Therapeutic Recommendations in the Youth Justice System Cohort Diagnosed with Foetal Alcohol Spectrum Disorder
| Author | Natasha K. Russell,Kuen Yee Tan,Carmela F. Pestell,Sophia Connor,James P. Fitzpatrick |
| DOI | http://doi.org/10.1177/14732254211036195 |
| Published date | 01 April 2023 |
| Date | 01 April 2023 |
| Subject Matter | Original Articles |
https://doi.org/10.1177/14732254211036195
Youth Justice
2023, Vol. 23(1) 6 –28
© The Author(s) 2021
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DOI: 10.1177/14732254211036195
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Therapeutic Recommendations in
the Youth Justice System Cohort
Diagnosed with Foetal Alcohol
Spectrum Disorder
Natasha K. Russell , Kuen Yee Tan,
Carmela F. Pestell, Sophia Connor
and James P. Fitzpatrick
Abstract
Patches Paediatrics is a specialised private multidisciplinary service in Western Australia (WA), offering
a range of developmental diagnostic assessments such as foetal alcohol spectrum disorder (FASD). Many
FASD assessments occur in children and youth who are engaged with the justice system in WA and the
Northern Territory (NT). There are currently no studies outlining the types of clinical recommendations
and management strategies made or implemented by clinicians for this clinical population within Australia.
This study outlines therapeutic recommendations made as part of the youth justice FASD diagnostic process
within Patches Paediatrics to ultimately refine recommendations to inform therapeutic strategies. This was
a retrospective cross-sectional descriptive study of those aged 10 years to 17 years 11 months (N = 64)
who were diagnosed with FASD within Patches Paediatrics; and referred from the youth justice system
in WA and the NT between January 2017 and February 2019. Information on FASD recommendations
was gathered by reviewing participants’ source documents, such as FASD diagnostic reports. ‘FASD
recommendations’ categories were divided into subdomains: medical, mental health, developmental, lifestyle,
future goals and others. In the various categories of recommendations, the most prominent were referral
for National Disability Insurance Scheme (NDIS) funding (75%) followed by education support (67.2%),
occupational therapy (56.3%), and drug and alcohol services (45.3%). Significant correlations between
impaired neurocognitive domains and recommendations were also observed. Similarly, there were significant
correlations between comorbidities and recommendations. Our study highlighted gaps in recommendations
for those with comorbid attention-deficit/hyperactivity disorder (ADHD), rural communities and access to
NDIS, therapeutic rehabilitation programmes as well as community work programmes. Other gaps included
making adequate recommendations for speech/language therapy, education support, life skills advice and
staff/clinician education. This study was the first to describe therapeutic recommendations for the youth
cohort assessed by Patches Paediatrics in WA and the NT. It also showed significant correlations between
the neurocognitive/comorbidity profile and clinical recommendations. This highlights areas within the
recommendations that can be individualised as well as ways to improve community integration. A discussion
of limitations and suggestions for future research is also provided.
Corresponding author:
Natasha K. Russell, Patches Paediatrics, 10 Leura Street, Nedlands, WA 6009, Australia.
Email: nrussellresearch@hotmail.com
1036195YJJ0010.1177/14732254211036195Youth JusticeRussell et al.
research-article2021
Original Article
Russell et al. 7
Keywords
Australian aboriginal, foetal alcohol spectrum disorder (FASD), FASD therapeutic recommendations,
Patches Paediatrics, youth justice system
Highlights
Youth justice assessments at Patches Paediatrics in WA and the NT
Fetal alcohol spectrum disorder therapeutic recommendations in youth justice
Findings highlight recommendations need to be location specific and culturally
appropriate
Forms the basis of future research avenues for establishing clinical guidelines
Introduction
The term foetal alcohol syndrome was first used in 1973 to describe children with poor
prenatal care and/or growth and characteristic facial features who were born to mothers
who were ‘alcohol dependent’ (Jones and Smith, 1973). It was not until 2000, that foetal
alcohol spectrum disorder (FASD) was coined after recognition that alcohol exposure in
utero results in neurodevelopmental problems with or without facial/physical features
(Sokol et al., 2003). Currently to be diagnosed with FASD within Australia an ‘individual
must have prenatal alcohol exposure (PAE) and severe neurodevelopmental impairment
in at least three of ten specified domains of the central nervous system structure or func-
tion’ (Bower and Elliot; On behalf of the Steering Group, 2016). The Australian Guide to
the Diagnosis of FASD categorises this into two diagnostic entities – FASD with three
sentinel facial features and FASD without three sentinel facial features (Bower and Elliot;
On behalf of the Steering Group, 2016).
Patches Paediatrics is a community-based multidisciplinary team, offering child devel-
opment, disability, therapy and early intervention services in many locations including
Western Australia (WA) and the Northern Territory (NT). The Patches Paediatrics team
specialise in the diagnosis and therapy management of children and adolescents with
FASD among other developmental concerns. The cohort that are referred receive assess-
ments for FASD to aid in justice proceedings and management. Connor et al. (2020)
described the demographic, neurocognitive and comorbidity profile of the first 199 indi-
viduals who received a FASD diagnosis in Patches Paediatrics clinics. This study high-
lighted the importance of how understanding the nature of neurodevelopmental
impairments further facilitates both the diagnostic process and providing targeted therapy
and management strategies. In the community, Reid et al. (2017) assessed 37 children
between 2014 and 2015 as part of the first Australian public FASD diagnostic service. It
was found that 84 per cent had a comorbid diagnosis, in particular: 61 per cent attention-
deficit/hyperactivity disorder (ADHD) and a majority had no significant facial features.
The Australian Institute of Health and Welfare report 2018–2019 describes the different
kinds of supervision in the youth justice system. Unsentenced supervision can be either on
bail (community-based) or remanded in custody (detention). Sentenced supervision can be
parole/supervision release/ suspended detention (community-based) or sentenced to deten-
tion (detention) (Australian Institute of Health and Welfare (AIHW), 2020). On an average
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