Prevalence of Fetal Alcohol Spectrum Disorder and Screening in the Forensic Context

Abstract

In juvenile corrections systems, 18.3% of children and adolescents (one in every six people) have a fetal alcohol spectrum disorder (FASD), and rates for adults in the criminal justice system are similar. FASD is a lifelong condition, with outcomes complicated by delayed recognition and treatment (less than 1% are ever diagnosed), which delays entry into diagnosis-informed care pathways. Rates of adverse childhood experiences (ACEs) are greatly increased in people with FASD (only 10% have 0 or 1 ACE, 35.7% have 2–6 ACES, and 54.1% have 7–10 ACEs). Delayed diagnosis and exposure to ongoing adversity increase risk of learning disorders, poor judgment, impaired socialization, substance use disorders, familial and individual mortality, chronic illness, mental disorders, incarceration, victimization, and dependent living. This chapter presents a recent validity study involving the Alcohol Related Neurodevelopmental Disorder Behavioral Checklist (ABC), a screening instrument designed to detect possible FASD in children and adolescents. Routine screening for the neurocognitive symptoms of FASD as a case-finding strategy during childhood should be a routine component in well-child visits. This process should include at least one screen for all children and three or more screens for children in out-of-home placements (e.g., foster care, special education, juvenile corrections) as well as children with attention-deficit hyperactivity disorder, intellectual disability, and anxiety disorders. Along with routine screening, increased training is urgently needed for forensic professionals (e.g., court, corrections, and parole and probation systems) to improve recognition of FASD and link recognition with diagnosis-specific services.

Screening: If you get what you want—you may not want what you get.—Burd (2015), Screening for FASD in corrections systems