Fetal Alcohol Spectrum Disorder in a correctional population: Preliminary results from an incidence study in a federal penitentiary Brian A. Grant

1
Fetal Alcohol Spectrum Disorder in a
correctional populationPreliminary results from
an incidence study in a federal
penitentiaryBrian A. Grant Patricia
MacPherson Addictions Research CentreAlbert E.
Chudley, University of Manitoba
Addictions Research Centre23 Brook St.,
Montague, PEI C0A 1R0 902-838-5905
addictionsresearch_at_csc-scc.gc.ca
2
Project Team

• Patricia MacPherson, Addictions Research Centre
  (ARC)
• Brian Grant, (ARC)
• Ab Chudley, University of Manitoba
• Fred Boland, Queens University
• Charlotte Fraser (ARC)
• Staff

3
Expression of Neurological impacts

• Adaptive behaviour
• meets standards of personal independence and
  social responsibility
• Language words not fully understood
• Attention
• Reasoning do not learn from experience, problem
  solving, judgement
• Memory - confabulation
• ALARM from Conry Fast (2000)

4
Secondary Disabilities

• Result from the environment potentially
  preventable
• Academic failure
• Mental health disorders
• Addiction
• Sexual deviance
• Inability to live independently
• Problems with the justice system

5
Prevalence

• Health Canada
• FAS 1 3 per 1000 live births
• FASD 9 per 1000 live births
• Consistent with U.S. estimates
• Rate varies dramatically in special populations
• Less than 1 to 190 per 1000 live births

6
Correctional Populations

• Conry and Fast, 1999
• young offenders remanded to a forensic
  psychiatric inpatient assessment unit
• 23 (3 FAS 67 FAE)
• Streissuth et. al. (2004)
• 60 of FASD affected adolescents adults had
  contact with the law

7

• Boland et al., (1998).
• Although there is substantial evidence
  suggesting a link between FASD and crime. there
  are no known studies reporting the prevalence of
  FASD in prisons.

• http//www.csc-scc.gc.ca/text/rsrch/reports/r71/er
  71.pdf

8
Challenges in the prison environment

• Victimization
• Prison routine / rules
• Wanting to fit in
• Inappropriate sharing of information
• Inappropriate social behaviours

9
Challenges for Corrections

• How to identify affected individuals
• Number of offenders with FASD
• How to adapt current programs
• How best to accommodate
• Management in the institution and community
• Reducing risk of re-offending keeping the
  community safe

10
Purpose of CSC Research

• Determine incidence
• Identify scope of the problem
• Appropriate resource allocation
• Develop targeted interventions
• Develop a screening instrument
• Identify offenders for further assessment
• Integrate into intake assessment process.

11
Study Sample

• Offenders processed by Winnipeg Parole Office
• 30 and under
• Over 18 month period
• New admissions transferred to Stony Mountain
  Institution
• Aboriginals are over-represented in our sample
  (40 vs. 17)
• Everyone is asked to participate
• Statistical methods will be used to generalize to
  CSC population
• Women are not purposely excluded, SMI is a male
  facility

12
Participant Recruitment

• Remand Centre/Headingly Correctional Centre
• Parole officer conducts preliminary assessment
  with newly sentenced offenders
• Explains that research assistant will be coming
  to see them
• Research Assistant
• Explain the study to offenders both verbally and
  in writing
• Audiotapes consent interview
• Obtains signed consent

13
Community Information

• 28 Behavioural Indicators
• Judgment, distractability, mood swings,
  hyperactivity, financial, consequences.
• Historical Indicators
• Adopted, foster care, developmental challenges,
  school disruption, mental health
• Maternal consumption of alcohol
• Information collected from the offender, parole
  officers, collateral sources

14
Information Sources - Institution

• Medical Intake Interview
• FASD Facial Photographic Analysis Software
• Physical exam
• Facial measurements, about 10 minutes
• Neuropsychological testing
• IQ executive functioning visual and auditory
  memory social adaptive functioning

15
Diagnosis

• Case Conference to determine outcome
• Doctor
• Psychologist
• Research Liaison Officer
• Information from all sources will be compiled
• Checklists (community)
• Medical records
• Medical intake interview
• Photometric report
• Physical/neuropsychological evaluations

16
Four Research Outcomes
Research Outcome
A Diagnosis in one of the FASD categories
B Does not meet diagnostic criteria but remains a possibility
C No FASD-related diagnosis but other impairments noted
D Normal
17
Debriefing

• If no FASD diagnosis, Research Liaison Officer
  will debrief participants
• Letter from Dr. Chudley stating results
• Certificate of appreciation for participation
• If positive neuropsychological findings, letter
  from psychologist detailing results
• If FASD diagnosed, Dr. Chudley will be present
  for debriefing and will explain results to
  participant

18
Disclosure

• Participants can decide if they want their
  results disclosed to CSC
• Results placed on CSC file
• Health care
• Psychology
• Case management
• Used by case management team
• Will be offered Research Liaison Officer support

19
Follow-up

• Once a year for two years
• Those diagnosed with FASD
• Brief Questionnaire (approximately 10 minutes)
• Adjustment
• Views on participation in study
• Value or benefit of their experience with the
  Research Liaison Officer

20
Preliminary Results

• Participant Recruitment
• 96 current participants
• 58 declined
• 8 withdrawn
• 59 participation rate

21
Demographics for case conference sample

• 64 Aboriginal
• 25 Caucasian
• 11 Other racial groups
• 51 Single
• 49 Married/common law
• Average age 24

22
Summary of collateral informationCase conference
sample

• Average of 2 per participant (range 0 7)
• 45 participated with maternal alcohol
  information
• 17 participated without maternal alcohol info
• 28 unable to contact
• 10 declined

23
Summary of maternal informationCase conference
sample

• 83 of offenders provided mother as a contact
• 63 agreed to participate
• 18 unable to contact
• 14 declined
• 5 language barrier

24
Summary of Collateral Information
Relation Maternal Alcohol History No Maternal Alcohol History
Aunt/Uncle 27 7
Sibling 23 11
Father 19 4
Grandparent 15 0
CLW, spouse 7 52
Other 6 15
Professional 3 11
Other includes step-parent, foster parent,
adoptive parent, friend, or cousin
25
Average Scores on Behavioural Items
26
Average Score on Historical Items
27
Reported Prenatal Alcohol Exposure
Drinking Questions Collateral (N 17) Mother (N 6)
Drink during full pregnancy 35 17
Drink during part of pregnancy 35 67
Drink 2-3 times per week 29 0
Drink 2-4 times per month 12 50
Binge Drinking (gt 5 drinks) 41 33
28
Reporting on prenatal alcohol exposure
Yes17
Yes3
Yes6
29
Other Drug Use During Pregnancy
30
Birth/Hospital Records

• All participants agreed to allow access to birth
  records
• 71 of records received
• 13 hospital did not have records
• 9 offender did not know where born
• 4 records were destroyed
• 3 offender not born at the hospital that
• he indicated

31
Birth/Hospital Records

• Maternal pregnancy records
• 77 of mothers agreed to release records related
  to their pregnancy
• 59 of pregnancy records have been received

32
FASD Neuropsychological Test Battery
Wechsler Abbreviated Scale of Intelligence WASI
Wechsler Individual Achievement Test Second Edition Abbreviated WIAT-II-R
Adaptive Behaviour Assessment System Second Edition ABAS-II
Wechsler Memory Scale Third Edition Abbreviated WMS-III-A
Wisconsin Card Sorting Test Revised WCST-R
Connors Continuous Performance Test CCPT
Rey Complex Figure Test and Recognition Trial RCFT
33
Level of Neuropsychological Deficits Identified
in case conference sample
34
Overall risk and need for offenders with
prenatal alcohol exposure identified
35
Overall risk and need for offenders with
neuropsychological deficits identified compared
to those without

36
Youth Court History
37
Adult Court History
38
Conclusion

• 75 offenders assessed to date
• Data collection ongoing
• Analysis will assist CSC to determine
• Incidence of FASD
• Characteristics of offenders with confirmed PAE
• Characteristics of offenders with significant CNS
  impairment
• Factors that identify offenders who are at risk
  for FASD