Understanding FASD

Understanding FASD, Employment and Involvement with the Justice System​

What is FASD

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FASD and Involvement in the Justice System

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FASD and Transitioning into Employment

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In this section

What is FASD?

Fetal Alcohol Spectrum Disorder, or FASD, refers to a spectrum of lifelong and adverse effects that occur in an individual who has been exposed to alcohol before birth.

There is no ‘safe’ level of alcohol consumption during pregnancy. To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy are advised not to drink alcohol.

If consumed during pregnancy, however, alcohol can readily pass through the placenta and enter the bloodstream of a fetus. Alcohol has the potential to damage the developing brain and to significantly interfere with development.

FASD has significant effects on individual persons, their families and society at large. These effects are particularly significant for health, education, disability and justice systems.

In Australia, FASD is under-recognised and often goes undiagnosed for the entirety of an individual’s life.

In Australia, FASD is under-recognised and often goes undiagnosed for the entirety of an individual’s life.

Most people with FASD do not display overt, physical symptoms of FASD and therefore, the disorder is often referred to as a ‘hidden disability’.

Click to view the impacts on an individual’s physiology that FASD can cause:

Impairments in neurodevelopmental domains

There are ten neurodevelopmental domains that are assessed when diagnosing FASD, with at least 3 of those needing to be met:  
  • Brain structure/neurology
  • Motor skills (movement and actions of muscles)
  • General cognition (e.g., intelligence)
  • Language
  • Academic Achievement
  • Memory and learning
  • Attention
  • Executive function including impulse control and hyperactivity
  • Regulation of mood and affect
  • Adaptive behaviour, social skills or social communication

Atypical facial characteristics

Some people with FASD can have distinctive facial features though most do not. When they occur, those facial features may present as; small eye openings, thin upper lip, and smoothed groove between the nose and the upper lip.

Additional medical issues

Alcohol can cause serious physical and medical damage to the fetus. An individual exposed to alcohol in utero can be born with several medical issues including:

  • Sensory problems – vision and/or hearing (at times involving permanent hearing loss)
  • chronic otitis media
  • Skeletal defects
  • Organ damage -brain, heart, liver and kidney
  • Stunted growth
  • Preterm birth is also more common among infants with FASD.

FASD is a spectrum disorder, and the range and severity of cognitive and physical symptoms differs from one person to the next.

FASD is permanent, with symptoms and impairments remaining apparent throughout the person’s life.

FASD can result in uneven and confusing maturity development. Strong abilities in some areas such as general intelligence can mask delays or challenges in others such as language.

When interacting with someone with FASD, one is encouraged to think younger, as ‘dysmaturity’ can be a symptom of the condition.

How Common is FASD?

The prevalence of FASD in Australia is unclear due to a lack of accurate research data for the Australian population. 

Detection of FASD is also  impacted by confusion around standard diagnostic criteria and definitions of FASD. A consistent approach for accurate diagnosis is still under development in Australia and internationally.  

Click to view what we know about FASD Prevalence:

Internationally

FASD affects communities worldwide. According to recent estimates, 7.7 per 1,000 persons suffer from FASD and associated impairments worldwide1.

1. Lange, S., Probst, C., Gmel, G., Rehm, J., Burd, L., & Popova, S. (2017). Global prevalence of fetal alcohol spectrum disorder among children and youth. A systematic review and meta-analysis. JAMA Pediatrics, 171(10), 940 – 941.

Nationally

In Australia, state and territory data have indicated that the rate of FASD may be 0.01 to 0.68 per 1,000 births in the general population.

2. Australian Institute of Health and Welfare. (2015). Fetal alcohol spectrum disorders: a review of interventions for prevention and management in Indigenous communities. Resource sheet no. 36 prepared by the Closing the Gap Clearinghouse. Retrieved from https://www.aihw.gov.au/getmedia/778f54f3-5618-428f-a094-40c347ed3c7f/ctgc-rs36.pdf.aspx?inline=true

However, it is argued that these Australian estimates are largely underestimated and there will likely be an increase in diagnoses over time as health professionals become more familiar with the diagnosis of FASD and its implications.  

FASD in Aboriginal and Torres Strait Islanders (Indigenous Australians)

FASD is diagnosed at higher rates in Aboriginal and Torres Strait Islanders (Indigenous Australians) children compared with non-Indigenous children in Australia. Such differences are also found in other Indigenous communities such as those in Canada.

Research suggests that between 2.0 to 9.3 per 1000 Indigenous Australians have FASD1. Some estimates are much higher2,3.

1. Australian Institute of Health and Welfare. (2015). Fetal alcohol spectrum disorders: a review of interventions for prevention and management in Indigenous communities. Resource sheet no. 36 prepared by the Closing the Gap Clearinghouse. Retrieved from https://www.aihw.gov.au/getmedia/778f54f3-5618-428f-a094-40c347ed3c7f/ctgc-rs36.pdf.aspx?inline=true
2. Fitzpatrick, J., Latimer, J., Olson, H. C., Carter, M., Oscar, J., Lucas, B. R… Elliott, E. J. (2017). Prevalence and profile of Neurodevelopment and Fetal Alcohol Spectrum Disorder (FASD) amongst Australian Aboriginal children living in remote communities. Research in Developmental Disabilities, 65, 114 – 126.
3. Hamilton, S., Doyle, M., & Bower, C. (2021). Review of Fetal Alcohol Spectrum Disorder (FASD) among Aboriginal and Torres Strait Islander people. Australian Indigenous HealthBulletin, 2(1). Retrieved from https://ro.ecu.edu.au/aihhealthbulletin/vol2/iss1/1.
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Research undertaken in the Fitzroy Valley, a remote Western Australian community, has provided some of the highest estimates of FASD worldwide, showing that persons with any diagnosis along the FASD spectrum may be up to 194.4 per 10001.

The reasons for the higher presence of FASD in Indigenous Australian populations compared to non-Indigenous populations are complex and reflect the interactions of psychosocial, political, historical, cultural and geographical factors.

Past policies such as the dispossession from land, community and culture, and the forceful removal of Indigenous children from their families known as the Stolen Generations, have left a legacy for many Indigenous Australians of disrupted families, disharmonious communities, mental health problems, poverty and disadvantage, marginalization, incarceration and drug and alcohol misuse3.
FASD and the Australian Indigenous Context

Our understanding of FASD in the Australian Indigenous context cannot be disentangled from the  historical context within which alcohol use has permeated Aboriginal and Torres Strait Islander (Indigenous) Communities. Prior to colonisation, alcohol use was limited in those communities. In fact, a variety of plant-based fermentations were produced for ceremonial and medicinal purposes but were regulated by strict cultural lore. This changed, however, upon the arrival of the first fleet and the subsequent colonisation of Australia when the use of alcohol as a recreational substance became commonplace and was also introduced into Aboriginal and Torres Strait Islander communities, often in exchange for labour.

Eventually, as the colonies of Anglo immigrants grew, the Aboriginal and Torres Strait Islander people were dispossessed from their land and communities. They were moved to missions, their children taken away and placed in homes with the intent of assimilating into the “white” society. Diseases were introduced by the colonies arriving in Australia leading to increased deaths in Indigenous communities. Faced with the increases in diseases and deaths and dispossession, alcohol increasingly became an antidote for the Aboriginal and Torres Strait Islander people to cope with the enduring trauma and pain caused by colonisation.

Eventually, excessive consumption of alcohol in Indigenous communities became problematic to the point where in the 1920s, all states and territories prohibited the sale of alcohol to Indigenous Australian, banning from pubs, bars and taverns. Indigenous Australians were also punished for possessing any form of alcohol and were placed under strict surveillance and punishment. Due to these discriminatory and exclusionary controls, Indigenous communities became targeted by the illegal trading of alcohol and Indigenous women became sexually exploited. The motivation to not get caught with alcohol led to large amounts being consumed quickly, often so without proper nutrition.

Seeing FASD as an ‘Indigenous issue’ is a harmful misconception and can perpetuate disadvantages endured by Indigenous Australian people. 

Research shows that a higher proportion of Indigenous Australian women drink at high-risk levels than non-Indigenous Australian women including during pregnancy.  

However, the data also shows that Indigenous Australian women are far more likely to abstain from alcohol compared to non-Indigenous Australian women.

FASD is a universal disorder. Alcohol consumption is ubiquitous in Australia and is common in Australian women of childbearing age regardless of cultural background. 

FASD occurs across the community, irrespective of socioeconomic, ethnic or other demographic factors.

FASD and involvement in the Justice System

People with FASD are more likely to be involved with the Justice system.

The risk of contact with the Justice system is approximately 30 times greater for a person with FASD compared to a person without FASD.

In a Youth Detention Centre in Western Australia, it was found that 36% of detainees had a diagnosis of FASD; the highest rate of FASD documented in a Justice setting in the world3. Seventy-Five percent of participants were Indigenous Australians3.

People with FASD are 30 times more likely to be in contact with the Justice system than people without FASD.

The over-representation of Indigenous Australians within the Justice system is evident in that Indigenous youth are over 20 times more likely to end up in the Justice system than non-Indigenous youth. 

The rate of FASD in Indigenous youth in the justice system is currently estimated to be more than double the rate of FASD in non-Indigenous incarcerated youth. 

The link between having FASD and criminal behavior is neither simple nor direct. 

A suite of impairments that are inherent to FASD has been found to increase the person’s vulnerability to engage in unlawful behavior and engaging with the Justice system. 

These factors can greatly affect the person with FASD at every stage of the Justice system, from their initial interactions with Police, to giving evidence in Court, while incarcerated and adhering to bail conditions on release.

Click to read more about the factors that can pre-dispose a person with FASD engage in criminal behavior:

Family dynamics & interpersonal issues

People with FASD often (but not always) have been exposed to a dysfunctional or chaotic family setting, have experienced several foster home placements and negative role modelling in the home predisposing them to illegal/criminal behavior later in life. Poor parental support, guidance and supervision can also result in youth with FASD becoming exposed to negative peer influences and being manipulated into engaging in risky and unlawful behavior. Due to their interpersonal difficulties, people with FASD may also struggle to maintain appropriate social and interpersonal boundaries. 

Language issues

People with FASD can be very chatty and engaging. Hence, others (including police, lawyers and judges) may overestimate their level of understanding of complex verbal processes and their competency to stand trial. Combined with other cognitive problems, language difficulties can increase suggestibility and cause the individual to admit to crimes they did not commit. Difficulties comprehending and appreciating information relating to the legal process, including their legal rights, factual knowledge regarding the legal procedure and the nature of the charges can lead to difficulties participating in defense and communicating with counsel.

Memory issues

People with FASD do not simply choose to forget. They may be truly unable to recall what happened and this can make them particularly suggestible and vulnerable during a police investigation. They may recount a story omitting details or adding inaccurate details and or in a non-cohesive manner. To others, this may seem as though the individual is distorting the truth or not complying. They may also poorly recall sentencing conditions or bail conditions and demonstrate poor adherence to them.

Thinking difficulties

The person with FASD may struggle in several aspects of their thinking such as

  • linking actions and consequences (or cause and effect),
  • integrating knowledge and previously-learnt information (e.g., acceptable and nonacceptable behavior) and making smart choices that are focused on long-term goals,
  • grasping abstract concepts such as time, money and math and more importantly, laws and rules (which are abstract) as well as the future consequences of current poor behavior.
Difficulties with generalising

People with FASD may be unable to draw the connection between separate events although they may share similarities. For instance, an individual may learn that they will go to jail for committing an illegal act, but they may not understand that they may also go to jail for being an accomplice to an illegal act.

Poor behaviour planning, organisation & inhibition

People with FASD may have difficulties with planning and envisioning the flow on effects of their behavior (an abstract process) and following a series of complex steps. This can lead to poorly considered and impulsive behaviour.

Challenges they face within the criminal justice system

Given their cognitive challenges, it comes as no surprise that people with FASD will face challenges at every stage of their encounter within the criminal justice system.

Other factors

A disrupted educational experience, which is common in persons with FASD, is associated with criminal behaviour and recidivism.
FASD often goes unrecognized and undiagnosed until later in life and sometimes for a whole life. As a result, the individual may develop secondary problem behaviors to cope with their daily life difficulties and mental health issues such as depression, trauma and anxiety. Some of those problem behaviors include self-medicating with alcohol and illicit substance use and can lead to conflict with the law.

In many cases, people with FASD may engage in criminal behavior due to not having a full understanding of the long-term impact of their actions. 

Challenges Transitioning out of Prison and into employment

Persons with both FASD and a criminal history often want employment as part of living a productive and meaningful life.

There are a number of challenges for persons with FASD seeking employment.

Many have patterns of behavior that are difficult to change. They may have challenges with reintegrating themselves into community life following incarceration, particularly if they have been in prison for a long period of time or have continually cycled in and out of prison.

Such barriers exist for non-Indigenous Australians but are compounded for Indigenous Australians with FASD.

These barriers can be grouped as follows:

  • Tangible barriers
  • Intangible barriers

Tangible barriers

Tangible or practical barriers to employment for people with disability and a justice system involvement can include unmet basic needs such as:

Safe accommodation

Housing that is alcohol and drug free with supportive family members that limit risk of illegal behaviours. 

Appropriate clothing

Lack of clean and appropriate clothing for presenting at interviews and for work, including boots/footwear appropriate to safety standards. 

Transportation

Lack of driver’s license due to driving bans, poor knowledge of public transport and not being able to afford to pay for transport.

Financial resources

Knowledge of how to manage finances and budget while living on reduced incomes. 

Lack of valid ID

Birth certificates or photo identification are required to access many services such as bank accounts. 

IT Skills

Not being able to access online job advertisements, preparing job applications and using job search technologies.
Parole conditions – requirements to report to the police station which may be during working hours or a significant distance from workplace.

Intangible barriers

Criminal record/Negative attitudes of employers 

Workplaces may not have a Human Resource policy around employing someone with a criminal record. Hence, recruitment is very subjective. Employers may see persons who have both a disability such as FASD as well as experience of the justice system, as presenting a double risk to the workplace. Employers may also feel ill-equipped to mitigate this perceived risk. 

Pre-existing cognitive and behavioural issues. 

Persons with a justice background often face the pressure of transitioning from prison life which is highly-structured and offers schedules around activities (e.g., sleeping and waking times, meals, showers, etc.) to suddenly being left to their own devices and making their own decisions as to where to live, how/where to access healthcare, manage their own appointments, establish and re-establish relationships, manage their own finances, look for employment and possibly manage the demands of parole, all on their own and with the challenges that their cognitive problems may present. Such lack of support typically stems from poor coordination amongst services and programs that have been set up to assist the individual transition out of the prison system. 

Lack of social support

Upon entering the justice system, the individual may lose or disconnect from family and friends. In some cases, this may be because of a reluctance from family and friends to remain involved in the life of the individual. People with a justice system background may also lack appropriate role models who model positive/adaptive behaviors and provide support.

Drug and alcohol use 

It is common in people with FASD as well as in people who become involved with the justice system. A lack of appropriate supports coupled with negative peer influences can result in the individual succumbing to old ways.

A lack of employability skills 

Including poor literacy and numeracy and social skills, working in groups, organisational skills, time management skills.

Criminogenic environments

Returning to family and friends and communities who continue to engage in unlawful behavior can predispose the individual with FASD to re-engage in unlawful behavior.

How it feels to leave prison

Finding Work To Facilitate Reintegration

Returning to work can be an important goal in rehabilitation and reintegration into the community following incarceration. 

People with disabilities are an underutilised pool of talents and skills and are increasingly becoming recognised as a valuable resource.

Employing persons with disabilities makes good business sense for several reasons.

For instance, people with disabilities are:

Loyal and reliable

They tend to take fewer days off, request sick leave less often, have longer tenure and stay working for the same employer for longer than their coworkers without a disability.

Productive

Once they have found the right job, they tend to perform as well as their coworkers.

Affordable and safe

Recruiting and covering insurance and compensation costs are lower for employers with disability. People with disabilities also tend to have fewer accidents whilst at work relative to other colleagues.

Good team members

They foster strong and warm relationships with customers, boost staff morale and model loyalty. They also bring a diversity of skills, backgrounds and life experiences to the team thus enhancing cohesion and teamwork.

Good for business

They enhance the overall image of the company amongst its staff members, the community and clients/customers and lift the employer/company’s brand.

What a person with disability brings to the workplace

Benefits of Work for Employees with FASD

Whilst employers certainly benefit from including persons with disability into the workplace, the latter also derive a range of positive outcomes from gaining access to employment opportunities.

Work promotes health and well-being in people, including those who have a disability.

Disability can often lead to the individual becoming socially isolated. Work promotes meaningful social interaction and social inclusion.

Work can improve independence, reducing the likelihood of poverty and dependence in persons with a disability by providing them with a steady and regular source of income

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