Fetal Alcohol Spectrum Disorder in Fetal Alcohol Spectrum Disorder in a correctional population:a correctional population:

Preliminary results from an incidence Preliminary results from an incidence study in a federal penitentiarystudy in a federal penitentiary

Brian A. Grant & Patricia MacPherson Brian A. Grant & Patricia MacPherson Addictions Research CentreAddictions Research Centre

Albert E. Chudley, University of ManitobaAlbert E. Chudley, University of Manitoba

Addictions Research Centre23 Brook St., Montague, PEI C0A 1R0

902-838-5905 addictionsresearch@csc-scc.gc.ca

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Project Team

• Patricia MacPherson, Addictions Research Centre (ARC)

• Brian Grant, (ARC)

• Ab Chudley, University of Manitoba

• Fred Boland, Queens University

• Charlotte Fraser (ARC)

• Staff:

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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)

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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

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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

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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

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• 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/er71.pdf

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Challenges in the prison environment

• Victimization

• Prison routine / rules

• Wanting to fit in

• Inappropriate sharing of information

• Inappropriate social behaviours

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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

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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.

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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

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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

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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

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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

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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

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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

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• 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

Debriefing

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• 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

Disclosure

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• 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

Follow-up

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Preliminary Results

Participant Recruitment

• 96 current participants

• 58 declined

• 8 withdrawn

• ~ 59% participation rate

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Demographics for case conference sample

• 64% Aboriginal • 25% Caucasian • 11% Other racial groups

• 51% Single• 49% Married/common law

• Average age 24

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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

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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

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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

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Average Scores on Behavioural Items

97

79 7667

0

20

40

60

80

100

120

A B C D

Ave

rag

e S

core

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Average Score on Historical Items

4

1.85

1.070.66

0

1

2

3

4

5

A B C D

Ave

rag

e S

core

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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 (> 5 drinks)

41 33

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Reporting on prenatal alcohol exposure

Offender

52%

4%

44%

Yes

No

Unknown

Collateral

50%

23%27%

Mother

85%

15%

Yes=3Yes=17

Yes=6

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Other Drug Use During Pregnancy

0

10

20

30

40

50

60

Tobacco Prescription Illicit

Offender

Collateral

Mother

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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

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Birth/Hospital Records

Maternal pregnancy records

• 77% of mothers agreed to release records related to their pregnancy

• 59% of pregnancy records have been received

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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

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Level of Neuropsychological Deficits Identified in case conference sample

0% 20% 40% 60% 80% 100%

Visuomotor Skills

Attention

Executive functioning

IQ - Cognitive

Language

Memory

Adaptive Behavior

Academic Achievement

No Impairment Moderate Impairment Significant Impairment

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Overall risk and need for offenders with prenatal alcohol exposure identified

0

10

20

30

40

50

High Risk High Need

Perc

ent

Prenatal Alcohol

No Alcohol Exposure

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Overall risk and need for offenders with neuropsychological deficits identified compared to those without

0

20

40

60

80

High Risk High Need

Perc

ent

CNSNo Deficits

*

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Youth Court History

0

20

40

60

80

100

Youth Court History DisciplinaryReports

Transfer from youthto adult

Perc

ent

CNSNo Deficits

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Adult Court History

0

20

40

60

80

Previous Adult Offence Segregation Reclassified to higherlevel of custody

Perc

ent

CNSNo Deficits

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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