Suggestibility, false confessions and competency to stand trial in individuals with fetal alcohol spectrum disorders: current concerns and recommendations

Published date04 November 2019
Date04 November 2019
DOIhttps://doi.org/10.1108/JCP-11-2019-050
Pages166-172
AuthorClare Sarah Allely,Raja Mukherjee
Subject MatterHealth & social care,Criminology & forensic psychology,Criminal psychology,Sociology,Sociology of crime & law,Deviant behaviour,Public policy & environmental management,Policing,Criminal justice
Clare Sarah Allely and Raja Mukherjee
Suggestibility, false confessions and competency to stand trial in individuals with
fetal alcohol spectrum disorders: current concerns and recommendations
Fetal alcoholspectrum disorder( FASD)is a lifelong disorderwhich is the result of prenatalexposure
to alcohol (PAE) (Charness et al., 2016; Rangmaret al., 2015). Alcohol crossesthe placenta which
may result in cell damage and have an impact on developing organs (including the brain and the
spinal cord).There are numerous organs which are sensitiveto alcohol exposure across all stages
of pregnancy (Jonsson, 2019). FASD, previously considered an umbrella term for a range of
accepted diagnoses including: fetal alcohol syndrome (FAS), partial FAS, alcohol-related
neurodevelopmental disorder (ND) and alcohol-related birth defects. Increasingly these terms are
being replaced by the FASD with and without dysmorphic features in the UK (SIGN, 2018).
Individuals with FASD exhibit a variety of symptoms including cognitive (e.g. intelligence,
executive control, and memory),social (e.g. communication skills and suggestibility) and adaptive
(e.g. decisionmaking ability and capacityto solve problems) impairments(Brown et al.,2011;BoS,
BMA, 2016).One of the misconceptionsregarding FASD is that individualwill exhibit facialfeatures
that would suggest PAE. However, this is rarely the case. The majority of individuals who
experiencethe negative effects of PAElack any physical symptoms. It has beenestimated that less
than 10 per centof individuals with FASDexhibit the physical featureswhich have been foundto be
associatedwith PAE (Astley, 2010).Moreover, individualswho do exhibit the physicalsymptoms of
PAE, typically diagnosed as FAS (i.e. short palpebral fissures, thin vermilion border, smooth
philtrum and growth deficits), tend to become less marked or pronounced as the individual gets
older (Streissguth et al., 1991). Individuals withFASD often present with a range of other physical
and mental health problems. A review identified 428 comorbid conditions linked to FASD. They
suggest rather thanbeing referred for FASD, these comorbid conditions are how individuals may
present to services (Popova et al., 2016).
Currently, there a re no guidelines whic h are developed to inf orm and support men tal health
professionals in the detection and identification of PAE in mental health professionals amongst
their patient popu lation (Mela et al., 2019). In order to make the diagnostic process more
accessible to mental health professionals (as well as address some of the key diagnostic
complexities sur rounding FASD), the D iagnostic and Statis tical Manual Fifth Edition
(DSM-5; American Psychiatric Association, 2013) included ND associated with prenatal
alcohol exposure (ND-PAE) as an example under the diagnosis Other Specified
Neurodevelopmental Disorder. Therefore, DSM-5 allows for a clinical diagnosis of
Other Specified Neurodevelopmental Disorder Neurodevelopmental Disorder Associated
with Prenatal Alcohol Disorder. The diagnostic criteria are included in a section of the DSM-5
which is designate d as Conditions for Further Study(Brown et al., 2017). Based on a review
of the FASD literature, Roozen et al. (2016) found the overall prevalence rate of FASD to be
3.35 per cent in the US A. McQuire et al. (2019) recently carried out a study which screened for
the prevalence of FASD in a region of the UK using data from a popula tion-based birth-cohort
study. The screeni ng prevalence estimates identi fied in this study indicates that F ASD is likely
to be a significant pub lic health concern i n the UK. Given current patterns of alcoho l
consumption and re cent changes in prenatal guidance, a ctive case ascertainment studies a re
urgently needed to f urther clarify the current epid emiology of FASD in the general pop ulation of
the UK(McQuireet al., 2019, p. 344).
The prevalence in the legal context seems to be higher in both juvenile and adult offender
samples (e.g. Fast et al., 1999; MacPherson et al., 2011; Brintnell et al., 2019). It is important to
Clare Sarah Allely is based at
The University of Salford,
Salford, UK.
Raja Mukherjee is based at the
FASD, Surrey and Borders
Partnership NHS Foundation
Trust, Leatherhead, UK.
PAGE166
j
JOURNAL OF CRIMINAL PSYCHOLOGY
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VOL. 9 NO. 4 2019, pp. 166-172, © Emerald Publishing Limited, ISSN 2009-3829 DOI 10.1108/JCP-11-2019-050
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