Foetal alcohol spectrum disorder (FASD) – its relevance to forensic adolescent services
| Pages | 124-137 |
| Published date | 08 September 2014 |
| Date | 08 September 2014 |
| DOI | https://doi.org/10.1108/JIDOB-10-2014-0015 |
| Author | Ernest Gralton |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour |
Foetal alcohol spectrum disorder (FASD) –
its relevance to forensic adolescent
services
Ernest Gralton
Dr Ernest Gralton is a
Consultant Forensic
Psychiatrist, based at
Adolescent Developmental
Disabilities, St Andrew’s
Healthcare, Northampton, UK.
Abstract
Purpose – There needs to be an increased recognition of fetal alcohol spectrum disorder (FASD)in services
that deal with young people with disruptive and offending behavior, not just those services that deal with
adolescents with a recognized intellectual disability. The paper aims to discuss these issues.
Design/methodology/approach – This is a general review of the current available evidence on FASD and
how it is likely to predispose affected young people to have contact with secure mental health services and
the criminal justice system.
Findings – FASD is likely to have become a more common cause of intellectual disability and behavioral
disturbance but the history of significant alcohol exposure in utero if often missed. There is evidence that
the hyperactivity is less responsive to psychotropic medication and may represent a different condition to
conventional ADHD. However the majority of those affected are in the low normal IQ range.
Research limitations/implications – There is so far very limited research in what is likely to be a relatively
common disorder with significant costs to criminal justice, mental healthcare and social services.
Epidemiological information from the UK is lacking and urgently needed.
Practical implications – Professionals who work with mentally disordered young people need to be more
aware of FASD and its potential contribution to the problems and disabilities in their population.
Social implications – Social workers, foster carers and adoptive parents need to be more aware of FASD
and how it can contribute to the breakdown of social care.
Originality/value – There is currently no other review of FASD and the implications for criminal justice,
secure mental health and social care for young people.
Keywords Offending, Adolescent, Intellectual disability, Criminal justice, FASD, Fetal alcohol
Paper type General review
The history of FASD
The dangers of alcohol in pregnancy may have been reported as far back as Aristotle and the
Bible. Francis Bacon commented in 1627, “if the mother [y] drink wine or strong drink
immoderately [y] it endangereth the child to become a lunatic, or of imperfect memory” (Black,
2014). Perhaps the first overt forensic reference comes from the increase in criminal behavior in
London described by Henry Fielding following the eighteenth century “gin epidemic” famously
illustrated by Hogarth (Calhoun and Warren, 2007). However the teratogenicity of alcohol was
only scientifically recognized in the late 1960s in the French medical literature and subsequently
formally describedas Fetal Alcohol Syndromeor FAS in the early 1970s (Jonesand Smith, 1973).
Diagnosis
FAS was classically associated with a specific clinical presentation, with: prenatal and/or
postnatal growth deficiency; characteristic facial features (e.g. short palpebral fissures,
PAGE 124
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JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
j
VOL. 5 NO. 3 2014, pp. 124-137, CEmerald Group Publishing Limited, ISSN 2050-8824 DOI 10.1108/JIDOB-10-2014-0015
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