Neurocognitive Functioning and Treatment Implications in Offenders with Fetal Alcohol Spectrum Disorder

Abstract

This dissertation consists of three separate papers exploring how an understanding of neurocognitive functioning can guide treatment for offenders with FASD. The first paper is a review of the literature on the relationship between neurocognitive impairment and high risk, delinquent, and criminal behaviour, followed by an overview of the needs of offenders with FASD in the context of the current Canadian justice system. This review concludes with the recommendation that a systemic shift, which incorporates a consideration of the biological, psychological, and social factors that impact criminality, will best support pro-social behaviours and reduce recidivism among individuals with FASD. The goal of the second paper was to explore whether young offenders with FASD present with a unique profile of neurocognitive functioning compared to young offenders without FASD. A retrospective file review was conducted on clinical data obtained from neurocognitive assessments with 81 youth with and without FASD (aged 12 to 20 years) in an Alberta young offender treatment program. Relative to a Comparison group, young offenders with FASD displayed a unique neurocognitive profile, with deficits in cognitive flexibility, verbal and working memory, academics, complex processing speed, verbal ability, and inhibition (in males only), and relative strengths in simple processing speed, motor skills, visual memory, and visual-perceptual reasoning ability. These findings are discussed in the context of how we may use information about neurocognitive functioning to guide screening, sentencing, and programming practices for young offenders with FASD. In the third paper, I explored perspectives of service providers working with an innovative justice program in rural Alberta for adults with suspected FASD. The goal was to identify the perceived impacts and challenges of using information from neurocognitive assessments to inform court decisions. Through two focus groups with 18 participants, four themes were identified: building capacity, humanizing the offender, creating bridges, and moving forward. Themes are discussed in reference to existing recommended practices for working with offenders with FASD, and future avenues for research are identified.