Transcript Preliminary Results of Fetal Alcohol Spectrum Disorder

Fetal Alcohol Spectrum Disorder in
a correctional population:
Preliminary results from an incidence
study in a federal penitentiary
Brian A. Grant & Patricia MacPherson
Addictions Research Centre
Albert E. Chudley, University of Manitoba
Addictions Research Centre
23 Brook St., Montague, PEI C0A 1R0
902-838-5905
[email protected]
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)
3
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:
• FASD:
1 – 3 per 1000 live births
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
9
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 evaluations15
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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Debriefing
• 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
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Disclosure
• 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 18
Follow-up
• 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
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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 information
Case 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 information
Case 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
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* Other includes step-parent, foster parent, adoptive parent, friend, or cousin
Average Scores on Behavioural Items
120
Average Score
100
97
79
80
76
67
60
40
20
0
A
B
C
D
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Average Score on Historical Items
Average Score
5
4
4
3
1.85
2
1.07
1
0.66
0
A
B
C
D
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Reported Prenatal Alcohol Exposure
Drinking
Questions
Drink during full
pregnancy
Drink during part
of pregnancy
Drink 2-3 times
per week
Drink 2-4 times
per month
Binge Drinking (>
5 drinks)
Collateral
(N = 17) %
35
Mother
(N = 6) %
17
35
67
29
0
12
50
41
33
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Reporting on prenatal
alcohol exposure
Offender
Collateral
Yes
No
Unknown
4%
52%
23%
27%
44%
50%
Yes=17
Yes=3
Mother
15%
Yes=6
85%
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Other Drug Use During Pregnancy
60
Offender
Collateral
Mother
50
40
30
20
10
0
Tobacco
Prescription
Illicit
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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
No Impairment
Moderate Impairment
Significant Impairment
Academic Achievement
Adaptive Behavior
Memory
Language
IQ - Cognitive
Executive functioning
Attention
Visuomotor Skills
0%
20%
40%
60%
80%
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100%
Overall risk and need for offenders with
prenatal alcohol exposure identified
50
Prenatal Alcohol
No Alcohol Exposure
40
30
Percent
20
10
0
High Risk
High Need
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Overall risk and need for offenders with neuropsychological
deficits identified compared to those without
80
CNS
No Deficits
Percent
60
40
*
20
0
High Risk
High Need
35
Youth Court History
100
CNS
No Deficits
80
Percent
60
40
20
0
Youth Court History
Disciplinary
Reports
Transfer from youth
to adult
36
Adult Court History
80
CNS
No Deficits
Percent
60
40
20
0
Previous Adult Offence
Segregation
Reclassified to higher
level of custody
37
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
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