Primary disabilities in children prenatally exposed to alcohol have a major impact on their daily life. It is suggested that these issues persist into adulthood, but few studies have addressed the outcome in adults with prenatal exposure, especially those with fetal alcohol syndrome (FAS). The aim of this follow-up study was to investigate outcome variables, such as education, employment, health, and criminal acts, in 79 adults diagnosed with FAS.
We carried out a national register–based study of 79 adults with an FAS diagnosis, at a mean age of 32. Education, social adjustment, and mental health outcomes were analyzed and compared with 3160 comparison individuals matched on age, gender, and place of birth.
The FAS group was much more likely to have received special education (25% vs 2%), be unemployed (51% vs 15%), and receive a disability pension (31% vs 3%) than the comparisons, but the levels of criminal offenses were similar. The FAS group had higher hospital admission rates for alcohol abuse (9% vs 2%) and psychiatric disorders (33% vs 5%) and was more likely to be prescribed psychotropic drugs (57% vs 27%).
Swedish children with FAS have quite diverse psychosocial outcomes in adulthood, considerably worse than for majority population peers. Potential risk and protective factors within the FAS group deserve study to enable development of effective interventions.
Comments
Fetal Alcohol Spectrum Disorder (FASD): Screening Needed in North American Criminal Justice Settings
Rangmar and colleagues are to be congratulated for their well- conducted national register-based study of adults in Sweden diagnosed with Fetal Alcohol Spectrum Disorder (FASD). Although the research literature in the United States supports the finding that individuals diagnosed with FASD are more likely to have received special education, be unemployed, receive a disability funds, and to have alcohol abuse problems, there is epidemiological evidence to suggest that rates of crime are higher in this population in North America.
At a prevalence of between 2-5% of the population in the United States (May et al., 2009), FASD is a public health issue impacting millions of residents. Individuals diagnosed with FASD generally experience a host of impairments that can negatively impact social, educational, vocational, and cognitive functioning. Such impairments have been associated with serious adverse outcomes such as criminality (Fast & Conry, 2009). Hence, professionals working in the justice sector - where impairments in adjudication capacities and Miranda rights understanding and appreciation have been seen (McLachlan et al., 2014) - need to cultivate an increased awareness of how to effectively approach, communicate with, and treat individuals with FASD.
It is currently unknown how many legal professionals receive training on the various clinical phenomena associated with FASD. Such training is important, as the effects of FASD do not always appear as obvious birth defects (Caprara et al., 2007). Thus, those with FASD tend to have major disadvantages within the criminal justice system, since police officers, lawyers, and judges may not recognize the signs and symptoms of their disability.
Understanding the characteristics of FASD would aid forensic professionals in developing an improved awareness about how to approach, communicate, and best serve individuals with FASD who are most at risk for coming into contact with the criminal justice system. A critical first step in this process is conducting further research to establish a validated screening protocol for FASD in forensic settings such as pretrial evaluation centers, courtrooms, prisons, jails, community corrections facilities, and mental health units designed to restore competency. In addition to developing screening protocols, future research could explore the unique needs of individuals diagnosed with FASD when it comes to different forms of forensic assessment including recidivism risk, competency, and malingering assessments.
References
Caprara, D. L., Nash, K., Greenbaum, R., Rovet, J., & Koren, G. (2006) Novel approaches to the diagnosis of fetal alcohol spectrum disorder. Neuroscience & Behavioral Reviews, 31, 254-260.
Fast, D. K., & Conry, J. (2009). Fetal alcohol spectrum disorders and the criminal justice system. Developmental Disabilities Research Reviews, 15, 250-257.
May, P. A., Gossage, J. P., Kalberg, W. O., Robinson, L. K., Buckley, D., Manning, M., & Hoyme, H. E. (2009). Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Developmental Disabilities Research Reviews, 15, 176-192.
McLachlan, K., Roesch, R., Viljoen, J. L., & Douglas, K. S. (2014). Evaluating the psycholegal abilities of young offenders with Fetal Alcohol Spectrum Disorder. Law and Human Beahvior, 38, 10-22.
Conflict of Interest:
None declared