iaKe ilit-r't ul)set.

15. I believe thatZane'sdrugabuse was amajor factorin the incident because hewould neverhad
durrc sur:h aui> hat! iic brcn ir: his rigiii niirid. Ii ju:[ was rrr]i iri Zaris's uiiarauicr.

16. Valerie was Zane's champion. It seemed like she was the only one in the world who loved him
..--^-.. I:r:-.--11- T!-:- :^.1.-.--- -- rl-^.
Liiicoilurrlullaii). iiils is ilie Ieasiri-i Illal l-^..
ile \^,as
^^..- l--..--r.-.-1,--t-^--.-1,,
so oe\-as[aler:i wiiell sile passefr
-^- -l -
ah'ay.

17. I was with Mike at Ely State Prison when Mike broke the news to Zane that his mother had
passcd. Zanc iricd tG n-iaiil'iaifi his composurc aroi;iid thc otlicr iru-,mfcs. bui hc complctcly lost
it when he was told his mother died. Zane was inconsolable.

I declare underpenalty ofpe{ury that the foregoing is true and correct and that this
tieciaration was executed on iviay 3,2 2i rn Moberiy. fuiissowi.

ay-Hodson

002
 Declaration of Kathleen Susan "Sue" Ilodson

I, Kathleen Susan Hodson, hereby declare as follows:

1- My rc is Kaftleem Suro Tludsoa- I aua sixty-ffi\ren lmrs old:md urrcady reside

in Rando$h County, Missouri. My sister was Valerie Floyd, Zane Ftoyd's mother.
Valerie passed away in 2005.

2. I was eight years yormger than Valerie. As far as I can remember, Valerie had a
,aoqddrd r€*stiffie{p wit& *s# gw#s. S&e ure** smt ervay h grai* H# rch+ol ia
fuirenabeeanme *he was ffi€akingffiswt& aboymy fatherdidn't atrlprove of.

n
J. Valerie left home when I was 8. After high school and a short stint in college, she
meve* m,X;mg E@h eeexia t* Eive wi& w' @ (@s Ev#ly *e
siffi6)"
got hooked on heroin and started roaming the streets. Our family did not know what
happened to Valerie unfil they received a call from authorities in Califomia informing
aa *m 1ffiss*p eM M s&Mes* @.#kt d txperfrwd a mry*ufl
breakdovin. Our parenB paid for Valerie's fligfut home. When she arrived back in
Cotorado, her hair was a mess! her clothes were disheveled her hygrene was paor,
ard skkdea.vcf€*dtr tlrew*y ,Califuia,wi&dy w sfue wkfe*
Valerie was admitted to a psychiatric hospital and underwent elecffoshock therapy.
Ve*ffib'ery>gy r.# eu ffir.esds' &jsiffi * pmit #.k**fuk kapy" V"*lerie
left home again qihsn I was 14 md moved to Alas*a where she met lim Cobis, Zane's
biological father.

4. I believe that Valerie abused dmgs while she was pregnant with her first child,
Francisco Cobis. Francisco died a crib death before he was a year old.

5. Valerie rehrned home h Cotorado when she was a few months pregnant with 7.ane.
During her pregnancy with Z,aneo Valerie abused alcohol not less than five days out of
sev* unw}}y Mit slle t!ree
iwxie*c6" k&. w&ed,w[]w"-serd tiew
a week and smoked cigarettes daily. I would not be surprised if Valerie was also using
eeiffi,€sds#&e{ba,rders*b,seruesdrs&g,es{pr,esrcecyboferd"re fhey werc €e6y ts
tsrre by'# ee t,truggfldwie affifutirmr $o &qe rcrb*tafiss pi<xto kpe$ffincy.

6. Valerie sought the approval of the men in her life. Valerie also did not believe that
k
Z*ffi6 sk*trh* sra*sed wifuB * fuk, FCIr tMe r:w ldehm&s mw'*is& a rckmic
when Zane was either two or three years old. When her new husband started to abuse
her, Valerie fled. The marriage lasted only about six weels.

7- Zane desperatety sought approval from friends and famity but never seemed to
achieve this goal.

8. Mike and Zane loved one another and had a real father-son relationship. However,

003
 Mike was extremely hard on Zane and sometimes emotionally and physically abused
irirn. \,vhen lviike yeiied ar, Zar+e, Zane often trernbled arui visuaiiy shrank. it seemed
like Zane never lived up to Mike's expectations. Mike also did not recognize that
Zanewas a child with special needs.

9. I remembet a time when Zane was about 5, the Floyds came 0o visit us in Colorado.
Mike, Valerie. and Zane'*,ere eating dinner one night when I walked in. Mike was
yelling at Zane about sorcething and Zant was visibly shaking and unable to eat. lt
was clear Zanewas terrified of Mike.

lfi. Zane deeply admird his grandfather, Wayne Cool llodson, and sought his apprcval,
but his grandfather never showed Zane much affention or respect. Cole was their
grandiaiiier's favorite ani' Zarie sornetiinus meiitionerj ihis to Colc, liut he never
misffeated or blamed Cole for the circumstances. Zane was more hurt than anything
else.

11. When Zane tumed sixteen, he had a birthday party and invited some peers over to the
house. Mike ended up serving all the kids alcohol, even though they were underage.
When the parents arrived to take their childrrn home, they faturd their kids
intoxicated. Many of the parents did not let their children socialize again withZane.

12- { noiiced a big change in Z,an*''spersonality when he came home frorn the hdarines.
He was more assertive and talked a lot about guns and the things he saw and did
rvhile io Guantanarno Ba1;, Cuba. I recall Zaqe's first Thant.sgiving short!); after he
returned home, Zane did not seem comfortab,le at fhe gadrering. W'e knew thatZane
could not reenlist due to his drinking problems and Zane's grandfather, a decorated
*iilitary veieran. spoke in a ui'ay that w'as criticai of Zaiie . Zane still souglit his
grandfather's approval, but it was obvious that the grandfather was disappointed in
Zane. Zaneleft the gathering early to avoid being around everyone. Zane said
sornethitg io ihe effect thai no ono w-affie.ihirn arotrnrJ anyx-ay'-

13. After Zane's arrest in 1999, Valerie and I had a falling out. Valerie told me to stay
ii:wav rl'ofir Zffle. tr wanted toirclp Zane butrespected my sisier's w-ishes alri ceased
contact withZane.

I declare under penalty of perjury that the foregoing is true and correct and that
this deciaratiot was executed on May 3,2,021 ia.Moberly, fuiissouri.

Kathleen Susan Hodson

004
 REPORT OF DR. CARL ANDREW CASTRO, Ph.D.

I have been asked by current counsel for Zane Floyd, the Office of the Federal

Public Defender, District of Nevada, to provide an analysis and insight into Mr.

Floyd’s military service, his transition to civilian life, his mental state on the day of

crimes due to his methamphetamine use, and his state of mind during his post-

arrest statements. My findings on these questions are set forth below.

BIOGRAPHY

Dr. Carl Castro is currently Professor and Director of the Military

and Veteran Programs at the Suzanne Dworak-Peck School of
Social Work at the University of Southern California. Dr. Castro is
one of the leading military behavioral theorists in the world.
Before joining the University of Southern California, Professor
Castro served in the U.S. Army for over 30 years. He began his
military career as an infantryman in 1981, and completed two
tours in Iraq, as well as serving on peacekeeping missions to Saudi
Arabia, Bosnia and Kosovo, retiring at the rank of colonel. While
on active duty, he conducted the first-ever behavioral health assessment of service
members while they were still conducting active combat operations, setting a new
standard of care for service members during combat. Dr. Castro has chaired
numerous NATO and international research teams and he is currently Chair of a
NATO research group on Military Veteran Transitions and Co-Chair of a team
exploring Veteran Radicalization; a Fulbright Scholar; and member of several
Department of Defense and Veteran Affairs advisory boards. His current research
efforts are broad and include: (a) the exploration of the military culture that leads to
acceptance and integration of diverse groups; (b) understanding and ameliorating
the effects of military trauma and stress on service members, family, and unit
readiness; (c) the prevention of suicides and violence such as sexual assault and
bullying within the military; and (d) evaluating the process of transitioning into the
military and transitioning from military service back to civilian life.

005
ANALYSIS

If a person suffers from Fetal Alcohol Spectrum Disorder (FASD) and Post-
traumatic Stress Disorder (PTSD) before joining the military, can combat-
like and other traumatic military experiences have an exacerbated impact
on their mental health?

Fetal Alcohol Spectrum Disorder (FASD) can result in significant and life-

long changes in individuals when mothers drink alcohol during pregnancy. These

effects often include physical, behavioral, mental and/or learning disabilities.

Without question, additional traumatic experiences associated with military service

may exacerbate the effects of FASD. Likewise, traumatic events that result in post-

traumatic stress disorder (PTSD) prior to joining the military can be exacerbated by

other types of traumatic events, including combat-like events that often occur in the

military.

The military is a highly structured work environment. Thus, it is possible

that a Marine, such as Mr. Floyd, would have been able to not only function in the

Marine Corps, but would have been able to do so at a fairly high level, despite his

FASD and family and drug use history. This phenomenon has been referred to as

“suffering while functioning.” It is thought to be highly prevalent within the

military due to the mental health stigma that exists that impedes Marines and all

service members from seeking and receiving the mental and behavioral health care

services they need.

006
Alcohol Use/Abuse Involving Mr. Floyd

With the exception of two alcohol-related incidents, Mr. Floyd’s service in the

Marine Corps was exemplary. He successfully completed Marine Corps basic and

advanced training. Mr. Floyd received numerous letters of appreciation and

accommodation while serving. And he appeared to be well liked. Mr. Floyd also

completed a highly stressful, one-year tour of duty in Guantanamo Bay (GITMO).

Mr. Floyd received an Honorable discharge from active duty.1

Mr. Floyd’s military records include two Counseling Statements that he

acknowledges receiving by signature that document separate incidences involving

the inappropriate use of alcohol. The first instance occurred on July 11, 1996 while

Mr. Floyd was stationed at GITMO and involved drinking while on duty. At first

glance this is a serious charge. One that could have easily resulted in a Court

Martial, with Mr. Floyd spending time in a military jail. That this outcome did not

happen indicates that there is more to the story.

From other documents reviewed, Mr. Floyd relays that this incident involved

drinking alcohol in the barracks, a location that was considered “on duty.” When

the incident occurred, Mr. Floyd was off duty. Further, Mr. Floyd states that other

Marines were also drinking in the barracks, including higher ranking Marines, one

at the rank of sergeant, yet he was the only one reported for the offense. To further

the injustice, Mr. Floyd claims that the sergeant who reported him for drinking in

1Following his conviction in the instant case, Mr. Floyd was discharged from the
Marine Corps Reserve with Under Other than Honorable Conditions.
3

007
the barracks was also drinking, and only reported him to cover up for his own

misconduct. It should be noted that at the time Mr. Floyd held the rank of Private,

the lowest rank.

Mr. Floyd claims not to have implicated anyone else in this drinking incident.

He accepted his punishment alone. Such behavior is in keeping with the military

culture of not “ratting out” or turning in a fellow Marine. The sergeant who turned

in Mr. Floyd violated this ethos. Other than the single Counseling Statement there

does not appear to be any other adverse actions taken against Mr. Floyd for this

incident. Mr. Floyd successfully completed the remainder of his one-year tour at

GITMO without any further disciplinary issues.

Less than a year later (May 25, 1997), while stationed at Camp Pendleton,

California, Mr. Floyd received his second Counseling Statement for driving under

the influence (DUI). It appears that this incident led to Mr. Floyd participating in a

12-week alcohol use/abuse treatment program. Yet, in the documents provided, it

could not be confirmed that Mr. Floyd actually participated in such a program, nor

the outcome of his participation if he did participate. It was also during this time

that Mr. Floyd’s promotion to corporal was denied due to the DUI and that Mr.

Floyd was told the Commanding Officer would not approve his request to re-enlist.

Just over a year after the second alcohol-related incident, Mr. Floyd left the military

on July 4, 1998, returning to Las Vegas.

Ideally, Mr. Floyd should have received alcohol counseling and treatment for

his drinking problem while stationed at GITMO. Yet given that an assignment at

008
GITMO is a one-year tour of duty and given that the event occurred during the

middle of Mr. Floyd’s tour there, it might have been deemed impractical to begin an

alcohol prevention and treatment program at that time. It is also likely that the

Marine Corps simply did not take incidents like drinking in the barracks seriously.

Other than the single Counseling Statement no other actions were taken. Duty at

GITMO during this time was highly stressful. Mr. Floyd reported experiencing

numerous highly stressful and traumatic events while stationed at GITMO that

were corroborated by his Commanding Officer (Col. (retired) Robert Salasko). The

leadership at GITMO might have simply allowed the Marines to use alcohol as a

means to cope and “destress” from the duties there, while ignoring the possible

short-term and long-term behavioral health consequences, as well as its impact on

military readiness. Finally, there simply might not have been an alcohol prevention

and treatment program available at GITMO that Mr. Floyd could have participated

in. Regardless of the reason, Mr. Floyd should have received help for his alcohol

problem. That he did not was a failure in military leadership.

Mr. Floyd readily admitted after his arrest that prior to joining the Marine

Corps he was a chronic user of drugs and alcohol, and that he stopped using drugs

once he decided to join the Marine Corps. While there is no reason to doubt him

regarding the use of drugs, his alcohol use certainly continued, and likely escalated.

Alcohol use in the Marine Corps is a serious problem. Mr. Floyd’s use of alcohol as

means to alleviate stress and boredom is typical. Many Marines are no doubt high

009
functioning alcoholics, yet alcohol use tends to be tolerated as long as it does not

lead to serious incidents like DUIs or domestic and physical violence.

Can you explain what the military did, if anything, in mid to late 1990s to
transition military personnel, especially Marines, back into civilian life?
Are things different today?

Transitioning out of the military back to the civilian community is difficult.

Service members leaving the military are faced with numerous challenges that they

have never before faced. Separating service members first must find a place to live

and most importantly find a job. Research has found that nearly three-quarters of

all service members do not have a job when they leave the military and most

separating service members either move back home with their parents or move in

with their significant other. Military veterans frequently struggle to find a job that

provides them with the same pay and benefits that the military provides them.

Military veterans also have to start paying for things that were provided to them by

the military such as food, utilities, medical and dental care to name but a few. Most

military veterans have little life experiences in living in a civilian world, especially

if they join the military while still living at home with their parents.

In the 1990s, the military did have a Transition Assistance Program (TAP),

operated by the Department of Labor, to assist military personnel transitioning

from active duty military service back to civilian life. The focus of the TAP program

then and now was to help the separating service member find meaningful, well paid

employment. Another important feature of the TAP in the 1990s and today is that

all retiring service members must receive a comprehensive physical and mental

010
health examination that is placed in the service member’s official medical records.

These records are then used by the VA to determine medical care eligibility.

However, in the 1990s this program was only required for those service members

retiring from active duty. Other service members could attend the TAP classes on a

voluntary basis. However, very few service members who were not retiring

attended TAP classes. Most units would not allow Marines or Soldiers to attend

these courses as they wanted Marines and Soldiers leaving the military to work up

until the last day before they separated. The culture during this time was to get

every last bit of work out of those leaving the military. In some sense one may

think of Marines and Soldiers as being “punished” for leaving the military.

Attending TAP classes would be considered “shaming.”

It has only been since the wars in Iraq and Afghanistan that transition

support programs have been expanded to assist all separating service members.

Today every service member must attend TAP. It should be noted that the TAP

exists today only exist because Congress mandated it. The Department of Defense

opposed a TAP for all service members when it was first proposed. The active

military initially saw little value in helping service members successfully transition

back to their civilian communities. Medical and mental health evaluations are still

not a requirement of the TAP unless the service member is retiring. Much of this is

now changing. However, it has been a slow and difficult process. Unfortunately,

Mr. Floyd would not have had access to the services and support that are provided

to Marines leaving the military today.

011
Following his honorable discharge from the military, Mr. Floyd went on a
downward spiral: he could not find gainful employment, lacked focus,
turned to alcohol and drugs, and had to move back into his parents’ home.
Based on the lack of transition services he received, is this a typical
outcome?

Tragically, Mr. Floyd’s path after the military happens far too often. Serving

in the military provides a job in which there is real meaning. The mission of the

military is viewed by society as honorable and worthy. There is no nation in the

world that supports its military like the U.S. By all reports, Mr. Floyds mother and

stepfather, who was a retired Navy veteran, were extremely proud of Mr. Floyd

serving in the Marine Corps. Mr. Floyd was extremely proud to be a Marine. It

appears that Mr. Floyd wanted to re-enlist yet was told that he would not be

allowed to do so because of his drinking problem. Overall, one could conclude that

except for his alcohol incidents that Mr. Floyd had a fairly successful military

career.

It appears that Mr. Floyd had very little time to prepare for this transition

back to civilian life. While there are many jobs in the military that translate to

civilian jobs, Mr. Floyd did not have one of those jobs. Mr. Floyd was a weapons

specialist trainer and there are not many jobs in the civilian world for weapons

specialist trainers, especially someone who is relatively junior and at such a low

rank.

For many veterans, it is difficult to find a well-paying job in which they

derive personal meaning and satisfaction. Initially, veterans will bounce around

from one job to another until they find the job that suits them. Often veterans

012
struggle to relate to their civilian boss, often thinking their civilian boss is an “idiot”

or does not understand veterans. Most veterans cannot afford a place of their own

when they leave the military and are forced to move back home with their parents

because they have no other place to go. Naturally, many veterans see this as taking

a step backwards, having to start all over again. It is humbling. Many veterans

feel as if they wasted years of their life serving in the military. Many veterans also

leave the military with significant physical and psychological issues that have not

be diagnosed or treated.

Mr. Floyd experienced nearly all of these transition challenges. Mr. Floyd

left the military and struggled to find a job that he liked and one in which he got

along with his boss. He held several jobs in a fairly short period of time and was

unemployed the morning of the shootings. In fact, he also just moved back with his

parents because he could no longer pay his rent. Mr. Floyd never adequately

addressed his mental and behavioral health issues. His drinking behavior involving

alcohol was a major problem that continued once he left the military. Mr. Floyd

also began using drugs again, especially methamphetamine. Although Mr. Floyd

was eligible for VA care and services, there is no indication that he knew about the

services or attempted to use them.

Today, veterans enjoy many more benefits and have many more programs to

access when they leave the military than were available to Mr. Floyd’s generation of

veterans. The federal, state, and local governments provide much more support for

veterans, especially in the employment area. There are also hundreds of non-profit

013
agencies that are specifically focused on helping veterans transition back to their

communities.

What are the special or specific transition concerns related to servicemen

leaving the Marine Corps., apart from the other branches of the military?

The Marine Corps is a hypermasculine, combat focused branch of the

military. Marines pride themselves on being the Nation’s rapid reaction force:

ready to go anywhere in the world to engage in combat operations at a moment’s

notice. It has been demonstrated, for example, that junior enlisted service

members, such as Mr. Floyd, have the most difficult time transitioning back to

civilian life. Further, those service members whose military occupation was combat

arms, such as Mr. Floyd’s, also have greater difficulty transitioning back to their

civilian communities. This is primarily because the employment options are much

more limited for junior-ranking combat Marines and Soldiers. They lack experience

and job skills. Today, there are many programs to assist these Marines and

Soldiers that simply did not exist when Mr. Floyd left the Marine Corps.

Was Mr. Floyd experiencing a psychotic break before, during, and

immediately following the crimes?

The evidence presented at trial is consistent with Mr. Floyd experiencing a

methamphetamine-induced psychosis (MIP) episode prior to, during, and after the

shootings.

The biological bases for methamphetamine abuse are the highly rewarding

effects it produces due to increase dopamine release from the brain involving

10

014
activities such as eating, gambling, and engaging in sexual acts (La Rossa, 2018).

Methamphetamine use can cause hypersexuality leading to unsafe and unintended

sexual activities. Methamphetamine use also produces a flat affect, paranoia, and

cognitive deficits. Chronic methamphetamine use can lead to MIP, which has an

estimated prevalence rate of 13-50% in users. The key characteristics of MIP are

numerous. Here only those features of MIP that bear directly on the case involving

Mr. Floyd are highlighted.

The most common feature of MIP includes paranoid delusions and

persecutions, flat affect, impulsivity, and dissociation, which may be accompanied

by violent behavior. Chronic methamphetamine users frequently suffer from a

number of cognitive impairments, including deficits in executive functioning,

complex information speed, episodic memory, and psychomotor functions. MIP

episodes may occur long after drug use ceases yet recur with re-exposure to the

drug, or repeated stressful life events. MIP is comorbid with alcohol abuse.

Individuals undergoing a MIP episode are highly suicidal. MIP episodes may last

from hours to days. The facts show that Mr. Floyd was suffering from a

methamphetamine-induced psychotic state prior to, during, and after the shooting

incident.

First, Mr. Floyd admitted to being a chronic, heavy methamphetamine user

prior to joining the Marine Corps, and began using methamphetamines upon

11

015
leaving the Marine Corps.2 Mr. Floyd ingested methamphetamine the morning of

the shootings.

Second, the behavior and symptoms described by Ms. Tracie Carter, the last

person to see and to speak to Mr. Floyd before the shootings, are consistent

clinically with someone who is experiencing a methamphetamine-induced psychosis

and/or under the influence of methamphetamine. Ms. Carter describes Mr. Floyd’s

behavior as ranging from calm to erratic. Ms. Carter agreed that he was like “two

different people switching back and forth.” Yet, when asked if he was drunk or

intoxicated, she responded by saying, “I didn't think so. I mean, something was

wrong with him. . . . I couldn't tell you if he was drunk . . . but I could tell . . .

something was wrong.” Ms. Carter further described Mr. Floyd’s affect as “the

thousand-yard stare,” reminiscent of how combat veterans were described during

the Vietnam War who were so exhausted from weeks of prolonged combat yet

somehow managing to carry on.

Third, Mr. Floyd was clearly experiencing hypersexual behavior in which he

utilized an outcall service to satisfy his sexual behavior after having a falling out

with his girlfriend over losing all his money gambling at blackjack at the Rio.

Fourth, Mr. Floyd was clearly actively suicidal on the date in question.

Suicidality is highly prevalent during methamphetamine-induced psychosis. Ms.

Carter clearly indicated on two separate occasions during her testimony that Mr.

2There is no reason to doubt Mr. Floyd’s drug abstinence while serving in the
military since the Marine Corps conducts random drug urinalysis and no doubt if
Mr. Floyd was using any drugs he would have been caught.
12

016
Floyd wanted to die. After the shootings, Mr. Floyd stated categorically that he

wanted the police to shoot him when he came out of the store, a clear instance of

“suicide by proxy.” However, based on Mr. Floyd’s deep respect for the police, Mr.

Floyd was unable to take the necessary, more aggressive actions against the police

when he exited the store that would cause them to shoot and kill him.

Finally, several of the behavioral health care professionals that have

evaluated Mr. Floyd noted his psychotic and dissociative state. Dr. Edward

Dougherty stated that in his professional opinion Mr. Floyd suffered from a

“psychotic break or total breakdown of his normal mental functioning…” Dr.

Dougherty stated that “He [Mr. Floyd] didn’t at all times act knowing and

purposely.” Dr. Jakob Camp in his forensic psychiatric analyses of Mr. Floyd

described the “disillusionment and resultant dissociative rage” indicative of

dissociation. Mr. Floyd described feeling like his was in a “dream-like” state,

watching himself doing these things, yet not doing them himself. Dr. John Podboy’s

summary captured the consensus of the mental health experts who directly

assessed the mental health status of Mr. Floyd at the time of the shootings with the

following description,

“At the time of the incident, Mr. Floyd manifested what is

referred to as the "spectator phenomena," wherein he did
not experience himself doing anything. Rather, he was
watching himself engage in the activities of walking about
the supermarket.”

This description of Mr. Floyd’s behaviors and actions represent a classic dissociative

state, consistent with a methamphetamine-induced psychosis.

13

017
 Collectively the facts reviewed indicate that Mr. Floyd was suffering from a

methamphetamine-induced psychosis. It is highly likely that early life traumas,

including fetal alcohol exposure, and subsequent traumatic experiences in the

Marine Corps, especially those experienced at GITMO, contributed to Mr. Floyd’s

methamphetamine-induced psychosis. It is important to note that during a

methamphetamine-induced psychosis the individual experiencing the dissociative

state, as mentioned by the mental health experts, is not in control; indeed, what is

happening is perceived as not even real. Thus, the individual experiencing a

dissociation would see no need to stop what is happening and would see no point in

doing so.

Typically, psychotic breaks and the associated dissociate state are

accompanied by significant physical incapacitation. However, Mr. Floyd was able to

perform numerous highly complex and coordinated actions. How was Mr. Floyd

able to do this? The simple answer is that his Marine Corps training and

experience enabled him to do so.

Training in the Marine Corps, like training in all the military services,

consists of learning a task by performing a series of actions in a specific order over

and over until performing that task because automatic, routine, or innate. It is very

common, for example, for Marines and Soldiers who were engaged in combat, where

they are being shot at and their life was at stake, to describe their subsequent

behavior where they returned fire, and maneuvered on the battlefield, and killed

numerous insurgents as “being in a video game” or “going on autopilot” or saying

14

018
“my training kicked in.” These Marines and Soldiers, while in combat, were

clinically in a “dissociative” state; they were doing what they were trained to do.

Often, they do not remember all the actions they performed. However, these

combat veterans do remember some of their actions, particularly those actions that

touch upon a deeply held moral belief, such as the killing or saving a woman or

child or saving a fellow team from being injured or killed.

In the current case, the prosecution identified numerous actions performed

by Mr. Floyd that purported to demonstrate “purpose and knowledge.” However,

the entire episode can easily be accounted for by the training that Mr. Floyd

received while in the Marine Corps. Getting dressed in the military gear, the

camouflaging of his shotgun with the bathrobe, the route he took to the grocery

store, the loading and firing of the shot gun, his movements through the store,

acquiring “targets,” were all acts that would have been second nature to Mr. Floyd

based on his Marine Corps training. All of these acts were likely performed while

he was “on autopilot,” while he was experiencing a MIP (a psychotic break). That

Mr. Floyd referred to his victims as “targets” and not as people is further evidence

that he was dissociating.

Suicide by proxy

Mr. Floyd possessed numerous risk factors for dying by suicide: he lost his

job, he lost all his money gambling at blackjack, his girlfriend broke up with him,

and he was forced to move back in with his parents because he couldn’t pay his rent.

To Mr. Floyd, his prospects and future were bleak. He viewed himself as a “loser.”

15

019
He felt like he was a burden to everyone around him. Mr. Floyd was actively

suicidal. He wanted his life to end.

Mr. Floyd was high on methamphetamine and experiencing a psychotic

break. Suicidal thoughts are heightened during methamphetamine-induced

psychosis. These are all immediate risk factors for dying by suicide.

Mr. Floyd’s post-arrest statements

Mr. Floyd’s post-arrest audio statement can best be described as confused.

Throughout his statement, Mr. Floyd was constantly searching for answers as to

why he shot the people in the grocery store. Mr. Floyd repeatedly said, “I don’t

know why!,” when asked by the police, “Why did you do it?” When one listens to

that audio closely, the tone and pitch of Mr. Floyds’ voice and speech presents as if

he is still in a psychotic state. Mr. Floyd’s speech is slurred, almost as if he is out of

breath. Towards the end of the audio recording, Mr. Floyd is still searching for an

answer as to why he did it, like he was asking himself the same question. Mr. Floyd

eventually said, “I am thinking what’s it going to be like to shoot somebody?”

However, this is not a declarative answer to the question, “Why did you do it?” It is

not a definitive statement of his motivation. It is a searching question that he is

asking of himself. The only definitive statement that Mr. Floyd does make involves

the uncertainty about his own mental sanity, “I don't know what's wrong with me!”

This is a cry for help. A statement of desperation. In all the testimonies involving

interviews with mental health experts, Mr. Floyd constantly asks the mental health

16

020
experts to whom he spoke the same question, “Why did I do it?” Importantly, Mr.

Floyd is asking this question not to avoid taking responsibility but to understand

who he is.

Further, in none of the psychiatric interviews reviewed does Mr. Floyd ever

say, “…he wanted to know what it would feel like to kill” or “he wanted to know

what it was like to kill.” The only witness who claimed that Mr. Floyd made these

statements was Ms. Carter, who made these claims weeks after the incident.

It is doubtful that Mr. Floyd will ever be able to recount what happened given

his mental state at the time. Nevertheless, all the available evidence indicates that

Mr. Floyd was in a methamphetamine-induced psychotic state.

Dated: April 26, 2021

___________________________________
Carl Andrew Castro, Ph.D.

17

021
 Page 1 of 63
CURRICULUM VITAE
CARL ANDREW CASTRO, Ph.D.
Professor and Director
Colonel, U.S. Army (Retired)

Suzanne Dworak-Peck School of Social Work

669 West 34th Street
University of Southern California
Los Angeles, CA 90089-0411

Telephone: (213) 821-3623, Office

(240) 529-4678, Mobile
Email: [email protected]

SUMMARY OF CV

• 154 peer-reviewed publication and 30 book chapters

• 65 published technical reports, letters and proceedings
• 9 books (authored or edited)
• $30,903,085 in funded, federal research grants (PI or co-PI)
• 27 national or international advisory boards served or chaired

H-index: 58 (Google Scholar)

EDUCATION

Ph.D. 1989 University of Colorado, Boulder, Psychology

M.A. 1987 University of Colorado, Boulder, Psychology

B.A. 1985 Wichita State University, Psychology (Summa Cum Laude)

SUB-FIELDS AND AREAS OF RESEARCH

Military and Behavioral Health Theory; Global Military Health; Military Transitions; Trauma;
Leadership and Health; Organizational Interventions; Cultural Integration (Diversity, Acceptance

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and Equity); Work Stress and Performance; PTSD, Suicide and Risk-Taking Behaviors; Sexual
Assault; Bullying and Hazing; Resilience and Mental Health Training; Moral Injury

ACADEMIC POSITIONS

2020 – Present Professor, Suzanne Dworak-Peck School of Social Work,

University of Southern California, Los Angeles, CA

2020 – Present Professor, Department of Psychology, University of Southern California,

Los Angeles, CA

2017 – Present Director, Military and Veteran Programs, Suzanne Dworak-Peck School
of Social Work, University of Southern California, Los Angeles, CA

2017 – Present Director, Military Academic Center, Suzanne Dworak-Peck School of

Social Work, University of Southern California, Los Angeles, CA

2015 – Present Director, Center for Innovation and Research on Veterans and Military
Families, Suzanne Dworak-Peck School of Social Work,
University of Southern California, Los Angeles, CA

2016 – 2020 Associate Professor, Suzanne Dworak-Peck School of Social Work,

University of Southern California, Los Angeles, CA

2013 – 2016 Assistant Professor, Suzanne Dworak-Peck School of Social Work,

University of Southern California, Los Angeles, CA

2013 – 2015 Director of Research, Center for Innovation and Research on Veterans and
Military Families, Suzanne Dworak-Peck School of Social Work,
University of Southern California, Los Angeles, CA

2002 – 2013 Adjunct Lecturer for graduate students in Clinical Psychology,

Uniform Services University of the Health Sciences, Bethesda, Maryland

1985 – 1989 Research Assistant, Department of Psychology,

University of Colorado, Boulder

1985 – 1989 NSF Graduate Fellow, Department of Psychology,

University of Colorado, Boulder

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1983 – 1985 Research Assistant, Department of Psychology,
Wichita State University, Kansas

MILITARY PROFESSIONAL EXPERIENCE

2007 – 2013 Director, Military Operational Medicine Research Program

Headquarters, U.S. Army Medical Research and Materiel Command,
Fort Detrick, Maryland

2004 - 2007 Chief, Department of Military Psychiatry

Walter Reed Army Institute of Research,
Washington D.C.

2003-2004 Team Leader, Mental Health Advisory Team (IV)

Multi-National Forces-Iraq (MNF-I), Camp Victory, Iraq

2002-2003 Chief, Soldier and Family Readiness Branch

Walter Reed Army Institute of Research,
Washington D.C.

2002 Senior Science Officer, Mental Health Advisory Team (I)

V Corps, Green Zone, Iraq

2001 - 2002 Chief, Soldier and Family Readiness Branch

Walter Reed Army Institute of Research,
Washington D.C.
- Deployed to Kosovo (2002)

1997 - 2001 Commander, U.S. Army Medical Research Unit-Europe,

Heidelberg, Germany
- Deployed to Bosnia (1998-1999)
- Deployed to Kosovo (1999)

1996 – 1997 Team Leader, TF XXI Human Dimensions Assessment,

Department of Military Psychiatry.
Walter Reed Army Institute of Research, Washington D.C.

1995 – 1996 Program Director, Primate Research Facility,

Division of Neuropsychiatry, Department of Medical Neurosciences.
Walter Reed Army Institute of Research, Washington D.C.

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1994 Assistant Program Director, Depleted Uranium, Radiation

Biophysics Department.
Armed Forces Radiobiology Research Institute, Bethesda, Maryland

1992 - 1994 Assistant Program Director, Program in Sensory and

Motor Behavior, Behavioral Science Department.
Armed Forces Radiobiology Research Institute, Bethesda, Maryland

1991 - 1992 Program Manager, Operational Performance Evaluation,

Advanced Assessment Branch, Drug Assessment Division.
U.S. Army Medical Research Institute of Chemical Defense, Aberdeen,
Maryland

1991 Chief (Acting), Applied Pharmacology Branch,

Pharmacology Division, U.S. Army Medical Research Institute of
Chemical Defense, Aberdeen, Maryland

1989 - 1990 Research Psychologist, Advanced Assessment Branch,

Drug Assessment Division, U.S. Army Medical Research Institute of
Chemical Defense, Aberdeen, Maryland

HONORS AND SPECIAL AWARDS

2019 Society for Military Psychology Presidential Citation. The American

Psychological Association.

2019 Sterling C. Franklin Distinguished Faculty Award. The USC Suzanne

Dworak-Peck School of Social Work

2018 Outstanding Research Accomplishment Team/Academia for Senior

Advisor of the Military Suicide Research Consortium, the Department of
Defense Military Health Systems Research Symposium

2017 Scientific Achievement Award for Research and Technology Group on

Military Suicides, NATO Human Factors and Medicine Panel

2017 Gersoni Award, Outstanding contribution for research accomplishment in

the area of military psychology. The Society of Military Psychology,
American Psychological Association

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2014 Appointed Fulbright Specialist, J. William Fulbright Foreign Scholarship

Board

2013 President’s Special Recognition Award, Suicide Prevention Society

2008, 2012, 2013 Legion of Merit Medal, U.S Army (second highest medal awarded by the
US Army for outstanding service), awarded 23 other military medals and
decorations

2008 – 2012 Consultant (Research Psychology) to the Surgeon General of the U.S.
Army

2011 The Foster Award, NATO Human Factors and Medicine Panel,
Bergen, Norway (awarded once a year to the most outstanding Chair of a
NATO research activity)

2010 Order of Military Medical Merit (awarded to the top 1% of Army Medical
Department personnel.)

2007 Promoted to Colonel, U.S Army (highest ranking field grade officer just
below the ranks of general)

2006 – Present Fellow, Military Psychology (Division 19), American Psychological

Association

2003 Combat Casualty Care Award for Innovative Technology Excellence

2000 The Commander’s Award for Excellence in Improving Healthcare

1999 International Applied Military Psychology Symposium Award for Efforts

to Foster International Collaboration

1990 Chief of the Medical Service Corps Award of Excellence (for the most
outstanding junior officer)

1988 – 1989 Graduate School Fellowship

1988 Fellow, Cognitive Neuroscience, Harvard University, Cambridge, MA

1985 – 1988 Patricia Roberts Harris Fellowship

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1985 – 1988 Arnold Trust Fellowship

1985 Academic Research Scholarship

1983 – 1984 Charles Rickman Academic Scholarship

1982 – 1985 Myrral Houck Academic Scholarship

1981 – 1985 Army National Guard Scholarship

1981 Kansas State Scholar

FUNDED RESEARCH: Federal Grants

2019-2023 Co-Principal Investigator (PI: Hazel Atuel), Title: Exploring the Social
Network of Homegrown Violent Extremist (HVE) Military Veterans,
National Institute of Justice. Total Award: $1,670,395).

2018 – 2022 Co-Principal Investigator (PI: Michalle Mor Borak), Title: Performance
Outcomes of Inclusion Policy-Practice Decoupling: Diversity, Leadership
and Climate for Inclusion, Army Research Institute for the Behavioral
and Social Sciences. Total Award: $1,020,050.

2017 – 2020 Consultant (PI: Bradley Nindl), Title: Characterization of Psychological

Resilience and Readiness: Cross-Validation of Cognitive and Behavioral
Metrics during Acute Military Operational Stress, Department of Defense.
Total Award: $2,500,000.

2017- 2019 Co-Principal Investigator (PI: Eric Rice), Title: Predictive Modeling for
Early Identification of Suicidal Thinking in Social Networks, Army
Research Office. Total Award: $597,055.

2017–2019 Consultant, (PI: Hendler, Tel Aviv; USC Site PI: Jeremy Goldbach). Talk
2UR Brain. Department of Defense. $502,201.

2016 – 2018 Consultant (PI: Jae Yop Kim), Title: Developing a Korean Military
Social Work Program to Improve Quality of Life among Personnel and
Veterans: A Global network with the U.K, the U.S. and South Korean,
Korean National Institute of Health. Total Award: $438,000.

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2016 Principal Investigator, Title: Comprehensive Soldier and Family Fitness

II, Department of the Army. Total Award: $95,406

2015 - 2018 Principal Investigator (multiple PI’s: J. Goldbach and I. Holloway),

Title: Improving Acceptance, Integration, and Health among LGBT
Service Members, Department of Defense. Total Award: $1,894,846

2015 - 2018 Mentor (PI: Kathryn Sullivan), Title: Health and Mental Health
Outcomes Associated with Profiles of Risk and Resilience among Military-
Connected Youth, National Institutes of Health (F31). Total Award:
$34,135

2015 – 2017 Consultant (PI: Tamika Gilreath), Title: Measuring Stress in Military-
Connected Adolescents, National Institutes of Health (R21). Total Award:
$475,000.

2014-2018 Consultant (PI: Hazel Atuel), Title: Virtual Reality as a Tool for
Enhancing the Proficiency of Behavioral Health Providers, Department of
Defense. Total Award: $5,157,314.

2014 – 2015 Principal Investigator, Title: Comprehensive Soldier and Family Fitness,
Department of the Army. Total Award: $84,222

2013 – 2015 Principal Investigator, Title: Military Suicide Research Consortium.

Department of Defense/Denver Research Institute. Total Award: $43,537

2004 – 2010 Principal Investigator, Title: Battlemind Training,

Department of the Army. Total Award: $5,000,000

2002 – 2010 Principal Investigator, Title: The Land Combat Study,

Department of the Army. Total Award: $18,000,000

2001 – 2008 Co-Principal Investigator, USAREUR Family OPTEMPO Study,

Department of the Army. Total Award: $250, 000

2001 – 2004 Co-Principal Investigator, Title: Psychological Debriefing in Soldiers

Returning from Combat, Department of the Army. Total Award: $900,000

1998 – 2004 Co-Principal Investigator, Title: Post-deployment Mental Health

Screening, Department of the Army. Total Award: $490,000

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1998 – 2002 Principal Investigator, Title: USAREUR Soldier Study, Department of

the Army. Total Award: $900,000

FUNDED RESEARCH: Foundations and Corporations

2018 – 2019 Principal Investigator, Title: Veterans Employment Strategy (VES),

Carl and Roberta Deutsch Foundation. Total Award: $60,000

2018 – 2020 Principal Investigator, Title: Boys in the Barracks Revisited, Cohen
Veterans Network. Total Award: $245,520

2016 – 2018 Principal Investigator, Title: Cohen Veterans Network Program

Evaluation and Implementation, Cohen Veterans Network. Total:
$1,193,569

2015 – 2017 Principal Investigator, Title: The San Francisco Veterans Study, Wells
Fargo. Total Award: $350,000

2016 – 2017 Principal Investigator, Title: The San Francisco Veterans Study
Supplement, Deloitte. Total Award: $60,000

2015 – 2017 Principal Investigator, Title: Prevention of suicide and suicidal

behaviors, Wounded Warrior Project. Total Award: $116,587.

2015 – 2016 Co-Principal Investigator, Title: The Veteran Needs of Chicagoland,

McCormick Foundation. Total Award: $316,000

2013 – 2015 Principal Investigator (multiple PI’s: A. Hassan), Title: The Los Angeles
Veterans Study, Newman’s Own, Deloitte, UniHealth Foundation,
Prudential. Total Award: $400,000

2013 – 2016 Principal Investigator, Title: Orange County Veterans Study

Orange County Community Foundation, UniHealth Foundation.
Total Award: $200,000

FUNDED NON-RESEARCH Grants

2016 – present Endowment, Center for Innovation and Research on Veterans

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and Military Families. Total: $105,500; Target: $10 million

2019 – 2020 Principal Investigator, Center for Innovation and Research on Veterans
and Military Families Operations, Prudential Financial Foundation. Total
Award: $350,000

2016 – 2020 Principal Investigator, Title: The Ahmanson Foundation Veteran

Scholarship Initiative (AVSI) Military. The Ahmanson Foundation. Total
Award: $300,000

2018 – 2019 Principal Investigator, Center for Innovation and Research on Veterans
and Military Families Operations, Prudential Financial Foundation. Total
Award: $250,000

2017 – 2018 Principal Investigator, Center for Innovation and Research on Veterans
and Military Families (CIR): Military Academic Center, Cigna
Foundation Healthier Communities Grant. Total: $120,000

2017- 2018 Principal Investigator, Center for Innovation and Research on Veterans
and Military Families Operations, Prudential Financial Foundation. Total
Award: $300,000

2017 - 2019 Principal Investigator, Center for Innovation and Research on Veterans
and Military Families Operations, May and Stanley Smith Charitable
Trust. Total: $200,000

2016 Principal Investigator, Title: The forgotten wounds of war-an

interdisciplinary and international discourse on healing the wounds of
moral injury. The Borchard Foundation. Total Award: $35,000

2015 - 2016 Principal Investigator, Center for Innovation and Research on Veterans
and Military Families Operations, Prudential Financial Foundation, May
and Stanley Smith Charitable Trust, and Ralph M. Parsons Foundation.
Total: $850,000

SUBMITTED AND PENDING RESEARCH GRANTS

Co-Principal Investigator. Title: Integrating Social Network Analysis and Sexual Assault
Prevention: Targeted Effective Skills Training (EST) for Ending Sexual Assault. PI: Sara Kintzle.
DoD. Total: $2,029,666

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Co-Investigator. Title: Exploring Lived Experiences of Military Spouses on Foreign Postings
Across the Readiness Cycle. PI: Kate Sullivan. DoD. Total: 1,967,836

Co-Principal Investigator. Title: Targeted Alcohol Problem Prevention for Enlisted Personnel:
an Empirically Driven Approach. PI: John Clapp. DoD. Total: $2,483,141

Co-Principal Investigator. Title: Motherhood and Military Readiness: Examining the Return to
Active Duty after Childbirth for Women in the Armed Forces. PI: Sara Kintzle. DoD. Total:
$1,250,048

Principal Investigator, Center for Innovation and Research on Veterans and Military Families
Operations, Prudential Financial Foundation. Total Award: $200,000

SUBMITTED, NOT FUNDED RESEARCH GRANTS

Co-Principal Investigator. Title: Comprehensive Suicide Communications Research Program

Adopting a Suicide Assessment Virtual Experience (SAVE GAME; PI: Thomas Talbot, PI
(Main). CIR Subcontract (Hazel Atuel, PI; Sara Kintzle, Co-PI; and, Carl Castro, Co-PI).
Department of Defense.

Co-Investigator. Title: Mobile Mindfulness Intervention for Alcohol Use Disorder and PTSD
among OEF/OIF Veterans. PI: Davis & Pedersen. NIAAA. Total Award: $2,820,209

Co-Investigator. Title: A Mobile Mindfulness Intervention to Address Problematic Cannabis

Use among Veterans with PTSD. PI: Davis & Pedersen. NIDA. Total Award: $2,890,064

PUBLICATIONS

Research Papers - Peer reviewed

*Mentor role since arriving at the University of Southern California.

**Principal Investigator on the study the findings are based.

Goldbach, J., Schrager, S., Mamey, M. Klemmer, C., Holloway, I. & Castro, C. A. (submitted).
Development and Validation of the Military Minority Stress Scale. Applied Psychological
Measurement.

Markowitz, F. E., Kintzle, S. M. & Castro, C. A. Military-to-civilian adjustment strains and

risky and illegal behavior among U.S. veterans (submitted). Criminology.

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Davis, J. P., Lee, D. S., Saba, S., Fitzke, R. E,, Ring, C., Castro, C. A., & Pedersen, E. R.
(submitted). Applying poly-victimization theory to veterans: Associations with substance use
and mental health. Manuscript submitted for publication. PLOS ONE.

Saba, S., Davis, J., Castro, C. A. & Pedersen, E. (submitted). Associations between Symptoms
of Posttraumatic Stress Disorder, Pain, and Alcohol Use Disorder among Veterans. Drug and
Alcohol Dependence.

O’Loughlin, J. I., Cox, D. W., Ogrodniczuk, J. S., & Castro, C. A. (submitted). Disentangling
the individual and group effects of traditional masculinity ideology on PTSD symptom change:
Veteran men in a group treatment. Psychology of Men and Masculinities.

Atuel, H. R., Schuyler, A., Ursich, L., Kintzle, S. & Castro, C. A. (submitted). A mixed-method
study implementing cognitive processing therapy among community-based mental health
providers. Implementation Science.

Atuel, H. R., Strauss, K. & Castro, C. A. (submitted). Exploring mass shootings and violence
among military veterans. American Journal of Public Health.

Kintzle, S., Schuyler, A. C. & Castro, C. A. (submitted). The continuum of sexual trauma: An
examination of stalking and sexual assault in former US service members. Journal of
Interpersonal Violence.

McNamara, K. A., Goldbach, J. T., Kintzle, S. & Castro, C. A. (submitted). Sexual minority
status as a predictor of mental health and help-seeking among U.S. veterans. American Journal
of Public Health.

Raymond, H. F., Holloway, I. W., Wu, El, Tan, D., Mamey, M. R. Goldbach, J. T., Castro, C.
A., Schrager, S. M. (revise and resubmit). Recruiting sexual and gender minority United States
military personnel for research via peer networks: Successes and challenges.

Castro, C.A., Schuyler, A., Kintzle, S. & Warner, C. (revise and resubmit). Responding to
campus-based sexual assaults. Current Psychiatry Reports.

Atuel, H., Kintzle & Castro, C. A. (submitted). A mixed method study on implementing
cognitive processing therapy among community-based mental health providers. Journal of
Evidence-based Research.

*McNamara, K., Lucas, C. L., Goldbach, J. T., Holloway, I. W. & Castro, C. A. (revise and
resubmit). Even if the policy changes, the culture remains the same: A mixed methods analyses

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of LGBT service members’ Outness patterns post-LGBT military service bans. Armed Forces
and Society.

Atuel, H., Kintzle, S. & Castro, C.A. (submitted). Tri-ethnic comparison of veterans’ military
to civilian transition difficulty: The case for cultural competence.

Atuel, H., Jones, E., Greenberg, N., Williamson, V., Barr, N., Vermetten, E., Jetly, R. & Castro,
C. A. (in press). Understanding moral injury from a character domain perspective. Journal of
Theoretical and Philosophical Psychology. DOI: 10.1037/teo0000161.

Fulginiti, A., Segal, A., Wilson, J., Hill, C., Tambe, M., Castro, C., & Rice, E. (in press).
Getting to the root of the problem: A decision-tree analysis for suicide risk among homeless
youth. Journal of the Society for Social Work and Research.

Sullivan, K.S., Dodge, J., Williamson, V., Alves-Costa, F., Barr, N., Kintzle, S. Fear, N. T.,
Castro, C. A. (in press). Preliminary exploration of the relationship between veteran family
membership, school climate, and adverse outcomes among school-aged youth. Education and
Urban Society.

*Sullivan, K., Barr, N., Kintzle, S. & Castro, C. A. (in press). Impact of mental and physical
health on the family functioning of veterans. Journal of Marriage and Family.

154. Holloway, I. W., Green, D., Pickering, C., Wu, Elizabeth, Tzen, Michael, Goldbach, J. T.
& Castro, C. A. (2021). Mental health and health risk behaviors of active duty sexual minority
and transgender service members in the United States Military. LGBT Health.

153. Lucas, C. L., Harris, T., Stevelink, S. Rafferty, L., Talisha, M., Kwan, J., Dunn, R., Fear,
N., Kintzle, S. M. & Castro, C. A. (2021). Homelessness among veterans: posttraumatic stress
disorder, depression, physical health, and the cumulative trauma of sexual assault. Journal of
Social Work and Research.

152. Dunlap, S., Holloway, I. W., Pickering, C. E., Tzen, M., Goldbach, J. T., Castro, C. A.
(2021). Support for Transgender Military Service from Active Duty United States’ Military
Personnel. Sexuality Research and Social Policy, 18, 137-143. https://rdcu.be/b1PUF

151. Klemmer, C. L., Schuyler, A. C., Mamey, M. R., Schrager, S., Castro, C., Goldbach, J. T.,
Holloway, I. W. (2020). Health and service-related impact of sexual and stalking victimization
during United States military service on LGBT service members. Journal of Interpersonal
Violence.

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150. Blair, C., Dunlap, S., Castro, C., Goldbach, J., & Holloway, I. (2020). Mental health,
sexual orientation, and perceived social network support in relation to hazardous alcohol
consumption among active duty military men. American Journal of Men’s Health. DOI:
https://doi.org/10.1177/1557988320976306

149. Williamson, V., Greenberg, N., Murphy, D., Vermetten, E., Jetly, R. & Castro, C. A.
(2020). Moral injury and the need to carry out ethically responsible research. Research Ethics.
DOI:10.1177/1747016120969743

148. *Sullivan, K. S., Hawkins, S. A., Gilreath, T. D. & Castro, C. A. (2020). Mental health
outcomes associated with risk and resilience among military-connected youth. Family Processes.
DOI: 10.1111/famp.12596.

147. Gribble, R., Maha, A. L., Keeling, M., Sullivan, K., McKeown, S., Burchill, S., Fear, N. T.
& Castro, C. A. (2020). Are we family? A scoping review of how military families are defined
in mental health and substance use research. Journal of Military, Veteran and Family Health, 6,
85-119. DOI:10.3138/jmvfh-2019-0054

*146. Sullivan, K. S., Hawkins, S. A., Gilreath, T. D. & Castro, C. A. (2020). Preliminary
Psychometrics and Potential Big Data Uses of the U.S. Army Family Global Assessment Tool,
Military Behavioral Health, 8, 74-85.

145. Shelton, C. J., Kim, A., Hassan, A., Bhat, A., Barnello, J. & Castro, C. A. (2020). System-
wide implementation of telehealth to support military veterans and their families in response to
the COVID-19: A paradigm shift. Journal of Military, Veteran and Family Health.

*144. Sullivan, K. S., Hawkins, S. A., Gilreath, T. D. & Castro, C. A. (2020). Mental health
outcomes associated with profiles of risk and resilience among U. S. Army spouses. Journal of
Family Psychology.

*143. McNamara, K., Lucas, C. L., Goldbach, J. T., Holloway, I. W., Castro, C. A. (2020).
You don’t want to be a candidate for punishment”: A qualitative analysis of LGBT service
members’ disclosure decision-making after repeal of LGBT military service bans. Sexuality
Research and Social Policy. DOI; 10.1007/s13178-020-00445-x.

142. Williamson, V., Sullivan, K., Castro, C. A., Fear, N. (2020). Youth offending in military
connected children. Journal of Military and Veteran Families, 6, 108-111. DOI: 10.3183/jmvfh-
2018-0050.

141. Atuel, H. R., Chesnut, R., Richardson, C., Perkins, D. F. & Castro, C. A. (2020).
Exploring moral injury: Theory, measurement, and applications. Military Behavioral Health,

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DOI: 10.1080/21635781.2020.1753604. To link to this article:
https://doi.org/10.1080/21635781.2020.1753604

140. Keeling, M., Barr, N., Atuel, H. & Castro, C. (2020). Symptom severity, self-efficacy and
treatment-seeking for mental health among US Iraq/Afghanistan military veterans. Community
Mental Health. DOI: 10.1007/s10597-020-00578-8.

139. McFarlane, A., Jetly, R. Castro, C. A., Greenberg, N., & Vermetten, E. (2020). Impact of
COVID-19 on mental health care for Veterans: Improvise, adapt and overcome. This article is
under review by the Journal of Military, Veteran and Family Health. Due to the importance of
the subject matter, and rapidly changing nature of the topic, a pre-publication version of this
paper was published on line at https://jmvfh.utpjournals.press/toc/jmvfh/COVID-19

*138. O’Loughlin, J. I., Cox, D. W., Ogrodniczuk, J. S., & Castro, C. A. (2020). The
association between traditional masculinity ideology and predictors of military to civilian
transition in veteran men. Journal of Men’s Studies.

137. Schuyler, A., Klemmer, C., Mamey, M. R., Goldbach, J. T., Holloway, I. W. & Castro, C.
A. (2020). Experiences of military sexual harassment, stalking, and sexual assault among LGBT
and non-LGBT service members. Journal of Traumatic Stress. https://doi:org/10.102/jts.22506.

*136. Barr, N., Davis, J., DiGuiseppi, N., Keeling, M., & Castro, C.A. (2019). Mindfulness
and self-stigma of mental illness. Psychological Trauma, Theory, Practice, Research and
Policy. https://doi.org/10.1037/tra0000535.

*135. Barr, N., Keeling, M. & Castro, C. A. (2019). Association between mindfulness, PTSD
and depression in combat deployed post-911 veterans. Mindfulness. DOI: 10.1007/s12671-019-
1212-9.

134. Markowitz, F. E., Kintzle, S. M., Castro, C. A. & Lancaster, S. L. (2019). Effects of
perceived public regard on the well-being of military veterans. Society and Mental Health.
DOI: 10.1177/2156869319894372

*133. Mark, K. H., McNamara, K. A., Gribble, R., Rhead, R., Sharp, M.-L., Stevelink, S.A.M.,
Schwartz, A., Castro, C.A. & Fear, N.T. (2019). The health and wellbeing of LGBTQ serving
and ex-serving personnel: A narrative review. International Review of Psychiatry, 31, 75-94.
doi:http://dx.doi.org.libproxy1.usc.edu/10.1080/09540261.2019.1575190

132. Kintzle, S., Schuyler, A. C., Alday-Mejia, E., & Castro, C. A. (2019). The continuum of
sexual trauma: An examination of stalking and sexual assault in former U.S. service members.
Military Psychology, 31, 474-480.

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*131. Lucas, C. L., Cederbaum, J. A., Kintzle, S. & Castro, C. A. (2019). An Examination of
Stalking Experiences during Military Service among Female and Male Veterans and
Associations with PTSD and Depression. Journal of Interpersonal Violence.
https://doi.org/10.1177/0886260519889944

130. Castro, C.A. & Adler, C.A. (2019). Transitions: A theoretical model for Occupational
health and wellbeing. Occupational Health Science, 3, 105-123. Advance Online Publication.
https: //doi.org/10.1007/s41542-019-00043-3

129. Atuel, H.R., Urisch, L., Schuyler, A., Berg, D., Kintzle, S. & Castro, C. A. (2019).
Implementing the Knowledge Assessment of CPT Critical Skills (KACCS) Scale. Military
Medicine, 184, 461-466. DOI: 10.1093/miled/usy341

128. Thomas, J.T., Bliese, D.P., Castro, C.A., Cotting, D.I., Cox, A. & Adler, A.B. (2019).
Mental health training following combat: a randomized control trial comparing training group
size. Military Behavioral Health. DOI: 10.1080/21635781.2018.1526724

*127. McNamara, K. A., Lucas, C. L., Goldbach, J. T., Kintzle, S. & Castro, C. A. (2019).
Mental health of the bisexual veteran. Military Psychology, 31, 91-99, DOI:
10.1080/08995605.2018.1541393.

*122. Barr, N., Kintzle, S., Alday, E. & Castro, C. A. (2019). How does discharge status
impact suicide risk in military veterans. Social Work and Mental Health, 17, 48-58.
doi:http://dx.doi.org.libproxy1.usc.edu/10.1080/15332985.2018.1503214

115. Keeling, M., Ozuna, S., Kintzle, S. & Castro, C. A. (2019). Veterans’ civilian employment
experiences: Lessons learnt from focus groups. Journal of Career Development, 46, 692-705.
Published online at https://doi.org/10.1177/0894845318776785

*126. Sullivan, K., Kintzle, S., Barr, N. Gilreath, T., & Castro, C.A. (2018). Veterans’
social/emotional and physical functioning informs perceptions of family and child functioning.
Journal of Military, Veteran and Family Health, 4, 37-47. DOI: 10.3138/jmvfh.2017-0008

125. Kintzle, S., Ozuna, S., Keeling, M, Corletto, G., Berg, D., Munch, C., Atuel, H. & Castro,
C. A. (2018). The Use of Virtual Clients For Training Behavioral Health Providers: Promises,
Challenges and the Way Ahead", submitted to the Journal of Technology in Behavioral Science.
Journal of Technology in Behavioral Science, 3, 247-252. DOI: 10.1007/s41347-018-0058-2

124. Kintzle, S. & Castro, C.A. (2018). Examining veteran transition to the workplace through
military transition theory. Research in Occupational Stress and Well Being, 15, 117-127. DOI:

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*123. Wood, M. D., Adler, A. B., Bliese, P. D., McGurk, D., Castro, C.A., Charles W. Hoge,
C. W. & Koffman, K. (2018). Psychological Adjustment after Combat Deployment:
Decompression at Home versus at Sea. Military Behavioral Health, 6, 259-270. DOI:
10.1080/21635781.2017.1412842

121. Kintzle, S., Barr, N., Corletto, G. & Castro, C.A. (2018). PTSD in U.S. veterans: The role
of social connectedness, combat experience and discharge. Healthcare, 6 (102), 1-7. Published
online at https://doi.org/10.3390/healthcare6030102

120. Porter, B., Hoge, C.W., Tobin, L.E., Donoho, C.J., Castro, C.A., Luxton, D.D., Faix,
Dennis (2018). Measuring Aggregated and Specific Combat Exposures Associations with Post-
Traumatic Stress Disorder, Depression, and Alcohol-Related Problems. Journal of Traumatic
Stress. DOI: 10.1002/jts.22273.

119. Huffman, A.H., Dunbar, N., Broom, T.W. & Castro, C.A. (2018). Soldiers’ perspectives
of the married couples program: a review of perceived problems and proposed solutions.
Military Psychology, 30, 335-349. DOI: 10.1080/08995605.2018.1478537.

*118. Lucas, L.L., Mamey, M. R., Goldbach, J.T., Kintzle, S. & Castro, C. A. (2018). Military
Sexual Assault as a mediator of post-traumatic stress disorder and depression among lesbian,
gay, and bisexual veterans. Journal of Traumatic Stress. DOI: 10.1002/jts.22308.

*117. Keeling, M., Kintzle, S. & Castro, C.A. (2018). Exploring the experiences of US
veterans’ post service employment challenges. Military Psychology. Military, 30, 63-69.
DOI:10.1080/08995605.2017.1420976

*116. Harris, T., Winetrobe, H., Rhoades, H., Castro, C. A., & Wenzel, S. (2018). Moving
beyond housing: Service implications for veterans entering permanent supportive housing.
Clinical Social Work Journal, 46, 130-144.
http://dx.doi.org.libproxy1.usc.edu/10.1007/s10615-018-0648-7

114. Atuel, H. R. & Castro, C. A. (2018). From military cultural competence to military-
cultural competence. Clinical Social Work Journal.

**113. Lancaster, S., Kintzle, S. & Castro, C. A. (2018). Validation of the warrior identity
scale in the Chicagoland veterans study. Self and Identity, 18, 34-43. DOI:
https://doi.org/10.1080/15283488.2017.1410157

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*112. Barr, N., Sullivan, K., Kintzle, S. & Castro, C. A. (2017). Suicidality and Non-Suicidal
High Risk Behavior in Military Veterans: How does PTSD Symptom Presentation Relate to
Behavioral Risk? Traumatology. Advance online publication.
http://dx.doi.org/10.1037/trm0000133

*111. Harris, T., Kintzle, S., Wenzel, S. & Castro, C.A. (2017). Expanding the Understanding
of Risk Behavior Associated with Homelessness among Veterans. Military Medicine, 182,
e1900-e1907. DOI:10.7205/MILMED-D-16-00337

**110. Hawkins, S.A., Sullivan, K.S., Schuyler, A.C., Keeling, M., Kintzle, S., Lester, P.B., &
Castro, C.A. (2017). Thinking “big” about research on military families. Military
Behavioral Health, 5, 335-345.

*110. Hoge, C.W., Lee, D.J. & Castro, C.A. (2017). Refining trauma-focused treatments for
service members and veterans with posttraumatic stress disorder. Journal of the American
Medical Association Psychiatry, 74, 13-14. DOI:10.1001/jamapsychiatry.2016.2740.

*109. Schuyler, A.C., Kintzle, S., Lucas, C. L., Moore, H., & Castro, C. A. (2017). Military
sexual assault (MSA) among veterans in Southern California: Associations with physical health,
psychological health, and risk behaviors. Traumatology, 23(3), 223-234.
DOI:10.1037/trm0000098

*108. Sullivan, K., Barr, N., Kintzle, S., Gilreath, T. & Castro, C. A. (2016). The Association
of PTSD and Physical health symptoms with the family functioning of veterans. Marriage and
Family Review, 52(7) 689-705. DOI:10.1080/01494929.2016.1157122

*107. Barr, N., Sullivan, K., Kintzle, S. & Castro, C. A. (2016). PTSD symptoms, suicidality
and non-suicidal risk to life behavior in a mixed sample of pre- and post-9/11 veterans. Social
Work in Mental Health, 14. DOI: 10.1080/15332985.2015.1081666.

106. Hoge, C.W., Yehuda, R. Castro, C.A., McFarlane, A.C, Vermetten, E. Jetly, R. Koenen,
K.C., Greenberg, N., Shalev, A.Y., Rauch, S.A.M. Marmar, C.R., Rothbaum, B. (2016).
Unacceptable Consequences of Changing the PTSD Definition in DSM-5: Call for Action. New
England Journal of Medicines, Published on line, May 25,

**105. Britt, T.W., Herleman, H.A., Odle-Dusseau, H.N., Moore, D., Castro, C.A. & Hoge,
C.W. (2016). How stressful events at work may produce benefits that reduce mental health
symptoms. International Journal of Stress Management. Advance online publication. http://
dx.doi.org/10.1037/str0000026

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104. Goldbach, J.T. & Castro, C.A. (2016). Lesbian, gay, bisexual and transgender (LGBT)
service members. Current Psychiatry Reports, 18, 1-7. DOI 10.1007/s11920-016-0695-0

*103. Kintzle, S., Schuyler, A., C., Ray-Letourneau, D., Ozuna, S. M., Munch, C., Xintarianos,
E., Hassan, A. M. & Castro, C. A. (2015). Sexual trauma in the military: Exploring PTSD and
mental health service utilization in female veterans. Psychological Services, 12, 394-401.

102. Castro, C.A., Kintzle, S. & Hassan, A.M. (2015). The combat veteran paradox.
Traumatology, 21, 299-310.

101. Castro, C. A., Kintzle, S., Schuyler, A. C., Lucas, C. L. & Warner, C. H. (2015). Sexual
Assault in the military. Current Psychiatry Reports, 17, 53-65.
DOI 10.1007/s11920-015-0596-7.

*100. Kintzle, S., Oh, H., Wilcox, S., Hassan, A. M., Ell, K., & Castro, C. A. (2015). Civilian
unemployment and mental health: The moderating impact of alcohol misuse in returning
National Guard. Military Medicine, 180, 986-993. DOI: 10.7205/MILMED-D-14-00466.

99. Hoge, C.W. & Castro, C.A. (2014). Treatment of generalized war-related health concerns:
Placing TBI and PTSD in context. Journal of the American Medical Association, 312, 6670-
6672. DOI: 10.1001/jama.2014.6670.

**98. McGurk, D., Sinclair, R., Thomas, J.L., Bliese, P.D., Merrill, J.C., & Castro, C.A. (2014).
Destructive and supportive leadership in extremis: Relationships with post-traumatic stress
during combat operations. Military Behavioral Health, 2, 24-256. DOI:
10.1080/21635781.2014.963765.

97. Castro, C.A. & Kintzle, S. (2014). Suicides in the Military: The Post-Modern Combat
Veteran and the Hemingway Effect. Current Psychiatry Reports, 16, 460-469. DOI:
10.1007/s11920-014-0460-1.

96. Castro, C.A. (2014). The U.S. framework for understanding, preventing, and caring for the
mental health needs of service members who served in combat in Afghanistan and Iraq: A brief
review of the issues and research. European Journal of Psychotraumatology, 5, 24713. DOI:
10.3402/ejpt.v5.24713.

95. Vermetten, E., Greenberg, N., Boeschoten, M.A., Delanhije, R., Jetly, R., Castro, C.A. &
McFarlane, A.C. (2014). Deployment-related mental health support: comparative analysis of
NATO and allied ISAF partners. European Journal of Psychotraumatology, 5, 23732. DOI:
10.3402/ejpt.v5.23732.

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**94. Huffman, A.H., Payne, S.C., Koehly, L.M., Culbertson, S.S. & Castro, C.A. (2014).
Examining time demands and work-family conflict on psychological distress. Military
Behavioral Health, 2, 26-32. DOI: 10.1080/21635781.2013.844662

**93. Adler, A.B., Delahaij, R., Bailey, S.M., Vanden Berge, C., Parmak, M., van Tuessenbroek,
B., Puente, J.M., Landratove, S., Kral, P., Kreim, G. Rietdijk, D., McGurk, D. & Castro, C.A.
(2013). NATO survey of mental health training in army recruits. Military Medicine, 178, 760-
766. DOI: 10.7205/MILMED-D-12-00549

**92. Wilk, J.E., Bliese, P.D., Thomas, J.L., Wood, M., McGurk, D., Castro, C.A., & Hoge,
C.W. (2013). Unethical battlefield conduct reported by Soldiers serving in the Iraq War: A
combat model for the development of misconduct. Journal of Nervous and Mental Disease, 201,
259-265. DOI: 10.1097/NMC.0b013e318288d302

**91. Foran, H. M., Garber, B. G., Zamorski, M. A., Wray, M., Mulligan, K., Greenberg, N.,
Castro, C. A., & Adler, A. B. (2013). Post-Deployment Military Mental Health Training:
Cross-national Evaluations. Psychological Services, 10,152-160. DOI:10.1037/a0032609.

**90. Odle-Dusseau, H., Herleman, H., Britt, T. W., Moore, D., Castro, C. A., & McGurk, D.
(2013). Family-supportive work environments and psychological strain: A longitudinal test of
two theories. Journal of Occupational Health Psychology, 18, 27-36. DOI:10.1037/a00308003.

89. Adler, A. B., & Castro, C. A. (2013). An Occupational Mental Health Model for the
Military. Military Behavioral Health, 1, 1-11. DOI:10.1080/21635781.2012.721063.

88. Castro, C. A., Adler, A. B., McGurk, D. & Bliese, P. D. (2012). Mental health training with
soldiers four months after returning from Iraq: Randomization by platoon. Journal of Traumatic
Stress, 25, 376–383. DOI: 10.1002/jts.21721

87. Hoge, C. W., & Castro, C. A. (2012). Preventing suicides in US service members and
veterans: concerns after a decade of war. Journal of the American Medical Associaiton, 308(7),
671-672.

86. Peterson, C., Park, N & Castro, C.A. (2011). Assessment for the U.S. Army
comprehensive soldier fitness program: global assessment tool. American Psychologist, 66, 10-
18.

85. Melamed, B. & Castro, C.A. (2011). Observations and insights about strengthening our
soliders (SOS). Journal of Clinical Psychology in Medical Settings, 18, 210-223.

**84. Riviere, L. A., Kendall-Robbins, A., McGurk, D., Castro, C. A., & Hoge, C.W. (2011).

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Coming home may hurt: risk factors for mental ill health in US reservists after deployment in
Iraq. The British Journal of Psychiatry, 198, 136-142.

83. Bliese, P. D., Thomas, J. L., McGurk, D., McBride, S., & Castro, C. A. (2011). Mental
health advisory teams: A proactive examination of mental health during combat deployment.
International Review of Psychiatry, 23, 127-134.

82. Adler, A. B., Britt, T. W., Castro, C. A., McGurk, D., & Bliese, P. D. (2011). Effect of
transition home from combat on risk-taking and health-related behaviors. Journal of Traumatic
Stress, 24, 381-389. DOI: 10.1002/jts.20665.

**81. Kim, P.Y., Thomas, J.L., Wilk, J.E., Castro, C.A. & Hoge, C.W. (2010). Stigma, barriers
to care, and use of mental health services among active duty and National Guard soldiers after
combat. Psychiatric Services, 61, 582-586.

**80. Santiago, P.N., Wilk, J.E., Milliken, C.S., Castro, C.A., Engle, C.C. & Hoge, C.W.
(2010). Screening for alcohol misuse and alcohol-related behaviors among combat veterans.
Psychiatric Services, 61, 575-581.

**79. Garvey Wilson, A.L., Hoge, C.W., McGurk, D., Thomas, J.L., Clark, J.C. & Castro, C.A.
(2010). Stability of combat exposure recall in operation Iraqi freedom veterans. Annals of
Epidemiology, 20, 939-947.

**78. Garvey Wilson, A.L., Hoge, C.W., McGurk, D., Thomas, J.L., Clark, J.C. & Castro, C.A.
(2010). Application of a new method for linking anonymous survey data in a population of
soldiers returning from Iraq. Annals of Epidemiology, 20, 931-938.

**77. Picchioni, D., Cabrera, O.A., McGurk, D., Thomas, J.L., Castro, C.A., Balkin, T.J.,
Bliese, P.D., & Hoge, C.W. (2010). Sleep symptoms as a partial mediator between combat
stressors and other mental health symptoms in Iraq War veterans. Military Psychology, 22, 340-
355. DOI: 10.1080/089956052010491844.

**76. Wilk, J.E., Thomas, J.L., McGurk, D., Riviere, L.A., Castro, C.A., & Hoge, C.W. (2010).
Mild traumatic brain injury (concussion) during combat: Lack of association of blast mechanism
with persistent post-concussive symptoms. Journal of Head Trauma Rehabilitation, 25, 9-14.
DOI: 10.1097/HTR.0b013e3181bd090f.

**75. Thomas, J.L., Wilk, J.E., Riviere, L.A., McGurk, D.,Castro, C.A., &Hoge, C.W. (2010).
Prevalence of mental health problems and functional impairment among active component and
National Guard Soldiers 3 and 12 months following combat in Iraq. Archives of General
Psychiatry, 67, 614-623.

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**74. Killgore, W. D., Castro, C. A., & Hoge, C. W. (2010). Preliminary normative data for the
evaluation of risks scale – bubble sheet version (EVAR-B) for large-scale surveys of returning
combat veterans. Military Medicine, 175, 725-735.

**73. Cabrera, O. A., Bliese, P. D., Hoge, C. W., Castro, C. A., & Messer, S. C. (2010).
Aggressiveness and perceived martial quality: The moderating role of a family-supportive work
climate. Military Psychology, 22, 57-67.

**72. Gould, M., Adler, A., Zamorski, M., Castro, C. A., Hanily, N., Steele, N., Kearney, S. et
al. (2010). Do stigma and other barriers to mental health care differ across Armed forces?
Journal of the Royal Society of Medicine, 103, 148-156.

**71. McKibben, E. S., Britt, T. W., Hoge, C. W., & Castro, C. A. (2009). Receipt and rated
adequacy of stress management training is related to PTSD and other outcomes among Operational
Iraqi Freedom Veterans. Military Psychology, 21, 2, S68 –S81.

**70. Adler, A. B., Bliese, P. D., McGurk, D., Hoge, C. W., & Castro, C. A. (2009). Battlemind
debriefing and Battlemind training as early interventions with soldiers returning from Iraq:
Ramdomization by platoon. Journal of Consulting and Clinical Psychology, 77, 928-940.
doi:10.1037/a0016877 [Supplemental materials: http://dx.doi.org/10.1037/a0016877.supp]

**69. Hoge, C. W., Goldberg, H. M., & Castro, C. A. (2009). Care of veterans with mild
traumatic brain injury---flawed perspectives. New England Journal of Medicine, 360, 1588-
1591.

**68. Wright, K. M., Cabrera, O. A., Adler, A. B., Bliese, P. D., Hoge, C. W., & Castro, C. A.
(2009). Stigma and barriers to care in Soldiers postcombat. Psychological Services, 6, 108-116.

**67. Adler, A. B., Castro, C. A., & McGurk, D. (2009). Time-driven Battlemind
psychological debriefing: A group-level early intervention in combat. Military Medicine, 174,
121-129.

**66. Killgore, D. C., Cotting, D. I., Vo, A. H., Castro, C. A., & Hoge, C. W. (2008). Post-
combat invincibility syndrome: violent combat experiences are associated with increased risk-
taking propensity following deployment. Journal of Psychiatric Research, 42, 1112-1121.

**65. Hoge, C. W., McGurk, D., Thomas, J. L., Cox, A., Engel, C. C., & Castro, C. A. (2008).
Mild traumatic brain injury in U.S. Soldiers returning from Iraq. The New England Journal of
Medicine, 358, 453-463.

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64. Adler, A. B., Litz, B. T., Castro, C. A., Suvak, J. L., Thomas, J. L., Burrell, L., McGurk, D.,
Wright, K. M. & Bliese, P. D. (2008). A group randomized trial of critical incident stress
debriefing provided to US peacekeepers. Journal of Traumatic Stress, 21, 253-263. DOI:
10.1002/jts.20342.

63. Castro, C. A. & Gaylord, K. M. (2008). Incidence of posttraumatic stress disorder and mild
traumatic brain injury in burned service members: Preliminary report – Discussion. Journal of
Trauma-Injury Infection and Critical Care, 64, Supplement S, S205-S206.

62. Bliese, P. D., Wright, K. M., Adler, A. B., Cabrera, O., Castro, C. A., & Hoge, C. W.
(2008). Validating the primary care posttraumatic stress disorder screen and the posttraumatic
stress disorder checklist with soldiers returning from combat. Journal of Consulting and Clinical
Psychology, 76, 272-281.

**61. Eaton, K. M., Hoge, C. W., Messer, S. C., Whitt, A. A., Cabrera, O. A., McGurk, D.,
…Castro, C.A. (2008). Prevalence of mental health problems, treatment need, and barriers to
care among primary care-seeking spouses of military service members involved in Iraq and
Afghanistan deployments. Military Medicine, 173, 1051-1056.

**60. Britt, T. W., Greene-Shortridge, T. M., Brink, S., Nguyen, Q. B., Rath, J., Cox, A., Hoge,
C. W., & Castro, C. A. (2008). Perceived stigma and barriers to care for psychological
treatment: Implications for reactions to stressors in different contexts, Journal of Social and
Clinical Psychology, 27, 317-335.

**59. Huffman, A. H., Culbertson, S. S., & Castro, C. A. (2008). Family-friendly

environments and U.S. Army soldier performance and work outcomes. Military Psychology, 20,
253-270.

**58. Huffman, A. H., Youngcourt, S. S., Payne, S. C., & Castro, C. A. (2008). The
importance of construct breadth when examining interrole conflict. Educational and
Psychological Measurement, 68, 515-530.

**57. Cabrera, O., Bliese, P. D., Messer, S. Hoge, C. W., & Castro, C. A. (2007). Childhood
adversity as a predictor of depression and post-traumatic stress in deployed troops. American
Journal of Preventive Medicine, 33(2), 77-81. DOI:10.1016/j.amepre

**56. Johannes, B., Wittels, P., Enne, R., Eisinger, G., Castro, C. A., Thomas, J. L., …Gerzer,
R. (2007). Non-linear function model of voice pitch dependency on physical and mental load.
European Journal of Applied Physiology, 101, 267-276.

**55. Stetz, M. C., Castro, C. A., & Bliese, P. D. (2007). The impact of deactivation

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uncertainty, workload, and organizational constraints on reservists’ psychological well-being and
turnover intentions. Military Medicine, 6, 576-580.

**54. Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007).
Association of posttraumatic stress disorder with somatic symptoms, health care visits, and
absenteeism among Iraq War veterans. American Journal of Psychiatry, 164, 150-153.

53. Castro, C.A. & McGurk, D. (2007). Suicide prevention down range: A program
assessment. Traumatology, 13, 32-36. http://tmt.sagepub.com/cgi/contents/refs/13/4/32

52. Castro, C A., & McGurk, D. (2007). Battlefield Ethics. Traumatology, 13, 24-31.
http://tmt.sagepub.com/cgi/contents/refs/13/4/624

51. Castro, C. A., & McGurk, D. (2007). The intensity of combat and behavioral health status.
Traumatology, 13, 6-23. http://tmt.sagepub.com/cgi/contents/refs/13/4/6.

**50. Greene, T. M., Britt, T. W., & Castro, C. A. (2007). The stigma of mental health
problems in the military. Military Medicine, 172, 157-161.

**49. Britt, T. W., Dickinson, J. M., Castro, C. A., & Alder, A. B. (2007). Correlates and
consequences of morale versus depression under stress conditions. Journal of Occupational
Health Psychology, 12, 34-47.

**48. Burrell, L. M., Adams, G. A., Durand, D. B., & Castro, C. A. (2007). The impact of
military lifestyle demands on well-being, Army, and family outcomes. Armed Forces and
Society, 33, 43-58.

**47. Killgore, D. S., Stetz, M. C., Castro, C. A., & Hoge, C. W. (2006). The effects of prior
combat experiences on the expression of somatic and affective symptoms in deploying soldiers.
Journal of Psychosomatic Research, 60, 379-385.

**46. Killgore, D. S., Vo, A. H., Castro, C. A., & Hoge, C. W. (2006). Assessing risk
propensity in American soldiers: Preliminary reliability and validity of the evaluation of risks
(EVAR) scale---English version. Military Medicine, 171, 233-239.

**45. Adler, A.B., Castro, C.A. & Britt, T.W. (2005). Self-engagement, stressors, and health: a
longitudinal study. Personality and Social Psychology Bulletin, 31, 1475-1486.

**44. Britt, T. W., Adler, A. B., & Castro, C. A. (2005). Job engagement as a buffer against
the negative effects of a high workload: A longitudinal study. Personality and Social Psychology
Bulletin, 31, 1475-1486.

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**43. Huffman, A. H., Adler, A. B., Dolan, C. A., & Castro, C. A. (2005). The impact of
operations tempo on turnover intentions of Army personnel. Military Psychology, 17, 175-202.

**42. Dolan, C. A., Adler, A. B., Thomas, J. L., & Castro, C. A. (2005). Operations tempo and
soldier health: The moderating effect of wellness behaviors. Military Psychology, 17, 157-174.

**41. Thomas, J. L., Adler, A. B., & Castro, C. A. (2005). Measuring operations tempo and
relating it to military performance. Military Psychology, 17, 137-156.

40. Castro, C. A., & Adler, A. B. (2005). Operations tempo (OPTEMPO). Military
Psychology, 17, 131-136. [special issue guest editors]

**39. Allison-Aipa, T. S., De La Rosa, G. M., Stetz, M. C., & Castro, C. A. (2005). The
impact of National Guard activation for homeland defense: employers’ perspective. Military
Medicine, 170, 846-850.

**38. Wright, K. M., Bliese, P. D., Adler, A. B., Hoge, C. W., Castro, C. A. & Thomas, J. L.
(2005). Screening for psychological illness in the military. Journal of the American Medical
Association, 294, 42-43.

**37. Wright, K. M., Thomas, J. L., Adler, A. B., Ness, J. W., Hoge, C. W., & Castro, C. A.
(2005). Psychological screening procedures for deploying U.S. forces. Military Medicine, 170,
555-562.

**36. Adler, A. B., Huffman, A. H., Bliese, P. D., & Castro, C. A. (2005). The impact of
deployment length and deployment experience on the well-being of male and female military
personnel. Journal of Occupational Health Psychology, 10(2), 121-137.

**35. Adler, A. B., Thomas, J. L., & Castro, C. A. (2005). Measuring up: Comparing self-
reports with unit records for assessing soldier performance. Military Psychology, 17, 3-24.

**34. Hoge, C. W., Castro, C. A. & Messer, S. C. (2004). Combat duty in Iraq and
Afghanistan, mental health problems and barriers to care. U.S. Army Medical Department
Journal, Jul-Sep, 7-17.

**33. Britt, T. W., Davison, J., Bliese, P. D., & Castro, C. A. (2004). How leaders can
influence the impact that stressors have on soldiers. Military Medicine, 7, 541-545.

**32. Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L.
(2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New

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England Journal of Medicine, 351, 13-22.

**31. Adler, A. B., Wright, K. M., Huffman, A. H., Thomas, J. L., & Castro, C. A. (2002).
Deployment cycle effects on the psychological screening of soldiers. Army Medical Department
Journal, 4/5/6, 31-37.

30. Wright, K. M., Huffman, A. H., Adler, A. B., & Castro, C. A. (2002). Psychological
screening program overview. Military Medicine, 167(10), 853-861.

29. Landauer, M. R., Castro, C. A., Benson, K. A., Hogan, J. B. & Weiss, J. F. (2001).
Radioprotective and locomotor-responses of mice treated with nimodipine. Journal of Applied
Toxicology, 21, 25-31.

28. Bliese, P. D., & Castro, C. A. (2000). Role clarity, work overload and organizational
support: multilevel evidence of the importance of support. Work and Stress, 14, 65-73.

**27. Martinez, J. A., Huffman, A. H., Adler, A. B., & Castro, C. A. (2000). Assessing
psychological readiness in U.S. soldiers following NATO operations. International Review of
the Armed Forces Medical Services, 73, 139-142.

26. Castro, C. A., Bienvenu, R. V., Huffman, A. H., & Adler, A. B. (2000). Soldier dimensions
and operational readiness in U.S. Army forces deployed to Kosovo. International Review of the
Armed Forces Medical Services, 73, 191-200.

25. Castro, C. A., & Adler, A. B. (1999). OPTEMPO: Effects on soldier and unit readiness.
Parameters, 86-95.

**24. Matzke, S. M., & Castro, C. A. (1998). Primacy and recency effects in rhesus monkeys
(Macaca mulatta) using a serial probe recognition task III. A developmental analysis.
Developmental Psychobiology, 32, 215-224.

23. Castro, C. A. (1997). Primacy and recency effects in rhesus monkeys (Macaca mulatta)
using a serial probe recognition task II. Effects of atropine. Behavioral Neuroscience, 111,
676-682.

22. Castro, C. A. (1995). Primacy and recency effects in rhesus monkeys (Macaca mulatta)
using a serial probe recognition task I. Effects of diazepam. Psychopharmacology, 119, 421-
427.

21. Castro, C. A., Hogan, J. B., Benson, K. A., Shehata, C. W., & Landauer, M. R. (1995).
Behavioral effects of vehicles: DMSO, ethanol, Tween-20, Tween-80, and emulphor-620.

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Pharmacology, Biochemistry and Behavior, 50, 521-526.

20. Castro, C. A., Gresham, V. C., Finger, A. V., Maxwell, D. M., Solana, R. P., Lenz, D. E., &
Broomfield, C. A. (1994). Behavioral decrements persist in rhesus monkeys trained on a serial
probe recognition task despite protection against soman lethality by butyrylcholinesterase.
Neurotoxicology and Teratology, 16, 145-148.

19. Castro, C. A., & Rudy, J. W. (1993). Impaired short-term memory resulting from postnatal
undernutrition is attenuated by physostigmine. Behavioral and Neural Biology, 60, 282-285.

18. Doctor, B. P., Blick, D. W., Caranto, G., Castro, C. A., Gentry, M. K., Larrison, R.,
…Wolfe, A. D. (1993). Cholinesterases as scavengers for organophosphorus compounds:
Protection of primate performance against soman toxicity. Chemical-Biological Interactions, 87,
285-293.

17. Maxwell, D. M., Castro, C. A., De La Hoz, D. M., Gentry, M. K., Gold, M. B., Solana, R.,
P., … Doctor, B. P. (1992). Protection of rhesus monkeys against soman and prevention of
performance decrement by pretreatment with acetylcholinesterase. Toxicology and Applied
Pharmacology, 115, 44-49.

16. Castro, C. A., & Larsen, T. (1992). Primacy and recency effects in nonhuman primates.
Journal of Experimental Psychology: Animal Behavioral Processes, 18, 335-340.

15. Broomfield, C. A., Maxwell, D. M., Solana, R. P., Castro, C. A., Finger, A. V., & Lenz, D.
E. (1991). Protection by butyrylcholinesterase against organophosphorus poisoning in non-
human primates. Pharmacology and Experimental Therapeutics, 259, 633-638.

14. Warren, D. A., Castro, C. A., Rudy, J. W., & Maier, S. F. (1991). No spatial learning
impairment following exposure to inescapable shock. Psychobiology, 19, 127-134.

13. Castro, C. A., Larsen, T., Finger, A. V., Solana, R. P., & McMaster, S. B. (1991).
Behavioral efficacy of diazepam against nerve agent exposure in rhesus monkeys.
Pharmacology, Biochemistry and Behavior, 41, 159-164.

12. Castro, C. A., & Finger, A. V. (1991). The use of serial probe recognition in non-human
primates as a method for detecting cognitive deficits following CNS challenge.
Neurotoxicology, 12, 125-129.

11. Castro, C. A., & Rudy, J. W. (1990). Undernutrition during the brain growth period of the
rat significantly delays the development of the memory processes mediating Pavlovian trace
conditioning. Behavioral and Neural Biology, 53, 307-320.

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10. Castro, C. A., Paylor, R., Moye, T. B., & Rudy, J. W. (1990). The cholinergic agent
physostigmine enhances short-term memory based performance in the developing rat.
Behavioral Neuroscience, 104, 390-393.

9. Chiszar, D., Castro, C. A., Murphy, J. B., & Smith, H. M. (1989). Discriminations between
thermally different rodent carcasses by bull snakes (Pituophis melanoleucus) and cobras (Naja
pallida and Asipelaps scutatus). Bulletin of the Chicago Herpatological Society, 24, 181-183.

8. Castro, C. A., Silbert, L. H., McNaughton, B. L., & Barnes, C. A. (1989). Recovery of
spatial learning deficits following decay of electrically-induced synaptic enhancement in the
hippocampus. Nature, 342, 545-548.

7. Foster, T. C., Castro, C. A., & McNaughton, B. L. (1989). Spatial selectively of rat
hippocampal neurons is dependent on preparedness for movement. Science, 244, 1581-1583.

6. Castro, C. A., Tracy, M., & Rudy, J. W. (1989). Early-life undernutrition impairs the
development of the learning and short-term memory processes mediating performance in a
conditional-spatial discrimination task. Behavioural Brain Research, 32, 255-264.

5. Chiszar, D., Castro, C. A., Smith, H., & Guyon, C. (1986, appeared in 1989). A behavioral
method for assessing utilization of thermal cues by snakes during feeding episodes, with a
comparison of crotaline and viperine species. Annals of Zoology, 24, 123-131.

4. Castro, C. A., & Rudy, J. W. (1989). Early-life malnutrition impairs the performance of
both young and adult rats on visual discrimination learning. Developmental Psychobiology, 22,
15-28.

3. Castro, C. A., Paylor, R., & Rudy, J. W. (1987). A developmental analysis of the learning
and memory processes mediating performance in conditional-spatial discrimination problems.
Psychobiology, 15, 308-316.

2. Castro, C. A., & Rudy, J. W. (1987). Early-life malnutrition selectively retards the
development of distal- but not proximal-cue navigation. Developmental Psychobiology, 20, 521-
537.

1. Rudy, J. W., & Castro, C. A. (1987). A developmental analysis of brightness discrimination

in the rat: Evidence for an attentional deficit. Psychobiology, 15, 79-86.

Books

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10. Castro, C.A. & Kintzle, S. (in preparation/under contract). Military transition theory.
Springer Press.

9. Warner, C. H. & Castro, C. A. (in preparation/under contract). Veteran and military mental
health: The psychiatrist’s role. American Psychiatric Association.

8. Castro, C. A. & Dursun, S. (2019). Military veteran reintegration. London, Elsevier.

7. Weiss, E. & Castro, C.A. (Eds.), (2019). American Military Life in the 21st Century: Social,
Cultural, Economic Issues and Trends. Vol. 1. Santa Barbara, CA: ABC-CLIO.

6. Weiss, E. & Castro, C.A. (Eds.), (2019). American Military Life in the 21st Century: Social,
Cultural, Economic Issues and Trends. Vol. 2. Santa Barbara, CA: ABC-CLIO.

5. Adler, A. B., Bliese, P. B., & Castro, C. A. (Eds.) (2011). Deployment Psychology: The
Impact of Combat on Mental Health. Washington, D.C.: American Psychological Association

4. Britt, T. W., Castro, C. A., & Adler, A. B. (Eds.) (2006). Military life: The psychology of
serving in peace and combat. Vol. 1: Military performance. Westport, CT: Praeger Security
International.

3. Adler, A. B., Castro, C. A., & Britt, T. W. (Eds.) (2006). Military life: The psychology of
serving in peace and combat. Vol. 2: Operational stress. Westport, CT: Praeger Security
International.

2. Castro, C. A., Adler, A. B., & Britt, T. W. (Eds.) (2006). Military life: The psychology of
serving in peace and combat. Vol. 3: The military family. Westport, CT: Praeger Security
International.

1. Britt, T. W., Adler, A. B., & Castro, C. A. (Eds.) (2006). Military life: The psychology of
serving in peace and combat. Vol. 4: Military culture. Westport, CT: Praeger Security
International.

NATO Reports

1. NATO STO. Castro, C. A. & Dursun, S. (Chairs). (2021). The Transition of Military
Veterans from Active Service to Civilian Life. Technical Report STO-TR-HFM-263, Neuilly-
sur-Seine, France. DOI 10.14339/STO-TR-HFM-263.

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2. NATO STO. Castro, C. A. (Chair). (2016). Mental Health Training. Technical Report STO-
TR-HFM-203, Neuilly-sur-Seine, France. DOI 10.14339/STO-TR-HFM-203.

Book Chapters

34. Castro, C. A., Dursun, S., MacLean, M.B., Lazier, R., Fossey, M. & Pedlar, D. (2019).
Essential components for a successful military-to-civilian transition.. In C.A. Castro & S.
Dursun (Eds.), Military veteran reintegration (pp 21-50). London, Elsevier.

33. Pedlar, D., Thompson, J.M. & Castro, C. A. (2019). Military-to-civilian transition theories
and frameworks. In C.A. Castro & S. Dursun (Eds.), Military veteran reintegration (pp 21-50).
London, Elsevier.

32. Truusa, T. T. & Castro, C. A. (2019). Definition of a veteran: The military viewed as a
culture. In C.A. Castro & S. Dursun (Eds.), Military veteran reintegration (pp 6-19). London,
Elsevier.

31. Castro, C. A. & Dursun, S. (2019). Introduction to military-to-civilian life transition. In

C.A. Castro & S. Dursun (Eds.), Military veteran reintegration (pp 1-3). London, Elsevier.

30. Kintzle, S. & Castro, C. A. (2018). Examining veteran transition to the workplace through
military transition theory. In P.D. Harms, P.L, Perrewe, J.R.B., Halbesleben & C.C. Rosen
(Eds.), Occupational Stress and Well-being in Military Contexts (pp. 117-128). Emerald
Publishing: Bingley, UK.

29. McNamara, K., Castro, C. A. & Goldbach, J. (2019). Lesbian, gay, bisexual and
transgender service members in the U.S. military. In E. Weiss & C.A. Castro (Eds.), American
Military Life in the 21st Century: Social, Cultural, Economic Issues and Trends.

28. Atuel, H. R. & Castro, C. A. (2019). Military transition process and identity. In E. Weiss
& C.A. Castro (Eds.), American Military Life in the 21st Century: Social, Cultural, Economic
Issues and Trends.

27. Castro C.A. & Goldbach J. (2018) The Perpetrator Hypothesis: Victimization Involving
LGBT Service Members. In: Roberts L., Warner C. (eds), Military and Veteran Mental Health
(pp 145-156). Springer, New York, NY. DOI https://doi.org/10.1007/978-1-4939-7438-2_10

26. Castro, C.A. & Sullivan, K. (2018). Military Families Research: Department of Defense
Funding and the Elements of a Fundable Proposal. In L. Huges-Kirchuble, S. MacDermind

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Wadsworth & D. Riggs (Eds.), A Battle Plan for Supporting Military Families (pp. 323-332).
Cham, Switzerland: Springer. DOI10.1007/978-3-319-68984-5_1.

25. Castro, C.A. (2017). Research at the tip of the spear. In E.C. Ritchie, C.H. Warner, & R.N.
McLay (Eds.), Psychiatrists in combat (pp. 99-108). Cham, Switzerland: Springer International
Publishing.

24. Aiken, A.B., Castro, C.A. & Hodson, S. (2017). An international perspective on transition.
In J. Hacker Hughes (Ed.), Military veteran psychological health and social care: Contemporary
issues (pp. 193-202). Hove: Routledge Taylor and Francis.

23. Atuel, H.R., Keeling, M., Kintzle, S.M, Hassan, A., & Castro, C.A. (2016). Veteran
employment in the 21st century. In L. Hicks, E. Weiss, & J.E. Coll (Eds.), The civilian lives of
U.S. Veterans: Issues and identities (Vol. 1) (pp. 161-179). Santa Barbara, CA: Praeger/ABC-
CLIO.

22. Castro, C.A. & Hassan, A.M. (2016). Military mental health and combat deployments. In
H.S. Friedman (Ed in Chief.), Encyclopedia of mental health (second edition) (pp. 137-143).
Waltham, MA: Academic Press.

21. Castro, C.A. & Wilcox, S.L. (2015). Mental health and combat veterans. In A. Powles, N.
Partow & M. N. Nelson (Eds.), United Nations Peacekeeping Challenge: The Importance of the
Integrated Approach (pp. 147-166). Surrey, England: Ashgate.

20. Bryant, R. A., Castro, C. A., & Iverson, G. I. (2012). Implications for service delivery in the
military. In J. J. Vasterling, R. A. Bryant, & T. M. Keane (Eds.), PTSD and mild traumatic brain
injury (pp. 235-259). New York, New York: Guilford Press.

19. Castro, C. A., & Adler, A. B. (2011). Military mental health training: Building resilience.
In S. M. Southwick, B. T. Litz, D. Charney, & M. J. Friedman (Eds.), Resilience and Mental
Health: Challenges Across the Lifespan (pp. 323-339). Cambridge, UK: Cambridge University
Press.

18. Hoge, C. W., Adler, A. B., Wright, K. M., Bliese, P. D., Cox, A., McGurk, D., … Castro,
C. A. (2011). Walter Reed Army Institute of Research Contributions During Operations Iraqi
Freedom and Enduring Freedom: From Research to Public Health Policy. In C. E. Ritchie (Ed.),
Combat and Operational Behavioral Health (pp. 75-86). In M. K. Lenhart (Series Ed.), The
Textbooks of Military Medicine. Washington, DC: Department of the Army, Office of The
Surgeon General, Borden Institute.

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17. Castro, C. A., & Adler, A. B. (2011). Re-conceptualizing combat-related posttraumatic
stress disorder as an occupational hazard. In A. B. Adler, P. B. Bliese, & C. A. Castro (Eds.),
Deployment psychology: Evidence-Based Strategies to Promote Mental Health in the Military
(pp. 217-242). Washington, D.C.: American Psychological Association.

16. Bliese, P. B., Adler, A. B., & Castro, C. A. (2011). The deployment context: Psychology
and implementing mental health interventions. In A. B. Adler, P. B. Bliese, & C. A. Castro
(Eds.), Deployment psychology: Evidence-Based Strategies to Promote Mental Health in the
Military (pp. 103-124). Washington, D.C.: American Psychological Association.

15. Adler, A. B., Bliese, P. D., & Castro, C. A. (2011). An introduction to deployment
psychology. In A. B. Adler, P. B. Bliese, & C. A. Castro (Eds.), Deployment psychology:
Evidence-Based Strategies to Promote Mental Health in the Military (pp. 3-13). Washington,
D.C.: American Psychological Association.

14. Castro, C. A. & Adler, A. B. (2011). Training for resilience: Military mental health training:
building reliance. In Castro, C. A. & Adler, A. B. (Eds.), Resilience and Mental Health:
Challenges across the lifespan (pp. 323-324), New York: Cambridge University Press.

13. Castro, C.A., McGurk, D., and Wright, K.W. (2008). A review of the U.S. Army Soldier
suicides in Iraq. In B.K. Wiederhold (Ed). Lowering suicide risk in returning troops, (pp.45-52).
IOS Press. DOI: 10.3233/978-1-58603-889-2-45

12. Burrell, L., Adams, G. A., Durand, D. & Castro, C. A. (2010). Families facing the demands
of military life: new research directions. In P. Bartone, R. Pastel & M. Vaitkus (Eds.), The 71F
Advantage: Applying Army Research Psychology for Health and Performance Gains.
Washington, DC: National Defense University Press.

11. Castro, C. A. (2006). In Hoge, C. W., Adler, A. B., Wright, K. M., Bliese, P. D., Cox, A.,
McGurk, D., … Castro, C. A. (Eds.) Walter Reed Army Institute of Research Contribution
During Operations IRAQI Freedom and Enduring Freedom: From research to public health
policy, (pp. 75-83). Silver Spring, MD: Combat and Operational Behavior Health.

10. Castro, C. A. (2006). Military courage. In T.W. Britt, A.B. Adler & C.A. Castro (Eds.),
Military life: The psychology of serving in peace and combat. Vol. 4: Military culture (pp. 60-
78), Westport, CT: Praeger Security International.

9. Castro, C. A., Thomas, J. L., & Adler, A. B. (2006). Towards a liberal theory of leadership.
In A. B. Adler, C. A. Castro & T. W. Britt (Eds.), Military life: The psychology of serving in
peace and combat, Vol.2: Operational Stress (pp. 192-212). Westport, CT: Praeger Security
International.

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8. Castro, C. A., Engel, C. C., & Adler, A. B. (2004). The challenge of providing mental health
prevention and early intervention in the U.S. military. In B. T. Litz (Ed.), Early intervention for
trauma and traumatic loss in children and adults (pp. 301-318). New York, New York: Guilford
Press.

7. Thomas, J. L., & Castro, C. A. (2003). Organizational behavior and the U.S. peacekeeper.
In T. W. Britt & A. B. Adler (Eds.), The psychology of the peacekeeper: Lessons from the field
(pp. 127-146), Westport, CT: Greenwood Publishing.

6. Castro, C. A. (2003). Considerations when conducting psychological research during

peacekeeping missions: The scientist and the commander. In T. W. Britt & A.B. Adler (Eds.),
The psychology of the peacekeeper: Lessons from the field, Westport, CT: Greenwood
Publishing.

5. Bliese, P. D., & Castro, C. A. (2003). The soldier adaptation model (SAM): Applications to
peacekeeping research. In T. W. Britt & A.B. Adler (Eds.), The psychology of the peacekeeper:
Lessons from the field, Westport, CT: Greenwood Publishing.

4. Weerts, J. M. P., White, W., Adler, A. B., Castro, C.A., Algra, G., Bramsen, I., … van der
Ploeg, H. M. (2001). Studies on military peacekeepers. In Y. Danieli (Ed.), Sharing the Front
Line and the Back Hills (pp. 31-48). Amityville, NY: Baywood Publishing

3. Castro, C. A. (2001). Primacy and recency effects. In W.E. Craighead & C.B. Nemeroff
(Eds.), The Corsini Encyclopedia of Psychology and Behavioral Science (3d edition, pp. 1241-
1243), New York: Wiley.

2. Castro, C. A. & Adler, A. B. (2001). The impact of operations tempo: Issues in

measurement. In S. Truscott & S. Flemming (Eds.), Human dimensions of deployments among
TTCP nations (pp. 29-35), Ottawa, Ontario: National Defense Headquarters. [also published as
Proceedings of the 42nd International Military Testing Association, Edinburgh, UK and DTIC
ADA388336].

1. Castro, C. A., Adler, A. B., & Huffman, A. H. (2001). Senior leaders in the U.S. Army,
Europe. In P. Essesn, A. Vogelaar, E. Tanercan & D. Winslow (Eds.), The Human in Command:
Peace Support Operations (pp. 264-275). Amsterdam: Mets & Schilt.

Technical Reports, Proceedings, Letters, Forwards

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65. Thompson J.M., Lockhart W., Roach, M.B., Atuel, H., Bélanger, S., Black, T, Castro C.A.,
Cox, D., Cooper, A., de Boer, C., Dentry, S., Hamner, K., Shields, D., & Truusa, T.T. (2017).
Veterans’ Identities and Well-being in Transition to Civilian Life – A Resource for Policy
Analysts, Program Designers, Service Providers and Researchers. Report of the Veterans’
Identities Research Theme Working Group, Canadian Institute for Military and Veteran Health
Research Forum 2016. Charlottetown PE: Research Directorate, Veterans Affairs Canada.
Research Directorate Technical Report.

64. Castro, C. A. & Kintzle, S. (2017). The state of the American veteran: The San Francisco
Veterans Study. Los Angeles, CA: USC School of Social Work, Center for Innovation &
Research on Veterans & Military Veterans.

63. Kintzle, S., Rasheed, J. M., Castro, C. A. (2016). The state of the American veteran: The
Chicagoland Veterans Study. Los Angeles, CA: USC School of Social Work, Center for
Innovation & Research on Veterans & Military Veterans.

62. Castro, C.A. & Goldbach, J. (2016). Lesbian and Gay Service Members: Life After Don't
Ask, Don't Tell. Atlas Abstracts, November 12.

61. Keeling, M., Ozuna, S., Kintzle, S. & Castro, C. A. (2016). The State of the American
Veteran – Chicagoland: Employment investigation for Prudential. Los Angeles, CA: USC
School of Social Work, Center for Innovation & Research on Veterans & Military Veterans.

60. Foster, R., von Thaden, T., Castro, C., Dominguez, C., Gabreski, T., Maybury, M., Schenck,
L. & Struckman-Johnson, C. (2014). Combating sexual assault. Washington, DC., SAB-TR-14-
04.

59. Castro, C.A. (2016). Forward. L.S. Katz (Ed.), Treating military sexual trauma. New York:
Springer Publishing Company.

58. Castro, C.A. (2016). Forward. N.D. Ainspan, C. Bryan & W.E. Penk (Eds.), Handbook of
psychosocial interventions for veterans: A guide for the non-military mental health clinician.
New York: Oxford University Press.

57. Castro, C.A., Hassan, A.M. & Wenzel, S.L. (2015). Call to action: Toward ending female
veteran homelessness. Los Angeles, CA: USC School of Social Work, Center for Innovation &
Research on Veterans & Military Veterans.

56. Castro, C.A., Kintzle, S. & Hassan, A.M. (2015). The state of the American veteran: The
Orange County veterans study. Los Angeles, CA: USC School of Social Work, Center for
Innovation & Research on Veterans & Military Veterans.

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55. Castro, C.A., Kintzle, S. & Hassan, A.M. (2014). The state of the American veteran: Los
Angeles Veteran Study. Los Angeles, CA: USC School of Social Work, Center for Innovation &
Research on Veterans & Military Veterans.

54. Hoge, C.W., Warner, C.H. & Castro, C.A. (2014). Mental health and the Army. Journal of
the American Medical Association - Psychiatry, 71, 965-966.

53. Hassan, A.M., Castro, C.A. & Jacobs, R.J. (2014). Going forward: Implications for post-
combat military leadership. Los Angeles, CA: USC School of Social Work, Center for
Innovation & Research on Veterans & Military Veterans.

52. Castro, C.A. (2013). Forward. R.R. Sinclair & T.W. Britt (Eds.), Building psychological
resilience in military personnel: theory and practice. Washington, D.C., American Psychological
Association.

51. Hoge, C.W. & Castro, C.A. (2012). Preventing suicides in the U.S. service members and
veterans; concerns after a decade of war. Journal of the American Medical Association, 15, 671-
672.

50. Hoge, C. W. & Castro, C. A. (2011). Blast-related traumatic brain injury in the U.S.
military personnel. New England Journal of Medicine, 365, 860.

49. Andruetan, Y. & Castro, C.A. (2010). Le Battle Mind training ou comment preparer le
retour des combatants = Battle mind training, a therapeutic strategy to accompany the soldier
from the battle front to the home front. Perspectives Psychiatriques, 49, 27-30. Published in
French.

48. Castro, C.A. (2009). Impact of combat on the mental health and well-being of soldiers and
marines. Smith College Studies in Social Work, 79, 247-262.

47. Hoge, C. W., Goldberg, H. M. & Castro, C. A. (2009). Care of war veterans with mild
traumatic brain injury – reply. New England Journal of Medicine, 361, 537-538.

46. Hoge, C.W. & Castro, C. A. (2008). Post-traumatic stress disorder in UK and US forces
deployed to Iraq. Lancet, 368, 837.

45. Hoge, C. W., Engel, C. C. & Castro, C. A. (2008). Mild traumatic brain injury in US
soldiers returning from Iraq – Reply. New England Journal of Medicine, 358, 2179.

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44. Hoge, C. W., Clark, J. C., & Castro, C. A. (2007). Commentary: Women in combat and the
risk of post-traumatic stress disorder and depression. International Journal of Epidemiology,
DOI:10.1093/ije/dym013.

43. McGurk, D. & Castro, C.A. (2007). MHAT IV Commentary. Traumatology, 13, 59-60.

42. Castro, C. A., Hoge, C. W., & Cox, A. L. (2006). Battlemind training: Building soldier
resiliency. In Human Dimensions in Military Operations --- Military Leaders Strategies for
Addressing Stress and Psychological Support (pp. 42-1 --- 42-6). Proceedings of RTO-MP-
HFM-134, Paper 42. Neuilly-sur-Seine, France: RTO.
Available from http://www.rto.nato.int/abstracts.asp.

41. Castro, C. A. & McGurk, D. (2007). MHAT IV Commentary. Traumatology, 13, 59.

40. Castro, C. A. (2005). Building Battlemind. Countermeasures, 26, 6-8.

39. Castro, C. A. (2004). How to build Battlemind. NCO Journal, April, 23-24.

38. Hoge, C. A., Messer, C. A. & Castro, C. A. (2004). Combat duty in Iraq and Afghanistan
and mental health problems – reply. New England Journal of Medicine, 351, 1799-1800.

37. Castro, C. A. & Huffman, A. H. (2002). Predicting retention rates in U.S. soldiers stationed
in Europe. Alexandria, VA: Defense Technical Information Center (DTIC: 20020520 191).

36. Wright, K. M., Huffman, A. H., Adler, A. B. & Castro, C. A. (2002). Psychological
screening program overview. sAlexandria, VA: Defense Technical Information Center (DTIC:
2002520 192).

35. Adler, A. B., Wright, K. M., Huffman, A. H., Thomas, J. L. & Castro, C. A. (2001).
Deployment cycle effects on the psychological screening of soldiers. Alexandria, VA: Defense
Technical Information Center (DTIC: 20010410 150).

34. Adler, A. B., & Castro, C. A. (2001). The impact of lost leave on the medical readiness of
U.S. soldiers: It’s not a European vacation. Proceedings of the 37th International Applied
Military Psychology Symposium, Prague, Czech Republic.
https://apps.dtic.mil/sti/pdfs/ADA401612.pdf.

33. Adler, A. B., Dolan, C. A., & Castro, C. A. (2001). US soldier peacekeeping experiences
and wellbeing after returning from deployment to Kosovo. Proceedings of the 37th International
Applied Military psychology Symposium (pp30-34), Split, Croatia: Ministry of Defense of the
Republic of Croatia.

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32. Castro, C. A., Huffman, A. H., Dolan, C. A., Bienvenu, R. V., & Adler, A. B. (2000).
Working in the zone: Maintaining optimal readiness in U.S. soldiers. Proceedings of the 36th
International Applied Military Psychology Symposium (pp. 69-72). Split, Croatia: Ministry of
Defense of the Republic of Croatia. [DTIC ADA 388338]

31. Castro, C. A., & Adler, A. B. (2000). The impact of operations tempo: Issues in
measurement. Proceedings of the 42nd International Military Testing Association, Edinburgh,
UK.

30. Castro, C. A., Adler, A. B., Huffman, A. H., & Belenky, G. (2000, May-June). Maintaining
the health and well-being of senior leaders in the Army through medical research. Army AL&T,
12-13.

29. Huffman, A H., Adler, A. B, & Castro, C. A. (2000). The impact of deployment history on
the wellbeing of military personnel: The gender effect. Alexandria, VA: Defense Technical
Information Center (DTIC: 20010220 074).

28. Bliese, P. D., & Castro, C. A. (1999). Cumulative effects of organizational stressors:
Evidence for the buffering hypothesis. Alexandria, VA: Defense Technical Information Center
(DTIC: ADA369023).

27. Castro, C. A., & Adler, A. B. (1999). Military deployments and soldier readiness.
Proceedings of the 34th International Applied Military Psychology Symposium, Florence, Italy.

26. Adler, A. B., Huffman, A. H., & Castro, C. A. (1999). Psychological screening with
deployed and nondeployed soldiers. Alexandria, VA: Defense Technical Information Center
(DTIC: ADA361535).

25. Huffman, A. H., Adler, A. B., & Castro, C. A. (1999). The impact of deployment history
on the well-being of military personnel. Walter Reed Army Institute of Research Technical
Report, USAMRMC-TR-ADA361109. Washington, D.C.

24. Castro, C. A., Huffman, A. H., Adler, A. B., & Bienvenu, R. V. (1999). USAREUR soldier
study. U.S. Army Medical Research Unit-Europe Technical Brief, USAMRU-E-TB-99-02.
Heidelberg, Germany.

23. Castro, C. A., Adler, A. B., Huffman, A. H., & Bienvenu, R. V. (1998). The physical and
mental health status of soldiers in garrison compared to military personnel in Bosnia. U.S. Army
Medical Research Unit-Europe Technical Brief, USAMRU-E-TB-98-18. Heidelberg, Germany.

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22. Castro, C. A., & Adler, C. A. (1998). Operational tempo of forward-deployed soldiers in
Europe. U.S. Army Medical Research Unit-Europe Technical Brief, USAMRU-E-TB-98-17.
Heidelberg, Germany.

21. Adler, A. B., Bartone, P., & Castro, C. A. (1998). OPTEMPO/BURNOUT II survey: Final
report. U.S. Army Medical Research Unit-Europe Technical Brief, USAMRU-E-TB-98-16.
Heidelberg, Germany.

20. Castro, C. A. (1998). Bosnia deployments and unit morale, cohesion, and soldier career
intentions. U.S. Army Medical Research Unit-Europe Technical Brief, USAMRU-E-TB-98-15.
Heidelberg, Germany.

19. Huffman, A. H., Adler, A. B., & Castro, C. A. (1998). Joint medical surveillance mental
health and physical screening: Gender report. U.S. Army Medical Research Unit-Europe
Technical Brief, USAMRU-E-TB-98-13. Heidelberg, Germany.

18. Bienvenu, R. V., Adler, A. B., & Castro, C. A. (1998). Joint medical surveillance in Bosnia:
Psychological screening. Report VI: Task Force Eagle decentralized screening May-June 1998.
U.S. Army Medical Research Unit-Europe Technical Brief, USAMRU-E-TB-98-12. Heidelberg,
Germany.

17. Adler, A. B., Castro, C. A., & Huffman, A. H. (1998). Joint medical surveillance in Bosnia:
Psychological screening. Report V: FEB 96-DEC 97. U.S. Army Medical Research Unit-Europe
Technical Brief, USAMRU-E-TB-98-11. Heidelberg, Germany.

16. Adler, A. B., & Castro, C. A. (1998). Joint medical surveillance in Bosnia: Psychological
screening. Report IV: Air Force. U.S. Army Medical Research Unit-Europe Technical Brief,
USAMRU-E-TB-98-10. Heidelberg, Germany.

15. Adler, A. B., Castro, C. A., & Huffman, A. H. (1998). Joint medical surveillance in
Bosnia: Psychological screening. Report III: 1 AD. U.S. Army Medical Research Unit-Europe
Technical Brief, USAMRU-E-TB-98-09. Heidelberg, Germany.

14. Adler, A. B., & Castro, C. A. (1998). Joint medical surveillance in Bosnia: Psychological
screening. Report II: Component analysis. U.S. Army Medical Research Unit-Europe Technical
Brief, USAMRU-E-TB-98-08. Heidelberg, Germany.

13. Adler, A. B., & Castro, C. A. (1998). Joint medical surveillance in Bosnia: Psychological
screening. Report I: FEB 96-JUN97. U.S. Army Medical Research Unit-Europe Technical Brief,
USAMRU-E-TB-98-07. Heidelberg, Germany.

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12. Castro, C. A., & Huffman, A. H. (1998). Operation Joint Endeavor: Lessons learned for
improving psychological readiness. U.S. Army Medical Research Unit-Europe Technical Brief,
USAMRU-E-TB-98-04. Heidelberg, Germany.

11. Adler, A. B., Bartone, P., Bienvenu, R. W., Britt, T., & Castro, C. A. (1998). Operations
Joint Endeavor: Re-deployment assessment of 1st AD soldiers. U.S. Army Medical Research
Unit-Europe Technical Brief, USAMRU-E-TB-98-03. Heidelberg, Germany.

10. Castro, C. A. and Adler, A. B. (1998). Operational tempo of forward-deployed soldiers in

Europe. Proceedings of the 33rd International Applied Military Psychology Symposium, Paris.

9. Bliese, P. D., Escolas, S. M., Christ, R. E. and Castro, C. A. (1998). Human dimensions
assessment of the Task Force XXI Advance Warfighter Experiment. Alexandria, VA: Defense
Technical Information Center (DTIC: ADA349889).

8. Castro, C. A., Benson, K. A., Bogo, V., Daxon, E. G., Hogan, J. B., Jacocks, … Shehata, C.
W. (1996). The establishments of an animal model to evaluate the biological effects of
intramuscularly embedded depleted uranium (DU) fragments. Armed Forces Radiobiology
Research Institute Technical Report, 96-3. Bethesda, Maryland.

7. Larsen, T., & Castro, C. A. (1995). Diazepam attenuates long-term behavioral incapacitation
in Rhesus monkeys exposed to nerve agent. U.S. Army Medical Research Institute of Chemical
Defense Technical Report, USAMRICD-TR-95-07. Aberdeen Proving Ground, Maryland.

6. Halverson, R. R., Bliese, P. D., Moore, R. E., & Castro, C. A. (1995). Psychological well-
being and physical health symptoms of soldiers deployed for Operation Uphold Democracy: A
Summary of Human Dimensions Research in Haiti. Walter Reed Army Institute of Research
Technical Report, USAMRMC-TR-ADA298125. Washington, D.C.

5. Castro, C. A., Larsen, T., Clayson, E. T., Mershon, M., M., & McCreery, M. J. (1992). The
effectiveness of a topical skin protectant against a sulphur mustard simulant in Saudia Arabian-
simulated environmental conditions in human subjects. U.S. Army Medical Research Institute of
Chemical Defense Technical Report, USAMRICD-TR-92-04. Aberdeen Proving Ground,
Maryland.

4. Larsen, T., Castro, C. A., Clayson, E. T., Mershon, M. M., & McCreery, M. J. (1991).
Development of a sulfur mustard simulant for testing topical skin protectants in human subjects
under different environmental conditions. Proceedings of the Medical Defense Bioscience
Review, 119-122.

3. Broomfield, C. A., Maxwell, D. M., Solana, R. P., Castro, C. A., Finger, A. V., &Lenz, D. E.

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(1991). Protection by butyrylcholinesterase against organophosphorus poisoning. Proceedings
of the Medical Defense Bioscience Review, 415-422.

2. Doctor, B. P., Brecht, K., Castro, C., De La Hoz, D., Finger, A., Gentry, M. K., Woodard, C.
(1991). Protection against soman toxicity and prevention of performance decrement in rhesus
monkeys by pretreatment with acetylcholinesterase. Proceedings of the Medical Defense
Bioscience Review, 407-414.

1. Castro, C. A., Finger, A., Larsen, T., Solana, R. P., & McMaster, S. B. (1991). Behavioral
Efficacy of diazepam against nerve agent exposure in rhesus monkeys. Proceedings of the
Medical Defense Bioscience Review, 385-392.

LECTURES AND CONFERENCES

Refereed Conferences (selected and since arriving at USC in 2013)

August, 2021 Kintzle, S. & Castro, C. A. (2021). The Impact of COVID-19 on

Loneliness in Veterans. Poster to be presented at the annual meeting of the
American Psychological Association Convention, San Diego, CA.

August, 2021 Kintzle, S., Castro, C. A., Carlton, M. A., & Mor Barak, M. (2021).
Factors Related to Exclusion in the U.S. Army. Poster to be presented at
the annual meeting of the American Psychological Association
Convention, San Diego, CA.

August, 2021 Alday, E., Corletto, G., Kintzle, S., & Castro, C. (2021). The Impact of
COVID-19 on Telehealth Use for US Veterans. Poster to be presented at
the annual meeting of the American Psychological Association
Convention, San Diego, CA.

August, 2021 Castro, C.A. & Atuel, H.R. Exploring Homegrown Extremism (HVE)
among Military Veterans and Civilians. Poster to be presented at the
annual meeting of the American Psychological Association Convention,
San Diego, CA.

August, 2021 Castro, C.A. & Atuel, H.R. The Beliefs that Kill Us: Homegrown
Violent Extremist ideologies of Civilians and Military Veterans. Poster to
be presented at the annual meeting of the American Psychological
Association Convention, San Diego, CA.

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August, 2021 *Nations, M., Atuel, H.R., *Calfo, C., *Mickle, J., *Uruburu, K., Darst,
M, & Castro, C.A. The terrors that bind: Women who engage in
homegrown violent extremism. Poster to be presented at the annual
meeting of the American Psychological Association Convention, San
Diego, CA.

August, 2021 *Mickle, J., Atuel, H.R., *Uruburu, K., *Calfo, C., *Nations, M., Darst,
M, & Castro, C.A. Dangerous liaisons: Exploring dyadic homegrown
violent extremism among civilians and military veterans, Poster to be
presented at the annual meeting of the American Psychological
Association Convention, San Diego, CA.

August, 2021 *Uruburu, K., Atuel, H.R., *Mickle, J., *Calfo, C., *Nations, M., Darst,
M., & Castro, C.A. The lone wolf terrorists among us. Poster to be
presented at the annual meeting of the American Psychological
Association Convention, San Diego, CA.

March, 2021 Saba, S. K., Davis, J. P., Prindle, J. J., Castro, C. A. & Pedersen, E. R.
Associations between symptoms of posttraumatic stress disorder, pain, and
alcohol use disorder among veterans [Poster presentation]. 9th Annual
Collaborative Perspectives on Addiction Conference.

October, 2020 Castro, C. A. The impact of COVID-19 on the health and wellbeing of
military service members and veterans from an international perspective.
Panel Chair, Military Psychology Summit during COVID-19, Washington,
D.C. Hosted Virtually.

August, 2019 Atuel, H. R. & Castro, C. A. Exploring Mass Shootings and Violence
among Military Veterans. Talk presented at the American Psychological
Association annual meeting, Chicago, IL.

August, 2019 McNamara, K. A., Goldbach, J. T., Holloway, I. W. & Castro, C. A.

Beyond Don’t Ask, Don’t Tell: Outness” patterns of LGBT service
members. Talk presented at the American Psychological Association
annual meeting, Chicago, IL.

August, 2019 McNamara, K. & Castro, C. A. Lesbian, gay, bisexual and transgender
(LBGT) service members: a mediation analysis explores the relationship
between LGBT-affirming workplace climate, unit-level cohesion, and and
social support in mental health outcomes. Talk presented at the Military
Health System Research Symposium annual meeting, Kissimmee, Florida.

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July, 2019 Castro, C. A. Acceptance, integration, and mental health among active
duty LGBT and non-LGBT service members. Talk presented at the
International Congress on Law and Mental Health annual meeting, Rome,
Italy.

May, 2019 Heimdal, J. O. & Castro, C. A. NATO leader development framework

for future multinational operations. Talk presented at the International
Applied Military Psychology Symposium annual meeting, Sarajevo,
Bosnia and Herzegovina.

January, 2019 Sullivan, K., Hawkins, S., Gilreath, T. & Castro, C. A. Mental health
outcomes associated with profiles of risk and resilience among Army
spouses. Paper presented at the Annual Conference of the Society for
Social Work and Research, San Francisco, CA.

January, 2019 Lucas, C., Harris, T., Cederbaum, J., Kintzle, S. & Castro, C. A. A
narrative inquiry of mental health treatment: barriers, facilitators, and
military identity among female veterans who experienced military sexual
assault. Paper presented at the Annual Conference of the Society for
Social Work and Research, San Francisco, CA.

January, 2019 Schuyler, A., Kintzle, S. & Castro, C. A. Ending Military Sexual
Assault: Development and Pilot Testing of Skills-Based Sexual Assault
Prevention Training for Military Service Members. Poster presented at
the Annual Conference of the Society for Social Work and Research, San
Francisco, CA.

January, 2019 Castro, C.A. & Kintzle, S. Financial health amongst U.S. military
veterans: Implications for practice. Paper presented in the symposium
entitled, “Financial Upheaval in U.S. Households: Systems of Guidance”
at the Annual Conference of the Society for Social Work and Research,
San Francisco, CA.

January, 2019 Sherraden, M., Huang, J., Bernacchi, J., Johnson, L. & Castro, C. A.
Models of financial guidance for disadvantaged families. Paper presented
in the symposium entitled, “Financial Upheaval in U.S. Households:
Systems of Guidance” at the Annual Conference of the Society for Social
Work and Research, San Francisco, CA.

January, 2019 Castro, C.A. Bullying and hazing among active duty LGBT and non-

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LGBT service members. Paper presented in the symposium entitled, “The
Military Acceptance Project: Disclosure, Discrimination, Bullying,
Harassment, and Violence Among Active Duty LGBT Military Service
Members” at the Annual Conference of the Society for Social Work and
Research, San Francisco, CA.

January, 2019 Schuyler, A., Klemmer, C., Mamey, M. R., Schrager, S. M., Castro, C.
A., Goldbach, J. & Holloway, I. W. Experiences with sexual harassment,
stalking, and sexual assault during military service among LGBT and non-
LGBT service members. Paper presented in the symposium entitled, “The
Military Acceptance Project: Disclosure, Discrimination, Bullying,
Harassment, and Violence Among Active Duty LGBT Military Service
Members” at the Annual Conference of the Society for Social Work and
Research, San Francisco, CA.

January, 2019 Schrager, S., Holloway, I., Goldbach, J., Castro, C. A. & Mamey, R. R.
Recruitment and data collection with active duty sexual and gender
minority service members: methods of the military acceptance project.
Paper presented in the symposium entitled, “The Military Acceptance
Project: Disclosure, Discrimination, Bullying, Harassment, and Violence
Among Active Duty LGBT Military Service Members” at the Annual
Conference of the Society for Social Work and Research, San Francisco,
CA.

January, 2019 McNamara, K.A., Lucas, C.L., Goldbach, J.T., Holloway, I.W. & Castro,
C.A. “You don’t want to be a candidate for punishment”: A qualitative
analysis of LGBT service members’ disclosure decision-making post-
Don’t Ask, Don’t Tell. Paper presented in the symposium entitled, “The
Military Acceptance Project: Disclosure, Discrimination, Bullying,
Harassment, and Violence Among Active Duty LGBT Military Service
Members” at the Annual Conference of the Society for Social Work and
Research, San Francisco, CA.

January, 2019 Dodge, J. McNamara, K., Kintzle, S., Lancaster, S. & Castro, C.A. What
Does It All Mean? Using Sensemaking Theory with the Warrior Identity
Scale to Examine Military Transition Preparedness Among U.S. Veterans.
Poster presented at the 23rd Annual Conference of the Society for Social
Work and Research, San Francisco, CA.

January, 2019 Lucas, C., Harris, T., Stevelink, S.., Rafferty, L., McNamara, K., Dunn,
R., Kwan, J., Fear, N. Kintzle, S. & Castro, C. A. Homelessness Among

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Male Veterans and the Role of Military Sexual Assault and Posttraumatic
Stress Disorder. Poster presented at the 23rd Annual Conference of the
Society for Social Work and Research, San Francisco, CA.

August, 2018 Atuel, Hazel & Castro, C.A. A Tri-Ethnic Comparison of Veteran and
Ethnic Identity: Implications for Civilian Healthcare Setting. Paper
presented at the annual meeting of the American Psychiatric Association,
San Francisco, CA.

March, 2018 Atuel, H. R. & Castro, C. A. A (Very Preliminary and Alternative)

Framework to Understanding Moral Injury. Paper presented at the
Association for Practical and Professional Ethics Annual Meeting,
Chicago, IL,

January, 2018 Barr, N., Kintzle, S. & Castro, C.A. How Does Discharge Status Affect
Military Veterans' Mental and Physical Health and Suicide Risk? Paper
presented at the 22nd Annual Conference of the Society for Social Work
and Research (SSWR) Annual Meeting, Washington, DC.

January, 2018 McNamara, K., Goldbach, J. & Castro, C.A. Mental health, physical
health, and help-seeking disparities among lesbian, gay and bisexual US
veterans. Poster presented at the 22nd Annual Conference of the Society
for Social Work and Research (SSWR) Annual Meeting, Washington, DC.

January, 2018 Lucas, C., Kintzle, S. & Castro, C.A. An Examination of Stalking Among
Female and Male Veterans and Associations with PTSD and Depression.
Poster presented at the 22nd Annual Conference of the Society for Social
Work and Research (SSWR) Annual Meeting, Washington, DC.

November, 2017 Schuyler A, Kintzle S, Castro C.A. Stalking in the US Military and
Associations with Experiences of Military Sexual Assault. Poster
presented at the American Public Health Association (APHA) Annual
Meeting. Atlanta, GA.

September, 2017 Castro, C.A. & Atuel, Hazel. Virtual Reality as a Tool for Enhancing the
Proficiency of Behavioral Health Providers: The Virtual Client-Trainer.
Paper presented in the symposium entitled, “Artificial Intelligence for
Social Good: A Transformative Approach to Social Services,” University
of Southern California Global Conference, Tokyo, Japan.

August, 2017 Castro, C.A., Holloway, I.W. & Goldbach, J. Hazing, harassment, and

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life for LGBT members of the military. Paper presented at the annual
meeting of the American Psychological Association, Washington, D.C.

August, 2017 Atuel, H., Kintzle, S. & Castro, C.A. Implementing the knowledge of
CPT-C critical skills (KACCS) scale. Poster presented at the annual
Military Health System Research Symposium, Kissimmee, FL.

June, 2017 Schuyler, A., Kintzle, S. & Castro, C.A. Sexual difficulties within
relationships and associated factors among male veterans living in
Chicagoland. Poster presented at the annual National Sexual Health
Conference, Denver, CO.

January, 2017 Lucas, C., Goldbach, J, Kintzle, S. & Castro, C.A. Military Sexual
Assault as a Mediator of Post-Traumatic Stress Disorder and Depression
Among Lesbian, Gay, and Bisexual Veterans. Paper presented at the
annual Conference of the Society for Social Work and Research, New
Orleans, LA.

January, 2017 Ozuna, S., Corletto, G., Kintzle, S. & Castro, C. A. Social
Connectedness: An Exploratory Analysis of Pre 9/11 and Post 9/11 Male
and Female Veterans Feelings of Connectedness to Society. Paper
presented at the annual Conference of the Society for Social Work and
Research, New Orleans, LA.

January, 2017 Sullivan, K., Kintzle, S., Barr, N., Gilreath, T. & Castro, C. A. The
Association of Military Veterans' Social/Emotional and Physical
Functioning with Child and Family Outcomes. Paper presented at the
annual Conference of the Society for Social Work and Research, New
Orleans, LA.

January, 2017 Barr, N., Kintzle, S., Sullivan, K. & Castro, C. A. How Do Somatic
Symptoms and Barriers to Care Affect Mental Health Service Use for
Veterans with PTSD? Paper presented at the annual Conference of the
Society for Social Work and Research, New Orleans, LA.

November, 2016 Schuyler, A., Atuel, H., Ursich, L., Dax, B., Kintzle, S. & Castro, C.A.
Virtual Training in Cognitive Processing (CPT-C) for Military/Veteran
Behavioral Health Providers. Paper presented at the annual meeting of the
International Society for Traumatic Stress Studies, Atlanta, Georgia.

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November, 2016 Fletcher, K. L., Albright, D. L., Borah, E. V. & Castro, C. A. Unpacking
Grand Social Work Challenges and its application for military social
work. Panel presented at the Annual Program Meeting of the Council on
Social Work Education, Atlanta, GA.

November, 2016 Atuel, H.R. & Castro, C.A. Exploring veteran identity and perceived
veteran discrimination in civilian settings: A tri-ethnic comparison. Paper
presented at the annual meeting of the Canadian Institute for Military
and Veteran Health Research, Ontario, Canada.

May, 2016 Castro, C. A. & Goldbach, J. Lesbian, Gay, Bisexual, and Transgender
(LGBT) Service Members: Life After Don’t Ask, Don’t Tell. Paper
presented at the annual meeting of the American Psychiatric Association,
Atlanta, Georgia.

January, 2016 Castro, C. A. Grand Challenges for Military Behavioral Research.

Roundtable presented at the annual Conference of the Society for Social
Work and Research. Washington, D.C.

January, 2016 Keeling, M, E., Kintzle, S. & Castro, C. A. A Qualitative Study of

Veteran Clients Using Employment and Housing Services in Southern
California: Exploring the Risk Factors to Persistent Employment
Problems. Paper presented at the annual Conference of the Society for
Social Work and Research. Washington, D.C.

January, 2016 Ray-Letourneau, D., Kintzle, S., & Castro, C. A. Health and Disability
among Veterans. Poster presented at the annual Conference of the Society
for Social Work and Research. Washington, D.C.

January, 2016 Kintzle, S. and Castro, C. A. Difficulty Adjusting to Civilian Life after
Military Transition: The impact on current physical and mental health
status in Pre and Post 9/11 Veterans. Poster presented at the annual
Conference of the Society for Social Work and Research. Washington,
D.C.

January, 2016 Ozuna, S. M., Schuyler, A. C., Keeling, M., Kintzle, S., & Castro, C. A.
An Exploration of Female Veteran’s Perception of Military Service in the
Context of a Male-Dominated Environment. Poster presented at the
annual Conference of the Society for Social Work and Research.
Washington, D.C.

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January, 2016 Lucas, C. L., Kintzle, S., & Castro, C. A. Military Sexual Trauma with
Military Transition as a Moderator for Relationship Issues Among
Veterans. Paper presented at the annual Conference of the Society for
Social Work and Research. Washington, D.C.

January, 2016 Schuyler AC, Lucas CL, Moore H, Kintzle S, & Castro CA. Military
sexual trauma (MST) among male and female veterans in Southern
California and associated physical and psychological health, and risk
behavior outcomes. Paper presented at the annual Conference of the
Society for Social Work and Research. Washington, D.C.

January, 2016 Barr, N., Kintzle, S., Castro, C. & Sullivan, K. What Can Specific PTSD
Symptom Profiles Tell Us about Suicidality and Non-Suicidal High Risk
Behavior in Military Veterans? Paper presented at the annual Conference
of the Society for Social Work and Research. Washington, D.C.

January, 2016 Sullivan, K., Barr, N., Kintzle, S., & Castro, C. A. The Impact of Mental
Health, Physical Health and Previous Deployments on the Family
Functioning of Veterans. Paper presented at the annual meeting of the
Society for Social Work Research, Washington, DC.

January, 2016 Belton, J., Adler, A. B., Castro, C. A. & Shields, J. J. Beyond Combat
Exposure: Non-Traumatic Deployment Stressors and Anger as Risk
Factors for Developing Posttraumatic Stress Symptoms. Poster presented
at the annual meeting of the Society for Social Work and Research.
Washington, D.C.

November, 2015 Keeling, M., Kintzle, S., and Castro, C. A. Exploring the Risk Factors to
Persistent Employment Problems among Veteran's Using Employment
and Housing Services in Southern California: A Qualitative Study. Poster
presented at the annual meeting of the British Psychological Society,
Basingstoke, England.

November, 2015 Schuyler, A., Kintzle, S., Hassan, A., and Castro, C. Military sexual
trauma among male veterans: Impact on health and risk behaviors. Poster
presented at the annual meeting of the American Public Health
Association, Chicago, IL.

August, 2015 Castro, C.A. & Kintzle, S. Military transition theory and the Los Angeles
veterans study. In C.A. Castro (Chair), Returning home from war – The
military transition theory. Symposium presented at the annual meeting of

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the American Psychological Association, Toronto, Canada.

August, 2015 Keeling, M. Kintzle, S. & Castro, C.A. PTSD and Depression in Pre and
Post-9/11 Veterans. In C.A. Castro (Chair), Returning home from war –
The military transition theory. Symposium presented at the annual
meeting of the American Psychological Association, Toronto, Canada.

August, 2015 Kintzle, S. & Castro, C.A. Suicidality in Los Angeles County Veterans.
In C.A. Castro (Chair), Returning home from war – The military
transition theory. Symposium presented at the annual meeting of the
American Psychological Association, Toronto, Canada.

August, 2015 Schuyler, A., Kintzle, S. & Castro, C.A. Experiences of Military Sexual
Trauma, and Associated Health Outcomes and Behaviors, among
Veterans. In C.A. Castro (Chair), Returning home from war – The
military transition theory. Symposium presented at the annual meeting of
the American Psychological Association, Toronto, Canada.

May, 2015 Castro, C.A. Effectiveness and limitations of resiliency programs. In

C.H. Warner (Chair), Resiliency’s role in force health protection:
Determining the effectiveness of international military efforts. Symposium
presented at the annual meeting of the annual American Psychiatric
Association, Toronto, Canada.

May, 2015 Castro, C.A. & Kintzle, S. Myths of sexual harassment and assault in the
military. In C.H. Warner (Chair), Military sexual assault: Root causes,
prevention effectiveness, and challenges in treatment. Symposium
presented at the annual meeting of the American Psychiatric Association,
Toronto, Canada.

May, 2015 Kintzle, S. & Castro, C.A. Root causes of sexual assault in the military.
In C.H. Warner (Chair), Military sexual assault: Root causes, prevention
effectiveness, and challenges in treatment. Symposium presented at the
annual meeting of the American Psychiatric Association, Toronto,
Canada.

May, 2015 Castro, C.A. Military transition theory. In C.H. Warner (Chair),
Transitioning from servicemember to veteran: Impact, assistance, and a
way ahead. Symposium presented at the annual meeting of the American
Psychiatric Association, Toronto, Canada.

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May, 2015 Castro, C.A. Prior DoD research efforts and response to the IOM report.
In C.H. Warner (Chair), Posttraumatic stress disorder treatment in the
military: The impact of the IOM report. Symposium presented at the
annual meeting of the American Psychiatric Association, Toronto,
Canada.

October 2014 Kim, A.K., Castro, C., Brunning, M. & Wilcox, S. Joining Forces: An
Intercollegiate Approach to Teaching Interprofessional, Patient-Centered
Military Health Care. Symposium presented at the annual meeting of the
Council on Social Work Education, Miami, FL.

April 2014 Pearson, J., Nassauer, K. Brenner, L., Satow, P. & Castro, C. Multiple
Approaches to Measuring Suicide Research Progress: Updates from the
National Research Action Plan and the Prioritized Suicide Research
Agenda Portfolio Analyses. Symposium presented at the annual meeting
of the American Association of Suicidology, Los Angeles, CA.

November 2013 Castro, C.A. Defense Against Suicide: Worldwide Military Suicide
Prevention and Continuum of Care Efforts. Symposium presented at the
annual meeting of the International Applied Suicide Prevention
Conference, Oslo, Norway.

November 2013 Zamorski, M., Adler, A., Castro, C., Greenberg, N., Sadler, N. & Sudom,
K. An International Consensus Definition of Psychological Resilience for
Military Organizations. Paper presented at the annual meeting of the
International Society for Traumatic Stress Studies, Philadelphia, PA.

November 2013 Castro, C.A. What We Know about Combat and Mental and Behavioral
Health. Paper presented at the annual meeting of the International
Society for Traumatic Stress Studies, Philadelphia, PA.

September 2012 Gutierrez, P.M., Joiner, T. & Castro, C.A. Preventing Suicide in the
United States Military: Research Challenges and Opportunities. Paper
presented at the European Symposium of Suicide and Suicidal Behavior,
Tel Aviv, Israel.

June 2012 Gutierrez, P.M., Castro, C.A., Fitek, D.J., Jobes, D. & Holloway, M.
Status of Department of Defense Funded Suicide Research. Symposium
presented at the Departments of Defense and Veterans Affairs Suicide
Prevention Conference, Washington, D.C.

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May 2011 Castro, C.A. Learning from Observations Already Learned. Paper
presented at the annual meeting of the International Applied Military
Psychology Symposium, Vienna, Austria.

November 2010 Castro, C.A. Developing a Valid Definition of mTBI/Concussion. Paper

presented at the annual meeting of the International Society of Stress
Studies, Montreal, Canada.

Invited presentations/Key note addresses (selected and since arriving at USC in 2013)

September, 2020 Castro, C. A. Risks, Leadership and Virtual Care. Professorial and
Discussant at the Confronting the Pandemic: A Mental Health Perspective
and Maintaining Operational Readiness of NATO Forces Symposium.
Hosted Virtually.

October, 2019 Castro, C. A. Lessons Learned After 15 Years of War: Thoughts for
Senior Leaders. Talk present at the Swiss Federal Institute of Technology,
Zurich, Switzerland.

October, 2019 Castro, C. A. Military and Family Mental Health: A Global Perspective.
Talk presented at the Swiss Military Academy at ETH Zurich
Kaserne, Zurich, Switzerland.

October, 2019 Castro, C. A. Castro, C. A. Lessons Learned After 15 Years of War: Role
of Military Psychology. Talk presented at the Swiss Military Academy at
ETH Zurich Kaserne, Zurich, Switzerland.

November, 2019 Castro, C. A. The role of Social Connectedness in Service Member and
Family Transition. Talk presented at the Bristol-Myers Squibb
Foundation Veterans Mental Health and Well-being Grantee Summit,
Tampa Bay, Florida.

June, 2019 Castro, C. A. Military and Veteran Health: A Global Perspective. Talk
presented at the Conference Series on Military Social Work, Health and
Intervention for the Military, Veterans, and Their Families, Seoul, South
Korea.

June, 2019 Castro, C. A. The Health and Well-being of the U.S. Military and Veteran
Family. Talk presented at the Conference Series on Military Social Work,

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Health and Intervention for the Military, Veterans, and Their Families,
Seoul, South Korea.

May, 2019 Castro, C. A. PTSD and Moral Injury. Talk presented at the 53rd
International Applied Military Psychology Symposium annual meeting,
Sarajevo, Bosnia and Herzegovina.

October, 2018 Castro C. A. Moral Injury from a Character Disruption Perspective.

Talked presented at the Defence Ethics Programme Speaker Series,
Symposium on Moral Injury, RCAF 17 Wing, Winnipeg, Manitoba,
Canada.

October, 2018 Castro, C.A. Global Perspectives on Military and Family Mental Health.
Talked presented at the Cohen Veterans Care Summit, Washington, D.C.

June, 2018 Castro, C.A. Mental Health Advisory Team (MHAT) IV. Talk presented
at the Moral Decisions and Mental Health NATO Lecture Series Human
Factors and Medicine (HFM-284), London, England.

May, 2018 Castro, C.A. Military Transitions: Resilience and Risk Post-Deployment.
Talk presented at the 52nd International Applied Military Psychology
Symposium annual meeting, Bucharest, Romania.

May, 2018 Castro, C.A. The Military (and Veteran) Family. Workshop presented at
the 52nd International Applied Military Psychology Symposium annual
meeting,
Bucharest, Romania.

April, 2018 Castro, C.A. Military Transition: A NATO Research and Technology
Group Perspective. Talk presented at Veteran Empowerment and
Transition Summit, Kiev, Ukraine.

April, 2018 Castro, C.A. Transitions and the Veteran. Talk presented at the Joint
Department of Veterans Affairs and the Department of Defense Military to
Civilian Transition Summit 2.0, Washington, D.C.

March, 2018 Castro, C.A. Military Transition, Identity and Health. Talk presented at
Queen’s University, Kingston, Ontario, Canada.

March, 2018 Castro, C.A. Military Transition is King. Talk presented at the Veteran’s
Mental Health conference. London, England.

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November, 2017 Castro, C.A. Military Transition Theory. Talk presented at the Marne
Behavioral Health Summit annual meeting. Fort Stewart, GA.

May, 2017 Castro, C.A. GI Bill: Overview and Analysis. Talk presented at the
Association of Pacific Rim Universities. Los Angeles, CA.

May, 2017 Castro, C.A. Military Transition Theory. Talk presented at the
Association of Pacific Rim Universities. Los Angeles, CA.

April, 2017 Castro, C.A. Differentiating TBI and PTSD: Language and definitions.
Talk presented at the annual World Brain Mapping conference. Los
Angeles, CA.

January, 2017 Castro, C.A. Things to Know about Veterans. Talk presented at the
quarterly meeting of the Valley Industrial Association. Santa Clarita, CA.

January, 2017 Castro, C.A. Communities Working with Veterans. Talk presented at the
monthly Santa Clarita Veterans Collaborative. Santa Clarita, CA.

November, 2016 Castro, C.A. Moving Beyond the Repeal of Don’t Ask, Don’t Tell:
Welcoming LGBT Service Members in the Military. Talk presented at the
Marne Behavioral Health Summit. Fort Stewart, GA.

September, 2016 Castro, C.A. The Combat Veteran Paradox and the Transition Back to
Civilian Life. Keynote talk presented at the Service Member to Civilian
(S2C) Summit, Birmingham, Alabama.

April, 2016 Castro, C.A. Combat Veteran Paradox, Sexual Trauma in the Military,
and Combat and Mental Health. Three talks presented as part of the
Distinguished Visitors Program of the Conflict Management and
Resolution Program, The Ben Gurion University of the Negev, Israel.

September, 2015 Castro, C.A. Military Family Research. Talk presented at the Battle Plan
for Supporting Families Symposium, Washington, D.C.

July, 2015 Castro, C.A. Combat Veteran Paradox. TED-like Talk presented at the
Military Child Education Coalition Conference pre-event, Addressing the
Emotional Needs of Military and Veteran Children: Building Connections
and Supportive Communities, Washington, D.C.

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June, 2015 Castro, C.A. The Military Transition Theory. Paper presented at the
Department of Defense’s Transition Research Summit, Washington, D.C.

May, 2015 Castro, C.A. Military Social Work Research: Theory and Framework.
Paper presented at the International Symposium on Military Social Work
Theories and Practice, Nanjing, China.

March, 2015 Castro, C.A. & Hassan, A.M. Enhancing Mental Healthcare in a
Military Setting (multiple presentations). Workshop (three days)
presented to the Ministry of Defense, Singapore.

November, 2014 Castro, C.A. Coming Home: The Impact of Combat Duty on Civilian
Integration. Paper presented at the Canadian Institute for Military and
Veteran Health Research, Toronto, Canada

September 2014 Castro, C.A. The Influence of Combat on Veterans. Paper presented at
the Native American Veterans Association (NAVA) Summit, Los
Angeles, CA.

April 2014 Castro, C.A. Brain Health: Defining a Movement. Paper presented at the
Army Medicine Brain Health Consortium, Washington, D.C.

March 2014 Castro, C.A. & Hassan, A. Advice for Military Social Workers: Facing
Tough Facts to Become More Effective. Paper presented at Fu Hsing Kang
College, Taipei, China.

September 2013 Castro, C. A. A Comprehensive Approach to Caring for Service

Members, Veterans, and their Families. Paper presented at the Pacific
Armies’ Chiefs’ Conference VIII (PACC) and Pacific Armies’
Management Seminar XXXVII (PAMS), Auckland, New Zealand.

September 2013 Castro, C.A. Veteran Transition. Paper presented at True Love Patriot
Conference, Canada House, London, England.

April 2012 Ruzek, J., Shalev, A., Castro, C.A., de Jong, J., Keane, T., Rosen, R. &
Vermetten, E. Reaching Vulnerable Populations Worldwide: Applying
Evidence-Based Training and Core Psychological Change Processes to
Disseminate Effective Services for Trauma Survivors. NATO Advanced
Research Workshop, Amsterdam, The Netherlands.

December 2011 Castro, C.A. Combat and the Mind of the Veteran. Paper presented at

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the Chicago Institute for Psychoanalysis, Chicago, IL.

March 2011 Castro, C.A. 10 Things We Think We Know about the Mental Health and
Well-being of U.S. Soldiers Returning from Combat Duty in Iraq. Paper
presented at the Royal Higher Institute for Defence, Brussels, Belgium.

February 2011 Castro, C.A. Definition of Mild Traumatic Brain Injury. Paper presented
at Wounds of War III: Coping with Blast-related Traumatic Brain Injury
in Returning Troops, Vienna, Austria.

October 2010 Castro, C.A. Reconceptualizing the Diagnosis of Combat-related

Posttraumatic Stress Disorder. Paper presented at the Military Mental
Health Group, University Medical Center, Utrecht, The Netherlands.

June 2009 Castro, C.A. Impact of Combat on the Mental Health and Well-being of
Soldiers and Marines. Paper presented at the Royal United Services
Institute, London, England.

October, 2007 Castro, C.A. Military Mental Health. Paper presented at the conference
on the occasion of the 140th anniversary of the The Netherlands Red Cross
entitled, “Protecting human dignity in armed conflict,” The Peace Palace,
The Hague, The Netherlands.

May, 2005 Castro, C. A. & Clark, J. C. Work–family balance in soldiers and their
families. Paper presented at the Defense Department Advisory Committee
on Women in the Services Business Meeting, Arlington, VA.

Podcasts and Blogs

1. Huggins, J. (Producer) & Hoffberg A.S. (Host). (2017, February 22). Dr. Carl Castro on the
Military Suicide Transition Theory, The Hemingway Effect and the Importance of
Understanding the Military Family. Rocky Mountain MIRECC Short Takes on Suicide
Prevention [Audio podcast]. Retrieved from
https://www.mirecc.va.gov/visn19/education/media/#podcast_castro_transitions

2. Bustamante, C. (Producer & Host). (2017, April 24). Dr. Carl Castro, CIR Director discusses
sexual assault in the military [Audio Podcast]. Retrieved from https://soundcloud.com/usc-
cir/cir-director-carl-castro-discusses-sexual-assault-in-the-military.

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3. Bustamante, C. (Producer & Host). (2017, June 9). Professors Jeremy Goldbach and Carl
Castro discuss LGBT in military [Audio podcast]. Retrieved from https://soundcloud.com/usc-
cir/professors-goldbach-and-castro-discuss-lgbt-in-military

4. Schuyler, A.C., Klemmer, C., Mamey, M.R., Schrager, S.M., Goldbach, J.T., Holloway, I.W.
and Castro, C.A. (2020, April 1). LGBT Service Members Report More Sexual Assault, Sexual
Harassment and Stalking than their Cisgender Heterosexual Peers.
https://istss.org/public-resources/trauma-blog/2020-april/lgbt-service-members-report-more-
sexual-assault,-s

5. Arrendone P. (Producer & Hoste). (2020, September 30). Dr. Carl Castro on the struggles
of veterans, military service members and their families have faced during the coronavirus
pandemic. Blazing Battles with MVP Episode 1: The Impacts of Covid-19 on the Military
Community. Retrieved from
https://youtu.be/8GlARFiehAc.

TEACHING, MENTORING AND CURRICULUM DEVELOPMENT

2019 Clinical Practice with Service Members and Veterans (SOWK 641)
Small Systems Theories (SOWK 703)

2018 Clinical Practice with the Military Family (SOWK 640)

Small Systems Theories (SOWK 703)

2017 Small Systems Theories (SOWK 703)

2017 Developed Military Theoretical Foundations for Military Social Work

Theories and Applications (SOWK 633)

2016 Human Behavior in the Context of Social Environments: Behavioral and

Social Science Theory and Research (SOWK 702)

2015 Developed Military and Veteran Policy and Program Management

(SOWK 650)

2014 -2015 Clinical Practice with Service Members and Veterans (SOWK 641)
Independent Research for 7 students (SOWK 590)
Evaluation in Mental Health Settings (SOWK 625)

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2013 – 2014 Clinical Practice with the Military Family (SOWK 640)

2013 Co-developer and lecturer, Interprofessional Education Workshop, Mount

St Mary’s College, Los Angeles, CA

2005 – 2007 Developed the Battlemind Resilience Training System which was
validated in three large group randomized trials. Battlemind was
subsequently adopted by the U.S. Army as part of their Comprehensive
Soldier Fitness Military Resilience Training Program. Battlemind training
was also adopted by Canada, The Netherlands and Norway as part of their
reintegration training following deployment.

2002 – 2005 Lecturer, Combat and Operational Stress Control Course

Army Medical Department Center and School, San Antonio, TX

1993 - 1994 Instructor, Medical Effects of Nuclear Weapons Course

Armed Forces Radiobiology Research Institute,
Bethesda, Maryland

ACADEMIC AND RESEARCH MENTORING

Visiting Scholars

2016 – 2017 Liu Yan (China)

2015 – 2016 David Pedlar (Canada, Fulbright)

2014 – 2015 Eyal Fructer (Israel)

Dissertations/Capstones

2018 – Present Julia O’Laughlin, Doctoral Student, University of British Columbia

Dissertation Title: “The Impact of Traditional Masculinity Ideology on
Military to Civilian Transition in Veteran Men”
Member Dissertation Committee

2017 – Present Jessica Dodge, Doctoral Student, Suzanne Dworak-Peck School of Social
Work. Mentored in academic writing and research methods in the area of

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military and veteran families.
Chaired Qualifying Examination

2018 – 2020 Stephen Morgano, Suzanne Dworak-Peck School of Social Work.

Mentored in academic writing and research methods in the area of
behavioral care support to military personnel.

2017 – 2019 Jenny Paul, MPH Student, University of Washington

Capstone Title: Analysis of Department of Defense Transgender Service
Policy: Exploring Facilitators and Barriers to Integration and Acceptance
Member Capstone Committee (External Member)

2016 – 2019 Katie McNamara, Doctoral Student, Suzanne Dworak-Peck School of

Social Work.
Dissertation Title: “Disclosure of LGBT Identity Among U.S. Military
Members After Don’t Ask, Don’t Tell”
Chaired Qualifying Examination, passed with distinction.
Chair Dissertation Committee, passed with distinction.
Current Appointment: Major (U.S. Air Force) and Staff Faculty, Nellis Air
Force Base, Las Vegas, Nevada

2014 – 2018 Nicholas Barr, USC Suzanne Dworak-Peck School of Social Work.
Dissertation Title: “Mindfulness and Resilience: An Investigation of the
Role of Mindfulness in Post-9/11 Military Veterans’ Mental Health-
Related Outcomes.”
Chaired Qualifying Examination, passed with distinction.
Chaired Dissertation Committee, passed with distinction
Current Appointment: Assistant Professor, University of Nevada, Las
Vegas

2014 – 2018 Kate Sullivan, USC Suzanne Dworak-Peck School of Social Work.
Dissertation Title: “Mental Health Outcomes Associated with Profiles of
Risk and Resilience among Military-Connected Youth.”
Chaired Qualifying Examination, passed with distinction.
Chaired Dissertation Committee, passed with distinction
Current Appointment: Assistant Professor, School of Social Work, New
York University

2014 – 2017 Carrie Lucas, USC Suzanne Dworak-Peck School of Social Work.
Dissertation Title (completed): “An Examination of Sexual Harassment,
Gender Discrimination, Stalking, and Sexual Assault among Female and

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Male Veterans and Associations with PTSD and Depression.”
Chaired Qualifying Examination, passed with distinction.
Chaired Dissertation Committee.
Current Appointment: Major (U.S. Air Force) and Assistant Professor,
Uniformed Services University (USU) of the Health Sciences, Bethesda,
Maryland.

Post Docs

2018 – 2019 Nicholas Barr, USC Suzanne Dworak-Peck School of Social Work.
Mentored in military research grant preparation in the areas of military
mindfulness and intervention studies.
Current Appointment: Assistant Professor, University of Nevada, Las
Vegas

2015 – 2018 Mary Keeling, Post-doc, USC Suzanne Dworak-Peck School of Social
Work. Mentored in military research methods, grant management and
research grant preparation in the areas of military family and couples.
Current Appointment: Research Lead, United Kingdom Council of
Psychotherapist

2016 – 2017 Christopher Lamb, Post-doc, USC Suzanne Dworak-Peck School of Social
Work. Mentored in dissemination and implementation of behavioral
health care, grant management and research grant preparation.

Doctoral Tutorials

2015 – 2016 Tayler Harris, Doctoral Student, USC Suzanne Dworak-Peck School of
Social Work, Tutorial on military veteran homelessness and risk-taking
behaviors.

2014 – 2016 Hadass Moore, Doctoral Student, USC Suzanne Dworak-Peck School of
Social Work. Mentored in academic writing, statistical methods, research
methods and study design in the area of military female transitions.

MSW Independent Research Study

2018 Jessica Dodge, Thesis Title: “How Important Is It to Have a Job Upon

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Leaving the Military? Examining the Relationship between Current
Employment Status, Health Outcomes, and Prior Transitioning Out of the
Military Employment Status.”

2016 – 2017 Will Hill, Thesis Title: “Best Practices for Psychological First Aid”

SERVICE

University of Southern California Service

2020 – 2021 Member, USC Tenured and Tenured Track Faculty Affairs Committee

2020 – 2021 Member, USC Research Committee

2015 – Present Member, USC Military Affairs Committee, Chaired by the Vice Provost

2019 Panel Member, Perspectives on Native American Issues: The Veteran’s

Experience. Los Angeles, CA.

2018 – 2019 Member, USC Academic Senate

2018 Chaired and Hosted the fourth annual USC Military Transition Research
Summit, Financial Readiness for Transition, Los Angeles, CA.

2017 Co-chaired the Association of Pacific Rim Universities Symposium. Los

Angeles, CA.

2017 Co-chaired and Hosted the Northern Arizona University – University of

Southern California Veteran – Military Collaborative Research
Symposium, USC Suzanne Dworak-Peck School of Social Work,

2017 Co-chaired the third annual USC Military Transition Research Summit,
with the Department of Veterans Affairs, Veterans Policy Research
Roundtable on Women Veterans, Arlington, VA

2016 Chaired and Hosted the second annual USC Military Transition Research
Summit, Military to Civilian Life Transition: Theoretical Consensus. Los
Angeles, CA.

2015 Chaired and Hosted the inaugural USC Military Transition Research
Summit, Closing the Gap: Planning the Research Agenda for the Next

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Decade to Address the Needs of Service Members, Veterans and their
Families, Los Angeles, CA.

2014 Lecturer for the Center for Excellence in Research Workshop, Office of
Research Presented on Obtaining Department of Defense (DoD) Medical
Research Funding

2014 Reviewer for Military Scholarships, Provost Pre-College Scholars

2013 Panel Member, Work and Home: Addressing the Urgent Needs of
Returning Veterans, Sol Price School of Policy, USC

Suzanne Dworak-Peck School of Social Work Service

2016 – Present Chair, Military Track Curriculum Committee (formerly Sub-

Concentration)

2014 – Present Member, Doctoral Committee

2017 – 2019 Member, Position Management Review Committee

2019 Member, Provost Joint Working Group

2018 – 2019 Chair, Faculty Council

2017 – 2018 Chair, Policy Working Group, Sexual Harassment Task Force

2017 – 2018 Member, Faculty Council

2017, 2018 Member, Promotion Review Committee

2016 – 2018 Member, Search Committee

2016 – 2017 MSW Application Review Committee

2015, 2016, 2017 External Reviewer, Associate Professor to Full Professor

2015 – 2017 Member, Research Council

2015 – 2016 Member, Curriculum Committee, Department of Community,

Organization and Business Innovation

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2014 – 2017 Chair, Military Behavior and Trauma Research Cluster

2014 – 2018 Member, Annual Performance Review Committee (APR), Department of

Social Change and Innovation (formerly Community, Organization and
Business Innovation)

2013 – 2017 Member, Management Organization and Policy Transformation Research

Cluster

2013 – 2016 Member, Military Sub-Concentration Curriculum Committee

2014 – 2015 Member, Curriculum Council

2014 Presenter, Board of Councilors meeting

2014 Panel Member, All School Day: Serving those who Served in the Military

2013 Presenter, Board of Councilors meeting

National and Global Service

2020 – Present Board Member, Greater Los Angeles Veterans Research and Educational
Foundation (GLAVREF), Los Angeles CA

2020 – Present Chair, International Military Psychology Committee, Society for Military
Psychology, American Psychological Association

2018 – Present Member, Veteran Peer Access Network Steering Committee, Los Angeles
County Department of Mental Health

2018 – Present Member, Together with Veterans Advisory Board, Department of Veteran

2015 – Present Member, Advisory Board of the King’s Centre for Military Health
Research, London (Chaired by Field Marshall The Lord Guthrie)

2015 – Present Senior Advisor, Cohen Veterans Network (CVN) Scientific Advisory
Board

2020 – 2021 Member, Military Family Abstract Review Panel, Military Health Services
Research Symposium

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2014 – 2021 Chair, NATO Research and Technology Group – 132, The Transition of
Military Veterans from Active Service to Civilian Life

2015 – 2019 Chair, Scientific Review Committee, Military Service Members, Veterans
and their Families, Society for Social Work Research

2013 – 2020 Scientific Advisor, Military Suicide Research Consortium, Department of

Defense

2014 – 2019 Member, National Academy of Science for the Board on Army Science
and Technology (BAST)

2014 – 2019 Member, Scientific Advisory Board, Center of Excellence for Research on
Returning War Veterans, Department of Veteran Affairs

2019 Delegate, PREVENTS Task Force, National Association of Social

Workers Focus Group, Washington, D.C.

2012 – 2018 Member, Scientific Advisory Board for the Department of Veterans
Affairs for the National Centers of PTSD, Department of Veteran Affairs

2018 Consultation, Parliamentary Committee on Veteran Affairs, Chair,

Oleksandr Tretiakov, Member of Parliament, Ukraine.

2017 Witness, California Legislature Senate Committee on Veteran Affairs,

“Challenges Facing California Veterans during the Transition Back to
Civilian Life,” Sacramento, CA

2016 – 2018 Chair, CSWE Advanced Social Work Practice in Military Social Work
Guide

2016 – 2018 Member, CSWE Advanced Social Work Practice for Trauma in Social
Work Guide

2016 Reviewer (external), Veterans and Families Institute (VFI), Anglia Ruskin
University, Chelmsford, United Kingdom

2015 – 2016 Member, National Academy of Medicine (formerly Institute of Medicine,

IOM) Committee entitled “Evaluation of Research Management by DoD
Congressionally Directed Medical Research Programs (CDMRP)”

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2012 – 2016 Member, NATO Research and Technology Group – 218, Military Suicide

2009 – 2015 Chair, NATO Research and Technology Group – 203, Mental Health
Training

2014 – 2015 Scientific Advisor, Consortium to alleviate PTSD, Department of Defense

and Department of Veterans Affairs

2013 – 2015 Scientific Advisor, Air Force Scientific Advisory Board, Combating
Sexual Assault, Department of Air Force

2012 – 2013 Member, Advisory Board for the Department of Veterans Affairs for the
Center of Excellence for Suicide Prevention

2012 – 2013 Member, The White House Executive Order to Establish a National
Research Action Plan for TBI, PTSD and Suicide

2011 – 2013 Chair, Military External Advisory Board for the Military Suicide Research
Consortium, Department of Defense

2011 – 2013 Chair, External Advisory Board for the Violence within the Military
Consortium, Department of Defense

2010 – 2013 Chair, The Joint Program Committee for the Military Operational
Medicine, Department of Defense

2008 – 2013 Lead U.S. Technical Science Officer on bi-lateral agreements with United
Kingdom, Sweden, France and India, Department of Defense

2008 – 2013 Provided expert testimony on numerous occasions to Congress on the

mental health status of service members and their families

2005 – 2012 Chair, The Technical Cooperation Panel (TTCP) - Psychological Support
During Military Operations, Department of Defense

2010 Co-Chair, NATO Research Symposium – 205 Psychological Support

Across the Military Spectrum, Bergen, Norway

2009 Chair, International workshop - Third Location Decompression

Portsmouth, England,

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Professional Memberships

2019 – Present Member, National Association of Social Workers

2013 – Present Member, Council on Social Work Education (CSWE)

2013 – Present Member, Society for Social Work and Research (SSWR)

1997 – Present Member and Fellow, American Psychological Association

Editorship

2014 – Present Editor, Military Behavioral Health

Journal Reviewer

Journal of the American Medical Association

British Journal of Psychiatry
Lancet
Clinical Psychology Review
Current Psychiatry Reports
Journal of Traumatic Stress
Journal of Head Trauma Rehabilitation
Archives of General Psychiatry
Journal of Social and Clinical Psychology
Psychiatric Research
Military Medicine
Military Psychology

Grant Reviewer
NASA
NIDA
US – Israel Binational Science Foundation
U.S. Army Medical Research and Develop Command

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 Declaration of Randy Dale Floyd

I, Randy Dale Floyd, hereby declare as follows:

/t2,4.
Pt?
1. My name is1$andy Floyd. I am the brother of Michael Floyd, Zane’s father. I am
married to Mi4eF1oyd, and we have two sons, Zack and Josh. Zack passed away a few
years ago. We currently live in Amarillo, Texas.

2. Most of my interaction with Zane was from Zane’s childhood to his mid-teenage years.
I saw Zane at least once a year at family gatherings at our parent’s house in Clovis,
New Mexico, at our house in Amarillo, or at Mike’s house in Las Vegas.

3. Growing up, Zane was a good kid, well behaved and polite. Zane participated in sports
and other positive activities. I never saw Zane as a troublemaker.

4. My sons, Zane’s cousins, Zack and Josh, had a very good relationship with Zane and
spent time with one another when the families got together. Zane was like a big brother
to Josh, who was younger. When the three cousins got together, they usually played
games and sports, went to the movies, and hung out with one another.

5. Valerie told me that Zane had suffered some traumatic experiences while stationed in
Cuba. I also understood that it was a nerve-racking experience for Zane serving in
Cuba. The Cuban soldiers frequently pointed their weapons at Zane and his fellow
American troops, and he felt like an attack could take place at any time. Zane remained
on guard throughout his time there.

6. When we heard about Zane’s arrest, we were surprised and devastated. The shooting
was totally out of character from the Zane we knew and loved. To me, the incident does
not reflect Zane’s character. Zane is a kind and gentle person. I don’t believe the
shootings would have happened if Zane had been in his right mind.

7. Mike Floyd recently asked Josh to handle his and Zane’s burial rites. He asked Josh to
take their ashes and spread them in a designated location.

I declare under penalty of perjury that the foregoing is true and correct, and that
this declaration was executed on April 1’, 2021 in Amarillo, Texas.

Randy ]Yale Floyd

085
 Declaration of Aubra Hall-Smithson

I, Aubra Hall-Smithson, hereby declare as follows:

1. My name is Aubra Hall-Smithson. I am forty-three years old and currently reside in

Killen, Texas. My parents, Mike Hall and Tracy Delagardelle, both have remarried. My
father lives in Las Vegas, Nevada, where I was raised. My mother lives in Denison,
Texas. I have a brother named Robert “Jay” Hall who lives near me in Killeen.

2. I grew up in Las Vegas, Nevada. I met Zane Floyd through his friendship with my
brother, Jay, around the time that I was attending elementary school. Zane was at our
home on almost a daily basis when we were growing up, and he seemed more like a
family member than a friend.

3. Zane was a happy person and tried to make people laugh when we were kids. He treated
me like his little sister and was very protective of me. Zane also accompanied me to my
high school prom. Zane was always a gentleman and made me feel safe.

4. When Zane came home from military, it seemed like his whole personality changed. He
was unhappy, more introverted, did not joke around like he did when we were growing
up, and his overall demeanor was sober and serious. Zane was less joyful and was not the
same bubbly person that he was prior to his military service.

5. Zane was very dissatisfied with himself when he came home. He was not able to find a
good job and had to move back into his parents’ home. Zane saw himself as a failure for
losing the prestige associated with being a Marine and having to struggle while working
at odd jobs.

6. Zane came home with an odd fixation on guns. He was proud of being the youngest
weapons trainer at Camp Pendleton, in San Diego, and spoke about guns all the time.
During a New Year’s Eve gathering in 1998, just months after he came home from the
Marines, I recall Zane speaking about guns with my late uncle Danny Hall for several
hours. I found Zane’s fascination with guns to be very strange because he never talked
about guns prior to his military service.

7. Zane discussed some of the things he went through at Guantanamo Bay with my brother
and dad. I heard much of these details secondhand. It was clear to me that Zane
experienced traumatic events during his tour in Cuba and he never recovered afterwards.

8. Zane said that he hated Gitmo and looked forward to leaving throughout his deployment.

9. I had a chance to see the news footage of Zane being arrested at the Albertson’ s
following the incident and he did not look like anything like himself. In fact, I had to
look twice to make certain it was Zane. Eventually, I was able to confirm it was Zane,
but he had a distant and empty expression on his face like he was not there. I never saw
Zane look this way and it was shocking.

Page 1 of 2

086
 10. Zane’s actions were all surreal to me because it was totally out of character. He was a
good person who did not engage in violence.

11. I began visiting Zane within the first few days of his arrest. Zane was still out of it and
seemed like a Zombie. When he eventually was able to communicate, he was very
remorseful. He did not know why he did what he did, and he had little memory of what
happened. Zane was deeply regretful and felt great sorrow for the victims and their
families.

12. 1 believe Zane’s life should be spare because this was the worst thing Zane had ever done
in a life that was otherwise peaceful, loving, and free of any violence. Although his
actions on the day of the incident have come to define his character in news, those of us
who know Zane best understand that his life has so many more positive dimensions.

I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on April 2021 in Killeen Texas.

Page2 of2
087
 Declaration of Robert “Jay”John Hall

I, Robert “Jay” John Hall, hereby declare as follows:

1. My name is Robert “Jay” John Hall. I am forty-five years old and currently reside in
Killeen, Texas. My parents, Mike Hall and Tracey Delagardelle, both have remarried.
My father lives in Las Vegas, Nevada, where I was raised. My mother lives in Denison,
Texas. I have a sister named Aubra who lives near me in Killeen.

2. I grew up in Las Vegas, Nevada. I met Zane Floyd around the age of Il and we became
best friends.

3. Zane and I met while attending Hyde Park Junior High School. We both also attended
Faith Lutheran, Cashman, and Clark High Schools. Zane and I spent more time with
one another than anyone else. We also spent a lot of time at each other’s homes.

4. Zane was socially awkward. When we first met in the sixth grade, Zane often sat at
the back of the class and cracked jokes and did whatever he could to make people
laugh. Most of his jokes were self-deprecating and at his own expense. Many of the
kids in the class laughed, but Zane did not seem to realize that they were laughing at
him and not with him.

5. As a result of this behavior, many of the kids in school thought Zane was weird, and
he was bullied. I recall that kids sometimes waited for Zane outside after school. I
often had to walk Zane home to make sure no one picked on him or beat him up. I
transferred to another school after a few months and Zane did not have anyone to
protect him on his walks home.

6. Zane was a good guy, he was not a troublemaker, and liked to help people.

7. Zane did not have many friends growing up nor did he have many girlfriends.
Whenever I was not around Zane, he spent most of his time alone.

8. Zane’s parents—Mike and Valerie Floyd—drank a lot of alcohol around us. Valerie’s
drinking intensified during social gatherings and she often passed out before the
evenings were over. She would also become verbally abusive to Zane when she drank
too much.

9. When Zane was about 14 or 15 years old, Mike Floyd allowed us to drink with him.
On one occasion, we all got drunk and Mike started talking trash about Zane living
under his roof and having to follow his rules. Without warning, Mike punched Zane
in the jaw and Zane fell back and started crying. Mike also controlled Zane by using
intimidation.

088
10. Mike was a harsh disciplinarian. I recall one instance where Zane accidentally lost
season tickets that Mike had purchased for “Wet N’ Wild” water park. Mike
screamed at Zane and then picked him up by his hair and threw him against the
window of the car.

11. Zane’s grandfather was Wayne Hodson. Mr. Hodson was hard on Zane and he
favored his other grandchildren.

12. Zane was drinking a lot and his life did not seem to have a direction at the time he
decided to join the marines. I was surprised by Zane’s decision to join the military
and especially surprised with his decision to join the Marines of all branches. Zane
did not seem like the “Marine” type.

13. At some point Zane was stationed at Guantanamo Bay, Cuba. Zane talked to me
about his experiences there. Zane said he saw people blown up in landmine fields
between the Cuban and American military bases.

14. Zane also talked about bayonetting a Cuban civilian who ran up to his company. Zane
said he had no choice to use his bayonet because he did not understand what the
civilian was saying, and Zane believed he may have been a hostile.

15. Zane also spoke about the refugee duties he was assigned. The Cubans and Haitians
were trying to flee their desperate circumstances, but Zane and his fellow troops had
to round them up into detainment camps. Zane wanted to help them but could not,
and Zane felt completely powerless.

16. Zane hated Gitmo and could not wait to be reassigned back to San Diego.

17. When Zane came home from military it seemed like his whole personality had
changed. He was unhappy, more introverted, and stopped joking around. Zane’s
overall demeanor was somber and serious. Zane was less joyful and was not the same
bubbly person that he was prior to his military service.

18. Zane seemed depressed and was very unhappy with himself when he came home. He
was not able to find a good job and had to move back into his parents’ home. Zane
saw himself as a failure for losing the prestige associated with being a Marine and for
having to struggle working at odd jobs.

19. Zane also returned from the military with an odd fixation on guns, talking about them
all the time. I recall Zane speaking about guns for hours with my late uncle Danny
Hall during a New Year’s Eve gathering in 1998 just months after Zane returned
home. I found Zane’s gun fixation to be very strange because he never talked about
guns prior to his military service.

089
20. I saw the news footage of Zane being arrested at the Albertson’s. Zane did not look like
himself. He had a distant and empty expression on his face like he was not there. I had
never seen Zane in such a state.

21. I was shocked by the crime because it was totally out of character for Zane. Zane led a
life free of violence until this episode.

22. I began visiting Zane a few months after his arrest. He was very remorseful and
regretful about what he did from our first conversation. He did not know why he did
what he did and had virtually no memory of what happened.

I declare under penalty of perjury that the foregoing is true and correct, and that
this declaration was executed on April 2021 i
, illeen, as.

John Hall

090
 Declaration of Tracy Delaarde11e

I, Tracy Delagardelle, hereby declare as follows:

1. My name is Tracy Delagardelle. I am sixty-three years old and currently reside in

Grayson County, Texas. I am Robert “Jay” Hall’s mother. Mike Hall, Jay’s father, is
my former husband. Mike and I also have a daughter named Aubra. We all lived in Las
Vegas, Nevada.

2. Jay and Zane Floyd were friends since around the sixth grade. The two were inseparable
until Zane went into the military. Zane was an only child and liked to spend time at our
house because Jay and Aubra acted as substitute siblings. Zane became a de facto
member of our family.

3. Zane was a good kid. He was well-behaved, very polite, never loud, and did not talk
back or use profanity. Zane was not mean-spirited, nor did he bully other children. I
enjoyed having Zane around our home; he was funny and quirky. Zane was so trusted
by my husband and I that we allowed him to take our daughter, Aubra, to her Jr. High
school prom. Zane was always respectful and treated eveiyone like a gentleman.

4. I knew Zane was hyperactive and had a short attention span. I recall that Zane received
medication to help him control this.

5. Mike and I became friends with Mike and Valerie Floyd because our sons were so
close. Mike and Valerie liked to drink.

6. Jay told me that he witnessed domestic violence issues in Zane’s home.

7. After Zane went into the military, I lost touch with him. And I do not recall having
many interactions with Zane when he came home from the military. Nonetheless, I
believe it must have had an impact on him based on the experiences I had as a military
wife. My former husband Mike was a completely changed person after his experience
in the Marines.

8. I watched the news coverage of the shootings and found that Zane was unrecognizable
after his arrest. I only knew it was Zane because his name appeared on the screen. I had
to look at the new coverage for a while before I was able to tell it was really Zane. His
head was shaven, which was unusual, and his face looked distant and empty. It was
clear to me that Zane was not all there.

9. My family started visiting Zane regularly within the first couple days of his arrest. At
first, Zane was not very coherent. It took about a week or more before Zane seemed
more like himself. Nonetheless, Zane took responsibility for his actions and was very
remorseful from the start.

091
10. I am a very conservative person and have always supported the death penalty. However,
Zane was not someone I would have thought would have been capable of this kind of
crime. He was a good kid who never showed any sort of violent personality or
behaviors. I think the circumstances leading up to that point IE: Childhood trauma and
Military experiences combined with the alcohol and drugs created a mental break. Zane
also took responsibility for his crime and showed sincere remorse from the start.

I declare under penalty of perjury that the foregoing is true and correct and that
this declaration was executed on April, 2021 in Denison, Texas.
,

092
 Declaration of James Cobis

I, James Cobis, hereby declare as follows:

I am the ex-husband of Valerie Hudson who is Zane Floyd’s mother. lam also the
biological father of Zane Floyd. Valerie became pregnant with Zane during the end
of our marriage. I have never met Zane. I am 73 years old and I currently reside in
Bisbee, Arizona.

2. Valerie and I lived together for three years in what I can only call a “rocky”
relationship. The main issues in our troubled relationship was Valerie’s
overindulgence in alcohol and other substances; her infidelities with other men; and
her intent on having children despite our agreement not to have children.

3. I met Valerie in Kodiak, Alaska at a nightclub in 1970 not long after I relocated
there. Although I was not aware at the time. Valerie suffered from a severe
addiction to alcohol.

4. Valerie went out drinking four to five nights a week during our marriage, and she
usually drank at bars that stayed open 24 hours a day. Valerie drank during the night
into the morning, while I was at work, and she usually ran up huge tabs that she
could not pay. It was not uncommon for bar owners to give me her tabs, which
often came out to a few hundred dollars each week. Valerie and I struggled
financially during the early years of our marriage. Valerie’s addiction to alcohol
placed a great burden on our finances.

5. I was not a complete angel in those days myself because I partied, used drugs, and
also drank at times. However, my life never became unmanageable like Valerie’s.
I was always employed and made enough money to support the two of us. I saw to
it that all of the bills were paid and we had everything that we needed. Valerie on
the other hand was too deeply affected by her addictions and I knew that I could
not depend on her. Valerie was not able to hold down jobs and frequently
unemployed because she was often fired after showing up to work intoxicated.

6. Valerie and I had a son in 1973, Francisco, prior to Zane’s birth. During her
pregnancy with Francisco, Valerie drank and abused substances. The baby was born
with health problems and ultimately died of SIDS (Sudden Infant Death
Syndrome). The loss threw Valerie into a deep depression and her drinking became
more severe than it had been previously. To make things worse, Valerie developed
an addiction for Valium.

7. Valerie was involved in illegal drug transactions. I recall receiving many calls from
Valerie in the middle of the night where she asked me for money to finance drug
deals. I always told Valerie that I could not get involved and hung up the phone on

093
 her.

8. My relationship with Valerie became toxic and we were about to split up when
Zane was conceived in Kodiak. I did not want children and was upset with Valerie
for getting pregnant again. Valerie was compulsive when it came to wanting a baby.
I could understand how Valerie got pregnant by accident the first time, but when
she conceived the second time with Zane, I realized it was more like a ‘Tix” to her
than anything.

9. During the early months of her pregnancy, Valerie continued drinking, smoking
cigarettes and marijuana, and abusing cocaine and possibly other drugs.

10. Valerie and I split about two months into her pregnancy with Zane. Valerie moved
out of my place and into a boyfriend’s home. This person was a drinking buddy of
Valerie’s named Ken. Valerie eventually left Kodiak and returned to Colorado to
live on her family’s ranch in Colorado.

11. Mutual friends reported to me that Valerie continued abusing drugs and other
substances throughout her pregnancy with Zane. Mother mutual Mend of Valerie
and mine from Kodiak went to Colorado after Zane was born. She told me that
while she was there, she saw Zane, who at the time was a little baby, alone in the
backseat of a Volkswagen that was parked outside of a bar. Valerie was inside the
bar drinking.

12. Although I no longer had contact with Valerie, I agreed to pay child support. Zane
and I never made contact although 1 was open to the possibility.

13. Valerie’s immediate family were alcoholics. Her parents were heavy whiskey
drinkers and drank daily. I would describe them as functional alcoholics. Many
other members of Valerie’s nuclear and extended family also suffered from alcohol
addictions as well. I had several opportunities to witness the drinking habits of
Valerie’s family because I spent many nights on the family’s ranch. I recalled
attending events at the home of Valerie’s parents where her mom would sit in a
room drinking whiskey for hours behind closed doors, and then would barely be
able to walk out of the mom to greet guests.

14. Alcoholism was a problem in my family as well. My dad was a drunk, along with
his brothers and first cousins. Both of my younger sisters suffered from this disease.

15. I struggled with alcohol and marijuana abuse when I was a young man. When I was
in the Navy, my drinking became a problem. I ultimately received a medical
discharge under honorable conditions and like Zane, was told not to reenlist.

16. Now that I am older and much wiser, if I had it all to do over again I would never

094
 have gotten involved with a woman like Valerie to begin with. Although Valerie
was a nice person and had some redeeming qualities, she lived a lifestyle that was
completely incompatible with mine.

I declare under penalty of peijury that the foregoing is true and correct and that
this declaration was executed on April 19, 2021 in Bisbee, Arizona.

James Cobis

095
 DECLARATION OF Rosalie Ann Cobis

1. I am the sister of James Cobis Jr. I moved to Kodiak Ak. in

early 1971. I lived on Noch. dr. next door to my brother and his
girlfriend,Valerie Hodson.

2. We were all in our 20’s and loved to drink and smoke pot and
dance at the Beachcombers Bar. It became obvious after my first
winter of observing my new sister that she was on another level with
alcohol and drugs.

3. We lived without running water or electricity, life was

challenging. We learned to balance our work and play, unfortuneately
Valerie never could. She had trouble keeping a job for long.

4. In 1973 Valerie became pregnant and I was sure this would be her
ticket out of overindulgence but it didn’t work that way. She
continued to drink and drug during her pregnancy. Francisco was only
with us for a few months and then died of SIDS (sudden infant death
syndrome)

5. My brother was not happy and he and Valerie were on the verge of
breaking up when she announced she was pregnant again.

6. After watching Valerie drink and do drugs for a few more months he
asked for a divorce and Valerie moved in with her friend Ken.

7. Sometime after she moved to Colorado to stay with her parents and
have the child.

8. If Valerie continued to live as she had in Kodiak then there

probably is no doubt that Zane
was damaged in many ways. Be never had a chance to be normal.

I DECLARE UNDER PENALTY OF PERGURY THAT THE FOREGOING IS TRUE AND

CORRECT AND THAT THIS DECLARATION WAS EXICUTED ON APRIL ,8TH 2021 IN
BISBEE AZ

-
‘q

096
 Declaration of Michael Eugene Hall

I, Michael Eugene Hall, hereby declare as follows:

1. My name is Michael Eugene Hall. I am sixty-three years old and currently reside in
Clark County, Nevada. I am Robert “Jay” Hall’s father. Jay’s mother is my former
wife, Tracey Delagardelle.

2. Jay and Zane Floyd were best friends growing up in Las Vegas, Nevada. I first met
Zane when he was about 12 or 13 years old when Jay and Zane were attending the same
school. Zane was like a member of our family and Jay was like a member of Zane’s
family.

3. Zane was a sweet kid, polite, quiet, and never rude in my presence. He was a pleasure
to be around and our family loved Zane.

4. Zane was socially awkward when he was a kid, was not the best athlete, and was not
as popular as Jay. It also appeared to me that Zane lacked self-confidence.

5. Tracey and I befriended Zane’s parents, Valerie and Mike. We used to attend social
events at the Floyd’s home. Mike and I both worked at a test site in Nevada.

6. I believe that Mike had a drinking problem and sometimes became aggressive when he
drank too much. On these occasions, I would go over and retrieve Zane and Valerie
and bring to them our house so they could have a break from Mike.

7. Zane knew I was a former Marine and we spoke about Zane’s plans to enlist. Zane
was extremely excited about enlisting and said he looked forward to the experience.
Although we never directly spoke about the matter, I believed that Zane’s motivation
to enlist was an attempt to prove something to himself and others.

8. While my time in the Marines was a positive experience, I know that some troops
undergo trauma during their service. When Zane returned from the military, he
discussed with me some of the bad things he had experienced while stationed in
Guantanamo Bay. Zane seemed to have been negatively impacted by what he saw over
there.

9. I recall the day of the shooting, my commute to work was interrupted due to an active
shooter at the local Albertson. I had no idea Zane was the shooter until I heard about it
from my then wife when she called me at work.

10. Zane was unrecognizable in the media coverage following his arrest at the scene. He
had an empty look on his face, like he was out of it, and he looked like a different
person.

097
11. I was completely shocked and caught off guard when I learned of the shooting. It was
totally out of character of the Zane I knew.

12. I visited Zane at the county jail on several occasions during the first few weeks after
his arrest. Zane had difficulty effectively communicating for the first few days and he
seemed like a zombie. I would speak to Zane, but it seemed like Zane did not
comprehend what I was saying. He spoke very slowly and incoherently.

13. It was after several days or a week or two that Zane was able to engage in conversation.
Zane’s first words expressed his extreme remorse over what happened, and Zane took
responsibility for what he did. Zane said he did not know why he did what he did and
said the entire episode did not seem real. Zane experienced a blackout of the events and
could not remember most of what had happened.

14. I told Zane that I would be supportive of him as much as I could. But I also told him
that I was supportive of the death penalty and if he was sentenced to death, I would
support that outcome. Since that time, I have learned more about Zane’s life as I sat
through the trial. I now feel that Zane was set up to fail by the adult family members
closest to him, including his mother’s drinking while carrying Zane; the domestic abuse
at home; and Zane’s overbearing grandfather. This was also Zane’s one and only
criminal act. And this act was out of character for Zane. I still believe in the death
penalty, but I do not believe it is justified in Zane’s case.

I declare under penalty of perjury that the foregoing is true and correct and that
this declaration was executed on 13th day of April, 2021 in Las Vega evada.

Mi ael ugene Hall

098
 Declaration of Michael Eoff

I, Michael Eoff, hereby declare as follows:

1. My name is Michael Eoff. I am seventy-six years old and currently reside in Clark
County, Nevada. I was Zane Floyd's Western Little League baseball coach when
Zane was 13 and 15 years old.

2. I remember Zane because I used to pick him up from his house and drive him to practice
and then back home. Zane loved to talk baseball during these car trips. He was a good
and respectful kid.

3. Zane really liked baseball. He showed up at every game. Zane's position was catcher,
which is an important position on the team.

4. While Zane was a typical 13 year old player, and not one of the best hitters. He matured,
tried hard, and greatly improved when he played as a 15 year old. Zane greatly
assisted in getting the team to first place in the league that year. And because Zane was
older than the other boys, he was the team leader. Zane got along well with his
teammates.

5. Zane's father did not attend any of the games during Zane's first season. When I
coached Zane the second time, Zane's father attended every game, sitting behind the
dugout screaming at Zane during each game. Zane was emotionally impacted by this.
I asked Zane's father to stop yelling at Zane and to move to another area, but he ignored
my request. This was the first time I had trouble with a little league parent while
coaching. I understood that Zane's father was a skilled baseball player in his youth and
that he had unreasonable expectations for Zane to live up to.

6. I met Zane's mother and she seemed genuinely nice.

7. I saw Zane angry only once, when he was 13 years old. I brought in another batter to
replace Zane and he used some profanities and threw his bat. I was surprised by his
behavior because it was so out of character. Zane's mother explained that Zane was
experiencing side effects from the medication he was taking which caused mood
swmgs.

8. I heard about the shootings that morning on the television. I did not recognize Zane as
the boy I had coached before and I wondered what happened in his life between the last
time I coached him and the day of the incident. I learned during the trial and news
coverage that Zane was a veteran of the Marine Corp. I am a Marine Corp veteran
myself and I'm aware of the struggles that some ofmy fellow servicemen experienced
just from boot camp training. The training was a hellish experience that broke
individuals down and rebuilt them. The training was sometimes just as bad if not worse

099
 than deployment depending where you were stationed.

I declare under penalty of perjury that the foregoing is true and correct and that
this declaration was executed on ___J_};_, 2021 in Las Vegas, Nevada.

/l-Pn'/ ~ ~c
---c Micllael Eoff ~

100
 Declaration of Natalie Novick Brown, Ph.D.

I, Natalie Novick Brown, declare under penalty of perjury that the following is true and correct:

A. BACKGROUND AND QUALIFICATIONS

1. I have been a licensed psychologist in the State of Washington for approximately 25 years. I
also am a licensed psychologist in Florida and Alaska.

2. I completed a Bachelor of Arts Degree in Sociology and Psychology from the University of
California at Los Angeles (UCLA). In 1994, I obtained a Ph.D. in Clinical Psychology from
the University of Washington in Seattle, which included an internship in forensic
psychology. I then completed a postdoctoral fellowship in fetal alcohol spectrum disorders
(FASD) at the University of Washington, which involved participation in research on the
adverse developmental outcomes in FASD (called “secondary disabilities”). My fellowship
advisor Ann Streissguth, Ph.D., was a pioneer researcher in the FASD field. Along with Dr.
Kenneth Jones and others, Dr. Streissguth was part of the original medical team that first
identified fetal alcohol syndrome (FAS) in the United States and published that discovery in
The Lancet in 1973. Dr. Streissguth subsequently became the first psychologist in the nation
to study the long-range developmental and adaptive behavior of children with FASD in
large-scale longitudinal studies that spanned more than 30 years.

3. Since my formal training in the early 1990s, my private practice in psychology has involved
a specialization in FASD. I have treated and evaluated several hundred people with FASD in
clinical and forensic settings. In the forensic context alone, I have conducted over 450 FASD
evaluations involving defendants charged with a range of offenses, including capital murder.
I have conducted over 60 post-conviction FASD evaluations at the state and federal levels. I
have conducted FASD assessments at the request of both defense and government attorneys.
The latter included evaluations referred by the court and by Developmental Disabilities
Administration in Washington State, and evaluations of crime victims with FASD referred by
state attorneys general.

4. I am a Clinical Assistant Professor (courtesy staff) in the University of Washington’s School

of Medicine, Department of Psychiatry and Behavioral Medicine. In this capacity, I consult
with staff at the University of Washington’s Fetal Alcohol and Drug Unit regarding criminal
behavior in persons with FASD, train judicial staff on FASD in King County, Washington,
and conduct pro bono FASD evaluations of crime victims for the Seattle Police Department.

5. I have published over 30 peer-reviewed articles and book chapters on FASD and presented
on FASD at many state, national, and international conferences. I helped author the
American Bar Association’s 2012 Resolution on FASD. Currently, I am editing a book for
Springer on evaluating FASD in the forensic setting, which will be published in 2021. I have

Declaration of Natalie Novick Brown, PhD

February 24, 2021
Page 1 of 37

101
 been recognized as an FASD expert in approximately 20 state and federal jurisdictions and
have testified in numerous capital murder trials and habeas hearings wherein an FASD
diagnosis was found to matter to the court. For example, in Williams v. Stirling, the Fourth
Circuit Court of Appeals ruled FASD was a “cause-and-effect” diagnosis that had direct
bearing on offense conduct.

6. A CV that more fully describes my qualifications is attached as Appendix A to this

declaration.

B. REFERRAL

7. I evaluated Zane Floyd in 2006 at the request of habeas counsel at the time and diagnosed
him with a fetal alcohol spectrum disorder, hereinafter referred to as “FASD” (see
Declaration dated 10/17/06).

8. I have been asked by Zane Floyd’s current counsel, Office of the Federal Public Defender,
District of Nevada, to evaluate Mr. Floyd’s adaptive functioning and address the following
consultative questions:

a. Is Zane Floyd’s adaptive and functional history consistent or inconsistent with the mental
defect associated with FASD, which in DSM-5 is diagnosed generally as Other Specified
Neurodevelopmental Disorder (Code 315.8) and specifically as Neurodevelopmental
Disorder Associated with Prenatal Alcohol Exposure (ND-PAK)?

b. How does Mr. Floyd’s ND-PAE/FASD compare to intellectual disability (ID) and
attention-deficit/hyperactivity disorder (ADHD)?

c. Did ND-PAE/FASD make it likely Mr. Floyd had an “immature brain” at the time of the
offense given he was 23 years old, and if so, how would that have affected his
functioning?

C. SUMMARY OF OPINION

9. Based upon my psychological evaluation of Mr. Floyd, I hold the following opinions to a
reasonable level of psychological certainty:

a. Zane Floyd’s adaptive/functional history is consistent with the mental defect

associated with FASD, which in DSM-5 is diagnosed generally as Other Specified
Neurodevelopmental Disorder (Code 315.8) and specifically as Neurodevelopmental
Disorder Associated with Prenatal Alcohol Exposure (ND-PAL).

Declaration of Natalie Novick Brown, Phi)

February 24, 2021
Page 2 of 37

102
 b. Mr. Floyd’s ND-PAE[FASD is a brain-based, congenital, lifelong, impactful
disorder deserving of the rubric “ID Equivalence.” Regardless of how severity is
measured, Mr. Floyd’s FASD is similar in severity to ID but substantially more
severe than ADHD, with broad ramifications that have affected all important
functional domains in his life. Unlike ADHD, Mr. Floyd’s ND-PAEIFASD is a cause-
and-effect condition that not only explains his attention deficits, impulsivity, and
hyperactive behavior during childhood but explains all of his behavior across his
—

entire lifespan.

c. Given that the normally-developing “adolescent brain” does not have mature
executive control capacity until at least age 25 and brain development in young
adults with FASD lags many years behind rates seen in neurotypical age peers, it is
likely Mr. Floyd’s brain was not fully developed at the time of the offense due to his
ND-PAEIFASD, which would have had an additive and cumulative effect on the
brain damage he was born with.

D. PROCEDURES

10. Collateral interviews were conducted by telephone with Carolyn Smith (family friend and
social worker), Jay Hall (friend), and Mike Hall (father of Jay Hall), each of whom was
asked to rate Mr. Floyd’s behavior on three standardized measures:
• Behavior Rating Inventory of Executive Function (BRIEF),
• Vineland Adaptive Behavior Scales Third Edition (Vineland-3), and
—

• Fetal Alcohol Behavior Scale (FABS).

11. Record review consisted of prior mental health evaluation reports/declarations (Drs. Maria
Cardle, 1989; David Schmidt, 2000; Thomas Kinsora, 2000; Jakob Camp, 2000; Frank Paul,
2000; Edward Dougherty, 2000; Norton Roitman, 2000; Natalie Novick Brown, 2006;
Jonathan Mack, 2006; Jonathan Lipman, 2006); expert penalty phase testimony (Drs.
Dougherty and Roitman); penalty phase testimony and declaration of Robert J. Hall;
declaration of Robert “Jay” Hall; 9th Circuit Opinion; and NOFAS Amicus.

12. I consulted with Neuropsychologist Paul Connor, PhD (formally trained in FASD at the
University of Washington Fetal Alcohol and Drug Unit) regarding test result patterns. At my
request, Dr. Connor produced two graphs of Mr. Floyd’s neuropsychological test results (see
later in this declaration).

13. I also consulted with Stephen Greenspan, PhD, regarding the comparison of FASD with ID
and ADHD.

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 E. BRIEF SUMMARY OF FASD

14. Human behavior is a direct reflection of the anatomy and physiology of the central nervous
system (CNS).’ Consequently, behavior is disrupted to the extent anatomy and physiology of
the CNS are disrupted.
A fetus is susceptible to damage from alcohol exposure throughout pregnancy. The first few
weeks of pregnancy when brain cells are developing and forming brain structures are
especially vulnerable.2 Within minutes after a pregnant woman consumes alcohol, the
substance crosses the placenta and blood-brain barrier, and the blood alcohol level in the
fetus equals that of the mother.3 Prenatal alcohol exposure typically causes widespread
structural damage throughout the brain.4’5’ 6 Even mild structural brain damage that is
difficult to see in standard brain scans significantly impairs brainfunction.7 Research has
found there is no “safe” time, amount, or type of alcohol consumption during pregnancy.8’ 9
Beyond brain damage, prenatal alcohol exposure also may cause defects in cardiac, skeletal,
renal, visual, auditory, immune, and other systems.’°
Alcohol exposure during pregnancy is a major known cause of birth defects,
neurodevelopmental impairments, and learning problems in the United States.”
“Fetal alcohol spectrum disorder(s) (FASD)” is a non-diagnostic umbrella term that
encompasses all of the medical conditions caused by prenatal alcohol exposure that were
described in diagnostic guidelines published in 1996 by the Institute of Medicine (TOM).’2
Four medical diagnoses under the FASD umbrella were listed: (a) fetal alcohol syndrome
(FAS), (b) partial FAS (pFAS), (c) alcohol related neurodevelopmental disorder (ARND),

Garrett. B. (2015). Brain and behavior: An introduction to biological psychology. 4th Ed. New York: Sage Publications.
2
Whitty. J.E., & Sokol, R.J. (1996). Alcohol teratogenicity in humans: critical period, thresholds, specificity and vulnerability. In
Spohr, H.L. & Steinhausen, H.C., Eds. Alcoho4 pregnancy and the developing child: Fetal Alcohol Syndrome. Cambridge,
England: Cambridge University Press, 3—13.
Grant, TM., Novick Brown, N., Dubovsky, D., Sparrow, J., & Ries, R. (2013). Journal ofAddiction Medicine, 7, 87-95.
4Nunez, S.C., Roussotte, F., & Sowell, E.R. (2011). Focus on: Structural and functional brain abnormalities in fetal alcohol
spectrum disorders. Alcohol Research and Health, 34, 121-132.
Moore. EM., Migliorini, R., Infante, M. A., & Riley, E.P. (2014). Fetal alcohol spectrum disorders: Recent neuroimaging
findings. Current Developmental Disorders Reports, 1, 161-172.
6
Ware, A.L., Infante, MA., O’Brien, J.W., Tapert, S.F., Jones, K.L., Riley, E.P., & Mattson, S.N. (2015). An fMRI study of
behavioral response inhibition in adolescents with and without histories of heavy prenatal alcohol exposure. Behavioral Brain
Research, 278, 137-146.
hnp /7 v nm n,h l1LdLI mit/i I Ls/public u,o,ivl( (I A’,I)/N( TIC TI\SI) (juic1LIlnl1 12012016 pj! accessed
1/15/20
8
Centers for Disease Control and Prevention. (2005). Notice to readers: Surgeon General’s advisory on alcohol use in pregnancy.
Morbidity Mortal Weekly Report, 54, 229.
1201201 6.pdf, accessed
1/15/20
10 O’Leary, CM., Nassar, N., Kurinczuk,
J.J., de Klerk, N., Geelhoed, E., Elliott, E.J., & Bower, C. (2010). Prenatal alcohol
exposure and risk of birth defects. Pediatrics,126, e843-850.
“Stratton, K., Howe, C., & Battaglia, F. (Eds.) (1996). Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and
treatment. The Institute ofMedicine Report. Washington, DC: National Academy Press.
12 Stratton,
K., Howe, C., & Battaglia, F. (Eds.) (1996). Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and
treatment. The Institute ofMedicine Report. Washington, DC: National Academy Press.

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 and (d) alcohol related birth defects (ARBD).’3 Together, these four medical diagnoses
involve a broad continuum of physical, mental, behavioral, and learning deficits that can
result from prenatal alcohol exposure. Prior to the TOM publication in 1996, ARND had been
referred to as ‘fetal alcohol effect’ (FAE). In 2004, a consensus of governmental, research,
and advocacy organizations accepted “FASD” as a collective term that included the more
specific medical diagnoses described in the 1996 TOM report on FAS.’4 Over the years, the
term ‘FASD’ also has come to include diagnostic terms in the clinical setting, such as static
encephalopathy-alcohol exposed (SE-AE), which is equivalent to ARND.’5 Since 2013, the
term ‘FASD’ also includes the specific DSM-5 diagnosis for the CNS dysfunction due to
prenatal alcohol exposure, neurodevelopmental disorder associated with prenatal alcohol
exposure (ND-PAE).
FAS involves three diagnostic criteria: characteristic facial abnormalities, growth deficiency,
and CNS abnormality but does not require evidence of prenatal alcohol exposure because the
full spectrum of facial abnormalities in FAS is pathognomonic for prenatal alcohol exposure.
Partial FAS requires one or two facial abnormalities, CNS abnormality, and evidence of
prenatal alcohol exposure. ARND and SE-AE simply require CNS abnormality and evidence
of prenatal alcohol exposure. The CNS abnormality common to all of these medical
conditions typically is measuredfunctionally but also can be measured neurologically and
structurally.
Importantly, research has found that regardless of diagnosis under the FASD umbrella, brain
damage is the same.’6 That is, brain damage in ARND tends to be just as severe as in FAS.
Not every individual exposed to alcohol prenatally will have FASD. The primary
determinants of clinically relevant fetal damage include quantity (amount of alcohol per
occasion), frequency (how often a pregnant mother drinks), and timing (stage of pregnancy
and whether there is drinking just as the fetus is developing a particular feature). Binge
drinking and regular heavy drinking carry the greatest risk of severe problems,’7’ 18 but even

13
Bertrand, J., Floyd, R.L., Weber, M.K., O’Connor, M., Riley, E.P., Johnson, K.A., Cohen, D.E., NTFFAS/E. (2004). Fetal
alcohol syndrome: Guidelines for referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention.
http://\ w\v.cdc.go\ /ncbddd/tssd/dociiinents/FAS guidelines accessible.pdf, accessed 1/15/20
“
Warren, K.R., & Hewitt, B.G. (2009). Fetal alcohol spectrum disorders: When science, medicine, public policy, and laws
collide. Developmental Disabilities Research Reviews. 15, 170-175.
5
Astley, S.J. (2004). Diagnostic guide for Fetal Alcohol Spectrum Disorders. The 4-digit diagnostic code, 3rd Ed Seattle: FAS
Diagnostic and Prevention Network.
16
Vaurio, L., Riley, E.P., & Mattson, S.N. (2011). Neuropsychological comparison of children with heavy prenatal alcohol
exposure and an IQ-matched comparison group. Journal of the International Neuropsychological Society, 17, 463-473.
17
Maier S.E.. & West, J.R. (2001). Drinking patterns and alcohol’=related birth defects. Alcohol Research and Health, 25, 168-
169.
18
May, P.A.. Blankenship, J., Marais, A-S., Gossage, J.P., Kalberg, W.O., Joubert, B., Cloete, M., Barnard, R., De Vries, M.,
Hasken, J.,Robinson, L. K., Adnams, C. M., Buckley, D., Manning, M., Parry, C.D.H., Hoyme, H. E., Tabachnick, B., & Seedat,
S. (2013). Maternal alcohol consumption producing fetal alcohol spectrum disorders (FASD): Quantity, frequency, and timing of
drinking. Drug andAlcohol Dependence, 502-5 12.

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 lesser amounts can cause FASD.’9’20’21’22 Maternal characteristics interact with and affect
outcomes, such as the mother’s age, genetic make-up, number of previous pregnancies (i.e.,
younger siblings tend to be more affected than older siblings), overall health, diet and
nutritional status, lack of prenatal care, adverse living conditions, and things such as stress,
co-occurring diseases, mental health conditions, and concomitant use of tobacco and illicit
drugs.23’24’25’ 26 Also important is the genetic composition of the fetus, which convey
varying degrees of vulnerability or resilience.
FASD tends to be a hidden condition that is seldom diagnosed in childhood because most
people in this population have ARND rather than FAS and consequently, no obvious physical
abnormalities.27 Such children look normal to casual observers but have varying degrees of
neurocognitive damage that significantly impairs cognitive and adaptive functioning.28
The toxic effects of prenatal alcohol exposure appear to be widespread throughout the entire
brain,29 causing subtle but potent irregularities in brain structure that compromise brain
function and directly impact cognition and behavior.30’ 31 Deficits in cognitive functioning
often become evident in elementary school and ultimately impair adaptive behavior across
the lifespan.32
Of the many possible cognitive impairments in FASD, executive dysfunction a cardinal —

deficit is the most serious because the executive system in the prefrontal cortex controls
—

IS
Hamilton, D.A., Barto, D., Rodriguez, C.I., Magcalas, C.M., Fink, B.C., Rice, J.P., Bird, C.W., Davies, S., & Savage, D. D.
(2014). Effects of moderate prenatal ethanol exposure and age on social behavior, spatial response perseveration errors and motor
behavior. Behavioral Brain Research, 269, 44-54.
20
Carmichael Olson, H., Streissguth, A.P., Sampson, P.D., Barr, H.M., Bookstein, F.L., & Thiede, K. (1997). Association of
prenatal alcohol exposure with behavioral and learning problems in early adolescence. Journal of the American Academy of Child
Adolescent Psychiatry, 36 1187-1194.
21
Jacobson, S.W., Carr, L.G., Croxford, J., Sokol, R.J., Li, T-K, & Jacobson, J.L. (2006). Protective effects of the alcohol
dehydrogenase-ADH1B allele in African American children exposed to alcohol during pregnancy. Journal ofPediatrics, 148, 37.
22
Larkby, CA., Goldschmidt, L., Hanusa, B.H., & Day, N.L. (2011). Prenatal alcohol exposure is associated with conduct
disorder in adolescence: Findings from a birth cohort. Journal ofthe American Academy of Child and Adolescent Psychiatry, 50,
262-271.
23
Jacobson, S. W., Jacobson, J. L., Sokol, R. J., Chiodo, L. M., & Corobana,
R. (2004). Maternal age, alcohol abuse history, and quality of parenting
as moderators of the effects of prenatal alcohol exposure on 7.5-year intellectual function. Alcoholism: Clinical and Experimental
Research, 28(11), 1732-1745.
24
Astley, S. J. (2010). Profiles of the first 1,400 patients receiving diagnostic evaluation for fetal alcohol spectrum disorders at
the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network. Canadian Journal ofClinical Pharmacology,
17 e132-e164.
25
May, P. A., & Gossage, J. P. (2011). Maternal risk factors for fetal alcohol spectrum disorders: Not as simple as it might seem.
Alcohol Research and Health, 34, 15-26.
26
Jonsson, E., Salmon, A., & Warren, K. R. (2014). The international charter on prevention of fetal alcohol spectrum disorder.
Lancet Global Health, 2, e135-137.
27
, accessed 1/15/20
28
Chasnoff, I.J., Wells, A.M., Telford, E., Schmidt, C., & Messer, G. (2010). Neurodevelopmental functioning in children with
FAS, pFAS, and ARND. Journal ofDevelopmental and Behavioral Pediatrics, 3], 192-201.
29
ht1ps:// .niaaa.iuh.gov/stes/de1ault/1iIes/pub1ications/1CClASD/NCJlCJ FASD Guide Final— 1201201 6.pdr, accessed
2/2/20
30
Nunez, S.C., Roussotte, F., & Sowell, E.R. (2011). Focus on: Structural and functional brain abnormalities in fetal alcohol
spectrum disorders. Alcohol Research and Health, 34, 121-132.
Moore, E.M., Migliorini, R., Infante, M.A., & Riley, E.P. (2014). Fetal alcohol spectrum disorders: Recent neuroimaging
findings. Current Developmental Disorders Reports, 1, 161-172.
32
Riley, E.P., & Vorhees, CV. (1986). Handbook of behavioral teratology. New York: Plenum.

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 self-regulation, conscious decision-making, and everyday adaptive behavior.33’ Like the
term “FASD,” “executive functioning” also is an umbrella term that includes a range of
higher-order cognitive skills that integrate and coordinate numerous underlying processes in
the brain, including sensory input, memory retrieval, considering options, foreseeing
consequences and linking cause and effect, overriding and suppressing socially unacceptable
responses, modifying emotions and urges to fit socially acceptable norms, and forming
intentions and selecting actions.36 Executive functioning is largely controlled in the prefrontal
cortex and neural circuitry linking the prefrontal cortex to the limbic system, both of which
have been found in the research to be particularly sensitive to the damaging effects of
prenatal alcohol exposure.37 Compounding this problem, prenatal alcohol exposure also
creates hypersensitivity to stress via faulty neurological “hard-wiring” of the hypothalamic-
pituitary-adrenal system (HPA axis), which causes chronic overreaction to stressful events.38
However, because of executive function deficits, this population lacks the “top-down”
moderating influence of a fully functioning prefrontal cortex. As a result, those with FASD
are prone to act out their emotions, particularly in high stress situations that trigger
overreaction in the limbic system. Because of executive dysfunction, those with FASD have
considerable difficulty handling everyday stressors.
Review of the FASD literature has identified a typical cognitive profile in FASD, 39, 40,41, 42
which involves (a) variable neuropsychological profiles (i.e., a mixture of relative strengths
and weaknesses), often with significant discrepancies between IQ index scores,43’44’45 and
(b) a generalized deficit in the processing and integration ofcomplex information.46’ 47 That
is, the more complex a task or situation, the more impaired the processing and integration of

°
Hosenbocus, S., & Chahal, R. (2012). A review of executive function deficits and pharmacological management in children
and adolescents. Journal ofthe Canadian Academy of Child andAdolescent Psychiatry, 21, 223-229.
Schonfeld, A.M., Paley, B., Frankel, F., & O’Connor, M.J. (2006). Executive functioning predicts social skills following
prenatal alcohol exposure. Child Neuropsychology, 12, 43 9-452.
Ware, A.L., Crocker, N., O’Brien, J.W., Deweese, B.N., Roesch, S.C., Coles, C.D Mattson, S.N. (2012). Executive function
predicts adaptive behavior in children with histories of heavy prenatal alcohol exposure and attention deficit/hyperactivity
disorder. Alcoholism: Clinical and Experimental Research, 36 1431-1441.
36
Diamond, A. (2013). Executive functions. Annual Review ofPsychology, 64, 135-168.
Fryer. S.L., McGee. CL.. Matt, G.E., Riley, E.P., & Mattson, S.N. (2007). Evaluation of psychopathological conditions in
children with heavy prenatal alcohol exposure. Pediatrica, 199, e733—e741.
38
Keiver, K., Bertram, C.P., Off, A.P., & Clarren, S. (2015). Salivary cortisol levels are elevated in the afternoon and at
bedtime in children with prenatal alcohol exposure. Alcohol, 49, 79-87.
Kodituwakku, P.W. (2009). Neurocognitive profile in children with fetal alcohol spectrum disorders. Developmental
Disabilities Research Review, 15, 218-224.
40
Mattson, S.N., Riley, E.P., Gramling, L., Delis, D.C., & Jones, K.L. (1997). Heavy prenatal alcohol exposure with or without
physical features of fetal alcohol syndrome leads to IQ deficits. Journal ofPediatrics, 131, 718-721.
‘H
Kodituwakku, P.W., Kalberg, W., & May, P.A. (2001). The effects of prenatal alcohol exposure on executive functioning,
Alcohol Research and Health, 25, 192-198.
42
Sampson, P.D., Streissguth, A.P., Bookstein, F.L., Little, R.E., Clarren, S.K., Dehaene, P., et al. (1997). Incidence of fetal
alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder. Teratology, 56, 317-326.
‘°
O’Malley, K.D. (2007). ADHD andfetal alcohol spectrum disorders (FASD). New York: Nova.
Adubato, S.A., & Cohen, D.E. (2011). Prenatal alcohol use andfetal alcohol spectrum disorders: Diagnosis, assessment and
new directions in research and multimodal treatment. New Jersey: Bentham Science Publishers Ltd.
Olson, H.C., Feldman, J.J., Streissguth, A.P., Sampson, P.D., & Bookstein, F.L. (1998). Neuropsychological deficits in
adolescents with fetal alcohol syndrome: Clinical findings. Alcoholism: Clinical and Experimental Research, 22, 1998-2012.
46
Kodituwalcku, P.W., Handmaker, N.S., Cutler, S.K., Weathersby, E.K., & Handmaker, S.D. (1995). Specific impairments in
self-regulation in children exposed to alcohol prenatally. Alcohol: Clinical and Experimental Research, 19, 1558—1564.
‘H’
Kodituwakku, 2009, op. cit.

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 neurological information will be, particularly if there is time pressure, which adds an
additional element of complexity.48 Consequently, in novel social situations where behavior
is not guided or structured by some external means, behavior in this population typically
reflects marked impairment. In contrast, in routine situations that are well-practiced,
automatic “motor memory” precludes the need for executive functioning. Importantly,
because procedural motor memory developed through repetition governs actions rather than
executive functioning,49 this population tends to do best with familiar tasks where behavior
has become routinized due to practice or in structured contexts with predictable rules and
consequences and external guidance, both of which reduce the need for independent thinking
and decision-making. This is why people with FASD learn best with “hands-on” practice.
Since the everyday world is a very complex place full of surprises, which increases the need
for executive functioning, it is not surprising that a deficient adaptive profile is a universal
finding in the FASD literature, regardless of IQ or particular diagnosis under the FASD
umbrella.5° Rather than IQ, it is higher-level executive functioning that most determines how
information is processed and integrated in the brain and ultimately manifests as adaptive
behavior. In fact, executive functioning in FASD directly predicts adaptive behavior.51’ 52
DSM-5 defines adaptive functioning as everyday behavior that meets developmental and
sociocultural standards for personal independence and social responsibility.53 More simply
put, adaptive behavior is everyday behavior.

F. COLLATERAL INTERVIEWS

[First names are used in this section to facilitate identification.]

15. Robert J. Hall (“Jay”) was interviewed telephonically for 2.0 hours on October 29, 2020.
Jay said he and Zane met in early adolescence and were best friends throughout their teens
and into their early 20s. They also lived together for three months in 1999: “I was always at
Zane’s house in my teens. I’m about a year younger than he is. I was really his only friend.
He had a girlfriend at the end of high school. She was two years younger than me. Zane
really didn’t have any friends his age; they were all younger. My first memories of Zane
around the time we started hanging out together were that he was a class clown, always
making self-deprecating jokes to get the class to laugh. He would blurt out things in class,
look at me and laugh. I think I felt sorry for him at first because when we first met, he was

48 Ibid.
Ibid.
50 Thomas,
S.E., Kelly, S.J., Mattson, S.N., & Riley, E.P. (1998). Comparison of social abilities of children with fetal alcohol
syndrome to those of children with similar IQ scores and normal controls. Alcoholism: Clinical and Experimental Research, 22,
528—533.
Schonfeld, A.M., Paley, B., Frankel, F., & O’Connor, M.J. Executive functioning predicts social skills following prenatal
alcohol exposure. Child Neuropsychology, 12, 439—452.
52
Ware, A.L., Crocker, N., O’Brien, J.W., Deweese, B.N., Roesch, S.C., Coles, C.D Mattson, S.N. (2012). Executive function
predicts adaptive behavior in children with histories of heavy prenatal alcohol exposure and attention deficitfhyperactiviiy
disorder. Alcoholism: Clinical and Experimental Research, 36, 1431-1441.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, Fjflh Edition. Arlington, VA:
American Psychiatric Association.

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 being jumped in the parking lot at school, and I stepped in. From that point on, we were best
friends.” Jay said one of the things he noticed about Zane was how he always seemed to
function better in structured environments: “I was the same way, so I noticed that about
him.” Jay said Zane didn’t play organized sports, although he tried out for the basketball
team: “He would only get a few inches off the ground to do shots. He was so uncoordinated.”
Jay reported that he frequently observed Zane’s parents drinking alcohol, noting that Valerie
drank more often than Mike. Jay said he sometimes observed Mike assaulting Valerie and
Zane and occasionally observed Valerie saying “cruel” and “hurtful” things to Zane.

16. Mike Hall was interviewed telephonically for 2.0 hours on November 12, 2020. Mike
reported that he and his wife befriended Valerie and Mike Floyd when Zane became friends
with his son Jay in early adolescence. Mike said his family and the Floyds remained close
during both boys’ teen years, noting, “A few times over those years, my ex-wife and I would
get a call from Valerie, asking for us to come get her and Zane because Mike was drinking
and getting out of control. Valerie drank as well, occasionally too much. I remember seeing
her intoxicated.” Mike recalled his impressions of Zane in adolescence: “He was annoyingly
polite. I loved that kid. He seemed kind, gentle, sweet, sad... fragile. He was socially
awkward and had a soft, timid voice. He was hard to understand sometimes when he was
younger. He also was very uncoordinated and impulsive. These things gave me the
impression he was developmentally slow. His sweetness continued into high school. He took
my daughter to the prom.”

17. Carolyn Smith was interviewed telephonically for 2.0 hours on November 25, 2020.
According to her report, Carolyn is a retired social worker who lived near the Floyd family
and was a “godmother” to Zane Floyd during his childhood: “Zane grew up with alcoholic
parents who were always fighting, so our house was like a refuge for him. My husband and I
were like his parents.” Carolyn was a “very close friend” of Zane’s mother Valerie Floyd and
first met Zane when he was around 11 years old: “I had a close relationship with Zane and
saw him four or five times a week when our two families lived for a year in the same
apartment complex. My daughter Brittany was two years old at the time, and Zane played
with her almost every day. About a year after our two families met, the Floyds moved into a
house around the same time we did, but I regularly saw Zane and his mother several times a
month after we moved.” Noting the thing she remembered most about Zane in his teens was
his hyperactivity, she added. “Zane’s mother Val drank a lot. Before her pregnancy with
Zane, Val had another baby boy who died. I suspect the death was due to her drinking. Val
and Mike liked to party, have people over, barbeque, and drink. They seemed to drink all the
time when Zane was young. I often saw them both intoxicated. Val told me back then that
she drank alcohol throughout her pregnancy with Zane. This didn’t surprise me because her
drinking habits weren’t normal. My husband and I talked to Val and Mike about how out of
control their drinking was, which was how Va! and I became close friends. Val had problems
with Mike when they drank and had to call the police on him when he hit her.” Carolyn noted
that when Valerie first met Mike, she was a “mule” for her first husband, concealing drugs on
her body as she traveled.

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 G. STANDARDIZED BEHAVIOR ASSESSMENT

18. Three standardized behavior assessments were administered telephonically to the three
collateral individuals interviewed above, each of whom interacted regularly with Mr. Floyd
from the time he was an adolescent until his early adult years.

a. Fetal Alcohol Behavior Scale (FABS)54:

The FABS was developed by researchers at the University of Washington in Seattle to
describe the “behavioral essence” of the adaptive behavior deficits associated with
FASD. To reduce transparency of the FABS items, which constitute 36 behaviors that
differentiate FAS from non-FAS persons, relevant items are imbedded within a lengthier
measure (i.e., Personal Behaviors Checklist), which contains 71 items. The behaviors
addressed by the FABs are organized into seven categories (Communication and Speech,
Personal Manner, Emotions, Motor Skills and Activities, Academic/Work Performance,
Social Skills/Interactions, and Bodily/Physiologic Functions). Using a reference sample
of 472 patients aged 2 to 51 diagnosed with Fetal Alcohol Syndrome (FAS) or Fetal
Alcohol Effects (FAE), the FABS demonstrated high item-to-scale reliability and good
test-retest reliability over an average interval of five years, identifying subjects with
known or presumed prenatal alcohol exposure in multiple detection studies. A score of 15
or higher on the FABS reliably distinguishes persons with FASD (sample mean/median =
20) from those without FASD (sample mean/median = 5).
The three individuals interviewed in this evaluation (Carolyn Smith (family friend and
social worker), Jay Hall (friend), and Mike Hall (father of Jay Hall) rated Mr. Floyd’s
behavior on the FABS, producing the following results:

Fetal Alcohol Behavior Scale (FABS)

Rater Relationship Target Age Raw Score

Carolyn Smith Family Friend/Social Worker 12 25

Mike Hall Father of Jay HaIl 16 22

Jay Hall Childhood Friend 20 22

As shown above, all three collateral witnesses produced behavior ratings that fell
significantly above the threshold level of 15 and somewhat above the mean/median score
for FASD, indicating that Mr. Floyd displayed the “signature” behavior profile unique to
individuals with FASD, both in childhood and during his young adult years.

‘
Streissguth, A.P., Bookstein, F.L., Barr, H.M., Press, S., & Sampson, P.D. (1998). A Fetal Alcohol Behavior Scale.
Alcoholism: Clinical and Experimental Research, 22, 325 333.
-

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 b. Vineland Adaptive Behavior Scales — Third Edition (Vmeland-3):
The Vineland-3 is a widely-used measure in mental health that assesses an evaluee’s
adaptive behavior via ratings from individuals who know him/her well. Behavior items in
Vineland-3 involve specific tasks typically performed at different stages of development,
which are divided into three broad categories of adaptive behavior: Communication,
Daily Living, and Socialization skills. Rather than asking whether the person is capable
of performing a task, the Vineland-3 assesses whether the person regularly performs the
task without prompting or assistance. The Vineland-3 manual recommends that family
members or those who know the evaluee very well function as respondents (i.e., ‘raters’).
For retrospective assessment, at least two raters are recommended in order to ensure
reliability.
The Vineland-3 was administered to Carolyn Smith (family friend and social worker),
Jay Hall (friend), and Mike Hall (father of Jay Hall), each of whom rated Mr. Floyd’s
behavior around the time he/she had regular contact with him: age 12 in the case of
Carolyn Smith, age 16 in the case of Mike Hall, and age 20 in the case of Jay Hall.
Adaptive behavior ratings, scored by computer from an algorithm created by the test
developer (Pearson), are shown in the table below. In the table, results are converted to
standard scores for major domains (Mean = 100, Standard Deviation/SD 15) and v
scale scores for subdomains (Mean 15, Standard Deviation/SD = 3) and compared to
age-norms.
Vineland-3
Carolyn Smith Mike Hall Jay Hall
[Family Friend/Soc [Jay Hall’s Father] [Childhood Friend]
Domain / Subdomain Workerl
Target Age: 12 Target Age: 16 Target Age: 20
v-Scale! Percentile v-Scale! Percentile v-Scale! Percentile
Std Std Std
Score Score Score
Receptive 1 1 1
Expressive 1 1
Written 9 7 7
COMMUNICATION 36 <1 28 <1 20 <1
Personal 8 8 5
Domestic 9 9 5
Community 7 6 4
DAILY LIVING 66 1 51 <1 32 <1
Interpersonal Relationships 5 9 3
Play/Leisure Time 2 6 4
Coping Skills 4 8 5
SOCIALIZATION 38 <1 60 <1 20 <1
ADAPTIVE 48 <1 48 <1 25 <1
COMPOSITE

The Vineland results shown above provide reliable and convergent data that quantify the
nature and severity of Mr. Floyd’s adaptive behavior in childhood and adulthood. Results

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111
 show that compared to other 12- and 16-year-olds, Mr. Floyd’s adaptive functioning was
severely impaired (Adaptive Composite scores 48, or approximately 3.5 standard
deviations below the mean of 100). Such ratings are consistent with Dr. Maria Cardle’s
psychological evaluation in 1989 when Mr. Floyd was 13. According to Mr. Floyd’s
childhood friend Jay Hall, Mr. Floyd’s functioning was profoundly impaired in his early
adult years (Adaptive Composite score = 25, or 5.0 standard deviations below the mean).
Vineland-3 scores also show Mr. Floyd’s adaptive functioning decreased significantly
over time, showing that as adaptive responsibilities and expectations became more
complex with advancing age, his adaptive capacity diminished considerably in relation to
age peers.
The level of Mr. Floyd’s adaptive deficiency reported by all three raters is consistent with
the FASD research,55 as is the pattern of decreasing age-related adaptive ability over the
course of the developmental years.56’57

c. Behavior Rating Inventory of Executive Function (BRIEF):

The BRIEF is a standardized respondent-based measure58 that assesses an individual’s
executive functioning or self-regulation in his/her everyday environment. Items on the
BRIEF are rated in the same manner as items on the Vineland-3 (see below), but unlike
the Vineland-3 and other adaptive measures, the BRIEF contains validity scales that
address response bias.
In order to assess the possibility of biased Vineland-3 behavior ratings in the current
evaluation (see above), the BRIEF also was administered to Carolyn Smith (family friend
and social worker), Jay Hall (friend), and Mike Hall (father of Jay Hall).
Assessment results on the BRIEF, scored via a computer algorithm supplied by the test
developer (Pearson Assessments) are shown in the table below.

Streissguth, A. P., Barr, H. M., Kogan, J., & Bookstein, F. L. (1996). Final report: Understanding the occurrence ofsecondary
disabilities in clients with fetal alcohol syndrome (FAS) andfetal alcohol effects (FAE). Seattle, WA: University of Washington
Publication Services.
Jirikowic, T., Kartin, D., & Carmichael Olson, H. (2008). Children with fetal alcohol spectrum disorders: A descriptive profile
of adaptive function. Canadian Journal of Occupational Therapy, 75, 23 8-248.
Streissguth, A. P., Bookstein, F. L., Barr, H. M., Sampson, P. D., O’Malley, K., & Young, J. K. (2004). Risk factors for
adverse life outcomes for fetal alcohol syndrome and fetal alcohol effects. Journal ofDevelopmental and Behavioral Pediatrics,
25(4), 228—238.
58
Internal consistency was high for the lnlbnnant Report normative sample (alpha range = .80—93 for clinical scales: •95•()5 br
indexes and GEC). Using a mixed sample of clinical or healthy adults who were seen for clinical es aluation or research study
participation. internal consistency was high tbr the lntbrmant Report Form (alpha range .85—95 for clinical scales: .96—98 thr
indexes and GEC). Test-retest correlations across the clinical scales ranged from .91-94 over an average interval <sf4.21 weeLs
tbr the Informant Report Form (n .44). In terms of convergent validity, the Informant Report Form of the BRIEF—A
scales, indexes, and GEC demonstrated significant correlations in the expected direction with self- and informant
reports on the Frontal Systems Behavior Scale (FrSBe), Dvsexecutive Questionnaire (DEX), and Cognitive Failures
Questionnaire (CFQ).

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 BRIEF Reliability Scales
Clinical
Validity Carolyn Smith Mike Hall Jay Hall
Threshold
Scale [Target Age: 12[ [Target Age: 16] [Target Age: 20]
Score
Negativity 6 0 0 0

Inconsistency 5 2 0
Infrequency >3 0 0 0
RESULTS VALID VALID VALID

Results on BRIEF validity scales show that all three individuals approached the task of
rating Mr. Floyd’s behavior in a straighforwar unbiased manner:

H. PRIMARY DISABILITIES

19. Organic brain damage in FASD directly impairs the cognitive skills needed to think
adequately and self-regulate. In turn, the cognitive dysfunction in FASD directly impairs
adaptive functioning (i.e., real-world behavior) in an empirically demonstrated predictive
manner.59’ 60 Regardless of IQ, comprehensive neuropsychological testing in FASD typically
finds variable “patchy” cognitive profiles characterized by relative strengths and weaknesses
that on average fall below full-scale IQ (i.e., between-test variability), which reflects
intermittent exposure to alcohol during gestation even when exposure is heavy and regular.
At my request, Dr. Paul Connor graphically portrayed Mr. Floyd’s cognitive test results
documented in previous evaluation reports (see Exhibit 1 below): Dr. Cardle’s testing in
1989 when Mr. Floyd was 13; test results from Drs. Dougherty, Paul, and Schmidt in 2000;
and Dr. Mack’s testing in 2006. Current adaptive assessment results from the Vineland-3 also
are included (see last column on the right side of Exhibit 1). In Exhibit 1, direction of deficit
is made constant to facilitate ‘apples-to-apples’ comparison. The horizontal green line in
Exhibit 1 depicts z-score mean or average score (i.e., “0”) for each test; the horizontal red
line depicts the cut-point for a “deficit” finding according to measurement guidelines for
FAS published by the Centers for Disease Control6’ (i.e., -1 SD except for IQ, which requires
-2 SD).

Shonfeld, A.A., Paley, B., Frankel, F., & O’Connor, M. J. (2006). Executive functioning predicts social skills following
prenatal alcohol exposure. Child Neuropsychology, 12, 43 9-452.
60 Mattson, S.N. (2012). Executive function
Ware, A.L., Crocker, N., O’Brien, J.W., Deweese, B.N., Roesch, S.C., Coles, C.D
predicts adaptive behavior in children with histories of heavy prenatal alcohol exposure and attention deficitlhyperactivity
disorder. Alcoholism: Clinical and Experimental Research; 36, 1431-1441.
Bertrand, J., Floyd, L. L., Weber, M. K., O’Connor, M., Johnson, K. A., Riley, E., & Cohen, D. (2004). Guidelinesfor
identfjiing and referring persons withfetal alcohol syndrome. Atlanta, GA: Centers for Disease Control and Prevention.

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 Neuropsychological Testing of Zane Floyd

Co
Co

4
C
0
-2 ——2o2oTestirg (Brocn)
a) 2co6Tevtir€ (Mack)
o
2OOOTestirg (Dogker1y)
Co

C -
.—.2ceoTevtir€ (Pad)
Co
2ce0Testire (Sdrmidt(
-5
Testing 19 (Cardle)

-6 Ave rage

— Dekcd
Expect by 10

Scores Estimated from Dr. Paul Evaluation

Exhibit 1. Zane Floyd’s neuropsychological and adaptive assessment results from age 13 to the
present

As can be seen in Exhibit 1, Mr. Floyd’s cognitive test results (excluding adaptive
functioning) reflect extreme variability, ranging from a high score of 2.4 SDs above the mean
on a memory subtest (i.e., ability to remember rather simple geometric shapes he had held
and examined with his hands while blindfolded) to a low score of 4.4 SDs below the mean on
a visuospatial construction task (i.e., ability to copy a complex figure with significant details
and interactions between components). Overall, testing and adaptive assessment found
deficiency in the following 10 domains:
Cognitive Domains
• IQ (significant discrepancies among quotient/index scores)
• Attention
• Academic Achievement (math calculation)
• Memory/Learning (increasingly deficient performance with increasing task
complexity on visual tasks)
• Visuospatial Construction
• Motor Coordination

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 • Executive functioning (initial development of problem-solving strategies)
Adaptive Domains
• Communication (Vineland-3 all 3 raters) —

• Daily Living Skills (Vineland-3 all 3 raters) —

• Socialization (Vineland-3 all 3 raters) —

It is notable and consistent with FASD that Mr. Floyd’s full-scale IQ varied widely (i.e., 101
when tested by Dr. Cardle, 94 when tested by Dr. Dougherty, 102 when tested by Dr. Paul,
and 115 when tested by Dr. Mack). The latter score, which reflects significant improvement
in verbal skills, likely was due in part to long-term abstinence from alcohol and drugs while
incarcerated. Because of the significant discrepancies in sub-test scores, Mr. Floyd’s full-
scale IQ scores are not reliable representations of his intellectual functioning. As noted in
Paragraph 13, IQ scores in FASD range widely in FASD from the profoundly deficient range
to the superior range62 (e.g., IQs in this population have been recorded as high as 14263).
When IQs fall in the average range, which generally was the case for Mr. Floyd, significant
discrepancies within IQ subtests are diagnostically meaningful.64

20. The cognitive deficits in FASD directly impair adaptive functioning. Adaptive functioning
reflects everyday real-world capacity to deal with tasks and challenges in contexts that range
from semi-structured school environments to completely unstructured community settings.
When children exhibit chronic learning, social, and self-regulation problems in the relatively-
structured school years, such a pattern essentially predicts that later in life, they will have
even greater difficulties in the unstructured real world. While it may be possible for a person
to compensate for one or two mild impairments in a single cognitive domain, when there are
multiple mild impairments in several areas of the brain, compensation is virtually impossible
without external structure and supports.65 That is, the impact on behavior from a pervasive
pattern of mild cognitive impairment is devastating. Deficient adaptive functioning appears
to be universal in FASD, regardless of stage of development, instrument used to measure
behavior, or IQ.66’67’68’69’7°

62
Streissguth, Barr, Kogan, & Bookstein, op. cit.
Ibid.
64
Ibid.
Livingston, L.A., & Happe, F. (2017). Conceptualizing compensation in neurodevelopmental disorders: Reflections from
autism spectrum disorder. Neuroscience and Biobehavioral Reviews, 80, 729-742.
66
Carmichael Olson, H., Feldman, J. J., Streissguth, A. P., Sampson, P. D., & Bookstein, F. L. (1998). Neuropsychological
deficits in adolescents with fetal alcohol syndrome: clinical findings. Alcoholism: Clinical and Experimental Research, 22, 1998—
2012.
67
Carr, J. L., Agnihotri, S., & Keightley, M. (2010). Sensory processing and adaptive behavior deficits of children across the
fetal alcohol spectrum disorder continuum. Alcoholism: Clinical and Experimental Research, 34, 1022—1032.
68
Crocker, N., Vaurio, L., Riley, E.P., & Mattson, S.N. (2009). Comparison of adaptive behavior in children with heavy prenatal
alcohol exposure or attention-deficit/hyperactivity disorder. Alcoholism: Clinical and Experimental Research, 33, 2015—2023.
69
Fagerlund, A., Autti-Ramo, I., Kalland, M., Santtila, P., Hoyme, H. E., Mattson, S. N., & Korkman, M. (2012). Adaptive
behavior in children and adolescents with foetal alcohol spectrum disorders: A comparison with specific learning disability and
typical development. European Child and Adolescent Psychiatry 21, 221-231.
70
Jirikowic, T., Kartin, D., & Carmichael Olson, H. (2008). Children with fetal alcohol spectrum disorders: a descriptive profile
of adaptive function. Canadian Journal of Occupational Therapy, 75, 23 8—248.

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 21. In Mr. Floyd’s case, not only does he have many mild deficits in cognitive functioning, some
of his cognitive skills are moderately or severely impaired. As can be seen visually in the
Vineland-3 scores depicted in Exhibit 1, the widespread deficits seen in Mr. Floyd’s
cognitive profile have a profound effect on his adaptive behavior. According to Dr. Connor,
Mr. Floyd’s Vineland-3 results average -4.8 SDs for Conimunication, -3.4 SDs for Daily
Living Skills, -4.0 SDs for Socialization, and -4.0 for overall adaptive functioning.

I. SECONDARY DISABILITIES

22. Nearly 25 years ago, a massive research study sponsored by the CDC7’ identified an adverse
developmental trajectory in FASD, characterized by multiple negative life course outcomes
or “secondary disabilities.” The figure below, taken from this secondary disabilities study
and reprinted with permission from the University of Washington’s Fetal Alcohol and Drug
Unit, shows study results for children, adolescents, and adults with FAS and those with FAE
(the outdated diagnostic term for ARND).

Secondary Disabilities Study

100

90

80
70

%60

50

40

30
20
10

Inappropriate
Sexual Behavior
Disrupted School Confinement Alcohol & Drug Problems with
Experience Problems Employment

LZI FAS(n=109) FAE(n=144)

Negative developmental outcomes in FASD (“Secondary Disabilities”)

71
Streissguth, Barr, Kogan, & Bookstein, op. cit.

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 As can be seen above, compared to normally-developing children, those with FASD (i.e.,
both FAS and FAE/ARND) are at very high risk of several negative developmental
outcomes, particularly if they are exposed in childhood to risk factors such as abuse,
domestic violence, or neglect.72 In Mr. Floyd’s case, records indicate he was exposed to all
three risk factors.

The table below, which assesses Mr. Floyd’s life history in the context of the secondary
disabilities research, reflects many of the secondary disabilities typically seen in FASD:

Secondary Disabilities Analysis

Secondary Disability Zane Floyd’s History
Disrupted Education • Special education was recommended by school professionals around first grade
but not permitted by the birth mother (Dougherty, 2000)
. Repeated 2id grade (Dougherty, 2000)
• Expelled in elementary school for being “out of control” and placed on home
instruction (Dougherty, 2000)
. Left high school before graduating and did not receive diploma until completing
courses at Clark County Adult High School (Dougherty, 2000)

Mental Health Problems • Medicated with Ritalin for ADHD from first through third grade and again from
age 13 to 14 (Dougherty, 2000)
Documented Diagnoses:
• Adjustment reaction with mixed emotional and behavioral symptoms (Cardle,
1989)
. ADHD (Cardle, 1989; Paul, 2000; Schmidt, 2000; Mack, 2006)
• Developmental Coordination Disorder (Cardle, 1989; Mack, 2006)
• Learning Disorder NOS, Dysgraphia/Constructional Dyspraxis (Mack, 2006)
• Organizational Deficits (i.e., executive dysfunction) in visual-motor functioning
and integrating/organizing information (Cardle, 1989)
• Dysthymic Disorder, Primary, early onset (Paul, 2000)
• Major Depression, recurrent, without psychotic features (Paul, 2000)
• Obsessive Compulsive Disorder (Mack, 2006)
• PTSD, chronic (Mack, 2006)
• Dissociative Disorder NOS (Mack, 2006)
• Pathological Gambling (Paul, 2000)
• Sleepwalking Disorder by history (Mack, 2006)
• Sexual Disorder NOS (Paul, 2000)
• Personality Disorder NOS with avoidant, passive-aggressive, and dependent
personality characteristics, severe (Paul, 2000)
• Personality Disorder NOS with paranoid, schizoid, and antisocial features
(Schmidt, 2000)

72
Streissguth, Barr, Kogan. & Bookstcin, op. cit.

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 . Personality Change due to Neurodevelopmental Brain Damage (Mack, 2006)
. Avoidant Personality Disorder with antisocial personality features (Mack, 2006)
Relevant Axis III Diagnoses:
. Premature birth and birth weight (4 ibs, 1.5 ozs)
. Prenatal alcohol and drug exposure
. Prenatal intoxia
. History of mental tremors, recurrent ear infections

Substance Abuse • Used marijuana daily at age 15, began drinking alcohol at age 14/15 and
drinking steadily at age 16 (Dougherty, 2000)
. Daily use of alcohol, marijuana, and methamphetamine for several months in
late teens (Dougherty, 2000)
. After passing the physical in the Marine Corps, returned to drug use; arrested
for DUI and discharged from the military, asked not to re-enlist because of his
drinking problem (Dougherty, 2000)
Relevant Diagnoses:
. Alcohol Dependence (Paul, 2000); Alcohol Abuse (Schmidt, 2000; Mack,
2006)
. Polysubstance Abuse — marijuana, methamphetamine (Schmidt, 2000)
. Cannabis Dependence (Paul, 2000; Mack, 2006)
• Amphetamine Dependence (Paul, 2000; Mack, 2006)
. Cocaine Abuse (Paul, 2000)

Trouble with the Law • DUI in California

. INSTANT OFFENSE (1999)

Confinement • Incarceration from 1999 to present

Inappropriate Sexual • Diagnosed with Sexual Disorder NOS by Dr. Paul (Paul, 2000)
Behavior .

. In guilt phase testimony, Tracie Rose Carter testified that Mr. Floyd used a gun
to spread her legs apart during sexual activity (Mack, 2006)
. Found guilty during trial of 4 counts of sexual assault with the use of a deadly
weapon (Mack, 2006)

Employment Problems • Enlisted in Marine Corps at age 18, promoted to Lance Corporal after boot
camp, but was soon discharged and asked not to re-enlist after a DUI
(Dougherty, 2000; Mack, 2006)

Dependent Living • Lived with childhood friend Jay Hall after discharge from Marines, then moved
back to parents’ home

As can be seen above, Mr. Floyd history reflects all 8 ofthe secondary disabilities
ident/ied in the FASD research.

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 J. DIAGNOSTIC IMPRESSIONS

23. CNS dysfunction in FASD was diagnosed generally in DSM-IV-TR (2000) as cognitive
disorder not otherwise speced (i.e., Cognitive Disorder NOS) and now is specifically
diagnosed in DSM-5 (2013) as neurodevelopmental disorder associated with prenatal
alcohol exposure (i.e., ND-PAE). Both DSM diagnoses constitute a “mental defect” in the
forensic setting. ND-PAE is the diagnostic category used by DSM-5 to describe the sequelae
of developmental, behavioral, intellectual, and functional problems seen in people exposed
prenatally to alcohol.

24. DSM-5 diagnostic criteria for ND-PAE generally require evidence of prenatal alcohol
exposure, at least one impairment in neurocognitive functioning (i.e., standard score of 70/75
or below on an individually administered IQ test or impairments in executive functioning,
learning, memory, or visual-spatial reasoning/organization), at least one impairment in self-
regulation (i.e., mood or behavioral regulation, attention, or impulse control), and at least two
domains of adaptive impairment (i.e., communication, social communication and interaction,
daily living skills, or motor skills), with onset in the developmental period.
Records reviewed in my previous evaluation (10/17/06) reflect consistency between Mr.
Floyd’s documented cognitive and adaptive functioning, developmental trajectory, and ND
PAE, as summarized in the analysis below (prepared in consultation with Neuropsychologist
Paul Connor).

DSM-5 Criteria for ND-PAE

. .
Criterion
. Source
Documented Impairments in Zane Floyd
.

LTestimony or Reportsl
Prenatal alcohol exposure Birth mother Valerie Floyd testified she drank Trial testimony
alcohol heavily throughout her pregnancy with
Mr. Floyd.
Social worker Jorge Abreu, who had conducted Trial testimony
a psychosocial evaluation of Mr. Floyd,
testified that Valerie Floyd told him her
substance use began as a teenager and
“continued through both pregnancies” and that
she drank alcohol and used drugs, including
LSD and cocaine, “throughout the pregnancy”
with Mr. Floyd
Neurocognitive impairments Intellectual (sub-test discrepancies) Cardle (1989), Dougherty
(at least 1) (2000), Mack (2013)
Memory (complex visuospatial) Mack (2013)
Academic Learning (math calculation) Paul (2000)
Visuospatial Construction Mack (2006)

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 Self-Regulation impairments Attention Paul (2000), Schmidt
(at least 1) (2000)
Impulse Control (initial) Mack (2006)
Problem Solving (developing) Mack (2006)
Adaptive impairments Communication Vineland-3 (2020)
(at least 2) Daily Living Skills Vineland-3 (2020)
Socialization Vineland-3 (2020)
Motor Coordination Mack (2006)
Childhood onset Documented evidence of impairments in Record review
childhood
Disturbance causes clinically 8/8 secondary disabilities Current analysis
significant distress or
impairment in social,
occupational, or other
important areas of
functioning.
Disorder is not better Impairments precede substance use in the teen Current analysis
explained by the direct years
physiological effects of No evidence of traumatic brain injury in
postnatal use of a substance, childhood
a general medical condition
other than FASD, a genetic. No evidence of a general medical condition
. .

condition, or environmental other than prenatal alcohol exposure

neglect. Environmental neglect may have had an
additive and cumulative effect on underlying
brain damage but does not explain life history

As can be seen above, Mr. Floyd ‘sfunctioning and flfe history well exceed DSM-5 diagnostic
criteria for ND-PAE, the current diagnosis under DSM-5 for the CNS impairment (or
“mental defect”) in FASD.

25. In summary, Zane Floyd’s adaptive/functional history is consistent with the mental
defect associated with FASD, which in DSM-5 is diagnosed generally as Other Specified
Neurodevelopmental Disorder (Code 315.8) and specifically as Neurodevelopmental
Disorder Associated with Prenatal Alcohol Exposure (ND-PAE).

K. COMPARING FASD TO ADHI) AND ID

26. FASD, ADHD, and ID are all classified by DSM-5 as neurodevelopmental disorders,
meaning all three disorders typically (a) manifest early in development, often before a child
enters grade school; (b) are “characterized by developmental deficits that produce
impairments of personal, social, academic, or occupational functioning”; and (c) involve a
range of developmental deficits that vary “from very specific limitations of learning or

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 control of executive functions to global impairments of social skills or intelligence” (DSM-5,
p. 31).

27. Attention-Deficit/Hyperactivity Disorder (ADHD): In DSM-5, ADHD is described

(p. 59)
as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development...” Three sub-types are identified as: (a) inattention, (b)
hyperactivity impulsivity, and (c) mixed. Most individuals fall in the third, mixed, sub-
—

category. For the first two sub-types, six or more symptoms from a list of behaviors must
have persisted “for at least six months (five months for older adolescents and adults) to a
degree that is inconsistent with developmental level and that negatively impacts directly on
social and academic! occupational activities” and that are “not solely a manifestation of
oppositional behavior, defiance, hostility, or failure to understand tasks or instructions” (for
type 1) and “do not occur exclusively during the course of schizophrenia or another psychotic
disorder” (for type 2). These symptoms must be evident before age 12. Although ADHD can
be diagnosed in adults, most individuals diagnosed with the disorder in childhood cease to
manifest the disorder as they enter adulthood.73 Although people with ADHD often do
poorly in school because of inattention and interpersonal insensitivity due to impulsivity,
there is no cognitive or adaptive functioning criterion for the diagnosis.

28. Intellectual Disability (ID): ID has three definitional criteria: significant deficits in
intellectual functioning, impaired adaptive functioning, and onset within the developmental
period (typically interpreted to mean before age 18). Prong One (intellectual impairment) is
measured by a full-scale IQ score of 70-75 or below, although other measures such as
Executive Functions can be cited. Adaptive functioning, typically measured through a rating
instrument such as the Adaptive Behavior Assessment System (ABAS) or Vineland, has
three components: Conceptual, Practical, and Social, summarized into a Composite Adaptive
Index. Qualitative evidence such as gullibility and poor risk awareness also are important.
Significant deficiency (<2 standard deviations) has to be shown on standardized instruments
for only one of these four indices. As a rule, ID is a lifelong status, although with practice
individuals can improve adaptive skills during adulthood.

29. Fetal Alcohol Spectrum Disorders (FASD): CNS abnormality in ND-PAE typically is
established by multiple cognitive impairments (executive dysfunction and other cognitive
impairments) and impairments in adaptive functioning. For the latter, impairments are
required in at least two of the three domains usually included in standardized instruments
(communication, daily living or practical skills, and socialization), which actually is a more
stringent requirement than in ID (where only one impaired adaptive domain is required). In
Mr. Floyd’s case, Vineland-3 scores fall well below the -2 SD level in communication, daily
living skills, and socialization.

Newton-Howes, G. (20014). What happens when children with attention deficit/hyperactivity disorder grow up? Journal of the
Royal Society ofMedicine, 97, 53 1-535.

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 Mr. Floyd was diagnosed in 2006 with partial FAS,74 a diagnosis that falls under the FASD
umbrella. According to TOM criteria,75 the core diagnostic element in partial FAS (which
requires only some of the physical indicia in (a) and (b) is CNS dysfunction. CNS
dysfunction stems directly from structural brain damage that directly impairs thinking and
behavior throughout the lifespan.76
As noted previously, ND-PAE currently represents the CNS dysfunction for all of the
medical disorders under the FASD umbrella under DSM-5 (i.e., FAS, partial FAS, and
ARND) and is “intended to encompass the full range of developmental disabilities associated
with exposure to alcohol in utero” (DSM-5, p. 799).
DSM-5 also notes that evidence of CNS dysfunction in ND-PAE varies by developmental
stage. Although about half of young children prenatally exposed to alcohol show marked
developmental delay in the first three years of life, others may not exhibit signs of CNS
dysfunction until they are preschool- or school-age. When children with ND-PAE reach
school age, learning difficulties, impairments in executive function, and problems with
integrative language functions usually emerge more clearly, and both social skills deficits
and challenging behavior may become more evident. As school and other requirements
become more complex over the course of development, greater deficits are noted. The CNS
dysfunction seen in those with ND-PAE “often leads to decrements in adaptive behavior and
to maladaptive behavior with lifelong consequences,” as this population has “a higher
prevalence of disrupted school experiences, poor employment records, trouble with the law,
confinement (legal or psychiatric), and dependent living conditions” (DSM-5, p. 800). As
shown in the secondary disabilities table above (Paragraph 22), Mr. Floyd’s functional
history reflects this developmental course.

30. FASD ADHD: FASD is a medical disorder that occasionally is misunderstood as the
functional equivalent of ADHD. This view may reflect the fact that FASD often is not
diagnosed in childhood because very high rates of co-occurring attention and/or hyperactivity
problems distract providers and tend to get diagnosed as ADHD, thereby masking the
underlying medical condition.77 It is understandable that because both disorders often share
attention and self-regulation problems like hyperactivity, FASD would come to be seen
incorrectly as the functional equivalent of ADHD. However, the problem with this
assumption is that disability severity varies substantially in individuals with
neurodevelopmental disorders.
Researchers in the FASD field78 have noted the following significant differences between
FASD and ADHD, differences that refute the concept of FASD’s equivalency with ADHD:
(a) etiology and course of the two conditions are very different, in that FASD has a single

‘
Evaluation report of Zane Floyd by Novick Brown, dated 10/17/06
Stratton, Howe. & Battaglia, op. cit.
76
Mattson, S. N., Schoenfeld, A., M., & Riley, E. P. (2001). Teratogenic effects of alcohol on brain behavior. Alcohol Research
and Health, 25, 185-191.
“Chambers, C.D., Kalberg, W.O., Zeilner, J., Feldman, H., Buckley, D., Kopald, D., Hasken, J.M., eta!. (2018). Prevalence of
Fetal Alcohol Spectrum Disorders in 4 US Communities. Journal of the American Medical Association, 319, 474-482.
78
e.g., Peadon, E., & Elliott, E. J. (2010). Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum
disorders in children: Clinical guidelines. Neuropsychiatric Diseases and Treatment, 6, 509-5 15.

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 etiology that is known while ADHD is etiologically multifactorial and typically unknown; (b)
FASD has greatly increased mortality risk when compared to ADHD; (c) FASD is far more
complex and severe and requires much higher levels of care than ADHD; (d) annual cost of
care is over 10 times higher for FASD compared to ADHD; (e) expression of the two
conditions is dissimilar in that FASD has a similar male to female ratio while ADI-ID is three
times more prevalent in males; (f) while FASD is a causal factor for ADHD, there is no
evidence ADHD is a causal factor for FASD; (g) ADHD gradually decreases in severity
across childhood and adolescence while FASD becomes more complex, resulting in more
severe adaptive deficiency and greater adversity across the lifespan; and (h) FASD is
equivalent to ID in terms of everyday adaptive behavior, which is not the case for ADHD.
Whether measured in terms of depth of impairment for a single defining ability or breadth of
impaired abilities and their effects on overall adaptive functioning, FASD is a very severe
disorder comparable to ID, and ADHD is a much less severe disorder, as the analysis that
follows makes clear.

a. Definitional Complexity: One way to measure disability severity is by definitional

complexity (i.e., number of domains that must be impaired in DSM-5 to meet diagnostic
criteria). Table 1 below compares the three disorders in terms of DSM-5 definitional
complexity:

Neurocognitive
Deficits Self- Adaptive Significantly Number
Disorder Regulatory Function Interferes with Lifelong of
Deficient Executive Deficiency79 Deficits Functioning Elements
IQ Function
FASD NO YES YES YES YES YES 5
ADHD NO NO YES NO YES NO 2
ID YES YES NO YES YES YES 5
Table 1. Extent of definitional complexity in the three disorders

With respect to definitional complexity, FASD and ID are similar in that both require 5
diagnostic elements. In contrast, ADHD is the outlier with only 2 required diagnostic
criteria. The only diagnostic element in ID that is not required in FASD is deficient IQ
although in FASD, 27% of people with FAS and 9% of those with FAE/ARND have an
IQ of 70 or below. Generally in FASD, adaptive functioning tends to fall approximately 2
standard deviations below IQ, regardless of specific diagnosis.8° Both ID and FASD
require adaptive dysfunction: FASD requires at least 2 deficient adaptive domains; ID
requires at least 1. As noted previously, no adaptive dysfunction is required in ADHD.
FASD (as defined in ND-PAE) and ADHD both require self-regulatory dysfunction. In
fact, at its core, ADHD is defined solely by two aspects of deficient self-regulation:
attention and impulse control. In contrast to ADHD with respect to the self-regulatory

Impaired mood/behavior regulation

80
Streissguth, Barr, Kogan, & Bookstein, op. cit.

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 criterion, FASD is defined by a broader range of self-regulation deficiency: attention,
impulse control, and/or mood or behavioral regulation. Overall, considering the range of
definitional elements in DSM-5, FASD and ID are tied with respect to diagnostic
complexity, and both are substantially more complex and severe than ADHD.

b. Functional Capacity: Disability severity also can be compared in terms of how

extensively a disorder typically impairs functional capacity (i.e., both cognitive and
adaptive functioning). Ratings below in Table 2, arrived at in consultation with Dr.
Stephen Greenspan (a national expert on ID), are based on the following scale: 0 = Mild
(equal to or less than 10% of the disability’s population), 1 = Moderate (11-49% of the
disability’s population), and 2 = Severe (50% or more of the disability’s population).

IMPAIRMENT FASD ADHD ID

Cognitive IQ 1 0 2
Academics 2 2 2
Attention 2 2 2
Memory 2 1 2
Visuospatial 2 0 2
Processing Speed 1 1 2
Executive Function 2 2 2
Adaptive Communication 2 0 2
Daily Living Skills 2 0 2
Socialization 2 1 2
Motor 1 0 1
TOTAL DOMAINS OF 19 9 21
IMPAIRMENT
Table 2. Extent of functional impairments in the three disorders

Based on the analysis in Table 2 above, FASD and ID are quite similar in terms of
widespread functional deficiency in both cognition and adaptive functioning. In contrast,
ADHD is mildly affected.

c. Risk of Negative Outcomes: Another way of looking at disability severity is risk of

adverse developmental outcomes, including secondary disabilities. Table 3 below ranks
the three disorders in terms of secondary disabilities and other outcome risks on a 3-point
ordinal scale that compares outcome risk: 3 highest risk, 2 = next highest risk, and 0 =
lowest risk.

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 FASD ADHD Mild ID
Adverse Outcome
Rate Rank Rate Rank Rate Rank
%82
Poverty8’ 50 2 1.2% 0 31.3% 1
%85 %86
Homelessness 60 1 24 0 <63 %87
2
5389
ACEs88 2 2.1° 0 2.5’ 1
%92 %93
Mental health problems 94 2 66 1 S57
%94
0
%95 2896
Disrupted schooling 60 2 1 20 0
%98 %99
Dependent living 83 1 44 0 89 %°° 2

81
In 1919, poverty in the United States was 11.8% of the general population. See:
82 Streissguth, Barr, Kogari, & Bookstein, op. cit.
83
Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2016). Prevalence of
parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child
and Adolescent Psychology, 47, 199-212.
Ibid.
85
Streissguth, Barr, Kogan, & Bookstein, op. cit.
86
Stone, B.. Dowling, S., & Cameron, A. (2018). Cognitive impairment and homelessness: A scoping review. Health and Social
Care Community, 27, e125-e142.
87
Mercier, C., & Picard, S. (2011). Intellectual disability and homelessness. Journal of Intellectual Disability Researhc, 55, 441-
449.
88
Number of ACEs in the general population is 1.7 on average. See: Kambeitz, C., Klug, M. 0., Greenmyer, J., Popova, S., &
Burd, L. (2019). Association of adverse childhood experiences and neurodevelopmental disorders in people with fetal alcohol
spectrum disorders (FASD) and non-FASD controls. BMC Pediatrics, 19, 498 httns://doi.or/I 0.11 80/s 12887-0 9-1 878-8
89
Ibid.
90 Semiz,
U. B., Oner, 0., Cengiz, F. F., & Bilici, M. (2017). Childhood abuse and neglect in adult attention-deficitlhyperactivity
disorder. Psychiatry and Clinical Psychopharmacology, 27, 344-348.
‘ Santoro, A.
F., Shear, S. M., & Haber, A. (2018). Childhood adversity, health and quality of lice in adults with intellectual and
developmental disabilities. Journal ofIntellectual Disability Research, 62, 854-863.
92 Streissguth,
Barr, Kogan, & Bookstein, op. cit.
Reale, L., Bartoli, B., Cartabia, M., Zanetti, M. Costantino, M. A., Canevini, Termine, & Bonati, M. (2017). Comorbidity
prevalence and treatment outcome in children and adolescents with ADHD. European Child and Adolescent Psychiatry, 26,
1443-1457.
“
Munir, K. M. (2016). The co-occurrence of mental disorders in children and adolescents with intellectual disability/intellectual
developmental disorder. Current Opinions in Psychiatry, 29, 95-102.
Streissguth, Barr, Kogan, & Bookstein, op. cit.
96 Fried. R.,
Petty. C.. Faraone. S.V., Hyder, L.L.. Day, H.. Biederman, J. (2016). Is ADHD a risk factor for high school dropout?
A controlled studs’. Journal ofAttention Disorders, 20(5), 383-9.
Snyder, T. D., & Dillow, S. A. (2012). Digest of education statistics 2011 (NCES 2012-001). Washington, DC: National
Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education. Retrieved from
/ces.ed.pbs2() 1 2/201 2QQhpdl
Streissguth, Barr, Kogan, & Bookstein, op. cit.
Altszuler, A. R., Page, T. F., Gnagy, E. M., Coxe, S., Arrieta, A., Molina, R. S. 0., & Pelham, Jr., W. E. (2016). Financial
dependence of young adults with childhood ADHD. Journal ofAbnormal Child Psychology, 44, 1217-1229.
°°
Ross, J., Marcell, J., Williams P., & Carson, D. (2013). Postsecondary education employment and independent living
outcomes of persons with autism and intellectual disability. Journal ofPostsecondary Education and Disability, 26, 337-351.

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 Employment problems 79 %‘°‘ 2 16 %1o2
0 21 %103
1
35104
Substance abuse 1 52 %l05
2 5 %106
0
%107
Trouble with the law 61 2 12 %108
1 <8.6 %109
0

Social isolation 57 %“° 2 3 1-36 0 50 %h12

I
%111

%h13 %114
Victimization 72 2 73 0 17.5 %H5
1

TOTALSCORE 19 5 9
Table 3. Adverse outcome risk in the three disorders

Based on ratings of adverse outcome risk in Table 3, it is clear people with FASD are at
much greater risk of a negative developmental trajectory than those with ADHD or ID.
Much of this risk stems from lack of early diagnosis and appropriate interventions.116 In
contrast, ID and ADHD tend to get diagnosed early in life, which significantly improves
the odds of intervention (and protection in the case of ID). Overall, both ADHD and ID
are mild severity disabilities compared to FASD in terms of negative life course
outcomes. Notably, most people with FASD as well as ID cannot live independently in
society as adults.’17

01
Streissguth, Barr, Kogan, & Bookstein, op. cit.
102
Kuriyan, A. B., Peiham Jr., W. E., Molina, B. S. G., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., Babinski, D. E.,
Waither, C., Cheong, J. W., Yu, J., & Kent, K. M. (2012). Young adult educational and vocational outcomes of children
diagnosed with ADHD. Journal ofAbnormal Child Psychology, 31, 27-41.
103
Siperstein, G. N., Parker, R. C., & Drascher, M. (2013). National snapshot of adults with intellectual disabilities in the labor
force. Journal of Vocational Rehabilitation, 39, 157-165.
104
Streissguth, Barr, Kogan, & Bookstein, op. cit.
105
Carpentier, P. J. (2012). ADHD and addiction. In J. C> Verster, K. Brady, M. Galanter, & P. Contrad (Eds.), Drug abuse and
addiction in medical illness. New York: Springer.
106
Allen, J. R. (2019). Addressing substance use in patients with intellectual disability: 5 steps. Current Psychiatry, 18, 49-50,
107
Streissguth, Barr, Kogan, & Bookstein, op. cit.
108
Fletcher, J., & Wolfe, B. (2009). Long-term consequences of childhood ADHD on criminal activities. Journal ofMental
Health Policy Economics, 12, 119-138.
°
Fogden, B. C., Thomas, S. D. M., Daffern, M., & Ogloff, J. R. P. (2016). Crime and victimization in people with intellectual
disability: A case linkage study. BMC Psychiatry, 16, htijThpicpsvchiatrv.h medecnnaLni/ar1cIes’ ID.] I 86’s]28881) ID
O869-7[l aD]
10
Streissguth, Barr, Kogan, & Bookstein, op. cit.
Sasser, T. R., Kalvin, C. 13., & Bierman, K. L. (2016). Developmental trajectories of clinically significant attention-
deficit/hyperactivity disorder (ADHD) symptoms from Grade 3 through 12 in a high-risk sample: Predictors and outcomes.
Journal ofAbnormal Psychology, 125, 207-219.
112
Ibid.
113
Streissguth, Barr. Kogan, & Bookstein, op. cit.
“i
Hellstrom, L. (2019). A systematic review of polyvictimization among children with attention deficit hyperactivity’ or autism
spectrum disorder. International Journal of Environmental Research and Public Health, 16, 2280; doi:1O.3390/ijerphl6l3228O
115
Fogden, B. C., Thomas, S. D. M., Daffern, M., & Ogloff J. R. P. (2016). Crime and victimization in people with intellectual
disability: A case linkage study. BMC Psychiatry, 16, hups://hmcj Iiatrv.biomcdccnlral.com/arlicles/l0.1 186/s12888-016-
0869-7#lab I
16
Streissguth, Barr, Kogan, & Bookstein, op. cit.
II?
Burd, L., & Kerbeshian, J. (2013). Fetal alcohol spectrum disorders: Commentary. International Journal ofAlcohol and Drug
Research, 2, 3-6.

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 31. ID Equivalence: Whether measured by definitional complexity, functional capacity,
outcome risk, or any other logical metric, FASD is a much more severe disorder than ADHD
and, in some cases, ID and therefore is well-deserving of being viewed under the rubric of
“ID Equivalence.” The bases for FASD-ID similarity and FASD/ADHD dissimilarity are
multifaceted and compelling, as described below:

a. Etiology: Both ID and FASD stem from permanent structural brain damage. ADHD is
etiologically multifactorial (and typically unknown). While FASD is a causal factor for
both ID and ADHD, there is no evidence ADHD or ID are causal factors for FASD.

b. Diagnostic Protocol: Typically, ID and ADHD are diagnosed by a single provider (e.g.,
mental health professional or pediatrician) in the context of relatively minimal testing (in
DSM-5, ID requires IQ testing and adaptive assessment; ADHD does not require any
testing). In contrast, FASD is diagnosed by a multidisciplinary team comprised of a
neuropsychologist to conduct comprehensive cognitive testing to address the multiple
domains that must be deficient per diagnostic criteria, an adaptive functioning specialist
(usually a psychologist) to conduct standardized adaptive behavior assessment and assess
documented life history for consistency with FASD, and a medical doctor to assess
physical indicia of FASD (e.g., facial and growth abnormalities, brain damage). Thus, of
the three conditions, FASD requires more resources to diagnose.

c. Cognitive Dysfunction: While IQ distinguishes between ID and FASD in the majority of

individuals with FASD, executive and everyday adaptive functioning in both conditions
tends to be identical.”8 As noted previously, significant discrepancies in IQ domains are
seen frequently in persons with FASD,”9 which makes full-scale IQ an inaccurate way to
classify functional deficiency in FASD.’2° Full-scale IQ also has become less important
in ID according to DSM-5 as “intellectual” deficiency now is defined as a broad array of
mixed impairments that mostly involve executive dysfunction (i.e., reasoning, problem
solving, planning, abstract thinking, judgment, learning from instruction and experience,
practical understanding). Meta-analyses have found that persons with ADHD have full-
scale IQs (FSIQs) that are only 9 points lower than neurotypical controls’2” 122; in
contrast to ADHD, average IQ in FAS is 79 (21 points lower than neurotypical
controls).’23 A meta-analysis that directly compared IQ in FASD and ADHD found full-
scale IQ was 16 points lower in FASD compared to ADHD.’24 Executive functioning also

1)8
Greenspan, S., Novick Brown, N., & Edwards, W. (2016). FASD and the concept of “intellectual disability equivalence.” In
M. Nelson & M. Trussler (Eds.), Fetal alcohol spectrum disorders in adults: Ethical and legal perspectives. Switzerland: Springer.
1)9
Bertrand et al.. op. cit.
20
Greenspan, Novick Brown, & Edwards, op. cit.
121
Barkley, R. A., DuPaul, G. J., & McMurray, M. B. (1990). Comprehensive evaluation of attention deficit disorder with and
without hyperactivity as defined by research criteria. Journal of Consulting Clinical Psychology, 58, 775-789.
22
Frazier. T. W.. Demaree. H. A.. & Youngstrom, E. A. (2004). Meta-Analysis of Intellectual and Neuropsychological Test
Performance in Attention-Deficit/Hyperactivity Disorder. Neuropsychology, 18(3), 543—555.
123
Streissguth, Barr, Kogan, & Bookstein, op. cit.
24
Kingdon, D., Cardoso, C., & McGrath, J. J. (2016). Research review: Executive function deficits in fetal alcohol spectrum
disorders and attention-deficitJhyperactivity disorder A meta-analysis. Journal of Child Psychology and Psychiatry, 57, 116.-
—

131.

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 is similar in FASD and ID but different from both in ADHD. Executive functioning tends
to be universally impaired in FASD as well as ID,’25 but not all children with ADHD
have executive functioning impairments.’26’ 127 In fact, a 15-study meta-analysis that
compared executive functioning in FASD and ADHD found persons with FASD
performed significantly worse on cognitive measures of executive functioning than those
with ADHD.’28 In addition, a 51-study meta-analysis found more extensive executive
dysfunction in FASD compared to ADHD, particularly in executive skills requiring
complex mental effort.’29
There also is a fundamental difference in the qualitative nature of the attention deficit
seen in FASD versus ADIID. Children with FASD have greater difficulty with encoding
(i.e., capacity to hold information temporarily in working memory while performing
mental operations on it) and set-sh/iing (i.e., ability to flexibly shift attention from one
stimulus facet to another when appropriate), while children with ADHD have greater
difficulty withfocusing (i.e., concentrating attention on a particular task) and sustaining
attention (i.e., staying on task).130’ 131

d. Adaptive Dysfunction: Both ID and FASD require adaptive impairment in DSM-5 (at
least one deficient adaptive domain in ID, and at least two deficient adaptive domains in
FASD), typically making people with ID and FASD indistinguishable from each other in
terms of everyday behavior.’32 Moreover, adaptive deficits in FASD tend to worsen with
age, with adolescents showing arrested development that persists well into the adult
years.’33’ 134, In stark contrast to both FASD and ID, ADHD involves a very narrow
band of dysfunction, affecting only one (attention) and sometimes two (attention plus
executive functioning) cognitive domains, with no adaptive behavior deficiency. Most
people with ADHD are able to support themselves and live independently in their adults
years, while only a very small percentage of adults with ND-PAE can do both.’36

25
Kodituwakku, P. W. (2009). Neurocognitive profile in children with fetal alcohol spectrum disorders. Developmental
Disabilities Research Reviews, 15, 218-224.
126
Nigg, J. T., Wllcutt, E. G., Doyle, A. E., & Sonuga-Barke, E. J. S. (2005). Causal heterogeneity in attention
deficitlhyperactivity disorder: Do we need neuropsychologically impaired subtypes? Biology and Psychiatry, 57, 1224-1230.
127
Willcutt, E. G.. Doyle, A. E., Nigg, J. T., Varaone, S. V., & Pennington, B. F. (2005). Validity of the executive function
theoiy of attention-deficitlhyperactivity disorder; A meta-analytic review. Biology and Psychiatry, 57, 1336-1346.
28
Khoury, J. E., & Milligan, K. (2019). Comparing executive functioning in children and adolescents with fetal alcohol
spectrum disorders and ADHD: A meta-analysis. Journal ofAttention Disorders, 13, 1801-1815.
29
Kingdon, Cardoso, & McGrath, op. cit.
30
Coles, C. D. (2001). Fetal alcohol exposure and attention: Moving beyond ADHD. Alcohol Research and Health, 25, 199-203.
131
Peadon, E., & Elliott, E. J. (2010). Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders
in children: Clinical guidelines. Neuropsychiatric Disease and Treatment 6, 509-5 15.
132
Greenspan, Nov ick Brown, & Edwards, op. cit.
‘°
Crocker. N., Vaurio, L., Riley, E. P., & Mattson, S. N. (2009). Comparison of adaptive behavior in children with heavy
prenatal alcohol exposure or attention-deficit/hyperactivity disorder. Alcoholism: Clinical and Experimental Research, 33, 2015-
202 3.
‘
Fagerlund, A., Autti-Ramo, I. Hoyme, H. E., Mattson, S. N., & Korkman, M. (2011). Risk factors for behavioral problems in
foetal alcohol spectrum disorders. Acta Paediatrica, 100, 1481-1488.
135
Mattson, S. N., Bernes, G. A., & Doyle, L. R. (2019). Fetal alcohol spectrum disorders: A review of the neurobehavioral
deficits associated with prenatal alcohol exposure. Alcoholism: Clinical and E.sperimental Research, 43, 1046-1062.
136
l3urd, L., & Popova, S. (2019). Fetal alcohol spectrum disorders: Fixing our aim to aim for the fix. International Journal of
Environmental Research and Public Health, 16 1—6.

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 e. Comorbidity: Unlike ADHD, FASD has extremely high rates of comorbidity. For
example, a systematic review of prevalence studies that compared rates of comorbid
mental disorders and neurodevelopmental disorders in FASD versus normally-constituted
age-peers found that those with FASD were 45 times more likely to be diagnosed with
ADHD, 22 times more likely to be diagnosed with ID, 13 times more likely to be
diagnosed with oppositional defiant disorder, nearly 12 times more likely to be diagnosed
with a psychotic disorder, 10.6 times more likely to be diagnosed with depression, and 10
times more likely to be diagnosed with a learning disorder.’37

f. Likelihood of Misdiagnosis: In the United States, 99.9% of people with FASD are
undiagnosed or misdiagnosed.’38 In cases where attention and/or hyperactivity symptoms
are prominent, such symptoms tend to get diagnosed as ADHD; in cases involving
deficient IQ, ID typically is diagnosed, concealing underlying FASD. Notably, FASD is
the leading cause of both ID and ADHD.’39 In children with FASD, average or low-
average IQs in the context of learning disabilities, self-regulation problems, social
deficits, and interpersonal difficulties often lead teachers and providers to attribute the
difficulties to parenting deficiency. Moreover, when such symptoms occur in the context
of attention problems and hyperactivity, providers misdiagnose ADHD, which is far more
familiar than FASD to medical and mental health professionals. Under DSM-IV-TR,
nearly all mental health professionals were inexperienced in FASD because there was no
diagnosis specific to the condition until DSM-5 was published in 2013. As recently as
2015, a study found that 80% of pediatricians could not accurately diagnose FAS in
children presenting with developmental and behavioral problems.’4° Consequently, prior
to 2013, if a child had attention and/or hyperactivity problems, such symptoms were
diagnosed as ADHD, with cognitive symptoms beyond attention and hyperactivity (e.g.,
learning disabilities, self-regulation problems, social deficits and interpersonal
difficulties) attributed to a “severe” type of ADHD. Thus, unlike ADHD and ID, FASD is
very much a hidden disability. Unfortunately, once children with FASD are misdiagnosed
with ADHD, treatment tends to be limited to stimulant medication, with no
developmental disabilities interventions during childhood for the pervasive brain-based
cognitive dysfunction in FASD.

g. Course: Symptom manifestation in ID and FASD is lifelong and quite different from
ADHD. Symptoms of ADHD often are eliminated or significantly reduced with
medication; symptoms are permanent in FASD and ID.141’ 142 Symptom manifestation in
ADHD gradually decreases in severity across childhood and adolescence (i.e., research

31
Weyrauch, D., Schwartz, M., Hart, B., Kiug, M. G., & Burd, L. (2017). Comorbid mental disorders in fetal alcohol spectrum
disorders: A systematic review. Journal ofDevelopmental and Behavioral Pediatrics, 38, 283-291.
‘
Popova. S.. Dozet, D., & Burd, L. (2020). Fetal alcohol spectrum disorder: Can we change the future? Alcoholism: Clinical
and Experimental Research, 44, 815-819.
‘°°
Burd, L. (2016). FASD and ADHD: Are they related and how? BMC Psychiatry, 16, 325.
htp://\vw.ncbi.nhln.nih.o/plnc/alticles/PMC5032242
‘°
Stein, M. T. (2015). Misdiagnosis of fetal alcohol spectrum disorders in children presenting with developmental and
behavioral problems. Journal ofDevelopmental and Behavioral Pediatrics, http://dx .doi.or/ 10.1 097/DBP.0000000000000 I
14)
Oesterheld et al., 1998
42
Peadon & Elliott, 2010

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 finds ADHD prevalence in adolescence is about half the childhood rate, and prevalence
estimates continue to decrease by 50 percent more in adulthood’43). In contrast, symptom
course in ID remains relatively stable over the developmental years into adulthood, but
FASD becomes more complex and debilitating,’44 leading to greater adaptive severity in
adulthood.’45

h. Cost of Care: Estimated annual cost of care is high in both ID ($32,000146) and FASD
($23,000’). In contrast, estimated annual cost of care in ADHD is $5,000.148 Beyond the
personal costs of medical and mental health needs, FASD also is an important public
health and social problem that imparts a large financial burden on such sectors as the
healthcare system, mental health and substance abuse treatment services, foster care,
criminal justice system, and long-term care.149 In research directly comparing the cost of
care in FASD versus ADHD, the annual cost of care in FASD was found to be over 10
times higher than in ADHD.’5°

i. Mortality: Life expectancy for males in the general population is 76 years.’5’ In contrast,
life expectancy is 74 years in ID, 152 61 years in ADHD,’53 and only 34 years in FASD. 154
Thus, FASD has a greatly increased risk of mortality compared to ADHD and ID.

32. In summary, Zane Floyd’s ND-PAE/FASD is a brain-based, congenital, lifelong,

impactful disorder deserving of the rubric “ID Equivalence.” Regardless of how
severity is measured (e.g., definitional complexity, diagnostic protocol, functional
capacity, risk of negative outcomes, cognitive dysfunction adaptive dysfunction,
comorbidity, likelihood of misdiagnosis, course, annual cost of care, mortality), Mr.
Floyd’s FASD is similar in severity to ID but substantially more severe than ADHD,
with broad ramifications that have affected all important functional domains in his life.
Unlike ADHD, Mr. Floyd’s ND-PAE/FASD is a cause-and-effect condition with clear

‘
Caye, A., Swanson, J., Thapar, A., Sibley, M., Arseneault, L., Hechtman, L., Arnold. L. E.. Niclasen, J., Moffitt, T., & Rohde,
L. A. (2016). Life span studies of ADHD: Conceptual challenges and predictors of persistence and outcome. Current Psychiatiy
Reports, 18, el-eli.
144
Streissguth, A. P. (1994). A long-term perspective of FAS. Alcohol Health and Research World 18, 74-81.
‘‘
Kambeitz, C., Klug, M. G., Greenmyer, J., Popova, S., & Burd, L. (2019). Association of adverse childhood experiences and
neurodevelopmental disorders in people with fetal alcohol spectrum disorders (FASD) and non-FASD controls. BMC Pediatrics,
19, 498 https://doi.ora/lO.i I 86/s12887-O1’)-187$-$
46
Friedman, C. (2017). A national analysis of Medicaid home and community based services waivers for people with
intellectual and developmental disabilities: FY 2015. Intellectual and Developmental Disabilities, 55, 281-302.

/ lItlciL’ 4”
‘
Popova, S., Lange, S., Burd, L., & Rehm, J. (2016). Economic burden of Fetal Alcohol Spectrum Disorder in Canada in
2013. Alcohol andAlcoholism, 51, 367—375.
htsps:/!vvw.no
Life expectancy for males in the U.S. has hovered around age 76 for the past two decades. See:
bit >s://v \v.cdc.co\/ic s/dt1t!hes at/li -Lpçetancv/li Ic—ex teclane\ —21)1 S.him#Iahlel
152
Bittles, A. H., Petterson, B. A., Sullivan, S. G., Hussain, R., Glasson, E. J., & Montgomery, P. D. (2002). The influence of
intellectual disability on life expectancy. Journals of Gerontology, 57 m470-m472.
‘‘
Barkley, R. A., & Fischer, M. (2019). Hyperactive child syndrome and estimated life expectancy at young adult follow-up:
The role of ADI-ID persistence and other potential predictors. Journal ofAttention Disorders, 23, 907-923.
Thanh, N. X., & Jonsson, E. (2016). Life expectancy of people with fetal alcohol syndrome. Journal ofPopulation
Therapeutics and Clinical Pharmacology 23, e53-e59.

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 etiology informed by five decades of science: prenatal alcohol exposure causes brain
damage, which causes cognitive and adaptive dysfunction that leads to catastrophic
consequences in some situations. Unlike ADHD, which only explains attention deficits,
impulsivity, and hyperactive behavior during childhood, ND-PAE/FASD explains all of
Mr. Floyd’s behavior across his entire lifespan.
—

L. BRAIN MATURITY

Normal Brain Development

33. The mature brain is composed of more than 100 billion neurons,155 the information
processing cells in the brain. Neurons make connections with other neurons to form
information processing networks that are responsible for our thoughts, sensations, feelings,
and actions. The adult brain is estimated to have more than 60 trillion neuronal
connections.’56 The largest and most important brain information processing networks are
the neocortex (e.g., frontal, occipital, parietal, and temporal lobes) and subcortical nuclei that
relay information to and from the neocortex. The subcortical nuclei are clusters of neurons
located deep in the brain that serve as signal relay centers for communication within the
neocortex and with the rest of the body. Because both the neocortex and subcortical nuclei
contain the cell bodies of neurons, they are gray in appearance and thus are called “gray
matter.” Populations of neurons connect to one another via fibers that extend to and from the
cell bodies of individual neurons. There are two kinds of connecting fibers: axons that send
electrochemical signals from neurons and dendrites that receive such input. Because axons
are wrapped in a white fatty substance called myelin that, like insulation on a telephone wire,
makes transmission of electrochemical signals more efficient, these fiber pathways of brain
are referred to as “white matter.”

34. Brain development continues for an extended period postnatally. Generally, phylogenetically
older cortical areas (e.g., brain regions associated with more basic functions) mature earlier
than newer cortical regions (i.e., brain regions involved in executive functioning, attention,
and motor coordination).157 Frontal lobe maturation progresses in a back-to-front direction,
beginning in the primary motor and sensory cortices and ending with the prefrontal cortex
developing last.

35. Imaging studies show increases in gray matter density in childhood followed by losses in
density during adolescence and early adulthood, which correlates with synaptic pruning.’58
Myelination, which speeds neuronal transmission, occurs throughout childhood and increases

55
Pakkenberg, B., & Gundersen H, J. (1997). Neocortical neuron number in humans: effect of sex and age. The Journal of
Comparative Neurology, 384(2), 312—320.
156
Stiles, J., & Jernigan, T. L. (2010). The basics of brain development. Neuropsychological Reviews, 20(4), 327-348.
Goglay, N., Giedd, J. N., Lusk, L., Hayashi, K. M., Greenstein, D., Vaituzis, A. C., Nugent, III, T. F., Herman, D. H., Clasen,
L. S., Toga. A. W.Rapoport, J. L., & Thompson, P. M. (2004). Dynamic mapping of human cortical development during
childhood through early adulthood. Proceedings of the National Academy ofSciences, 101(21), 8174-8179.
58
Rakic. P. (1996) in Child and Adolescent Psychiatry, ed. Lewis, M. (Williams and Wilkins, Baltimore), pp. 9—30.

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 in mid-to-late adolescence,’59’ 160 with pronounced increases in the density of myelinated
axons in the neocortex well into the 20s,’61, 162 providing evidence of prolonged neocortical
maturation.’63’ 164, 165, 166 MRI studies also indicate that growth in cortical white matter
volume persists into early adulthood,’67, 168, 169, 170, with the greatest maturational delay in
areas of the brain that govern self-regulation (prefrontal cortex, inferior parietal lobe, and
anterior cingulate cortex).171’ 172, 173, 174, 175, 176, 177, 178, 179 In fact, synaptic pruning in the
prefrontal cortex has been shown to continue until age 30 years.’8°

Yakovlev, P. I., & Lecours, A. (1967). The myelogenetic cycles of regional maturation of the brain. In: A. Minkowski (Ed.),
Regional development of the brain in early life. Oxford: Blackwell Science.
160
Huttenlocher, P. R. (1990). Morphometric study of human cerebral cortex development. Neuropsychologia, 28(6), 517-527.
161
Yakovlev, P. I., & Lecours. A. (1967). The myelogenetic cycles of regional maturation of the brain. In: A. Minkowski (Ed.),
Regional development ofthe brain in early lfe. Oxford: Blackwell Science.
162
Benes, F. M. (1989). Myelination of cortical-hippocampal relays during late adolescence. Schizophrenia Bulletin, 15, 585—
593.
163
Miller, D. J., Duka, T., Stimpson, C. D., Schapiro, S. J., Base, W. B., McArthur, M. J., Fobbs, A. J., Sousa, A. M. M., Sestan,
N., Wildman, D. E., Lipovich, L., Kuzawa, C. W., Hof, P. R., & Sherwood, C. C. (2012). Prolonged mulelination in human
neo cortical evolution. Proceedings ofthe National Academy ofSciences, 109(4 1), 16480-16485.
164
Steinberg, L., Albert, D., Cauffman, E., Banich, M., Graham, S., & Woolard, J. (2008). Age differences in sensation
seeking and impulsivity as indexed by behavior and self-report: Evidence for a dual systems model. Developmental Psychology,
44(6), 1764-1778.
165
Cope, L. M., Hardee, J. E., Martz, M. E., Zudker, R. A., Nichols, T. E., & Heitzeg, M. M. (2020). Developmental maturation
of inhibitory control circuitry in a high-risk sample: A longitudinal IMRI study. Developmental Cognitive Neuroscience, 43,
https://doi.org/1 0.101 6/j.dcn.2020. 100781
166
Steinberg, L. (2009). Should the science of adolescent brain development inform public policy? American Psychologist, 64,
739-750.
167
Groeschel, S., Vollmer, B., King, M.D., & Connelly, A. (2010). Developmental changes in cerebral grey and white matter
volume from infancy to adulthood. International Journal ofDevelopmental Neuroscience, 28. 481—489.
68
Gogtay, N., Giedd, J.N., Lusk. L., Hayashi, K.M.. Greenstein, D., Vaituzis, A.C., et al. (2004). Dynamic mapping of human
cortical development during childhood through early adulthood. Proceedings of the National Academy ofSciences, 10], 8174—
8179.
169
Shaw, P., Kabani, N. J., Lerch, J. P., Eckstrand, K., Lenroot, R., Gogtay, N., Greenstein, D., Clasen, L., Evans, A., Rapoport,
J. L., Giedd, J. N., & Wise, S. P. (2008). Neurodevelopmental trajectories of the human cerebral cortex. Journal ofNeuroscience,
28, 3586—3594.
170
Sowell, E.R., Thompson, P.M., Holmes, C.J., Jernigan, T.L., & Toga, A.W. (1999). In vivo evidence for post-adolescent brain
maturation in frontal and striatal regions. Nature Neuroscience, 2, 859—86 1.
‘‘
Elston, G.N., Oga, T., & Fujita, I. (2009). Spinogenesis and pruning scales across functional hierarchies. Journal of
Neuroscience, 29, 3271—3275.
172
Huttenlocher, P. R. (1979). Synaptic density in human frontal cortex: Developmental changes and effects of aging. Brain
Research, 163, 195—205.
‘
Jacobs, B., Schall, M., Prather, M., Kapler, E., Driscoll, L., Baca, S., Jacobs, J., Ford, K., Wainwrights, M., & Tremi. M.
(2001). Regional dendritic and spine variation in human cerebral cortex: A quantitative Golgi study. Cerebral Cortex, 11, 558—
571.
Travis, K., Ford, K., & Jacobs, B. (2005). Regional dendritic variation in neonatal human cortex: A quantitative Golgi
study. Developmental Neuroscience, 27, 277—287.
Cope eta!., 2020, op. cit.
76
Casey, B. J. (2015). Beyond simple models of self-control to circuit-based accounts of adolescent behavior. Annual Review of
Psychology, 66, 295—319.
“
Casey, B. J., Getz, S., & Galvan, A. (2008). The adolescent brain. Developmental Review, 28(1), 62—77.
78
Eshel, N., Nelson, E.E., Blair, R.J., Pine, D.S., & Ernst, M. (2007). Neural substrates of choice selection in adults and
adolescents: Development of the ventrolateral prefrontal and anterior cingu!ate cortices. Neuropsychologia, 45(6), 1270—1279.
79
Luna, B., Padmanabhan, A., & O’Hearn, K. (2010). What has fMRi told us about the development of cognitive
control through adolescence? Brain and Cognition, 72(1), 10 1—1 13.
180
Petanjek. Z., Judas, M., Simic, G., Rasin, M. R., Uylings, H. B. M., Rakic, P., & Koslovic, I. (2011). Extraordinary neoteny of
synaptic spines in the human prefrontal cortex. Proceedings of the NationalAcademy ofSciences, 108, 1328 1—13286.

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 36. Functionally, self-regulation a central diagnostic criterion in ND-PAE is the byproduct of
—
—

interactions between neural processes that support controlled, reasoned, and deliberative
thought (“executive processing”) and those that drive reactive, emotional, and reward-
sensitive responding (“affective processing”).’8’ The affective processing system is the first
to mature in normally developing adolescent brains. In fact, one of the most important
structural and functional brain changes during adolescence is maturation of limbic and
paralimbic areas associated with reward processing (e.g., amygdala, ventral striatum,
orbitofrontal cortex, ventromedial prefrontal cortex, and superior temporal sulcus).’82’ 183, 184,
185 The affective system also includes neural circuits that mediate reward-sensitivity,’86
which is thought to influence “sensation-seeking”87 as well as valuation and prediction of
reward and punishment.’88’ 189, 190 The executive processing system is the last brain area to
fully develop. During the course of normal brain development, connections between the
prefrontal cortex and other self-regulatory brain regions become stronger and more efficient
through pruning of unused neuronal connections, which decreases gray matter, and
myelination (sheathing/insulating) of neurons, which increases white matter. In healthy
brains, both processes support improved executive control and multitasking (i.e., planning,
motivation, evaluating future consequences, weighing risk and reward, judgment, and
decision making while simultaneously moderating strong unconscious neural impulses from
the amygdala). 191, 192, 193, 194 Development of these neural connections in late adolescence
and early adulthood is thought to result in relatively late maturation of “top-down” control
systems that gradually strengthen their influence over early emerging and largely subcortical
“bottom-up” systems that are highly responsive to rewarding and emotional stimuli.’95

181
Smith, A. R., Chain, J., & Steinberg, L. (2013). Impact of socio-emotional context, brain development, and pubertal
maturation on adolescent risk-taking. Hormones and Behavior, 64, 323-332.
182
Adolphs. R. (2003). Is the human amygdala specialized for processing social information? Annals New York
Academy ofSciences, 985, 326—340.
83
Knutson, B., & Cooper, J. C. (2005). Functional magnetic resonance imaging of reward prediction. Current Opinion in
Neurology 18(4), 411—417.
84
Robbins, T. W., & Everitt, J. (1996). Neurobehavioural mechanisms of reward and motivation. Current Opinion in
Neurobiology, 6 228—236.
185
Spear, L p. (2009). The behavioral neuroscience ofadolescence. New York: W.W. Norton & Co.
86
Spear, op. cit.
187
Smith, Chain, & Steinberg, op. cit.
88
Hare, T. A., Tottenham, N., Galvan, A., Voss, H. U., Glover, G. 1-I., & Casey, B. J. (2008). Biological substrates of emotional
reactivity and regulation in adolescence during an emotional go-no go task. Biological Psychiatry, 63, 927—934.
Galvan. A., Hare, T. A., Parra, C. E., Penn, J., Voss, H., Glover, G., & Casey. B. J. (2006). Earlier development of the
accumbens relative to orbitofrontal cortex might underlie risk-taking behavior in adolescents. Journal ofNeuroscience, 26, 6885--
6892.
‘°
Luciana, M., & Collins, P. F. (2012). Incentive motivation, cognitive control, and the adolescent brain: Is it time for a
paradigm shift? Child Development Perspectives, 6 392—399.
‘
Olesen, P. J., Nagy, Z., Westerberg, H., & Klingberg, T. (2003). Combined analysis of DTI and fMRI data reveals a joint
maturation of white and grey matter in a fronto-parietal network. Cognitive Brain Research, 18, 48—57.
192
Schmithorst, V. J., & Yuan, W. (2010). White matter development during adolescence as shown by diffusion MRI. Brain and
Cognition, 72, I 6—25.
‘‘
Ljston, C., Watts, R., Tottenham, N., Davidson, M., Niogi, S., Ulug, A., & Casey, B. J. (2006). Frontostriatal microstructure
modulates efficient recruitment of cognitive control. Cerebral Cortex 16, 553—560.
‘p”
Stevens, M. C., Kiehl, K. A., Pearlson, G. D., & Calhoun, V. D. (2007). Functional neural networks underlying response
inhibition in adolescents and adults. Behavioural Brain Research, 181, 12—22.
‘
Casey, B. J., Getz, S., & Galvan, A.(2008). The adolescent brain. Developmental Review, 28(1), 62—77.

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 Behavioral evidence for delayed maturation in self-regulatory frontal regions is especially
evident on tasks requiring inhibitory self-control.196’ 197

37. Although the still-maturing self-regulatory system in adolescents and young adults generally
is adequate to support reasoned decision making in minimally arousing situations,’98’ 199, 200
in situations involving stress or other strong impulses from the amygdala, asynchronous
maturation leaves the brain’s affective processing system in a state of hypersensitivity during
a period of time when the deliberative processing system is not yet mature enough to
compensate for such heightened arousal, thereby increasing vulnerability to risky and
reckless behavior. 201, 202, 203, 204

Brain Development in FASD

38. Born with widespread brain damage, people with FASD also exhibit abnormal and delayed
brain maturation across the developmental years. Using magnetic resonance imaging (MRI)
and diffusion tensor imaging (DTI) to study structural integrity and functional connectivity,
studies consistently find significant maturational alterations and delays in the prefrontal
cortex205’ 206 and its microstructure207’208’ 209 in children, adolescents, and adults with prenatal
alcohol exposure (PAE) compared to normally-developing age-peers. In stark contrast to
normal changes in brain architecture during adolescence that improve speed and efficiency of
neurochemical communication, convergent longitudinal research finds that individuals with
PAE show: (a) blunted volume changes in grey matter in adolescence, indicating

‘
Durston, S., Davidson, M.C., Tottenham, N., Galvan, A.. Spicer, J., Fossella, J. A., et al. (2008). A shift from diffuse to focal
cortical activity with development. Developmental Science, 9(1), 1—20.
197
Casey, B. J., Trainor, R. J., Orendi, J. L., Schubert, A.B., Nystrom, L.E., Giedd, J.N., et al. (1997). A developmental
functional MRJ study of prefrontal activation during performance of a go-no-go task. Journal of Cognitive Neuroscience, 9(6),
835—847.
‘
Chein. J., Albert, D., O’Brien, L., Uckert, K., & Steinberg. L. (2011). Peers increase adolescent risk taking by
enhancing activity in the brain’s reward circuitry. Developmental Science, 14(2), Fi—FlO.
Gardner, M., & Steinberg, L. (2005). Peer influence on risk taking, risk preference, and risky decision making in adolescence
and adulthood: An experimental study. Developmental Psychology, 41(4), 625—635.
200
Smith, A. R., Chain, J., & Steinberg, L. (2013). Impact of socio-emotional context, brain development, and pubertal
maturation on adolescent risk-taking. Hormones and Behavior, 64, 323-3 32.
201
Liston, C., McEwen, B.S., & Casey, B.J. (2009). Psychosocial stress reversibly disrupts prefrontal processing and attentional
control. Proceedings ofthe National Academy ofSciences, 106(3), 912—917.
202
Ibid.
203
Casey, B. J., Jones, R. M., Levita, L., Libby, V., Pattwell, S. S., Ruberry, E.J.,... Somerville, L. H. (2010). The storm and
stress of adolescence: Insights from human imaging and mouse genetics. Developmental Psychobiology, 52, 225—23 5.
204
Shulman, E. P., Smith, A. R., Silva, K., Icenogle, G., Duell, N., Chein, J., & Steinberg, L. (2016). The dual systems model:
Review, reappraisal, and reaffirmation. Developmental Cognitive Neuroscience, 17, 103—117.
205
Treit, S., Lebel, C., Baugh, L., Rasmussen, C., Andrew, G., & Beaulieu, C. (2013). Longitudinal MRI reveals altered
trajectory of brain development during childhood and adolescence in fetal alcohol spectrum disorders. Journal of Neuroscience,
33, 10098-100109.
206
Sowell, E.R., Thompson, P.M., Mattson, S.N., Tessner, K.D., Jemigan, T.L., Riley, E.P., et al. (2002). Regional brain shape
abnormalities persist into adolescence after heavy prenatal alcohol exposure. Cerebral Cortex, 12, 856—65.
207
Lebel, C., Mattson, S.N., Riley, E.P., Jones, K.L., Adnams C.M., May, P.A., et al. (2012). A longitudinal study of the long-
term consequences of drinking during pregnancy: heavy in utero alcohol exposure disrupts the normal processes of brain
development. Journal ofNeuroscience, 32, 15243—15251.
208
Treit et al., op. cit.
209
De Guio, F., Mangin, J.F., Rivière, D., Perrot, M., Molteno, C.D., Jacobson, S.W., et al. (2014). A study of cortical
morphology in children with fetal alcohol spectrum disorders. Human Brain Mapping, 35, 2285-2296.

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 compromised pruning and diminished plasticity in the cerebral cortex, as well as (b) delayed
white matter myelination. Together, these brain development anomalies in PAE significantly
impair global network efficiency, speed of information processing, and executive self-
regulation.

39. Longitudinal MRT studies focused on brain development in PAE versus brain development in
unexposed individuals consistently find structural abnormalities in the former. For example,
in a longitudinal study21° usiiig MRI to measure cortical volume changes over time, normal
processes of brain maturation were significantly delayed or disrupted in children and
adolescents with PAE. While unexposed controls showed a plastic cortex with a prolonged
pattern of cortical volume increases in childhood followed by equally vigorous volume
decreases in adolescence (i.e., an inverted “U” shaped pattern), individuals with PAE showed
only volume loss in most cortical areas across the developing years. Another longitudinal
MRI study211’ 212 similarly found significantly less cortical thinning over time in self-
regulatory brain regions (i.e., frontal, parietal, and limbic) in adolescents with PAE. In
another longitudinal study that used a large sample size to follow brain development from
age 7-18, researchers213 found subjects with PAE consistently had smaller volumes than
control subjects in structures throughout the brain, with significantly different trajectories of
brain activation in visuospatial attention and working memory tasks compared to controls
(i.e., in contrast to unexposed subjects who exhibited increasing brain activation during
development, those with PAE exhibited decreasing brain activation). In a review of 64 MRT
studies that compared PAE groups to unexposed control groups,214 results indicated smaller
total brain volume as well as smaller volume of both white and grey matter in specific
cortical regions. The most consistently reported structural MRI findings were alterations in
the shape and volume of the corpus callosum, as well as smaller volume in the basal ganglia
and hippocampi. Resting-state functional MRT studies reported reduced functional
connectivity between cortical and deep grey matter structures.

40. DTI, a process that measures water diffusion in brain tissue, provides exquisitely sensitive
measures of white matter microstructure in vivo. A review of 23 DTI studies conducted on
children, adolescents, and adults with PAE215 found nearly universal diffusion abnormalities,

2)0
Lebel, C.. Mattson. S.N.. Riley, ER, Jones. K.L.. Adnams. C.M., May, PA. ,etal. (2012). A longitudinal study of the long-
term consequences of drinking during pregnancy. heavy in utero alcohol exposure disrupts the normal processes of brain
development. Journal ofNeuroscience, 32(44). 15243—51.
2)1
Treit, S., Zhou, D., Lebel, C., Rasmussen, C., Andrew, G., & Beaulieu, C. (2014). Longitudinal MRI reveals impaired cortical
thinning in children and adolescents prenatally exposed to alcohol. Human Brain Mapping, 35(9), 4892=4903.
2)2
Treit. S., Lebel. C.. Baugh, L.. Rasmussen, C., Andre’. G., & Beaulieu. C. (2013). Longitudinal N’IRI reveals altered
trajectory of brain development during childhood and adolescence in fetal alcohol spectrum disorders. Journal ofNeuroscience,
33(24), 10098—10109.
2)3
Gautam, P., Lebel, C., Narr, K. L., Mattson, S. N., May, P. A., Adnanis, C. M., Riley, E. P., Jones, K. L., Kan, E. C., &
Sowell, E. R. (2015). Volume changes and brain-behavior relationships in white matter and subcortical gray matter in children
with prenatal alcohol exposure. Human Brain Mapping, 36, 2318-2329.
2)4
Donald, K. A., Eastman, E., Howells, F. M., Adnams, C., Riley, E. P., Woods, R. P., Narr, K. L., & Stein, D. J. (2015).
Neuroimaging effects of prenatal alcohol exposure on the developing human brain: A magnetic resonance imaging review. Ada
Neuropsychiatrica, 27(5,), 251-269.
2)5
Sherbaf, F. 0., Aarabi, M. H., Yazdi, M. H., & Haghshomar, M. (2018). White matter microstructure in fetal alcohol spectrum
disorders: A systematic review of diffusion tensor imaging studies. Human Brain Mapping, 40(3), 1017-1036.

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 with no brain regions spared. Such findings indicate delayed maturation of axonal tracts over
the course of brain development, mostly through disruptions in the myelination process.
Specifically, there was convergent evidence of impaired integrity in communication
networks throughout the brain: (a) association fibers (axons connecting cortical areas within
the same cerebral hemisphere), (b) projection fibers (white matter tracts connecting the
cortex with deeper brain regions), and (c) callosal tracts (fibers connecting the right and left
cerebral hemispheres). In other words, there was impaired white matter integrity in
communication tracts throughout the brain throughout development. Moreover, in studies
that also investigated brain-behavior links, abnormalities in white matter pathways important
in self-regulation (e.g., corpus callosum, cerebellar peduncles, cingulum, and longitudinal
fasciculi connecting frontal and temporoparietal regions) were consistently associated with
extent of alcohol exposure and severity of cognitive/behavioral symptoms.

41. In summary, given that the normally-developing “adolescent brain” does not have
mature executive control capacity until at least age 25 and brain development in young
adults with FASD lags many years behind rates seen in neurotypical age peers, it is
likely Mr. Floyd’s brain was not fully developed at the time of the offense due to his
ND-PAE/FASD, which would have had an additive and cumulative effect on the brain
damage he was born with.

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

Dated: February 24, 2021

Natalie Novick Brown, PhD

Clinical and Forensic Psychologist

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 Appendix A
Resume

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 Natalie Novick Brown, PhD, SOTP
Northwest Forensic Associates, LLC
Mailing Address: 31811 Pacific Hwy South, B-341
Federal Way, WA 98003
Phone: (425) 275-1238
[email protected]

Curriculum Vitae

Licensed Psychologist (Washington State: #PY1965)

Certified Psychologist (CPQ #3258), Association of State & Provincial Psychology Boards
Certified Sex Offense Treatment Provider (Washington State SOTP #FC112)
National Register of Health Service Providers in Psychology, #49892
Certified Psychologist/Evaluator for Department of Corrections, Division of Developmental
Disabilities, Department of Social & Health Services (Washington State)
Certified Parenting Evaluator, University of Washington Department of Psychiatry and Behavioral
Sciences

EDUCATION

1995 - 1996 Post-Doctoral Internship in Sex Offender Evaluation/Treatment

Supervisor: Stuart Brown, EdD, SOTP

1994 - 1995 Post-Doctoral Fellowship in FASD

Fetal Alcohol and Drug Unit, Department of Psychiatry and Behavioral Sciences,
School of Medicine, University of Washington
Supervisor: Ann Streissguth, PhD

1993 - 1994 Forensic Internship in Parenting Evaluation

Parenting Evaluation Training Program, Department of Psychology, University of
Washington

1989 - 1994 Ph.D. in Clinical Psychology

University of Washington, Seattle, WA
Dissertation: Relation Between Psychological Correlates of Alcoholism Risk and
Stress-Response Dampening Across the Blood Alcohol Curve

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1978 - 1979 M.H.A. in Health Care Administration
University of Washington, Seattle, WA

1974 - 1975 M.L.S. in Library and Information Sciences

University of Washington, Seattle, WA

1964 - 1968 B.A. in Sociology/Psychology

University of California at Los Angeles (UCLA), Los Angeles, CA

ACADEMIC APPOINTMENTS

2005 – present Clinical Assistant Professor (courtesy faculty), Department of Psychiatry

and Behavioral Medicine, School of Medicine, University of Washington,
Seattle

1995 – 2005 Clinical Instructor (courtesy faculty), Department of Psychiatry and

Behavioral Medicine, School of Medicine, University of Washington, Seattle

1993 – 1995 Teaching Assistant, Department of Psychology, University of Washington,

Seattle

CLINICAL EXPERIENCE

1996 – present Clinical and Forensic Psychologist

Professional consultation/evaluation and related testimony in criminal and
civil matters, including adult/juvenile sex offense/risk assessment evaluation
(e.g., civil commitment under Sexually Violent Predator laws); adult,
adolescent, and child psychological evaluation (general psychological
assessment, competency, dependency, FASD, neurodevelopmental
disabilities (e.g., autism spectrum disorder, ADHD, learning disabilities),
child abuse/neglect); post-conviction/commitment treatment planning;
parenting evaluation; and independent medical examination (IME)
Psychological assessment of recidivists referred by King County Mental
Health and Drug Courts
Seattle Police Department: victim assessment and consultation regarding
neurodevelopmental impairment

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 Special Commitment Center (WA): community-based therapy for released
Sexually Violent Predators
Group therapy (1996-2000)/individual therapy (1996-present)
Supervision of doctoral students and psychologists obtaining SOTP
certification

1994 - 1995 Postdoctoral Fellowship / Faculty Appointment (1994-2000), Fetal

Alcohol and Drug Unit (Dr. Ann Streissguth), University of Washington
Training and research in FASD and other neurodevelopmental disorders,
maternal alcohol use assessment, and lifelong adaptive assessment/secondary
disabilities. Courtesy appointment as Clinical Instructor.

1992 - 1994 Pre-doctoral Internships (University of Washington)

(1) Psychotherapy
(3) Pain Management - assessment/treatment
(4) Traumatic Brain Injury Rehabilitation – assessment

PRE-DOCTORAL WORK EXPERIENCE

1987-89 CEO/Board of Directors

Columbia Hospital / Omni Substance Abuse Treatment Clinic

1981-87 CEO
Toppenish Hospital, Washington

1979-81 Assistant CEO / CEO

Virginia Mason Medical Center / McLeary Hospital
Seattle, Washington

1977-79 Medical Librarian

Providence Medical Center, Seattle, Washington

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RESEARCH

2005 – present Forensic Consultant (courtesy staff)

Fetal Alcohol and Drug Abuse Unit, Department of Psychiatry and
Behavioral Medicine, University of Washington, Seattle, Washington
Research on suggestibility and FASD prevention/treatment under Parent
Child Assistance Program (PCAP)

1994 - 1995 Postdoctoral Fellow

Fetal Alcohol Unit, University of Washington
Research on FASD in Washington State prisons

1991 - 1994 Research Coordinator

Department of Psychology, University of Washington, Seattle, Washington
Subject: Prediction of High-Risk Drinking in Young Adults

1990 – 1992 Research Coordinator

Department of Psychology, University of Washington, Seattle, Washington
Subject: Effects of Alcohol on Social Influence

1989 - 1991 Research Coordinator

Department of Psychology, University of Washington, Seattle, Washington
Subject: Factors Affecting Self-Esteem in Young Adults

PEER REVIEW

Journal of Mental Health and Clinical Psychology

Sciaccess Publishers

Epigenetics
Taylor & Francis

Criminal Behaviour and Mental Health

Wiley Online

International Journal of Law and Psychiatry

International Academy of Law and Mental Health, Harvard University

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Addiction
Society for the Study of Addiction

PUBLICATIONS

Novick Brown, N. (in process). Fetal alcohol spectrum disorders (FASD): A guide for forensic
mental health assessment. New York: Springer.

Novick Brown, N. (in press). Fetal alcohol spectrum disorders (FASD) and risk of violence. In J.M.
Fabian (Ed.), Violence risk in criminal offender populations. Oxford, UK: Wiley.
Novick Brown, N. (2019). Fetal alcohol spectrum disorders (FASD): Intellectual disability
equivalence. In G. Becker, K. Hennicke, & M. Klein (Eds.), Adults with fetal alcohol spectrum
disorders: Diagnosis, screening, intervention, and addiction prevention. Vol. 2. Berlin, Germany: De
Gruyter Publisher.

Novick Brown, N. (2019). Effective sustainable treatment approaches for individuals with fetal
alcohol spectrum disorders: What is the evidence? Seattle: Alcohol & Drug Abuse Institute,
University of Washington, 8p.

Grant, T.M., Graham, J.C., Carlini, B.H., Ernst, C.C., & Novick Brown, N. (2018). Use of marijuana
and other substances among pregnant and parenting women with substance use disorders: Changes
in Washington State after marijuana legalization. Journal of Studies on Alcohol and Drugs, 79, 79-
87.

Brown, J.M., Haun, J., Zapf, P.A., & Novick Brown, N. (2017). Fetal alcohol spectrum disorder
(FASD) and competency to stand trial (CST): Suggestions for a ‘best practices’ approach to forensic
evaluation. International Journal of Law and Psychiatry, 52, 19-27.

Brown, J., Haun, J., Novick Brown, N., & Zapf, P.A. (2016). The deleterious effects of fetal alcohol
spectrum disorder on competency to stand trial. The Journal of Special Populations, 1, 1-7.

Greenspan, S., Novick Brown, N., & Edwards, W. (2016). FASD and the concept of “intellectual
disability equivalence.” In M. Nelson & M. Trussler (Eds.), Law and ethics in fetal alcohol spectrum
disorder. Amsterdam: Springer.

Grant, T.M., Novick Brown, N., & Dubovsky, D. (2015). Screening for Fetal Alcohol Spectrum
Disorders: A critical step toward improving treatment success. In: G. Becker, K. Hennicke, & M.
Klein (Eds), Addicted adults with fetal alcohol spectrum disorders: Diagnosis, screening, and
intervention. Berlin, Germany: De Gruyter Publisher.

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Novick Brown, N., Burd, L., Grant, T. M., Edwards, W., Adler, R., & Streissguth, A. (2015).
Prenatal alcohol exposure: An assessment strategy for the legal context. International Journal of
Law and Mental Health, 42-43, 144-148.

Novick Brown, N., & Connor, P.D. (2014). Executive dysfunction and learning in children with fetal
alcohol spectrum disorders (FASD). Cognitive Sciences, 8, 47-105.

Novick Brown, N., & Connor, P.D. (2014). Impact of executive functioning on learning in fetal
alcohol spectrum disorders (FASD). In: Bennett, K.P. (Ed.), Executive functioning: Role in early
learning processes, impairments in neurological disorders and impact of cognitive behavior therapy
(CBT). Hauppauge, NY: Nova.

Grant, T., Graham, J.C., Ernst, C.C., Peavy, K.M., & Novick Brown, N. (2014). Improving
pregnancy outcomes among high-risk mothers who abuse alcohol and drugs: Factors associated with
subsequent exposed births. Children and Youth Services Review, 46, 11-18.

Novick Brown, N., Clarren, S., & Grant, T. (Winter 2014). Fetal alcohol spectrum disorders: What
judges and other legal professionals need to know. Judges’ Page, Court Appointed Special
Advocates.

Rich, S.D., & Novick Brown, N. (2014). A case for a diagnostic code for neurodevelopmental
disorder associated with prenatal alcohol exposure: A child/adolescent psychiatrist and forensic
psychologist speak out. Psychiatric News,
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1792237.

Grant, T.M., Novick Brown, N., Graham, J.C., & Ernst, C.C. (2013). The value of the
neuropsychological assessment for adults with fetal alcohol spectrum disorders: A case study.
International Journal of Alcohol and Drug Research, 2, 79-86.

Novick Brown, N., & Rich, S.D. (Winter 2013). A neurodevelopmental paradigm for fetal alcohol
spectrum disorder. Judges’ Page, Court Appointed Special Advocates.

Grant, T.M., Novick Brown, N., Graham, J.C., & Ernst, C.E. (2013). Substance abuse treatment
outcomes in women with fetal alcohol spectrum disorder. International Journal of Alcohol and Drug
Research, http://ijadr.org/index.php/ijadr/article/view/112/213.

Novick Brown, N., Wartnik, A., & Rich, S.D. (2013). Diagnosing FASD in the era of DSM-5: Good
news for the forensic context. Fetal Alcohol Forum, 10, 34-37.

Grant, T.M., Novick Brown, N., Dubovsky, D., Sparrow, J., & Ries, R. (i2013). The impact of
prenatal alcohol exposure on addiction treatment. Journal of Addiction Medicine, 7, 87-95.

CV: Natalie Novick Brown, Ph.D.

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Grant, T.M., Novick Brown, N., Graham, J.C., Whitney, N., Dubovsky, D., & Nelson, L.A. (2013).
Screening in treatment programs for Fetal Alcohol Spectrum Disorders that could affect therapeutic
progress. International Journal of Alcohol and Drug Research, 2, 37-49.

Novick Brown, N., Connor, P.D., & Adler, R. (2012). Conduct-disordered adolescents with fetal
alcohol spectrum disorder: Intervention in secure treatment settings. Criminal Justice and Behavior,
39, 789-812.

Novick Brown, N., O’Malley, K., & Streissguth, A.P. (2012). FASD: Diagnostic dilemmas and
challenges for a modern transgenerational management approach. In S. Adubato & D. Cohen (Eds.),
Prenatal Alcohol Use and Fetal Alcohol Spectrum Disorders: Diagnosis, Assessment, and New
Directions in Research and Multimodal Treatment. Bentham Online Publishing.

Novick Brown, N., Gudjonsson, G., & Connor, P. (2011). Suggestibility and Fetal Alcohol Spectrum
Disorders (FASD): I’ll tell you anything you want to hear. Journal of Psychiatry and Law, 39, 39-
71.

Novick Brown, N. (Spring 2011). Evidence-based interventions in children with Fetal Alcohol
Spectrum Disorders. Paradigm, 16, 12-17.

Novick Brown, N., Wartnik, A.P., Connor, P.D., & Adler, R.S. (2010). A proposed model standard
for forensic assessment of FASD. Journal of Psychiatry and Law, 38, 383-418.

Novick Brown, N. (June 2008). FASD Experts: Multidisciplinary forensic assessment for a
multidimensional condition. Iceberg, 18.

Novick Brown, N. (2007). ADHD and FASD: Comorbidity and its effect on sexual behavior
problems. In K O’Malley (Ed.), ADHD and FASD: Diagnosis, natural history, and therapeutic
issues across the lifespan. Hauppauge, NY: Nova Pub.

Novick (Brown), N. (1998). FAS: Preventing and treating sexual deviancy. In A.P. Streissguth & J.
Kanter (Eds.), The challenge of fetal alcohol syndrome: Overcoming secondary disabilities. Seattle:
University of Washington Press.

Novick (Brown), N.J. (1996). Sexual victimization and inappropriate sexual behavior in children:
Recommendations for evaluation and treatment. Proceedings of 1996 International Conference on
Fetal Alcohol Syndrome, Seattle, Washington.

Novick (Brown), N.J., & Streissguth, A.P. (1995). Identifying clients with possible fetal alcohol
syndrome: Fetal alcohol effects in the treatment setting. Treatment Today, 7(3), 14-15.

Novick (Brown), NJ, & Streissguth, AP (1995). Some thoughts on the treatment of adults and
adolescents impaired by fetal alcohol exposure. Treatment Today, 7(4), 20-21.

CV: Natalie Novick Brown, Ph.D.

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Novick (Brown), N.J., Cauce, A.M., & Grove, K. (1994). Competence self-concept. In B.A.
Bracken (Ed.), Handbook of self-concept. New York: Wiley.

Novick (Brown), N.J., & Brown, J.D. (1992). The influence of self-esteem on response to mood.
Paper presented, 100th Annual Convention of the American Psychological Association, Washington,
D.C., August, 1992.

Brown, J.D., Novick (Brown), N.J., Lord, K.A., & Richards, J.M. (1992). When Gulliver travels:
Social context, psychological relatedness, and self-appraisals. Journal of Personality and Social
Psychology, 62, 717-727.

Norris, J, Novick (Brown), N.J., & Kerr, K.L. (1992). Alcohol and violent pornography: Impact of
social influence on sexual arousal. Poster presented at the Research Society on Alcoholism
Meeting, San Diego, California, June, 1992.

Brown, J.D., & Novick (Brown), N. (1991). Social context, psychological relatedness, and self-
appraisals. Paper presented at the 99th Annual Convention of the American Psychological
Association, San Francisco.

INVITED PRESENTATIONS, WORKSHOPS, TRAININGS

10/19/19 Identifying Adaptive Function Deficits in Transitional-Age Youth with ND-PAE –

American Academy of Child and Adolescent Psychiatry (AACAP), Chicago, ILL

09/12/19 FASD in the Juvenile and Criminal Justice Systems – Washington State House of
Representatives Public Safety Committee, Olympia, WA

09/06/19 FASD Practicalities: Screening & Treatment – ABA FASD Resolution Summit,
Lewis & Clark Law School, Portland, OR

07/24/19 Developmental Disability and Sexual Offending: Brain Maturation – International

Congress on Law and Mental Health (IALMH). Rome, Italy

07/23/19 Investigating ID-Equivalence in People with FASD: Tips from a Forensic

Psychologist – International Congress on Law and Mental Health (IALMH). Rome,
Italy

03/13/19 Plenary: FASD - Screening and Assessment. Sixteenth Annual National Seminar on
the Development and Integration of Mitigation Evidence in Capital Cases.
Philadelphia, PA

09/20/18 FASD: Screening and Assessment. Law Office of the Public Defender. Albuquerque,

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 NM

05/11/17 FASD in the Capital Context. Capital Habeas Seminar, Chattanooga, TN

06/03/16 Fetal Alcohol Spectrum Disorders in the Parenting Context. 53rd Annual Conference,
Association of Family and Conciliatory Courts. Seattle, WA

05/18/16 FASD and Sexual Offending in Indian Country. Webinar, Health and Human
Services

04/29/16 Confabulation, Malingering, Memory, and Suggestibility: Clinical and Forensic

Considerations. American Institute for the Advancement of Forensic Studies, St.
Paul, MN

09/11/15 FASD: Identification, Assessment, and Treatment. Co-presented with Therese Grant
and Paul Connor. Western State Hospital, Tacoma, WA.

08/20/15 FASD and Sexually Inappropriate Behavior. FASD Train-the-Trainer Workshop for
Casey Family Programs, Indian Child Welfare, University of Washington, Seattle,
WA.

07/13/15 (1) One Size Does Not Fit All: Forensic Assessment of Sex Offenders with FASD.
XXXIV International Conference on Law and Mental Health, Vienna, Austria (2)
FASD in the Courtroom: FASDExperts Approaches Its Eighth Year (3) Panel: The
Central Role of Neuropsychology in Forensic FASD Assessment (4) Panel: Forensic
Assessment of FASD: The Impact of Suggestibility. XXXIV International
Conference on Law and Mental Health, International Academy of Law and Mental
Health, Vienna, Austria.

06/25/15 (1) Plenary: Identifying Fetal Alcohol Syndrome (2) Panel: Fetal Alcohol Syndrome:
Experts and Presentation at Evidentiary Hearing. Capital Habeas Unit (CHU)
National Conference, Denver, CO.

05/29/15 FASD: What You Should Know. Court Improvement Training Academy (CITA),
University of Washington Law School, Suquamish Nation, Poulsbo, WA.

10/23/14 Insights from Poverty to Death Row: ND-PAE Diagnosis and DSM-5. American
Academy of Child and Adolescent Psychiatry Annual Meeting, San Diego, CA.

05/23/14 Plenary: Forensic Assessment of FASD - Update on Diagnosis and Latest Research.
FASD and the Law Conference, Woodbury, MN

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05/14/14 FASD: Diagnosis and Intervention. Washington State Developmental Disabilities
Administration, Seattle, WA

04/29/14 Sex Is Not a Four-Letter Word: FASD and Sexuality. Living With FASD: 2014
Summit Conference (international webinar)

02/05/14 FASD: Dawn of a New Era in Diagnosis. Minnesota Organization on FAS

(MOFAS), MN (webinar)

11/26/13 Fetal Alcohol Spectrum Disorder. Washington State Developmental Disabilities

Administration, Kent, WA

10/16/13 Neurodevelopmental Disorders in the DSM-5. Skype workshop for Pathways

Counseling Center, St. Paul, MN

09/27/13 FASD: Back (and to) the Future: 1973 – 2013. 40th Anniversary Professional
Summit, New Jersey Task Force on FASD, Atlantic City, NJ

09/25/13 FASD: Practical Supports for the Legal Context. 2013 FASD Summit, The Arc of
Arkansas, Little Rock, AR

08/28/13 Developmentally Delayed Offenders in the Criminal Justice System. Frontier

Regional FASD Training Center, Missoula, MT

08/22/13 Developmentally Delayed Offenders in the Criminal Justice System. Frontier

Regional FASD Training Center, Fargo, ND

08/04/13 FASD: Moving Beyond Prevention to Practical Supports. The Arc: 2013 National
Convention. Bellevue, WA

07/26/13 Developmentally Delayed Offenders in the Criminal Justice System. Frontier

Regional FASD Training Center, Boise, ID

07/15/13 FASD and Criminal Justice: Cognitive and Social Deficits Associated With FASD.
33rd International Congress on Law and Mental Health, Amsterdam, Netherlands.

06/25/13 Developmentally Delayed Offenders in the Criminal Justice System. Frontier

Regional FASD Training Center. Cheyenne, WY

06/25/13 Developmentally Delayed Offenders in the Criminal Justice System. Frontier

Regional FASD Training Center, Cheyenne, WY

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05/03/13 Understanding and Treating Developmentally Delayed Sex Offenders. American
Institute for the Advancement of Forensic Studies; St. Paul, MN

04/06/13 Seeking the Standard of Care in Custody Assessments in WA State. AFCC-WA

Spring Conference; Seattle, WA

09/06/12 Understanding the Link Between FASD and Sexual Offending. Indian Health
Service; Seattle, WA

07/20/12 Forensic Assessment of Developmental Disabilities. American Institute for the

Advancement of Forensic Studies; St. Paul, MN

07/13/12 FASD and Competency. WI Association of Criminal Defense Lawyers; Stevens

Point, WI

04/19/12 Changing Public Policy in the Juvenile Courts: What Works? Fifth National Biennial
Conference on Adolescents and Adults with FASD: It’s a Matter of Justice,
Vancouver, BC, Canada

03/29/12 Fetal Alcohol Spectrum Disorders. Death Penalty Institute, Lexington, KY

02/03/12 Alcohol Related Birth Disorders and the Law. Mid-year ABA Conference,
Interagency Coordinating Committee on FASD in Collaboration with U.S. Dept. of
Justice and Minnesota Organization on FAS, New Orleans, LA

02/02/12 FASD and Neurobehavioral Issues in the Criminal Justice System. Capital Defense
Project of SE Louisiana, New Orleans, LA

11/18/11 Assessing and Understanding Fetal Alcohol Spectrum Disorders in Capital Clients.
Virginia Bar Assoc., 19th Annual Capital Defense Workshop, Richmond, VA

10/07/11 FASD and the Criminal Justice System. Seattle City Attorney’s Office and
University of Washington, Seattle, WA

09/21/11 FASD: Preventing and Treating Sexual Deviancy. Indian Health Service FASD
Training, Seattle, WA

07/09/11 FASD and Competency. Capital Mitigation – Beyond Atkins, Center for American
and International Law; Houston, TX

06/23/11 FASD in the Courtroom. Ninth Annual Statewide Conference, Arizona Public
Defenders Association; Tempe, AZ

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05/20/11 FASD and Intellectual Disability/Mental Retardation. Metropolitan Public Defender,
Oregon Capital Resource Center, Oregon Criminal Defense Lawyers Association;
Portland, OR

03/11/11 Forensic Aspects of Fetal Alcohol Spectrum Disorders. Sponsored by Pathways

Counseling Center, MOFAS, Minnesota DOC, MN Community Corrections
Association, & American Institute for the Advancement of Forensic Studies; St. Paul,
MN

10/27/10 FASD: Its Relevance Throughout the Legal Process from Competency to Stand Trial
to Clemency. 2010 Appellate Judicial Attorneys Institute, Burlingame, CA

10/02/10 Forensic Assessment of FASD in the Habeas Context. Federal Defenders Annual
Death Penalty Conference, Boise, ID

07/16/10 Team Approach to Litigating FASD (plenary). Center for American and International
Law, Plano, TX

07/10/10 Fetal Alcohol Spectrum Disorder in the Courtroom: The 20th Anniversary of Dr. Ann
Streissguth (plenary + break-out). NAACP LDF, Airlie, VA

04/22/10 Forensic Assessment of FASD with State-of-the-Art Facial Analysis, Diffusion

Tensor Imaging and MRIs. 7th National Seminar on the Development and Integration
of Mitigation Evidence (plenary). American Bar Association, Seattle, WA

04/17/10 Suggestibility in FASD: Forensic Assessment and Implications. 4th International

Conference on Fetal Alcohol Spectrum Disorder, Vancouver, BC, Canada

03/31/10 Fetal Alcohol Spectrum Disorder and Justice. Alcohol Healthwatch, Parnell, New
Zealand. (Abbreviated presentations also provided on 4-1-10 to New Zealand
Ministry of Health and Ministry of Justice.)

02/25/10 Fetal Alcohol Spectrum Disorder (FASD). Texas Criminal Defense Lawyers
Association, Austin, TX

02/12/10 FASD and Justice: A Multidisciplinary Assessment Model for Adults and
Adolescents. CACJ/CPDA Capital Defense Seminar, Monterey, CA.

02/06/10 Fetal Alcohol Syndrome: Practical Tools. 3rd Interdisciplinary Program: UW School
of Law & Washington Death Penalty Assistance Center, Seattle, WA.

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03/11/09 FASD in the Legal System: A Multidisciplinary Assessment Model for Adults and
Adolescents. 3rd International Conference on Fetal Alcohol Spectrum Disorder,
Victoria, BC.

11/18/08 Screening for FASD in Family Practice. Family Practitioners, University of

Washington/Swedish Hospital, Family Practice Medical Residents In-service.

10/25/08 Cross-Examination of Adverse Expert Witnesses in SVP Commitment Trials. Sex

Offender Commitment Defense Association (SOCDA), Atlanta, GA

05/30/08 Fetal Alcohol Syndrome and Fetal Alcohol Effect: Identifying Clients and
Understanding Consequences. Fifth National Seminar on the Development and
Integration of Mitigation Evidence, Habeas Assistance & Training Counsel Project,
Baltimore, MD

11/03/07 Direct and Cross Examination of Experts in SVP Cases. Sex Offender Commitment
Defense Association (SOCDA), San Diego, CA

08/18/07 Fetal Alcohol Syndrome / Fetal Alcohol Effects. 12th Annual Federal Habeas Corpus
Seminar, Nashville, TN

05/23/07 Fetal Alcohol Spectrum Disorders: History, Diagnosis, and Mitigation Issues. Capital
Federal Public Defender Unit (capital habeas and trial attorneys, Federal District of
Nevada)

04/14/07 What Attorneys and Policy Makers Need to Know About FAS and FASD. American
Bar Association/Harvard Law School National Conference on Children and the Law,
Cambridge, MA

02/18/07 Fetal Alcohol Spectrum Disorders (FASD). California Attorneys for Criminal
Justice/California Public Defender Association (CACJ/CPDA) Annual Death Penalty
Conference, Monterey, CA

06/30/06 Sexually Violent Predator Evaluation, Risk Assessment, and Testimony, Florida
Public Defenders Sexually Violent Predator Conference, Orlando, FL

04/19/06 Screening Protocol for Fetal Alcohol Spectrum Disorders (FASD). King County
Mental Health / Drug Courts, Seattle, WA

02/26/05 FASD: Problems of Witness Suggestibility and False Confessions. International

FASD Conference, Victoria, British Columbia, Canada

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PROFESSIONAL ORGANIZATIONS
1990 – present American Psychological Association (APA)
2008 – present American Society-Law Society (APA)
2015 – present International Association of Law and Mental Health (IALMH)
2005 – present Association for the Treatment of Sex Abusers (ATSA)
2004 – 2017 Association of Family & Conciliatory Courts (AFCC – National) (WA-
AFCC - Washington State; Board of Directors, Treasurer; Chair: Quality
Assurance and Ethics Committee)
2011 – 2017 Midwest Alliance on Shaken Baby Syndrome, Board of Directors
2001 – 2003 Jacksonville Youth Authority Advisory Board
1996 – 2000 Chairman, Social Issues Committee, Washington State Psychological
Association
1994 – 2000 Washington State Psychological Association, Board of Directors

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 Declaration of Col. Robert Salasko

I, Col. Robert Salasko, hereby declare as follows:

1. My name is Robert Salasko. I am 52 years old and live in Monument, Colorado. I am

a retired United States Marine Corps (USMC) Colonel.

2. I served at Guantanamo Bay, Cuba (Gitmo) from 1994 to 1996. At the time, my rank
was Captain. Zane Floyd was stationed at Gitmo from February 1995 to February 1996
and under my command.

3. I recognize Floyd from photographs shown to me, although I do not have a personal
recollection of him now. In August 1995, I issued an outstanding service certificate to
Private First-Class Floyd for completing water survival training.

4. There was a decided lack of popular knowledge, even in the USMC, regarding the
difficulty of the Guantanamo Bay (Gitmo) environment between 1994 and 1996. I have
served in the USMC for over 30 years and worldwide to include a combat tour in Iraq,
and I would describe Gitmo as intense and stressful, not an easy tour, and something
you lived 24 hours a day while there.

5. The level of conditioning and readiness at Gitmo was like those hostile combat
assignments in places like Iraq and Afghanistan. For example, the Cubans and the
American troops fired at one another; there were perimeter breaches, and there were
riots in the refugee camps. Anything could happen at any moment, so we were not
allowed to let down our guard.

6. Marines there had multiple missions including patrolling the fence line separating the
Cuban zone from the American zone and serving as a contingency force in the event of
refugee riots. Essentially, Marines worked a two-week cycle: a week of patrolling,
keeping on eye on the Cuban Frontier Brigade (our opposing force), and then one week
of barracks time where you would train, clean weapons, and serve as a contingency
force. Marines went on roving patrols as well as worked the guard towers using night
vision goggles and thermal sites to surveil. Marines routinely went on patrols with live
ammunition in their M-16s. Hence, Gitmo was an operational environment as opposed
to a training environment.

7. When the Marine were not patrolling, they lived in hardstand four story buildings, like
those on a Marine Corps base. When they were on patrol, they lived in tents close to
the fence line.

8. There were up to 40,000 refugees at Gitmo, made up of Cubans and Haitians. This
compared to the 500 Marines who were based on both sides of the island and 400 to
500 Navy troops stationed at Gitmo. We were very much outnumbered.

152
9. I did not differentiate between the Haitian and Cuban refugees other than to say that
the Cuban refugees tended to be more aggressive.

10. Our primary interaction with refugees was in riot suppression. When refugees would
riot and head toward the “critical infrastructure areas” of the Navy base, my Marines,
if called, would take up a blocking position: weapons on safe but fixed bayonets so as
to project a show of strength to deter the refugees from going towards the American
base. In one instance, a Marine bayoneted a refugee. There were a few times when
refugees attempted to grab Marine weapons.

11. Occasionally Cubans would attempt to swim across Gitmo Bay to the American side.
In one instance, a swimming Cuban family was literally harpooned and brought into a
Cuban patrol boat where they were beaten.

12. The American minefield at Gitmo was well-marked. The American minefield consisted
of anti-tank mines designed to stop Russian made tanks. Thus, if a person stepped on a
mine, they would meet a certain death.

13. The Cuban minefield was not well-marked, and I estimate that initially 300,000 mines
were placed in the aftermath of the Bay of Pigs Invasion. The Cuban mines were anti
personnel such that they would commonly maim as opposed to kill. Once the first
victim had detonated a mine, his colleagues who came to rescue him would also
encounter mines possibly inflicting further casualties. Despite warnings not to do so,
several of my more bravado Marines entered the Cuban minefield resulting in a
detonation causing the loss of a Marine’s leg from the knee down.

14. It was not uncommon to hear detonations as Cuban asylum seekers detonated anti
personnel mines on the Cuban side. I recall one incident where a Cuban, who had lost
his leg because of a detonation, was crawling towards the American fence line. The
Americans felt powerless to assist him in the Cuban area. Eventually the Americans
cut a hole in the fence and went out and got the Cuban and brought him to the American
side. Marines witnessed events like this and the aforementioned harpooning.
Similarly, Marines were aware that asylum seekers would frequently be shot by Cubans
attempting to get to the base.

15. There were PTSD issues among the troops at GITMO. This led to alcoholism, suicides,
and depression.

16. There was no extra screening for mental health issues before troops were assigned to
Gitmo. At the time, the military was in desperate need of bodies, so there was a bit of
a rush to get troops on the ground.

17. There were no substantial mental health resources in Gitmo other than a base Chaplain,

153
 and some counselors flown in on occasion following suicides.

18. Marines with emotional or psychological struggles were not provided with reentry-to-
civilian-life resources when they returned home from Gitmo. And those who reenlisted
were often sent off to their next assignment without providing them a chance to
decompress or process the traumatic experiences they endured at Gitmo. The military
is much more aware and proactive now about addressing those matters then they were
back then.

19. When a Marine’s one-year tour of duty at Gitmo was complete, I would compose a
“Letter to Gaining Command.” This letter would introduce the Marine to their new
commander. For those who served at Gitmo, like Floyd, I would write that the Marine
had served in a real-world screening and recognizant operations against the First Cuban
Frontier Brigade. I would also state that the Marine demonstrated astute proficiency
and meticulous attention to detail in the rules of engagement application and the
employment of deadly force. I would alert the new commander that the Marine
personally conducted over 120 live patrols against an adversarial force armed with
small arms and anti-personnel mines, and that he personally led over forty real world
patrols with fifty percent of his squad under one year of service. I also alerted the new
commander that the Marine was responsible for patrol preparation, patrol execution,
and the recommendation of future operations. I also wrote that added to that, my
Marines were in a pressured compound filled with 40,000 Haitian and Cuban refugees
who were seeking US asylum and had expertise in riot control.

I declare under penalty of perjury that the foregoing is true and correct and that
this declaration was executed on

Robert Salasko ol., USMC (Ret.

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 Declaration of Scott Rollenha2en

I, Scott Rollenhagen, hereby declare as follows:

1. My name is Scott Rollenhagen. I am 46 years old and live in Montague, Ivlichigan. I

am currently a stay-at-home dad.

2. I served as a Marine Infantryman at Naval Station Guantanamo Bay, Cuba (Gitmo)

from approximately February 1995 to February 1996. When I arrived at Gitmo my rank
was a Private First Class. I was later promoted to Lance Corporal.

3. I have been shown photographs of Zane Floyd when he was in the Marines and
recognize serving with him either at the School of Infantry (“SOT”) at Camp Pendleton,
California or at Gitmo. The images that I found on Google of Floyd from the time of
his arrest looked completely like someone else and were unrecognizable. Floyd and I
were roughly the same age and the same rank.

4. While at Gitmo our commanding officer was Captain Robert Salasko, USMC.

5. The Gitmo base was divided into the Leeward and Windward sides. I was stationed on
the Windward side.

6. During my time at Gitmo, most dependent families of Marine and Naval personnel had
been cleared out due to a riot that had occurred some months before my arrival.

7. At Gitmo, refugees made up of Cubans and Haitians were kept on a golf course and
later on the coastline. The refugees lived in tents. The refugee population ebbed and
flowed but I recall a population around 30,000. There were a lot more of the refugees
than there were of us Marines.

8. For an enlisted Marine like myself, a typical Gitmo tour was one year. It was a difficult
assignment. We did not receive riot training at SOT as riot control is not part of the
regular Marine infantry mission. Once we arrived at Gitmo, we were trained on how to
respond and handle riots on the island, and we kept our riot gear in our rooms. An ever-
present danger was the possibility that refugees could riot and overrun the base.
Another hardship of the assignment was the separation from family members. An
enlisted Marine was not permitted leave to see his family for his first six months at
Gitmo.

9. I was assigned to the security detail as part of the Rifle Security Company (“RSC”)
Windward during my first four months at Gitmo. My understanding is that this is the
same unit to which Zane was assigned. Our rotation was one week on border foot patrol
and one week on the base. We worked twelve-hour shifts at the fence line, and at night
would use night vision goggles to keep our eyes on the armed Cuban soldiers who were

155
 about 1000 yards away. At times you could hear the Cubans. While on patrol we carried
our M-16 rifles. When not patrolling, we would train in weapon and mortar firing. This
was a tough assignment. I witnessed and heard of many troubling events.

10. There was a Cuban mine field between our side and the Cuban side. The Cubans had
planted anti-personnel mines. There were weekly detonations on the Cuban side while
I was there.

11. I am aware that a Cuban family somehow made it past the Cuban mine field to the
American side, which was miraculous since the mine field was not marked.

12. I remember a situation where the Cuban forces used spotlights and detected a Cuban
asylum seeker swimmer in the Bay. The Cuban soldiers pulled the swimmer from the
water, took him to the shore, kicked and beat him. and then threw him in the back of a
truck and drove him away. During my tenure, the average Gitmo Marine would see
something like this at least once, but we were powerless to help these people who were
just seeking freedom.

13. There was a lot of drinking during our downtime at Gitmo mainly because there was
not a lot to do when one was not on patrol. Drinking took the edge off of the stress that
we experienced, and it was not uncommon for us to drink the entire weekend until
Monday rolled around. Looking back, it was not the healthiest pastime but there was
not much else to do to relieve the tension.

14. After four months at Gitmo, I was transferred from security and trained as a Fast Boat
operator and ferried Marines around the base. Driving boats during my last eight
months of my time there was fun, and it took me away from the stress and trauma of
patrolling the fence. This was by far my best experience at Gitmo. I had an opportunity
to meet and transport top military officials around the base and it was a much safer
detail. I felt sorry for my fellow Marines, like Floyd, who had no other options.

I declare under penalty of perjury that the foregoing is true and correct and that
this declaration was executed on January( 221 in Montague, Michigan.
,

%1 /1J/A

Scott Roflenhagen

156
10/17/2005 14:37 2057282425 BROWN OFFICES PAGE 02/24

DECLARATION OF NATALIE NOVICK BROWN, Ph.D.

I, Natalie Novick Brown, know and believe:

1, 1 practice as a psychologist and am licensed in Washington State and Florida. I also am a

certified Evaluator for the Department of Corrections and Division of Developmental Disabilities in
WaShington State.

2. I specialize in the evaluation and treatment of individuals with fetal alcohol impairment. My
training in this field began in 1994 when I accepted a postdoctoral fellowship with Dr. Arm
Streissguth at the University of Washington. Dr. Streissguth is a pioneer researcher in Fetal Alcohol
Syndrome (FAS) and Fetal Alcohol Effects (FAE), which are now referred to as "Fetal Alcohol
Spectrum Disorders," or FASD. Up until her retirement earlier this year, Dr. Streissguth was the
director of the University's Fetal Alcohol and Drug Unit as well as a prolific research scientist and
highly respected international expert in the FASD field. After completing a year of training and
research in 1995, I began evaluating and treating youth and adults with FASD or suspected FASD. I
estimate that since 1995,1 have evaluated and treated approximately 300 children and adults affected
by prenatal alcohol exposure. In addition, I currently hold a faculty position at the University of
Washington as Clinical Assistant Professor in the Fetal Alcohol and Drug Unit, Department of
Psychiatry and Behavioral Medicine. In this pOSition, I consult with staff at the Fetal Alcohol and
Drug Unit and screen for fetal alcohol impairment in adults and juveniles referred by the Drug and
Mental Health Courts in King County (Seattle), Washington. I also evaluate and diagnose individuals
referred by the Division of Developmental Disabilities who may have fetal alcohol impainnent. I
currently provide individual therapy to a caseload of fetal alcohol impaired YO\.Jth in an effort to
prevent adverse life outcomes and to a caseload of adults with FASD, many of whom are sex
offenders in Washington State's Commlll1ity Protection Program. Over th.e Jast 12 years, I have
published articles and lectured on the behavioral and developmental effects of prenatal alcohol
exposure. In the course of this work, I have attended diagnostic trainings and reviewed many
medical evaluations involving FASD diagnoses and am quite familiar with the diagnostic criteria and
process of evaluation. Thus, I have developed expertise in FASD through a combination of study,
practice, and research.

3. I was retained by the Las Vegas Federal Public Defender, Capital Habeas Unit, to examine
records related to Zane Floyd's case. 1 was asked specifically to detennine if he met criteria for an
FASD diagnosis, address how the condition might impact a child's functioning in general, and
explain how this disorder likely affected Zane Floyd's functionillg both as a child and as an adult.

4. { reviewed trial testimony from Tracie Carter, Robert Jay Hall, Zach Emenegger, Dr.
Mortillaro, Dr. Dougherty, Dr. Roitman, Jorge 1. Abreu, and Minoru Aoki. I also reviewed
Voluntary Statements from Zane Floyd and Paulina Atomah and the trial allocution of Zane Floyd.

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5. I reviewed summaries of medical interventions involving Valerie Floyd's consumption of

alcohol and her drug-related activities. I reviewed Zane Floyd's school records from Princess Ann
Elementary, Virginia Beach, Virginia; Boulder Bluff Elementary School, Goose Creek, Sooth
Carolina; Marrington Elementary, Charleston, South Carolina; Ellicott Elementary, Ellicott School
District, Calhan, Colorado; McClelland Center for Child Study, Pueblo, Colorado; Haaff School,
Pueblo, Colorado; various schools in the Clark County School District, Las Vegas, Nevada; Faith
Lutheran High School, Las Vegas, Nevada; and records from the Community College of Southern
Nevada. I reviewed military records from Zane Floyd's time in the Marines.

6. I reviewed evaluations conducted in 2000 along with the raw data from Frank E. Paul, Ph.D.;
David L. Schmidt, Ph.D.; and Edward J. Dougherty, Ed.D. I reviewed an evaluation and raw data
from tests conducted in 1989 by Maria J.P. Cardle, Ph.D. I reviewed reports published in 1999 and
2000 by Dr. Jacob O. Camp, M.D. I reviewed the 2000 report by Dr. Thomas F. Kinsora, Ph.D., who
critiqued Dr. Schmidt's and Dr. Cardle's reports. I reviewed Dr. Jonathan Mack's 2006 findings of
organic brain damage during his examination of Zane Floyd. I also reviewed schoolwork and over 50
photographs of Zane Floyd as an infant and young child.

7. FASD is a permanent birth defect caused by maternal consumption of alcohol during

pregnancy. Alcohol is a teratogen that inhibits and disrupts fetal development by causing structural
and functional damage to developing organs and systems, including the brain and central nervous
system. The damage starts at the cellular level, where ethanol may induce excessive cell death and
disrupt cell responses to molecules that regulate neuron proliferation, migration, and differentiation.
Because alcohol causes widespread damage throughout the fetus, there is a broad array of physical
anomalies and neurobehavioral defects. Hence, the condition is often referred to as a "s}11drome."
The most serious and pervasive damage occurs in the central nervous system (eNS). Brain imaging
studies over the last decade have shown that prenatal alcohol exposure causes significant
malformation in structures within the brain (e.g., corpus callosum, basal ganglia, cerebellum) that are
necessary for nonna! development and functioning (e.g., Bookstein et aI., 2001, 2002a, 2002b).

8. Fetal Alcohol Syndrome was first recognized and discussed in a public paper by researchers
at the University of Washington in 1973 (Jones & Smith, 1973). In addition to a detennination of
maternal alcohol consumption, these researchers identified three diagnostic features associated with
the syndrome: 1) pre- andlor postnatal growth deficiency, 2) a characteristic set of facial anomalies
(referred to as "facial dysmorphology"), and 3) eNS damage/dysfunction. Several years later, a study
of alcohol related damage in the central nervous system suggested that structural brain damage might
be the basis for many of the neurodevelopmental abnonnalities classified under the broader heading
of "eNS dysfunction" (Clarren & Smith, 1978).

9. By 1978, after more than 250 published case reports, it was clear that FAS was only one of
several identifiable disorders associated with maternal alcohol abuse. Hence, the term Fetal Alcohol
Effects, or FAE, was developed to classify additional manifestations (Clarren & Smith, 1978).
While individuals with FAE did not display all three of the primary facial abnonnalities associated

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with FAS (i.e., short palpebral fissures, flat philtrum, and thin upper lip), res~arch consistently
showed that compared to individuals diagnosed with FAS, those with FAE could suffer from as
many or more of the neurodevelopmental deficits (Streissguth & O'Malley, 2000). Thus, even
without facial evidence of FAS, the brain damage and resulting cognitive~behavioral problems can
be as severe in individuals with FAE as in those with f AS.

10. . Diagnostic labels applied to fetal alcohol impairment have changed over time to reflect
increasing diagnostic precision. For example, in 1996, there was refinement in the diagnosis by the
Institute of Medicine (10M) to include five categories of diagnosis: Type 1: FAS With Confinned
Maternal Alcohol Exposure; Type 2: FAS Without Confirmed Maternal Alcohol Exposure; Type 3:
Partial FAS With Confirmed Maternal Alcohol Exposure; Type 4: A1cohol~re1ated Birth Defects;
and Type 5: Alcohol-Related Neu:rodevelopmental Disorder. FAS Type 1 is the "classic" FAS
diagnosis and includes all four of the features typically associated with the syndrome: a) confilTIled
maternal alcohol exposure, b) characteristic facial abnonnalities or dysmorphology, c) pre- and/or
postnatal growth retardation, and d) evidence of central nervous system neurodevelopmental
abnonnalities. FAS Type 2 has all of these features except confinned maternal alcohol exposure.
FAS Type 3 is differentiated from .F AS Type 1 by virtue of the fact that only some of the facial
abnormalities are present, and in addition to confirmed prenatal alcohol exposure, the individual
manifests growth retardation, evidence of eNS neurodevelopmental abnonnalities, and a complex
pattern of behavioral or cognitive abnonnalities that are inconsistent with developmental level and
cannot be explained by familial background or environment alone (e.g., learning difficulties, deficits
in school perfonnance, poor impulse control, problems in social perception, language deficits, poor
capacity for abstraction, specific deficits in mathematical skills, and problems in memory, attention,
or judgment). FAS TyPe 4 (Alcohol-Related Birth Defects, or AR.8D) requires confirmed maternal
alcohol exposure and one or more congenital defects including malformations and dysplasias ofthe
heart, bone, kidney, vision, or hearing systems. FAS Type 5 requires confinued maternal alcohol
exposure, CNS neurodevelopmental abnonnalities, and/or a complex pattern of behavioral or
cognitive deficits.

11. The facial dysmorphology associated with F ASD is seen in only a minority of cases and, '
typically, only in young children before they enter puberty. Malformation of the face reflects alcohol
consumption during the first trimester of pregnancy when facial fearures are being fonned. However,
the brain and central nervous system are being fonned throughout the full nine months of pregnancy.
Thus, alcohol consumption at any point during gestation can cause brain damage.

12. FASD is diagnosed on Axis 3 by dysmorphologists, pediatricians, other medical doctors, and
psychologists - sometimes individually and sometimes as part of a multidisciplinary team. While
there is now increased specificity by researchers and governmental agencies regarding the various
manifestations ofF ASD, the same cannot be said for diagnosticians. Consequently, F ASD diagnoses
may be referred to as Fetal Alcohol Syndrome, Fetal Alcohol Effects, Partial FAS (PFAS), Alcohol-
Related Neurodevelopmental Disorder (ARND), Alcohol-Related Birth Defects (ARBD), Static
Encephalopathy, or by the umbrella tenn, Fetal Alcohol Spectrum Disorder (FASD). Although

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Streissguth and O'Malley (2000) recently proposed psychiatric nomenclature to broadly categorize
all manifestations of fetal alcohol impainnent under the nomenclarure "fetal alcohol spectrum
disorders," orFASD; and include the diagnosis as a mental health disorder in the Diagnostic and
Statistical Manual 0/Mental Disorders (DSM-IV), this change has not yet been made.

13. While the labels have become more precise and perhaps more confusing, the original
diagnostic criteria for FASD established in 1973 have changed very little over time, even after being
reconsidered by other groups such as the Fetal Alcohol Study Group of the Research Society on
Alcoholism (1980s), the Institute of Medicine (1990s), and the Center for Disease Control (2000).
Thus, by the time of Zane Floyd's trial in 2000, which was five years after I completed my FASD
postdoctoral fellowship, the syndrome was defmitely not a new or novel concept to medicine or
psychology.

14. Research has shown that prenatal alcohol exposure causes structural brain damage that aff~cts
functioning in the frontal lobe of the brain, particularly the prefrontal cortex, an area that is especially
sensitive to the teratogenic effects of ethanol (e.g., Bookstein et al., 2002). Brain imaging research
has found that prenatal alcohol exposure seems to target the corpus collosum in particular and is
Bssociated with a pattern of deficits in executive functioning in individuals diagnosed with FASIFAE
(Bookstein et aI., 2001). Executive functions, which control impulses and channel them into pro-
social rather than antisocial behavior, involve cognitive skills such as perception, social awareness,
organization, planning, internal ordering, working memory, self¥monitoring, inhibition, motor
control, regulation of emotion, and motivation, Appropriate socialization depends on intact basic
cognitive functioning (Connor et aI., 2000). When executive functions are compromised by prenatal
alcohol exposure or other sources of brain damage, an individual will:
• . have difficulty perceiving, prioritizing, and storing infonnation,
• have difficulty processing and retrieving that information,
• be unable to generalize and apply consequences from past actions to potential future
actions,
• lack motivation and initiative,
• need external motivators such as frequent clles or guidance from others,
• be unable to perceive the effect of hislher actions on others or the social
inappropriateness of those actions,
• display exaggerated emotions,
• be unable to control behaviors that stem from emotion-evoked urges, and,
consequently,
• engage in a wide range of socially (and often legally) inappropriate behaviors.

1S. Based upon my knowledge of FA SO and its cognitive¥behavioral manifestations and review
of the case documents listed above, it is my opinion that Zane Floyd meets criteria for a specific
FASD diagnosis of FAS Type 3. According to 10M diagnostic criteria, Type 3 (or Partial FAS With
Confinned Maternal Alcohol Exposure) requires some components of the FAS facial pattern, growth

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retardation, eNS neurodevelopmental abnonnalities (e.g., neurological hard or soft signs such as
impaired fine motor skills, poor tandem gait, and/or poor eye-hand coordination), and a pattern of
behavioral andlor cognitive abnonnalities inconsistent with developmental level and unexplained by
genetic background or environmental conditions. These abnonualities include learning difficulties,
deficits in school perfonnance, poor impulse control, problems in social perception, language
deficits, poor capacity for abstraction, specific deficits in mathematical skills, and problems in
memory, attention, or judgment. The diagnosis of FAS Type 3 primarily relies upon data prior to
Zane Floyd's adolescence and is fully consistent with diagnoses provided by Dr. Mack, whose
neuropsychological testing of Zane Floyd this year revealed the type of organic brain daroage that is
generally seen in individuals diagnosed with con finned FASD. (Mack 10/13/06) It should be noted
that a diagnosis of FAS Type 3 does not rule out additional mental health disorders, such as
Attention-Deficit/Hyperactivity Disorder (which has been diagnosed by multiple providers over the
course ofMr. Floyd's life), or diagnoses that were beyond the scope of the current analysis (e.g.,
Posttraumatic Stress Disorder, Dissociative Disorder, substance abuse disorders, personality
disorders ).

16. Prenatal alcohol exposure is confmned by the testimony of Mr. Floyd's birth mother at his
trial about her drinking pattern during her pregnancy. Growth deficiency is confinned by birth
records. Facial dysmorphology is confirmed through examination of early childhood photographs.
A pattern of neurodeveloprnental disorders is confinued by a variety of sources including medical
records, school records, childhood evaluations, and family reports. FAS Type 3 is a diagnosis that
accounts for all of Mr. Floyd's neurodevelopmental and cognitive~behavioral problems and his
behavioral history, not only during his childhood but also up to the present time.

17. Neurodevelopmentai disorders are the overt behavioral manifestation of underlying brain
damage, particularly (but not exclusively) in the frontal and prefrontal cortex of the brain where
executive functioning is controlled. "Executive functions" is an umbrella term for the prj mary
abilities that enable a person to develop new patterns of behavior and cognition and to introspect
upon them. Executive functions are critically important in unfamiliar situations where one doesn't
know from experience or training what to do or in situations where established ways ofbehavjng are
no longe:r useful or appropriate. Thus, the term refers to a whole range of adaptive abilities such as
creative and abstract thought, introspection, planning, multi-tasking, impulse control, socialization,
and many processes related to the control of meroOf}'. In other words, executive functions involve all
of the skills that enable individuals to analyze what it is they want, determine how they might get it,
decide whether their plan is appropriate, and then carry out their intentions, sometimes changing
their approach if they realize it is unproductive or yielding unwanted results. It is also widely
accepted that executive functions play a critical part in complex social behaviors such as
understanding how our actions impact others. Because it is generally thought that the frontal lobes of
the brain play a critical role in all of these functions, it is not uncommon to hear people refer
(imprecisely) to executive functions as "frontal lobe fooctions." Intact ~ecutive functioning is a
prerequisite for appropriate pro-social behavior. While those with intact executive functioning can
make choices about their behavior and consider consequences before acting, those with deficient

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executive skills have no choice. They are able to function only to the level that their impainnents
permit (CoMor et aI., 2000).

18. Executive function deficits are observed clinically as neurodevelopmental disorders. In

infancy, neurodevelopmental deficits are often first noticed in infants who show early evidence of
self-regulation problems (e.g., difficulties in self-soothing or excessive non-reactivity to stimuli),
over-sensitivity to environmental stimuli, and difficulty in reciprocal social interaction. An example
of the latter is an infant who resists the nurturing touches of a caregiver. Examples of
neurodeve!opmental disorders in early childhood (Le., toddlers) include delayed development in
motor skills (e.g., delays in sitting, standing, crawling, walking, learning to drink. from a cup), in
verbal skills, in social skills (i.e., learning how to respond reciprocal in interpersonal interactions
within the family), in emotional skills (i.e., emotional self~modulation), and in self-regulation of
behavioral pace (e.g., hyperactivity versus apathetic passivity). In the elementary school years,
neurodevelopmental disorders may manifest in conununication disorders, attention deficits, learning
disorders, poor impulse control (Le., behavioral problems), problems in social perception,
interpersonal communication deficits, and problems in working memory. In later childhood, or the
middle school years, neurodevelopmental disorders may manifest in abstraction deficits (particularly
in mathematics as coursework becomes more complex and less dependent upon rote memorization),
imp':llse control and judgment (e.g., pro~social versus antisocial behavior), and socialization deficits.
It is often in the adolescent years that that social skills deficits become obvious to professionals
outside the school environment. For example, youth who have not developed the ability to make and
keep friends begin gravitating to antisocial youth who accept them into their circle on the basis of
willingness to engage in antisocial conduct similar to their own. As in Mr. Floyd's case, thls is
typically the time when alcohol consumption and drug use begin, and rule-breaking behavior
escalates to law-breaking behavior. Once an impaired individual enters puberty, which may be
delayed a few years compared to age-peers, neurodevelopmental deficits significantly impact the way
FASD-affected youth handle their developing sexuality. Maintaining appropriate sexual boundaries
is a complex behavior requiring multiple executive skills, including awaxeness (e.g., perception and
understanding of environmental cues), memory (e.g., retention of knowledge about proper social
behavior), self~perception (e.g., ability to perceive whether one's behavior is consistent with social
boundaries), other~perception (e.g., ability to detect and appreciate how one's behavior is affecting
others), and self-regulation (e.g., ability to stop one's behavior if it goes beyond social boundaries).
Most unimpaired children learn social and sexual boundaries by assimilating infonnation gradually
from parents, television, movies, social interaction with peers, and other environmental sources.
However, if the ability to distinguish between appropriate and inappropriate envirorunental cues and
integrate them into one's behavioral repertoire is compromised by neurodevelopmental deficits in
multiple areas, the process can go awry. consequently, sexual bOlU1dary violations - both minor and
major -- are frequently seen in individuals with executive function deficits. Zane Floyd's history
indicates be is no exception.

19. Prenatal Alcohol Exposure: Birth mother Valerie Floyd confirms prenatal alcohol exposW'e.
Duri11g Zane Floyd's trial, Valerie Floyd testified that at the time she became pregnant with her son,

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she was a "hippie" who abused alcohol and used illegal street drugs. (Trial7IlS/OOpm, p. 154) She
testified that her first son died of sms, or Sudden Infant Death Syndrome, after she and her husband
placed him in the back of their van while they watched a baseball game. The infant's death waS
reportedly devastating for her, and she began drinking alcohol heavily to cope. She further testified
that she became pregnant with ber son Zane during this period of heavy drinking. (Trial 7/18/00pm,
p. 152-5) She testified that she drank throughout her pregnancy with Mr. Floyd. (Trial 7118100pm, p.
152, 157) Social worker Jorge Abreu, who conducted a psy<;hosocial evaluation of Mr. Floyd,
testified at trial that Valerie Floyd told him her substance abuse began as a teenager and "continued
through both pregnancies" (Trial 7/17/00pm, p. 40) and that she was drinking alcohol and using
drugs including LSD and cocaine "throughout the pregnancy in both cases" (i.e., in her first
pregnancy as well as her pregnancy with Zane Floyd). (Trial 7/17/00pm, p. 41) Mr. Abreu further
testified that Valerie Floyd told him her first child died of Sudden Infant Death Syndrome. (Trial
7117/00pm, p. 45) It should be noted that death from sms is associated with prenatal alcohol
exposure.

20. Growth Deficiency;' Birth records confinn growth deficiency for Zane floyd. Growth
deficiency is defined as confinned height or weight below the 10lb percentile. A birth certificate
issuedby Elizabeth Knutson Memorial Hospital in Estes Park, Colorado (Birth Certificate, 9/20175),
indicates that Zane Floyd was born September 20, 1975. He was considered six weeks premature
(Alfonso 7112/00, p. 10; DS9419), which placed his birth at the 34 th week of gestation. The 40th week
of gestation is typically regarded as the "due date." Zane Floyd weighed 4.875 pounds at birth (4
pounds, 14 ounces or 2.2 kg) and was 16.75 inches long (42.5 em). (Birth Certificate, 9/20175) His
weight was just below the 50th percentile and below the 10mpercentile for height (Fenton, 2003). The
length measurement meets criteria for FASD gro'Wth deficiency.

21. Facial Dysmorphology: Facial dysmorphology is partially confirmed with photographic

evidence. Photographs of Zane Floyd when he was an infant and small child display some of the
typical facial anomalies associated with FASD. Characteristic features evident in these photos are:
small palpebral fissures, ptosis, slight epicanthal folds, elongated upper lip, thin vennillion on upper
lip, sunken nasal bridge, short upturned nose, and clo\.Vll eyebrows.

22. Neurodevelopmental Disorders: MUltiple neurodeve!opmental disorders are confinned in

Zane Floyd's history by multiple sources of evidence. The data in this assessment not only indicate
neurodevelopmental disorders consistent with the type of primary disabilities typically seen in
individuals diagnosed with FASD but also pervasive adverse life outcomes because his primary
disabilities were not diagnosed and treated. According to research in the 1990s, disabilities stemming
froro FASD are categorized as either "primary" or "secondary" depending upon whether they are a
direct manifestation of central nervous system malfunction (i.e., primary disabilities) or whether they
are mediated by environmental influences (Le., secondary disabilities). "Primary disabilities" are
defined as functional deficits that stem directly from the structW'al brain damage and eNS
dysfimction caused by prenatal ethanol exposure (e.g., Streissguth et al., 1996). Individuals with
FASD are typically born with some or many of these primary disabilitie3, which may include deficits
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in general intelligence (in approximately one-third of affected individuals), learning, attention and
activity level (e.g., hyperactivity), communication, socialization, planning and problem solving, and
difficulties with adaptive functioning. I'Secondary disabilities" are functional deficits that an
individual acquires over time that presumably could have been ameliorated if there had been early
diagnosis and intervention. Environmental factors exert positive or negative influence on the
expression of secondary disabilities but have nothing to do with primary disabilities. However, with
effective treatment of primary d~sabi1ities, secondary disabilities can be prevented or at least reduced
(Streissguth, 1997). Without accurate diagnosis and treatment, secondary disabilities manifest in
adolescence and adulthood as extreme problems in psychosocial functioning that lead to adverse life
outcomes. Secondary disabilities include mental health problems, disrupted school experience,
trouble with the law, confinement, inappropriate sexual behavior, alcohol and drug problems,
dependent living, and problems with employment. It was surprising to researchers in the 19905 that a
large nwnber of individuals with fetal alcohol impairment displayed secondary disabilities
(Streissguth et a1., 1996; Streissguth & O'Malley, 2000). For example, 60% had been arrested,
charged, andlor convicted of a crime; 50% had been in a confinement setting (i.e., psychiatric
hospital, jail, prison, residential substance abuse treatment); and 30% had alcohol or drug abuse
problems.

23.,' Early childhood evidence ofneurodevelopmental disorders in Zane Floyd was described by
h;s mother during her testimony at trial. For example, she testified that her son Zane developed
slowly as an infant and could not draw circles in school (i.e., motor skill deficits). (Tria17/18/00pm,
p. 159-60) When Mr. Floyd was 13, a psychological evaluation dated April 30, 1989, reported
neurological disturbance (Le., "a slight motor tremor") and noted that he was significantly delayed in
achieving all of his early childhood developmental milestones. (Cardle 4/30/89, p. 1) The evaluation
also noted a report by both parents of multiple problems: shott attention span, easily frustrated,
immature, defensive, noncompliant, overly sensitive, physical aggression with other children, and
lying. (Cardle 4/30/89, p. 1) Socia) worker Abreu testified that Mr. Floyd did not begin talking until
he was three or four years old (i.e., speech delay), that he shook a lot and his body trembled (Le.,
neurological problems), and that he had difficulties with fine motor movement. (Trial 7/17/00pm, p.
50) Mr. Abreu testified that Mr. Floyd was clumsy and would fall often (i.e., gross motor skill
deficits). Birth father Michael Floyd testified that his son had problems with hand dominance after
beginning schoo!' (Trial 7/1S/00am, p. 114) Michael Floyd also testified that his son had difficulties
with coordination and motor skills as his hands would shake. (Tria17/18/00pm, p. 114) 'NII. Floyd's
Kindergarten teacher from Princess Anne Elementary School noted he had problems with motor skill
coordination in her class. (Princess Ann records) While in kindergarten in Boulder Bluff, his teachers
were concerned about his physical coordination and development and noted that he needed to work
on fine muscle control in his hands. (Boulder Bluffrecords)

24. Evidence of neurodevelopmental disorders observed when Mr. floyd was in elementary
school came from several sources as well. His mother reported that he had difficulty focusing and
completing tasks. (Alfonso 7112/00, p. 6; DS9967) Kindergarten reports from Boulder Bluff
Elementary School indicated multiple deficits in fine motor skills. (Boulder Bluff records) Mr.

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-,--" --" - - -

Floyd's teacher noted: "We have been very concerned about Zane's physical coordination and
development. It is not what it should be by this time." (Boulder Bluff records) A Kinderganen
progress report from the Virginia Beach Public School District noted; "Zane is capable of much
more self·control than he demonstrates in class." (Virginia Beach records) A lSI grade progress
report from Marrington Elementary School in. Charleston, South Carolina. noted: "Zane needs to pay
attention and follow directions. He can do much betteL" (Marrington records) The attached report
card noted that he had problems controlling his talking, listening attentively, and following
directions. (Marrington records) A 2"<1 grade progress report from Ellicott Elementary School in
Calhan, Colorado, noted a deficiency in expressing ideas clearly, (Ellicott records) School reports
from 2"d grade coofum a "very poor" attention span, "poor" fine motor skills, and social/emotional
delays ("immaturity, very easily upset and frustrated"). (Ellicott records) In 3rd grade, achievement
testing found he was below average in language mechanics. (California Achievement Tests,
McClelland Center for Child Study) An Academic Progress. review for grades 1-5 indicated self-
control problems with respect to classroom behavior. (McClelland Center for Child Study records)
A note within this progress report pertaining to 4th grade indicated he had a "short attention span"
and needed "regular reminding" about his behavior. (McClelland Center for Child Study recOI:ds)
Throughout his school experience, Mr. Floyd was criticized by his teachers for having poor self-
control and being inattentive in class despite being diagnosed Vvith Attention-Deficit/Hyperactivity
Disorder (ADHD) on several occasions during his school experience. (Paul 517100, p. 8) Mr. Floyd
was medicated with Ritalin in the 2"<1 grade in an attempt to address his ADHD, but the medication
was discontinued in 5lh grade and then staned again in 7'h grade "due to exacerbation in problem
behaviors." (Cardle 4/30/89, p. 1)

25. Pro Roitman, a child psychiatrist who saw Mr. Floyd when he was 13, testified that
neurologist Dr. Kehne was treating him for ADHD at the time. (Trial 7/lS/00am, p. 6) Dr. Roitman
noted that besides ADHD, there were additional issues that required more extensive analysis (Trial
7118/00am, p. 7), such as an "infonnation processing leaming disability" and the potential for a
"pennanent emotional problem." (Trial 7/1S/00am, p. 11)

26. Recent test results of Mr. Floyd as an adult are consistent with neurodevelopmental problems
observed during childhood by parents, teachers, and Drs. Roitman and Cardle. For example, Dr.
Dougherty testified that his psychological testing of Mr. Floyd at age 24 "continned the prior
diagnosis of Attention-DeficitIHyperactivity Disorder." (Trial 7118/00pm, p. 13) It should be noted
that attention and hyperactivity disorders as well as leaming disorders are frequently encountered
comorbid diagnoses in individuals diagnosed with FASP (e.g., Streissguth & Kanter, 1997; DSM-
IV -TR). Dr. Mack recently observed behaviors during his neuropsychological testing that were
consistent with neurodevelopmental dysfunction, su<;h as a mild resting tremor, poor emotional
regulation, poor pencil grasp (which he described as a "soft sign" of neurodevelopmental
dysfunction), and a tendency to cover test pages with his hand to reduce stimulus complexity (likely
a coping behavior for attention deficits). ParticularlY relevant with respect to Mr. Floyd's
uncontrolled aggression during his crimes, Dr. Mack observed "flashes of severe anger" and extreme
impulsivity that Mr. floyd had difficulty controlling even in the highly structured testing

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environment. (Mack 10/13/06, Behavioral Observation section).

27. Cognitive deficits and learning problems are other primary disabilities associated with FASD.
While FASD is a leading cause of mental retardation in the United States, only 25 percent of
individuals affected by prenatal alcohol exposure are mentally retarded. In fact, some individuals
diagnosed with FASD have lOs in the above aver<)ge range. Moreover, individuals with FASD may
perform in the average range on IQ tests but show significant discrepancies between Verbal and
PerfQllIlance skills, reflecting leaming disorders and underlying brain damage. They also may
achieve good school performance in the lower grades but show increasing problems or inconsistent
perfonnance as subjects become more complex: in higher grades. Mathematics seems to be a
particular problem because it requires good working memory skills (Le., the ability to hold complex:
infonnation in mind and manipulate it) and increasing abstraction skills as math subjects become
more complex. Zane Floyd repeated the second grade (Dougherty 7/13/00, p. 9; DS 1086) and began
failing subjects in 3rd grade, receiving "Fs" in Arithmetic, Reading, Language, and Social Studies.
(Goose Creek records) In 4th grade, his teacher noted that he did not use his time wisely or practice
self-control. (Pueblo School District records; ZFloyd006-MISC0310) Adoptive father Michael
Floyd testified that he recalled trying to help his son with a math formula during the 3 rd or 4th grades
that his son simply could not learn. (Trial 7/18/00am, p. 114) There also were occasions when Zane
Floyd would see and read instructional material but could not make sense out of them. (Alfonso
7112100, p. 16; DS9427) He was expelled during the 5111 grade for being "out of control" and had to
receive home schooling. (Dougherty 7/13/00, p. 9) He was placed back on Ritalin and within a year,
he turned himself around in school and was Captain of the Academic Team. (Dougherty 7/13/00, p.
9) When he was 12, he was diagnosed by child psychiatrist Dr. Roitrnan with ADHD and prescribed
Ritalin, which he took until age 15. (Dougherty 7/13/00, p. 10)

28. A comprehensive psychological evaluation when Mr. Floyd was 13 detennined he met
criteria for Attention Deficit Disorder, or ADD, along with an adjustment reaction with mixed
emotional and behavioral symptoms, developmental coordination disorder, and organization deficits.
(Cardle 4/30/89, p. 4) The report indicated that although he had an average IQ as measured on the
WISC- R (Full Scale IQ = 101), there was a significant discrepancy between his high average verbal
skills and low average perfonnance skills. (Cardle 4/30/89, p. 2) I should note that Dr" Dougherty
found convergent evidence for this discrepancy in his evaluation in 2000 when he determined by
means of a different IQ test (i.e., Kaufman Adolescent/Adult Intelligence Test) that there was a
significant difference between Mr. Floyd's crystallized IQ of 104 and fluid IQ of 84. (Trial
7/18100pm, p. 17) Dr. Mack recently found additional convergent evidence of this discrepancy in his
recent IQ testing with the WAlS-IiI. (Mack 10113/06, Intellectual Functions section) Discrepancies
of this nature are associated with learning disorders and brain damage. Dr. Cardle's report noted that
visual-motor skills were Mr. Floyd's poorest area of functioning. (Cardle 4/30/89, p. 2) Deficits in
reasoning abilities were also evident, where it was noted he functioned three years below age-peers.
According to Dr. Cardle: "When infonnation needs to be organized by him, or there is a great deal of
infonnation he must integrate, Zane seems to have more difficulty utilizing his general reasoning
skills." (Cardle 4/30/89, p. 2) It should be noted that organizational ability is an executive skill.

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Consistent with Dr. Cardle':s analysis, Mr. Floyd recently told Dr. Mack that he had difficulty
absorbing what he read because he was distracted. (Mack 10/13/06, MedicallPsychiatric History
section) Testing in Dr. Mack's evaluation also revealed perceptual difficulties as well as attention
and processing difficulties (i.e., all executive functions). A short-tenn working memory deficit was
noted, both in recalling series of digits. which is a fairly straightforward short-tenn memory task, and
in recalling and encoding more complex infonnation. Consistent with Dr. Cardle's analysis, Mr.
Floyd told Dr. Mack in his recent neuropsychological evaluation that his short-tetm memory was
"real bad," that he was \Ulable to remember which card he was playing during card games on his
Unit, and that he would constantly forget what he had just said to someone or follow through with a
recently stated intention. (Mack 10/13/06, Medical/Psychiatric History section) Dr. Cardle's
neuropsychological test results indicated a slightly elevated impainnent score, suggesting deficits.
The psychologist noted that organizational deficits might affect Mr. Floyd's "overall behavior" and
thereby impact his ability to behave appropriately. She also noted ··significant emotional difficulties"
and "unusual perceptual responsiveness," which she felt might be related to his exaggerated
responding and socialization deficits. It is noteworthy that she provided an example of a specific
behavior seen frequently in the histories ofF ASD youth: confabulation. She noted: "It was observed
in a group setting that Zane tends to exaggerate or make up stories to 'outdo' other members who
may be talking about something that is important to them. This seems to be a habitual response for
Zan~ .... " (Cardle 4/30/89, p. 4) It also is noteworthy that the psychologist concluded Mr. Floyd's
difficulties "may be related to some subtle frontal lobe dysfunction and/or emotional dysfunction."
(Cardle 4/30/89, p. 5) As a result of this extensive psychological evaluation, it was recommended
that Mr. Floyd and his family participate in family counseling, that he receive remedial support for
his visual-motor skill deficits, and that his parents and teachers provide him with more structure and
organization. Records do not indicate that the psychologist's advice was followed. Dr. Cardle
concluded her report prophetically: "While Zane may not qualify or have significant cognitive
deficits to enable him to receive assistance in academic areas in the school system, he is a child who
is extremely at risk for significant continued behavioral and emotional difficulties." (Cardle 4/:30/89,
p.5)

29. Mr. Floyd displayed increasing evidence of cognitive disabilities as he entered middle schoo!.
In 7th grade, he received "Ds" in math and social science. (Clark County School District records) In
gIl> grade, he received Fs in several classes, including Study Skills. (Hyde Park records) His
academic problems continued as he entered high school. When he was 16, he scored between the 6th
and 42"d percentiles on three different aspects of his math skills in the Survey of Basic Skills exam.
(Clark County School District records) An 11 Itt grade achievement test indicated significant deficits
in math and language skills. (Faith Lutheran High School records) A mid·year transfer dated
February 16, 1993, noted that he was on "behavioral probation" and tended to have "little outbursts."
(DS8247) A high school grade composite noted decreasing grades in math (Le., from a Band C in
pre-algebra in 10'h grade to Os and Fs in 11 III and 1i h grades) as the courses became more complex.
(Faith Lutheran High School records) While there were a few occasion5 where Mr. Floyd did well in
math, the majority of his school records indicated poor perfonnancc in mathematics in particular and
overall poor academic perfonnance in general. Because of his academic problems and poor judgment

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about priorities, he eventually dropped out of traditional high school and obtained his diploma
through night classes so that he could enter into the Marines. (Alfonso 7112100, p. 17)

30. Zane Floyd also had social skills deficits, another common neurodevelopmental or primary
disability associated with FASD. Children with this diagnosis have significant difficulty making
friends. Their social perception deficits interfere with their ability to detect social cues and interact
easily with others. They often fabricate stories or exaggerate events in an effort 10 hold the interest
of their peers and fit in. Because they lack awareness of social boundaries, they sometimes stWld too
close to others or touch them inappropriately. As a result of these skill deficits, their childhood
rustories typically reflect loneliness and isolation from peets. According to Dr. Cardle. Mr. Floyd
recognized at age 13 that he had deficient social skills. (Cardle 4/30/89, p. 4) She observed during
her evaluation of him that in a group setting, he would exaggerate or make up stories to "outdo"
other group members who were talking about topics of interest to them. (Cardle 4/30/89, p. 4) Dr.
Dougherty reported that Mr. Floyd would do anything to avoid rejection from peers (Trial
7/18/00pm, p. 59) and noted that a score at the 99th percentile on the Manson Evaluation indicated
Mr. Floyd felt isolated from others and had significant difficulty establishing personal relationships.
(Trial 7118/00pm, p. 26) He also scored in the 99th percentile on a scale reflecting excessive fears,
worries, feelings of insecurity, and inadequacy. Dr. Dougherty testified that based in pan on results
froll} the Basic Personality Test, Mr. Floyd appeared to be a social introvert with a very weak self-
ego. (Trial 7/18/00pm, p. 29-30) Robert Jay Hall, Mr. Floyd's best friend, testified that he met Mr.
Floyd when they attended Hyde Park Junior High SchOOl, thought of him as the "class clown," and
decided to befriend him primarily because he felt sorry for Mr. Floyd's lack of popularity. (Trial
7/l8/00am, p. 75)

31. In addition to the neurodevelopmental disorders addressed above, impulse control and
judgment deficits are two other primary disabilities typically seen in individuals affected by prenatal
alcohol exposure that have important implications in the current matter. Being able to control one's
urges and emotional reactions and make appropriate choices are skills essential for pro~social
behavior. Zane Floyd had significant deficits in both these areas. For example, Dr. Dougherty
testified that a 3ubscale score at the 99th percentile on the Basic Personality Test indicated Mr. Floyd
likely was impulsive and prone to engage in risky and reckless behavior. (Trial 7118/00pm, p. 29) Dr.
Dougherty further noted in his testimony that in elementary school, it was difficult for teachers to get
Mr. Floyd to control. his behavior. Instead of attending to instruction, he acted out. Mr. Floyd's
teacher at Princess Anne Elementary school noted he had problems with self-control. (Princess Ann
records) During his middle school years, he was expelled for fighting and failing to go to class.
(Alfonso 7/12/00, p. 16) Around this same time period, he was referred for psychiatric evaluation
due to attention deficits and emotional problems. (Trial 7/18/0Opm, p. 51; see also Dr. Cardle
4/30/89)

32. Zane Floyd also displayed deficits in his ability to express his sexuality in appropriate ways, a
problem that is observed in about half of all individuals diagnosed with FASD (Streissguth et al.,
1996). Vv11.en he was ten, he was accused of anally penetrating the neighbor's three-yeru'~old son.

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(Alfonso 7112/00, p. 8; D59969) Although formal charges were never brought, his father and the
boy's father were placed on probation for engaging in a fist fight over the incident. During his
psychological evaluation with Dr. Cardle, she observed him make several inappropriate sexual
comments to peers during group counseling sessions that made the other children uncomfortable.
(Cardle 4/30/89, p. 3) In a letter written to a potential girlfriend, Mr. Floyd infonned her that he was
concerned about dating her because he was recently accused by a female classmate's father of
statutorily raping the girl. (Jessica Letters DS 10901)

'33. Taken as a whole, Zane Floyd displayed almost every major neurodevelopmental disorder
that has been associated with the primary disabilities typically seen in individuals with FASD.
Beginning in adolescence, he also began displaying a number of adverse life outcomes because his
primary disabilities were not accurately diagnosed and treated.

34. Review of data in this case leads to a strong conclusion that Zane Floyd displayed secondary
as well as primary disabilities as a result of his brain damage and FASD. According to records,
except for intermittent Ritalin to treat two ofhi3 problematic neurodevelopmental symptoms (i.e.,
inattention and hyperactivity), he never received accurate diagnosis or treatment for the wide· ranging
primary disabilities inherent in his underlying condition. The lack of accurate diagnosis and
treatment in early childhood is an issue that has profound effects on the later life histories of many
individuals with FASD. In the case of Zane Floyd, the lack of an accurate diagnosis and treatment
was a significant factor in his later mental health problems, substance abuse, disrupted school
experience, inappropriate sexual behavior, dependent living, sporadic employment, criminal
behavior, and, in particular, his unrestrained brutal aggression in the 1999 sexual assault and
murders. Had he received appropriate treatment for his primary disabilities in childhood, it is highly
likely that his secondary disabilities would have been more manageable and less extreme, ifthey had
developed at all. This conclusion is based upon multiple studies of secondary disabilities in the
19905 (Streissguth et al., 1996; Streissguth et aI., 1999; Yates et at., 1998), including research that I
participated in during my postgraduate training.

35. As previously 'noted, deficits in impulse control and emotion self·regulation are hallmark
behavioral symptoms in individuals with FASP. These deficits often lead to compUlsive use of
alcohol and drugs as well as other uncontrolled behaviors such as rage reactions. physical aggression,
stealing, and other high risk behaviors. In some FASD·impaired individuals, there is very little self~
control even when they are not under the influence of disinhibitory substances such as alcohol. In
others, while they may generally function in a pro-social manner Wlder the best of circumstances,
when their central nervou3 system is affected by something that erodes inhibitory control, there can
be a significant and abrupt decrease in volitional control. Alcohol and illegal street drugs are
powerful disinhibitors because of their impact on the neurochemistry of the brain, In FASp·a[fected
individuals with deficits in self·control caused by brain damage, the disinhibitory effects of alcohol
and drugs tend to be greatly magnified. As a result, when faced with events that trigger negative
emotions, individuals with FASD often overreact and behave impulsively without the moderating
(Le.; socializing) steps involved in healthy executive functioning. Volitional control is not a

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dichotomous issue in individuals with FASD or anyone else, for that maner. hl some individuals
with f ASD, executive functions are severely affected, and there is constant difficulty in functioning
in a pro-social manner. In other affected individuals, executive function impairment may appear
more noticeable only at certain times, such as when the individual is severely stressed or is under the
influence of a substance that compromises executive functioning (e.g., alcohol and/or illegal drugs).
This analysis is relevant to Mr. Floyd's behavior on the day of the rape and murders, which
apparently occurred shortly after he drank an excessive amount of alcohol, used methamphetamine,
and experienced several stressful events: job problems, the death of his cousin, the "loss" of his best
friend to homosexuality, the, loss of his girlfriend, his unsuccessful return home to live with his
parents, the loss of his entire paycheck to gambling, and $10,000 debts that he waS behind in paying
(Paul 517100, p. 29-30).

36. Mr. Floyd clearly appears to suffer from an elevated sensitivity to alcohol due to his FASD
condition that affected his volitional capacity. For example, since his mid-teens, there is no evidence
of physical aggression except when under the influence of intoxicating substances. However, when
he was drinking in the military, he recalled provoking fights just to pick a fight and not really
knowing why. (Alfonso 7/12/00, p. 4) He even reported an incident where he thought it was a good
idea to "get into a fight with his locker" while intoxicated, which resulted in severe bruises on his
hanq..s. (CoW1sel Interview with Zane Floyd on October 10,2005) He eventual.ly received low marks
in his competency scores for his excessive drinking and for his fighting and other disruptive
behavior. (Alfonso 7/12/00, p. 20) His inability to see the effect of alcohol and drugs on his
functioning and see the potential consequences of his continued use were beyond his functional
capacity due to his FASD.

37. The fragility of Zane Floyd's executive functioning is a critically important issue in tenns of
his volitional control capacity. According to the Text Edition of the Diagnostic and Statistical
Manual, Fourth Edition (DSM-IV-TR), the essential feature of Substance Intoxication is the
development of a reversible substance~specific syndrome caused by recent ingestion of a substance.
In Mr. Floyd's case, the "substances" involved methamphetamin~ and marijuana as well as excessive
amounts of alcohol. The loss of volitional control caused by his alcohol and drug abuse combined
with the judg1l1ent and emotion control impairments he already possessed due to his FASD and
caused an exaggerated behavioral response beyond what is typically observed in people not impaired
by prenatal alcohol exposure. According to the DSM-IV -TR, in W1impaired individuals, Substance
Intoxication can cause "clinically significant maladaptive behavioral or psychological changes"
associated with the intoxication, such as belligerence, mood liability, cognitive impainnent, impaired
judgment, and impaired social functioning - all of which are due to the direct physiological effects of
the substance on executive functions within the central nervous system. The Manual further notes
that the specific clinical picture in Substance Intoxication "varies dramatically" among individuals
and also dependS on "the person's tolerance for the substance." In Mr. Floyd's case, these symptoms
were significantly magnified at the time he committed his 1999 crimes and may have triggered the
Dissociative Disorder noted in Dr. Mack's report. This exaggerated response stems from an
interaction between the temporary changes that alcohol and drugs cause in the frontal cortex ofthe

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brain where impulses are controlled and the permanent deficit in frontal cortex functioning that Mr.
Floyd suffered as 8 result of his prenatal alcohol exposure.

38. By the time of Zane Floyd' 5 trial in 2000, FASD had been recognized for over 25 years as a
major known cause of neurodevelopmental disabilities, and the life-long implications of these
disabilities had been recognized for 5 years. Follow-up studies in four countries had demonstrated
the continuing adverse effects of prenatal alcohol exposure into adolescence and adulthood
(Strei5sguth & Kanter, Eds., 1997). However, when Zane Floyd was a child and teenager, no one
knew about the damage and .long-tenn effects that prenatal alcohol exposure could cause. Thus,
while he might have been identified as a child at risk and referred for evaluation had he been born in
the 19905, unfortunately he was born too early to be detected in routine screening by medical or
school personnel and referred for medical evaluation. Thus, it was the timing of his birth that
prevented him from being diagnosed and treated as a child for FASD.

39. Regular and unbridled abuse of alcohol by Mr. Floyd's cw:egivers lll1doubtedly interfered
with adult recognition that Zane Floyd even had a leaming disability, much less a pervasive birth
defect that caused significant problems across all major domains of functioning. Although he was
diagnosed as a child with ADHD and medicated intermittently until age 15, his parents were in
denial regarding the fact that he had a leaming disability and unaware that the source of the learning
disability and his ADHD was brain damage. Instead of seeking appropriate treatment for problems
he couldn't control, they severely disciplined him for poor academic performance. For example,
Michael Floyd reported that when school officials told him his son should be placed in special
education classes, he told them he wouldn't allow him to be a class with "retards." (Michael Floyd
Declarati on)

40. Not only were Mr. Floyd's primary disabilities not effectively treated, they were significantly
increased by environmental influences (i.e., his parents' alcoholism and abusive parenting). Mr.
Floyd reported examples of his father throwing him across the room and into a wall and pummeling
him with fists as a method to discipline him for ADHD-related transgressions. (Dougherty 7/13/00,
p.9) He also reported an example of his mother becoming so intoxicated that she mistook the living
room coffee table for a bathroom in front of her horrified and embarrassed teenaged son. (Counsel
Interview with Zane Floyd, 10/10105) Robert Jay Hall reported incidents where Valerie Floyd would
give the boys beer during their teens l and the three of them would stay up late at night talking. (Trial
7118/00am, p. 85) Mr. Hall also testified that Michael Floyd threw a 16 th birthday party for his son
and encouraged the teenagers present to play drinking games, during which several of the teenagers
became inebriated. (Trial 7/18/00am, p. 85)

41. Secondary disabilities associated with fetal alcohol impainnent are not just modifiable but
preventable if an individual is diagnosed early and receives appropriate intervention. According to a
four-year study at the University of Washington funded by the Centers for Disease Control and
Prevention (1996), specific "risk factors" increase the probability that a fetal alcohol impaired
individual will go on to develop secondary disabilities, and specific "protective factors" reduce that

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probability. These risk and protel'tive factors apply to an individual's childhood up to 18 years of age
and are mutually exclusive. These mediating factors include the following: Jiving in a nurtur.ing and
stable home for at least 72% of childhood, receiving a diagnosis offetal alcohol impainnent prior to
age six (which permits positive interventions to be applied early in life), never having experienced
violence, living for at least 2.8 years in each household, experiencing a good quality home ("good
quality" was operationally defined by 12 specific factors), being FAS rather than FAE (because the
facial characteristics make the condition more noticeable to others and therefore more prone to
positive intervention), and having basic needs met at least 13% of the time during childhood. Follow-
up research (Streissguth et a1., 2004) also found that having been sexually or physically victimized in
childhood was an additional mediating factor that affected the later expression of inappropriate
sexual behavior. Data reviewed in this case revealed that Zane Floyd experienced most of these
mediating factors as risk factors rather than protective factors: he never lived in a "good quality"
home (Le., his early childhood and adolescence were spent in a non-nurtuxing, unstable home that
involved frequent moves, caregiver alcohol abuse, domestic violence, child physical abuse,
emotional neglect, and lack of structure), he was not diagnosed with FASD in childhood, and he was
frequently the target of his father's violence dUl'ing his childhood and adolescence. With respect to
having his basic childhood needs met, data indicate that this was a secondary disabilities risk factor
for Mr. Floyd during his entire childhood.

42. Behavior problems in children are often blamed on poor parenting, and by the time children
reach adolescence, any antisocial behavior they display is usually interpreted as willful misconduct.
Adolescents and adults are expected to have the developmental capacity to behave in pro-social
ways, even if they are exposed to poor parenting and multiple traumas in their childhoods. However,
for individuals with fetal alcohol impairment and associated deficits in executive functioning,
maintaining good behavior without adequate support is beyond their capability. Defective executive
functiOning causes them to be highly suggestible and prone to direct jnfluence from others in their
lives. If that influence is aggressive or antisocial, they are not neurologically equjpped to consider
alternative choices and behaviors.

43. When Zane Floyd was born in 1975, little was known about the long-teon effects of
FASfFAE on adult functioning. The tenn "Fetal Alcohol Syndrome" had just been identified publicly
(Jones & Smith, 1973). It was not until Zane Floyd was nine that researchers began to publicize
information about Fetal Alcohol Effects (Abel, 1984), and he was 14 (i.e., 1989) when Congress
finally passed legislation to mandate labels on all alcohol beverage containers sold in the United
States that warned against drinking alcohol during pregnancy. Although the tetnl "secondary
disabilities" was not widely recognized before the mid-1990s, by the late 1980s there was growing
awareness that fetal alcohol impaitnlent caused structural brain damage (West, 1986) and that this
damage in tum caused long-term behavioral and developmental distUl'bances (Spohr & Steinhausen,
1987; Streissguth & Randels, 1988; Streissguth, 1990). 8y the mid-1990s, knowledge about
secondary disabilities was widespread (e.g., Meyer et aI., 1990; Phillips, 1992; Streissguth, 1992).
For example, in 1992 the Centers for Disease Control and Prevention (CDC) funded a major research
project at the University of Washington to study secondary disabilities, and in early 1994, Alcohol

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Health and Research World (now titled Alcohol Research and Health) devoted a full issue to the
topic ofFAS and other alcohol-related birth defects (see Volume 18, Number 1, 1.994) that provided
a comprehensive overview of the existing knowledge on the effects of prenatal alcohol exposure.
(This issue was later awarded first prize in the technical publications category by the National
Association of Govenunent Communicators.) Thus, by the time of Zane Floyd's trial in 2000, any
expert in neurodevelopmental disorders could have testified in general about the primary disabilities
associated with FASD. and any expert aaned with the data provided to me by post-conviction
counsel could have testified about the specific impact of this condition on Mr. Floyd's childhood
functioning.

44. With respect to long-tenn outcomes from untreated FASD, prior to the 2000 trial knowledge
about the secondary disabilities associated with fetal alcohol exposure had become a primary focus
in research studies.ln the mid 19905, the United States Congress directed the National Institute on
Alcohol Abuse and Alcoholism (NlAAA) to prepare a comprehensive report on the subject. In
response, NIAAA commissioned the Institute of Medicine (lOM) of the National Academy of
Sciences to conduct a study. The resulting seminal report was titled, Fl!tal Alcohol Syndrome:
Diagnosis, Epidemiology, Prevention, and Treatment (Stratton et aI., 1996). This report critically
reviewed the major scientific issues in fetal alcohol research and made a number of
recommendations, including the new diagnostic terminology referred to earlier in this declaration
(Le.: FAS Types 1-5). By 1996, research at the University of Washington had revealed that secondary
disabilities became observable in people with FASD by their young adults years (Streissguth et aI.,
1996) and specifically identified the tisk and protective factors associated with these secondary
disabilities. A year later, Streissguth (1997) published a book for the lay public regarding these
secondary disabilities; Thus, by 2000, the year of Mr. Floyd's trial, and certainly by his appeal, any
expert with knowledge about FASD could have testified about the long-term social and behavioral
ramifications 'of prenatal alcohol exposure in general, and any expert armed with the information
provided to me could have testified about the long-tenn ramifications ofFASD in Mr. Zane's life.

45. The awareness that FASD is a birth defect with pervasive and long-range
neurodevelopmental effects has led to increasing awareness in the legal profession that a different
level of attribution is warranted for individuals with this condition (Fast, Corny, & Loock, 1999;
Baumbach, 2002). Rather 1han assuming they become unmotivated, manipulative, antisocial, and/or
self-defeating solely because of poor parenting experiences and free will, research over the last 15
years has shown consistently that untreated primary disabilities are the basis for maladaptive
behaviors. Notwithstancting the fact that environmental influences can playa significant role in the
expression of secondary disabilities, it also has been establiShed in the scientific research that
individuals with FASD have structural brain damage that makes it highly unlikely that they will be
able to withstand the negative influence of environmental risk factors without appropriate support
and treatment. As Streissguth and colleagues noted recently (Streissguth et aI., 2004), one of the
sttongesI correlates of adverse outcomes in individuals with FASD is lack of an early diagnosis:
"The longer the delay in receiving diagnostic infonnation, the greater the odds of adverse outcomes."
Thus, the research indicates that for Zane Floyd's debilitating substance abuse and subsequent brutal

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aggression to have been prevented, he needed appropriate intervention in childhood to eliminate or

reduce the risk factors he was exposed to and substitute protective factors. Through no fault of his
own, this intervention did not happen. Thus, while environmental risk factors were clearly important
in his outcome, unlike individuals without brain damage who have the capacity to withstand negative
environmental influences and emerge from childhood as pro~social adults, those like Mr. Floyd who
are affected by prenatal alcohol exposure but W1treated do not have that ability.

46. Zane Floyd is sentenced to death for the crimes he committed while tmder the influence of
alcohol and drugs. Given data in this case that support a diagnosis ofFASD, it is clear that substance
abuse (a secondary disability) and lack of impulse control and judgment (untreated primary
disabilities) rendered him a very dangerous man and were significant factors in his violence. It is
equally clear that given his birth defect and the pervasive short-tenn and long-tenn ramifications of
that condition on his functioning, he had virtually no ability on his own to change the negative course
of his life.

I declare under penalty of perjury that the foregoing is true and correct and that this declaration was
executed in Seattle, Washington, on October 17,2006.

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Appendix A
10M Criteria

In 1996, the Institute of Medicine (rOM) developed five diagnostic categories

related to fetal alcohol exposure:

Type 1.
Fetal Alcohol Syndro~e (FAS) with Confirmed Maternal Alcohol Exposure

Requires:
a.' confirmed maternal alcohol exposure
b. facial dysmorphia, including short palpebral fissures and abnormalities of
the premaxillary zone (e.g., flat upper lip, flat philtrum, flat midface)
c. growth retardation, such as low birth weight, lack of weight gain over
time, disproportional low weight to height
d. neurodevelopmental abnormalities of the Central Nervous System (eNS),
such as small head size at birth and structural brain abnoxmalities with
neurological hard or soft signs (e.g., impaired fine motor skills,
neurosensory hearing loss, poor tandem gait, poor eye-hand coordination)

Type 2.
FAS Without Confirmed Maternal Alcohol Exposure

Requires:

b. through d. above

Type 3.
Partial FAS With Confirmed Maternal Alcohol Exposure

Requires:
a. confinued maternal alcohol exposure
b. some components of the FAS facial pattern
c. growth retardation as in Category 1
d. eNS neurodevelopmental abnonnalities as in Category 1
e. Complex pattern of behavioral or cognitive abnonnalities inconsistent

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with developmental level and unexplained by genetic background or

environmental conditions (e.g., leanling difficulties, deficits in school
perfonnance, poor impulse control, problems in social perception,
language deficits, poor capacity for abstraction, specific deficits in
mathematical skills, and problems in memory, attention, or judgment)

Type 4.
Alcohol~Related Birth Defects (ARBD)

Requires:
a. continned maternal alcohol exposure
b. one or more congenital defects including malfonnations and dysplasias of
the heart, bone, kidney, vision, or hearing systems

Type 5.
Alcohol-Related Neurodevelopmental Disorder (ARND)

Requires:
a. confinned maternal alcohol exposure
b. eNS neurodevelopmental abnonnalities as in Category 1 and/or
c. complex pattern of behavioral or cognitive deficits as in Category 3

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---

AppendixB
References

Abel, E.L. (1984). Fetal alcohol syndromft andfetal alcohol effects. New York: Plenum Press.

Baumbach, J. (2002). Some implications of prenatal alcohol exposure for the treatment of
adolescents with sexual offending behaviors. Sexual Abuse: A Journal ofResearch and Treatment,
14 (4), 313-327.

Bookstein, F.L., Sampson, P.O., Streissguth, A.P., & Connor, P.O. (2001). Geometric
morphometries of corpus collosum and sub-cortical structures in the fetal-alcohol-affected brain.
Teratology, 64, 4-32.

Booksrein, F.L., Streissguth, A.P., Sampson, P.O., Connor, P.O., & Barr, H.M. (2002). Corpus
collosum shape and neuropsychological deficits ill adult males with heavy fetal alcohol exposure.
Neurolmage, J5, 233-251.

Bookstein, F.L., Sampson, P.O., Connor, P.O., & Streissgulh, A.P. (2002). Midline corpus collosum
is a,neuroanatomical focus of fetal alcohol damage. The Anatomical Record, 269, 162-174.

Clarren, S.K., & Smith, D.W. (1973). The fetal alcohol syndrome. New England Journal of
Medicine, 298, 1063-1067.

Connor, P.D., Sampson, P.D., Bookstein, F.L., Barr, H.M., & Streissguth, A.P. (2000). Direct and
indirect effects of prenatal alcohol damage on executive function. Developmental Neuropsychology,
18,331-354.

Fast, D.K., Conry, 1., & Loock, C.A. (1999). Identifying fetHl alcohol syndrome among youth in the
criminal justice system. Developmental and Behavioral Pediatrics, 20 (5),370-372.

Fenton, T.R. (2003). A new growth chart for preterro babies: Babson and Benda's chart updated with
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Institute of Medicine (1996). Fetal alcohol syndrome: Diagnosis, Epidemiology, Prevention, and
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Meyer, L.S., Kotch, L.E., & Riley, E.P. (1990). Neonatal ethanol exposure: Functional alterations
associated with cerebellar gro'Wth retardation. Neuro(oxicological Teratology, 12 (I), 15-22.

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Phillips, E.E. (1992). Effects of alcohol on the development of glial cell and myelin, in Alcohol and
Neurobiology: Brain development and hormone regulation (pp. 83-108). Watson, R.R. (Ed.). Boca
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Randall, C.L. (1977). Teratogenic effects of in utero ethanol exposure. In Blum, K., Bord, D., &
Hamilton, M. (Eds.). Alcohol and opiates: Neurochemical and behavioral mechanisms. New York:
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Spear, L. (2000). Modeling adolescent development and alcohol use in animals. Alcohol Research
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Spohr & Steinhausen (1987). Follow-up studies of children with fetal alcohol syndrome.
Neuropediarrics, 18, 13-17.

Streissguth, A.P. (1978). Fetal alcohol syndrome: An epidemiologic perspective. American Journal
o/Epidemiology, 107, 467-478.

Streissguth, AP. (1990). Pre",atal alcohol induced brain damage and long tenn postnatal
con$equences. Alcoholism: Clinical and Experimental Research, 14, 648·649.

Streissguth, AP. (1997). Fetal alcohol syndrome: A guide for families and communities. MD: Pearl
H. Brooks Publishing Company.
Streissguth, AP., Landesman-pwyer, S., Martin, J.e., Smith, D.W. (1980). Teratogenic effects of
alcohol in humans and laboratory animals. Science, 209, 353-361.

Streissguth, AP., Barr, H.M., Bookstein, F.L., Sampson, P.O., & Olson, H.C. (1999). The long term
neurocognitive consequences of prenatal alcohol exposure: A 14-year study. Psychological Science,
10 (3), 186-190.

Streissguth, A.P., Barr, H.M., Kogan, .T., & Bookstein, F.L. (\996). Understanding the occurrence 0/
secondary disabilities in clients with/etal alcohol syndrome (FAS) andfetal alcohol effects (FAE):
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96-16). Seattle: University of Washington, Fetal Alcohol and Drug Unit.

Streissguth, AP., Clarren, S.K, & Jones, K.L. (1985). Natural history ofthe fetal alcohol syndrome:
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Streissguth, AP. & Kanter, J. (Eds.) (1997). The challenge offetal alcohol syndrome: Overcoming
secondary disabilities.

Declaration: Nalalie Novick Brown

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Streissguth, A.P., & Randels, S. (1988). Long tenn effects of fetal alcohol syndrome In G.c.
Robinson & R.W. Annstrong (Eds.), Alcohol and Child/Family Health (pp. 135-150). Vancouver:
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Declaratioo: Natalie Novick Brown

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 Declaration of Carolyn Smith

I, Carolyn Smith, hereby declare as follows:

1. My name is Carolyn Smith and I am sixty-four years old. I am married to Herbert

Smith and we have one daughter, Brittany. We currently live in Little Rock,
Arkansas. We are longtime friends of the Floyd family.

2. I am a retired social worker. I feel that my former professional experience helped

me see things in Zane that others did not.

3. Herbert and I met Mike and Valerie Floyd when the Floyds moved into our Las
Vegas apartment complex around 1987. The Floyds lived directly across the hall
from us for two or three years and we all became very close. Valerie and I were
best friends. Zane was around eight or nine years old at the time we met the Floyds.

4. We socialized with the Floyds almost daily, and Zane was at our house quite a lot.
I was so close to Zane that he referred to me as his godmother, although I was not
officially Zane’s godmother. Zane was like a son to me.

5. Zane, who was four to five years older than my daughter, was like a big brother to
her. I was so comfortable with Zane that I let him babysit my daughter. Zane was
like a big teddy bear with her and very protective.

6. Zane was a good easy-going kid. I never saw him act violently while he was
growing up.

7. I often spoke to Zane when he was feeling down, and because he trusted me, he
would confide in me.

8. Oftentimes Mike was the source of Zane’s bad feelings. Mike was a macho man
who thought that Zane was “soft.” Mike wanted Zane to be more like him—tough
and good at sports. But Zane had a hard time living up to Mike’s expectations. This
caused Zane to suffer from self-doubt, lack of confidence, and I believe this led to
Zane having a poor self-image of himself.

9. After the Floyd’s moved to their house on Oakey, we continued to socialize with
them, spending a lot of time at their house. At one point our family moved into the
Floyd’s guest house on Oakey.

10. I saw the Floyd’s under the influence of alcohol on many occasions as there was
always drinking when we got together.

11. I remember one night, Valerie called our house and said that she and Mike had an

240
 argument. Valerie asked Herbert to come over and speak with Mike. Herbert told
me the police were called. I was told that Mike hit Valerie on the head.

12. Another time Valerie called us during a physical altercation between Mike and
Zane. Valerie feared for Zane’s safety. Herbert went over to the Floyd’s to calm
the situation.

13. I believe that Zane went into the military to please Mike. However, it was clear to
me that Zane was negatively impacted by his military service. He appeared to be a
different person when he returned home.

14. The first thing I noticed was the change in Zane’s overall demeanor and emotional
affect. Prior to his military service Zane was a happy-go-lucky kid. He was always
laughing, smiling, and displaying a joyful spirit. When he came home it seemed
like his joy was gone. He no longer laughed or smiled. He was much more of a
serious person.

15. Zane also seemed distracted and would silently sit and stare off into the distance.
When I asked him what he was thinking about he often talked about his military
service. Zane spoke about the stress he felt during his time in Guantanamo Bay,
and his weapons training. He spoke frequently about weapons and weapons
training. Before entering the military, Zane was not weapons-focused.

16. Zane also frequently talked about different kinds of guns and how they worked and
fired. When Zane discussed his military experiences, he often had a strange look
on his face as if he were transported back in time and was reliving the experiences
at that very moment. Zane also spoke like he longed to return to military service. It
was clear to me that Zane needed counseling to help him transition back into
civilian life. Instead, when he left the military he was left on his own to figure things
out. I was very concerned for his wellbeing. I told Valarie about my concerns, but
nothing really came of these discussions.

17. After the military, the only outfit that Zane kept in his closet was his military
uniform. He kept it in plastic and idolized it. I found this to be very strange.

18. What happened on June 3 was not the Zane I knew and loved. When I saw the news
coverage of his arrest, I had a hard time recognizing him. Zane had an empty look
on his face that I had never seen before and it was clear to me that he was not in his
right mind. When I spoke with Zane after his arrest, he was deeply remorseful,
ashamed, and horrified by his actions. Zane did not have much of a memory of the
things that transpired in the Albertson’s grocery store and he could not explain what
was going through his mind at the time. However, he took responsibility and felt
terrible for the harm that he caused to the victims and their families.

241
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3 242