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BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Fetal Alcohol Spectrum Disorder | Research article

Prevalence and characteristics of adults with fetal alcohol spectrum disorder in corrections: a Canadian case ascertainment study

Authors: K. McLachlan, A. McNeil, J. Pei, U. Brain, G. Andrew, T. F. Oberlander

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Individuals with fetal alcohol spectrum disorder (FASD) experience a range of cognitive, affective, and physical deficits following prenatal alcohol exposure. They are thought to be overrepresented in criminal justice settings. However, limited evidence is available to inform prevalence. We sought to estimate the prevalence of FASD in a Northern Canadian correctional population.

Methods

Using an active case ascertainment approach we recruited a representative sample of 80 justice-involved adults (ages 18–40, 85% male) over an 18-month period from 2013 to 2015. Participants completed interdisciplinary clinical assessments comprising medical and psychological evaluations that adhered to the 2005 Canadian FASD Diagnostic Guidelines.

Results

We identified a high rate of FASD (17.5, 95% CI [9.2, 25.8%]) in this sample, and this rate could have been as high as 31.2% with confirmation of prenatal alcohol exposure. Most participants in this study presented with significant neurodevelopmental and cognitive deficits in at least two domains of functioning, irrespective of diagnosis, with only five of 80 participants (6.3%) demonstrating no cognitive impairment.

Conclusions

Findings showed disproportionately high estimated FASD prevalence in this representative sample compared to general population estimates in both Canada and the U.S. (2–5%), underscoring the need for improved FASD screening and diagnosis in correctional settings, and education for clinicians working in the justice context. Strengthened health prevention and intervention efforts to support the needs of individuals with FASD outside the criminal justice context are needed.
Footnotes
1
Individuals serving Federal sentences or under the supervision of a Review Board were not eligible
 
2
Individuals identifying their background as First Nation, Métis, or Inuit.
 
3
A revised set of Canadian Diagnostic Guidelines for FASD were released subsequent to data collection, resulting in changes to diagnostic terminology and criteria [2].
 
4
PAE was ranked using the 4-digit diagnostic code [33]. Rank 4 (‘high risk’) is rendered in cases of confirmed high risk PAE, Rank 3 (‘some risk’) is reserved for cases where PAE is confirmed but level is considered less than rank 4 or unknown, Rank 2 (‘unknown risk’) is used when PAE is unknown, and rank 1 (‘no risk’) is given when PAE is confirmed to be completely absent.
 
5
Clinicians ranked the presence of neurodevelopmental deficits across all domains using the 4-digit diagnostic code (Rank 1 = No Dysfunction; Rank 2 = Moderate Dysfunction; Rank 3 = Severe Dysfunction) (Table 5). [33]
 
6
Hard and soft neurological signs, brain structure, and communication were not rated in this manner owing to more circumscribed measurement in these areas.
 
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Metadata
Title
Prevalence and characteristics of adults with fetal alcohol spectrum disorder in corrections: a Canadian case ascertainment study
Authors
K. McLachlan
A. McNeil
J. Pei
U. Brain
G. Andrew
T. F. Oberlander
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-6292-x

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