Abstract
BackgroundIndividuals with fetal alcohol spectrum disorder (FASD) experience a range of cognitive, affective, and physical deficits following prenatal alcohol exposure. They are thought to be overrepresented in criminal justice settings. However, limited evidence is available to inform prevalence. We sought to estimate the prevalence of FASD in a Northern Canadian correctional population.MethodsUsing an active case ascertainment approach we recruited a representative sample of 80 justice-involved adults (ages 18–40, 85% male) over an 18-month period from 2013 to 2015. Participants completed interdisciplinary clinical assessments comprising medical and psychological evaluations that adhered to the 2005 Canadian FASD Diagnostic Guidelines.ResultsWe identified a high rate of FASD (17.5, 95% CI [9.2, 25.8%]) in this sample, and this rate could have been as high as 31.2% with confirmation of prenatal alcohol exposure. Most participants in this study presented with significant neurodevelopmental and cognitive deficits in at least two domains of functioning, irrespective of diagnosis, with only five of 80 participants (6.3%) demonstrating no cognitive impairment.ConclusionsFindings showed disproportionately high estimated FASD prevalence in this representative sample compared to general population estimates in both Canada and the U.S. (2–5%), underscoring the need for improved FASD screening and diagnosis in correctional settings, and education for clinicians working in the justice context. Strengthened health prevention and intervention efforts to support the needs of individuals with FASD outside the criminal justice context are needed.
Highlights
Individuals with fetal alcohol spectrum disorder (FASD) experience a range of cognitive, affective, and physical deficits following prenatal alcohol exposure
Diagnostic decisions could not be made with reliability in 11 cases (13.8%, considered ‘deferred’), indicating that our prevalence estimate could have been as high as 31.2% with sufficient information about prenatal alcohol exposure (PAE)
These include lack of training and awareness about FASD among clinicians working in criminal justice contexts, limited diagnostic capacity, lack of evidence-based screening tools, and the relative “invisibility” of FASD [40, 41]
Summary
Individuals with fetal alcohol spectrum disorder (FASD) experience a range of cognitive, affective, and physical deficits following prenatal alcohol exposure They are thought to be overrepresented in criminal justice settings. Two published studies have estimated FASD prevalence in justice-involved youth using similar approaches in both Canada (23%) and Australia (36%), underscoring concerns regarding overrepresentation [20, 21] These estimates are all considered conservative, given the challenges inherent in confirming PAE in justice-involved populations in both clinical and research contexts. These challenges include lack of evidence regarding the ultimate phenotypic presentation of adults with FASD, including those in the criminal justice system, challenges inherent in identifying cases in the context of varied neurocognitive presentations that often go undetected, difficulties confirming PAE with increasing age, and lack of FASD-related knowledge and training in health professionals working in forensic and correctional settings [22,23,24]
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