Screening prevalence of fetal alcohol spectrum disorder (FASD) in a UK-based justice system setting: A pilot study

Introduction: International literature establishes the overrepresentation of individuals with fetal alcohol Spectrum disorder (FASD) within the justice system. Although the United Kingdom (UK) has the fourth-highest rate of alcohol consumption during pregnancy globally, no data currently exist on the prevalence of FASD within the justice system, as also acknowledged by UK guidance documents. This pilot study provides, for the first time, a screening prevalence estimate of FASD within a UK-based justice setting. Methods: Forty individuals (aged 19–67 years; 6 females and 34 males) attending a probation service were screened for indicators consistent with FASD. The Life History Screen Interview tool (LHSI) was employed in a cross-sectional, non-diagnostic design. Screening was undertaken by trained probation staff during routine appointments or probation induction. Results: A total of 42.5% of participants screened positive for FASD (95% CI 28.10% to 57.90%). Using a secondary and more conservative analysis, 18.0% (95% CI 8.2% to 31.3%) of the sample screened positive for FASD. Several day-to-day difficulties were reported by our sample; however, only 17.5% reported receipt of special educational support, which is lower than the general population prevalence of individuals with special educational needs in the UK. Discussion: Even when interpreted conservatively, this small UK-based pilot screening study of FASD within a justice setting suggests that a substantial proportion of individuals within the UK justice system may have unrecognized neurodevelopmental vulnerabilities consistent with FASD. Larger prevalence studies are needed to further investigate this, including gold-standard active case ascertainment studies.