Fetal Alcohol Spectrum Disorder Prevalence Estimates in Correctional Systems: A Systematic Literature Review

Abstract

Objectives: The objective of this study was to conduct a systematic search of the literature for studies that estimated the prevalence/incidence of Fetal Alcohol Spectrum Disorder (FASD) in correctional systems in different countries and, based on these data, to estimate a) the number of people with Fetal Alcohol Syndrome (FAS)/FASD within the criminal justice system population, and b) the relative risk of becoming imprisoned for individuals with FAS/FASD compared with those without FAS/FASD. Method:A systematic world literature review of published and unpublished studies concerning the prevalence/incidence of FASD in correctional systems was conducted in multiple electronic bibliographic databases.Synthesis: Very little empirical evidence is available on the prevalence of FASD in correctional systems. There were no studies estimating the prevalence/incidence of FASD in correctional systems found for any country other than Canada and the USA. The few studies that have identified incarcerated individuals with FASD estimate that the number of undiagnosed persons in correctional facilities is high. Based on available Canadian data, this study estimates that youths with FASD are 19 times more likely to be incarcerated than youths without FASD in a given year. Conclusion:More studies investigating the prevalence/incidence of alcohol-affected people in the criminal justice system are required. There is an urgent need to raise awareness about the prevalence and disabilities of individuals with FASD in the criminal justice system and about appropriate responses. The criminal justice system is an ideal arena for intervention efforts aimed at the rehabilitation and prevention or reduction of recidivism in this unique population.

Suggestibility, false confessions and competency to stand trial in individuals with fetal alcohol spectrum disorders: current concerns and recommendations

“…Such 'early' possible identification can then result in proper diagnosis by a clinician (as well as the specific impairments in the defendant) and highlight their need for appropriate and timely interventions which are specifically designed for individuals with FASD (Brown et al, 2019). The "criminal justice system is an ideal arena for intervention efforts aimed at the rehabilitation and prevention or reduction of recidivism in this unique population" (Popova et al, 2011). The case of Pora, discussed by Freckelton in detail in his paper, clearly highlights the need for criminal justice professionals (e.g., police, forensic mental health assessors, defence lawyers, prosecution lawyers and 9 judicial officers) to be aware of and alert to the potential impact that FASD may have on the defendants responses to questions asked of them during interrogation (Freckelton, 2016a).…”

“…Another important finding which has emerged from active case ascertainment studies is that a significant proportion of individuals identified as having a FASD only became aware of this when they are in the criminal justice system. This is despite the fact that they had previously been diagnosed with other psychiatric mental health conditions (e.g., Popova, Lange, Bekmuradov, Mihic, & Rehm, 2011;Bower et al, 2018;Brintnell et al, 2019). In a systematic review on prevalence, Popova and colleagues estimated that youth with FASD are 19 times more likely to be incarcerated when compared to youth with no diagnosis of FASD (Popova et al, 2011).…”

What can be done to lessen morbidity associated with fetal alcohol spectrum disorders?

“…Thus, the criminal justice setting is likely to have a higher prevalence of individuals with FASD. A systematic review of studies carried out in the criminal justice system (eg, prisons) in 201118 found that all the studies had been carried out in either Canada (five studies) or the USA (one). Studies using active case ascertainment (two Canadian studies) found prevalences of FASD substantially higher than the general population at 10.8%–23.3%.…”

The Cost-effectiveness of screening tools used in the diagnosis of fetal alcohol spectrum disorder: A modeled analysis

“…The prevalence of FASD in Canada is estimated to be between 2-3% and individuals impacted by FASD often face substantial burden [3]. Evidence suggests that this population experiences lower rates of academic achievement, higher rates of incarceration, increased risk of problematic substance use, and higher overall mortality than the general public [4][5][6][7]. In addition to significant impacts to patients' wellbeing, the annual economic burden of FASD to society is large and was estimated to be $1.9 billion in 2017 Canadian Dollars [8].…”