Background: Frequent emergency presentations to child and adolescent mental health services or repeated police contacts in adolescents often point to complex developmental and psychosocial challenges.Adolescent patients often present with acute psychiatric symptoms such as self-injurious behavior, suicidal ideation, and high-risk behaviors. While emotional dysregulation or suicidal behaviour are more apparent, neurodevelopmental disorders — particularly symptoms related to partial Fetal Alcohol Spectrum Disorder (pFASD) — are frequently overlooked. pFASD can present with subtle or absent physical features, making diagnosis difficult.Cognitive impairments, deficits in executive functioning, and adaptive skill difficulties, which can be present in pFASD, may be misinterpreted as oppositionality, leading to therapeutic misalignment or ineffective crisis management.Material and Methods: Written informed consent for publication was obtained from the adolescent and her parent/legal guardian.Case Presentation Summary: We report the case of a 15-year-old girl with over 30 presentations and high-frequency phone calls to child and adolescent psychiatric emergency services and emergency departments, alongside frequent police contacts.Presentations included suicidal ideation, self-injurious behavior, or somatic symptoms. She experienced recurrent family conflicts. Due to frequent absconding, she was repeatedly reported missing. Multiple short-term inpatient admissions and crisis interventions yielded only transient improvements. Her history revealed significant early adversity, including inconsistent caregiving and suspected prenatal alcohol exposure, though no formal diagnosis had been established.Neuropsychological assessment showed below-average intellectual functioning. No microcephaly, but dysmorphic features (narrow palpebral fissures, smooth philtrum, thin upper vermillion border) were apparent. Combined with developmental history, findings supported a diagnosis of pFASD.As a supportive intervention, a multi-agency round table was convened, including pediatricians, child and adolescent psychiatrists, police, and youth welfare services. This promoted shared understanding, improved cross-sector communication, and ensured coherent crisis responses. Key elements included clear routines, reduced transitions between services, contingency management, and tailored interventions. While the frequency of presentations had declined, the adolescent persisted in displaying marked help-seeking and contact-seeking behaviour.Discussion and Learning Points: This case illustrates the diagnostic and therapeutic challenges when pFASD co-occurs with trauma-related symptoms and dysregulation. Adolescents with pFASD often have difficulties in cause–and–effect reasoning, impulse control, and anticipating consequences. These vulnerabilities heighten sensitivity to environmental stressors.When such patients repeatedly present to emergency services, behaviors like absconding or “testing limits” are often framed as volitional or oppositional, risking neglect of underlying cognitive and adaptive deficits. Psychoeducation for caregivers and professionals on pFASD and its functional implications was crucial. In this case, partial stabilization followed reorganization into a coordinated, long-term plan involving psychiatry, welfare services, and consistent caregiving.Early recognition of pFASD is critical to preventing chronic psychiatric trajectories. Screening for prenatal alcohol exposure, even without classic dysmorphic features, should be considered in adolescents with high service use, early adversity, and unexplained cognitive dysfunction. A formal diagnosis can facilitate access to specialized services and the utilization of appropriate resources.
