Last updated February 22, 2018 at 9:59 am
And 90 per cent have a severe neuro-disability.
Prof Carol Bower and Clinical Associate Professor Raewyn Mutch spent two years working with 100 young people ranging in age from 10 to 17 in the Banksia Hill youth detention facility, with the results published in the BMJ Open today.
Many of the young people in detention have a long history of contact with government and child service agencies before their incarceration.
Bower said the team had set out to look specifically for Fetal Alcohol Spectrum Disorder (FASD) but were surprised to find evidence of severe neurodevelopmental impairment in almost every young person they assessed.
“Of the 99 young people who completed full assessments we found 36 of them – more than one in three – had FASD,” Professor Bower said. “Of this 36, only two had been previously diagnosed.”
Professor Bower said this was the highest known prevalence of FASD in a custodial/corrective setting worldwide, and almost double the previous highest Australian estimate in a non-custodial setting.
“Society has failed these children,” says Prof Bower, “If we’d been able to identify some of these disabilities before the extreme of getting into trouble with the law, we may have been able to prevent that happening.”
What is Fetal Alcohol Spectrum Disorder?
Fetal Alcohol Spectrum Disorder (FASD) is an “invisible disease” with life-long impacts. It is a brain injury caused by exposure of the unborn baby’s brain to alcohol during development. The damaging effects of alcohol on the developing brain can lead to difficulties and impairments in a huge range of domains for FASD sufferers including
- Motor skills
- Brain structure and neurology
- Cognition, including verbal and non-verbal reasoning skills
- Expressive and receptive language skills
- Academic achievement
- Excecutive function, including impulse control and hyperactivity
- Mood and anxiety disorders
- Difficulties with everyday life skills, social skills, or social communication
How big is this problem?
It’s thought that between 2 and 5 per cent of the general population may be affected by FASD, which often goes undiagnosed.
“Diagnosis in this country is very low,” says Prof Bower, “Though there is increased diagnosis with increased interest and research into the condition.”
There are surprisingly few studies of FASD in the youth justice system. The handful of previously reported studies, all from Canada, found a rate between 11 – 23 per cent.
The 36 per cent rate found in this study is much higher, and still may represent an underdiagnosis, as confirmation of exposure to alcohol prenatally is one of the diagnostic criteria.
“There were 13 of the young people in this study where we were unable to determine whether they had exposure, and some had severe impairment” says Prof Bower.
Indigenous people specially at risk
It’s an issue that disproportionally effects Aboriginal and Torres Strait Islander people, who are overrepresented in the justice system and among people with disabilities. Australia imprisons thousands of Aboriginal people with mental and cognitive disability every year. 73 per cent of young people in detention in WA are Aboriginal. Other studies of FASD in a remote Aboriginal community in Western Australia found 19 per cent of 7- and 8-year-olds had FASD.
The authors point out that the study was not confined to Aboriginal children though, and that a very high rate of non-Aboriginal children also were found to have FASD compared to the general population.
Two-thirds of the young people assessed had at least three domains of severe neurodevelopmental impairment, and 23 per cent had five or more severely impaired domains.
“The sorts of domains we’re talking about are problems with executive function, such as not being able to relate cause and effect or to plan, and problems with memory, cognition, motor skills, attention, social skills and adaptive behaviour,” Prof Bower said.
“Almost half the young people had severe problems with language, how to listen and understand and how to reply and explain what they think.”
“These are all really important neurodevelopmental aspects of a young person’s life, yet the majority of these problems had not been previously identified.”
This is despite it being well understood that catching developmental difficulties early leads to better outcomes.
What needs to change?
“It’s our hope that young people will have a comprehensive assessment on entry to the justice system,” says Prof Bower.
“The good news is we are already working closely with the relevant departments, who gave us unprecedented support and access to enable us to undertake this project.
The researchers are developing and testing training materials to help correction services staff manage the various neurodevelopmental impairments found in this study. These resources will be made available to anyone who wants to use them.
For the children involved in this study, the team prepared reports to help detention centre staff and their carers to understand the young person’s specific difficulties and create tailored rehabilitation plans to build on their relative strengths. These individualised reports have already been very helpful for the staff and for the young person and their family, and played an important role in their appearance before the court.
“What needs to follow is increased funding to make sure that’s equally accessible to all children, not just the ones participating in this study,” says Prof Bower.
“Costs of detention are significant, both economically but also from a social and wellbeing point,” says Assoc. Prof Mutch.
“It’s not a matter of spending more money, but spending the money in a way that will make a difference. Our study provides strong science supports spending money differently so that these young people can be rehabilitated as soon as possible.”
As well as being overrepresented in the criminal justice system, FASD sufferers are also more likely to be victims of crime.
“You have a brain that doesn’t understand or interpret the world normally and it makes you more vulnerable and more likely to be pulled in to episodes of crime and bullying,” says Assoc Prof Mutch. “They’re more easily led and not able to comprehend that it’s happening to them.”
For more information on FASD you can visit the FASD Hub Australia https://www.fasdhub.org.au/