Framework for action.

Background


Limited evidence suggests that people with ID (ID) are overrepresented in prisons although prevalence rates of ID among prisoners vary significantly across studies, making it difficult to identify prevalence and assess existing need.


Method


A systematic review of relevant literature was conducted, and results were organized and compared in relation to study aims, design, measures used to screen for ID, sample, limitations and key findings.


Results


Existing international data suggest a prevalence of prisoners with ID between 7 and 10%. Most frequent coexisting health issues among this population are hearing and vision impairments, obesity, diabetes and a range of mental health disorders, notably anxiety and personality and conduct disorders.


Conclusion


More research is required on prevalence rates and associated comorbidities of ID within prison settings, taking into account the heterogeneity of the population with ID.

Intellectual Disabilities Among Prisoners: Prevalence and Mental and Physical Health Comorbidities

Individuals with a diagnosis of fetal alcohol spectrum disorder (FASD) experience a range of physical, cognitive, and behavioral deficits thought to interfere with their ability to competently navigate the arrest, interrogation, and trial process. This study examined the psycholegal abilities of young offenders with FASD, including their understanding and appreciation of Miranda rights, and adjudication capacities (factual knowledge of criminal procedure, appreciation of the nature and object of the proceedings, ability to participate in a defense and communicate with counsel). Two groups of young offenders (50 with FASD and 50 without prenatal alcohol exposure) completed Grisso's Instruments for Assessing Understanding and Appreciation of Miranda rights and the Fitness Interview Test-Revised to assess overall rates of impairment in youth with FASD, as well as differences between the groups. Potentially important predictors of psycholegal abilities were also evaluated. Results indicated the majority of young offenders with FASD (90%) showed impairment in at least one psycholegal ability, and rates of impairment were significantly higher than the comparison group. However, considerable within-group variability was observed. IQ and reading comprehension emerged as robust predictors of participants' psycholegal abilities, while the FASD diagnosis differentiated participants' scores on the FIT-R. These findings underscore the importance of individualized and comprehensive forensic assessments of psycholegal abilities in this population when warranted. Additional system level strains for this population are discussed, including problems in approaching competency remediation, and the potentially growing need for accommodation and forensic assessments in the face of limited financial and professional resources in legal settings.

/pdf/evaluating-the-psycholegal-abilities-of-young-offenders-with-1qpx9dgljc.pdf

Evaluating the psycholegal abilities of young offenders with fetal alcohol spectrum disorder.

The Lililwan Project is the first population-based study to determine Fetal Alcohol Spectrum Disorders (FASD) prevalence in Australia and was conducted in the remote Fitzroy Valley in North Western Australia. The diagnostic process for FASD requires accurate assessment of gross and fine motor functioning using standardised cut-offs for impairment. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) is a norm-referenced assessment of motor function used worldwide and in FASD clinics in North America. It is available in a Complete Form with 53 items or a Short Form with 14 items. Its reliability in measuring motor performance in children exposed to alcohol in utero or living in remote Australian Aboriginal communities is unknown. A prospective inter-rater and test-retest reliability study was conducted using the BOT-2 Short Form. A convenience sample of children (n = 30) aged 7 to 9 years participating in the Lililwan Project cohort (n = 108) study, completed the reliability study. Over 50% of mothers of Lililwan Project children drank alcohol during pregnancy. Two raters simultaneously scoring each child determined inter-rater reliability. Test-retest reliability was determined by assessing each child on a second occasion using predominantly the same rater. Reliability was analysed by calculating Intra-Class correlation Coefficients, ICC(2,1), Percentage Exact Agreement (PEA) and Percentage Close Agreement (PCA) and measures of Minimal Detectable Change (MDC) were calculated. Thirty Aboriginal children (18 male, 12 female: mean age 8.8 years) were assessed at eight remote Fitzroy Valley communities. The inter-rater reliability for the BOT-2 Short Form score sheet outcomes ranged from 0.88 (95%CI, 0.77 – 0.94) to 0.92 (95%CI, 0.84 – 0.96) indicating excellent reliability. The test-retest reliability (median interval between tests being 45.5 days) for the BOT-2 Short Form score sheet outcomes ranged from 0.62 (95%CI, 0.34 – 0.80) to 0.73 (95%CI, 0.50 – 0.86) indicating fair to good reliability. The raw score MDC was 6.12. The BOT-2 Short Form has acceptable reliability for use in remote Australian Aboriginal communities and will be useful in determining motor deficits in children exposed to alcohol prenatally. This is the first known study evaluating the reliability of the BOT-2 Short Form, either in the context of assessment for FASD or in Aboriginal children.

/pdf/the-bruininks-oseretsky-test-of-motor-proficiency-short-form-4yb6w5qf5a.pdf

The Bruininks-Oseretsky Test of Motor Proficiency-Short Form is reliable in children living in remote Australian Aboriginal communities

Courts are becoming increasingly aware of Fetal Alcohol Syndrome (FAS)/Alcohol Related Neurodevelopmental Disorders (ARND) and there is a line of authority concerned with the development of specific legal principles that are exclusively applicable to the sentencing of offenders with such a condition. However, the courts that take into account the specific and unique needs of an offender with FAS/ARND face challenges and barriers because of the lack of cooperation and resources in the correctional system to accommodate and treat offenders with FAS/ARND.This paper will consider the jurisprudence in this area and describe how traditional sentencing principles are seen to be inappropriate and are rejected in favor of a sentencing approach that is sensitive to the unique circumstances of offenders with FAS/ARND. Beginning with an overview of the nature of FAS/ARND and its prevalence in the criminal justice system, we then examine the case law involving the sentencing of offenders with this condition and identify emerging sentencing principles and issues of concern. In particular, we discuss the problems identified by a number of judges who are prevented from being able to fashion appropriate sentences for offenders afflicted with FAS/ARND. Some of the problems with the initial assessment of FAS/ARND and of the failure of the existing corrections system to provide appropriate sentencing options for offenders with FAS/ARND have also given rise to various challenges based on Charter and potential human rights violations. Finally, we examine some of the responses to these problems and we offer a few suggestions for reform.

https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID2332280_code1212315.pdf?abstractid=2332280&mirid=3

The Sentencing of Offenders with Fetal Alcohol Syndrome

Nearly four decades have passed since a link was first established between alcohol consumption during pregnancy and a particular pattern of birth defects. Since then, autopsy, longitudinal, structural imaging, and functional imaging studies have revealed a great deal about the teratogenic effects of alcohol. This paper provides a comprehensive summary of the findings from the neurocognitive and behavioral literature on fetal alcohol spectrum disorder (FASD) and outlines the unique profile of cognitive deficits associated with it. We describe diagnostic issues as well as factors contributing to the heterogeneity of the FASD cognitive presentation. Next, we review research on the impact of prenatal alcohol exposure on intellectual functioning, attention, executive functioning, learning and memory, language, quantitative reasoning, and social cognition. In our opinion, future research can now begin to focus on FASD-specific interventions directly informed by the rich body of neurocognitive findings accumulated thus far. WIREs Cogn Sci 2013, 4:81-92. doi: 10.1002/wcs.1202 For further resources related to this article, please visit the WIREs website.

Cognitive aspects of fetal alcohol spectrum disorder

Individuals with FASD exhibit deficits in many domains that can include memory, learning, behavioural inhibition, executive functioning, interpersonal skills, and language. These deficits have serious implications for affected persons when they become engaged in the legal system. In 2004, Moore and Green reviewed case law and psychological literature which suggested that FASD-related deficits placed affected individuals at a significant disadvantage in the justice system. According to them, this disadvantage stemmed from the limited awareness and knowledge of FASD demonstrated by key players in the justice system, as well as the scarcity of effective interventions in place to rehabilitate affected defendants. The aim of the current paper is to assess the extent to which awareness of FASD-related issues in the Canadian justice system has advanced since the publication of Moore and Green’s conclusions. First, the deficits associated with FASD and their implications for the justice system are described. Next, recent case law and psychological evidence are reviewed as we consider issues of witness reliability and false confessions. The significance of FASD for sentencing, fitness to stand trial, and the Not Criminally Responsible by Reason of Mental Disorder defence are also briefly discussed. Finally, emerging system wide responses to FASD-related issues are presented. Overall, it appears that the call for closer examination of FASD by the justice system has been answered, but a need for increased education and awareness remains.

A need for closer examination of FASD by the criminal justice system: has the call been answered?

Fetal alcohol syndrome (FAS) is recognized by the World Health Organization as the leading cause of environment-related birth defects and mental retardation in the western world. It results from prenatal alcohol exposure, the consequences of which fall along a continuum ranging from subtle neurodevelopmental and behavioral manifestations to FAS, the most serious outcome. Recently, the term fetal alcohol spectrum disorder (FASD) was coined to encompass all the terms that describe alcohol-related defects, including FAS (Sokol, Delaney, & Nordstrom, 2003). Other terms, such as fetal alcohol effects (FAE), partial FAS (pFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD) describe other effects within the spectrum.


Keywords:

fetal alcohol syndrome (FAS);
prenatal alcohol exposure;
teratogen;
alcohol dehydrogenase

Karina Royer Gagnier

Papers

Cognitive aspects of fetal alcohol spectrum disorder

A need for closer examination of FASD by the criminal justice system: has the call been answered?

Fetal Alcohol Syndrome