Fetal Alcohol Spectrum Disorder as a Marker for Increased Risk of Involvement with Correction Systems

Article excerpt

Fetal alcohol spectrum disorders (FASD) may be common in adolescents and adults in the corrections systems. However, current prevalence estimates for FASD suggest that nearly all affected people are undiagnosed in corrections systems. In this article we provide an overview of our experience with FASD in corrections populations and present strategies for screening, assessment and intervention. We conclude with a plan to provide training to corrections staff in response to identified preferences and needs identified by Canadian and American corrections staff.

KEY WORDS: Fetal Alcohol Syndrome, corrections, prison, screening, diagnosis, management.

Of the four million annual pregnancies in the United States, about 40% of women drink some alcohol during pregnancy and about 3-5% of women drink heavily throughout pregnancy (Floyd, Decoufle, & Hungerford, 1999). The prevalence of alcohol use by women during their childbearing years in the United States was 53% in 2006 (Floyd et al., 2008). In pregnant women, frequent alcohol use was reported by 12.5%, and third trimester drinking by 4.6% in 2001 (Floyd & Sidhu, 2004). There is no known safe level of alcohol consumption during pregnancy. For the four million pregnancies each year in the United States, these rates translate to 500,000 pregnant women drinking at least weekly and about 80,000 with high levels of persistent exposure throughout pregnancy. Thus, the cumulative number of prenatally exposed infants, children and adolescents in the United States alone would be in the millions.

The most extreme adverse outcomes from high exposure include miscarriage, stillbirth, and increased risk for mortality throughout the lifespan (Burd & Wilson, 2004; Burd, Carlson, & Kerbeshian, 2009; Stratton, Howe, & Battaglia, 1996). The mortality risk for people with Fetal Alcohol Spectrum Disorders (FASD) is more than doubled. The mortality risk for siblings of people with FASD is increased 530% and the maternal mortality rate in the 10-year period after the birth of the child with FASD is about 4.5% (Burd, Klug, & Martsolf, 2004; Burd et al., 2008). With live births, exposure is associated with increased risk for a wide range of birth defects, growth impairments, and brain damage (Abel, 1998; Stratton et al., 1996). The societal implications of prenatal alcohol exposure (PAE) are substantial. The annual cost of care for affected people is estimated to be $3.6 billion dollars in the United States, and the lifetime cost of care for individuals with FASD is $2.9 million dollars per case (Lupton, Burd, & Harwood, 2004). Canadian research teams have reported similar costs, with an estimated annual cost close to CA$4 billion (Stade et al., 2009; Thanh & Jonsson, 2009). These studies have not included the substantial costs associated with involvement in juvenile corrections or the adult criminal justice system, including policing, lawyers, court time, incarceration, and transition back to the community.

Using current diagnostic criteria, about 5-10% of people with significant prenatal alcohol exposure will have FASD. FASD is an umbrella term encompassing the different diagnostic categories; it is not a diagnosis. The diagnostic categories include Fetal Alcohol Syndrome (FAS), partial Fetal Alcohol Syndrome (pFAS), Alcohol-Related Neurodevelopmental Disorder (ARND) and Alcohol-Related Birth Defects (ARBD) (Stratton et al., 1996).

Currently several schema are being used for diagnosis of FASD (Astley, 2006; Burd, Martsolf, & Juelson, 2004; Chudley et al., 2005; Hoyme et al., 2005; Stratton et al., 1996). The diagnosis of ARND is more complex than that of FAS and pFAS because of the absence of physical markers. More attention to ARND is required as many children, adolescents and adults have lifelong difficulties with behavioral and mental disorders from PAE (Burd et al., 2009). Table 1 provides a summary of the Canadian criteria for FASD (Loock, Conry, Cook, Chudley & Rosales, 2005). …