Comprehensive Clinical Paediatric Assessment of Children and Adolescents Sentenced to Detention in Western Australia
Main Article Content
Abstract
Objectives
To describe the comprehensive clinical paediatric assessment of a representative sample of children and adolescents (young people) sentenced to detention in Western Australia (WA) and participating in the first Fetal Alcohol Spectrum Disorder (FASD) prevalence study.
Settings
Individuals with FASD have lifelong difficulties with memory, attention, communication, emotional reg-ulation and social skills with associated risk of engagement with juvenile justice. We found prevalence of FASD in 36% of young people sentenced to juvenile detention in WA. This paper describes the comprehensive clinical paediatric assessment of all young people participating in this study.
Participants
All young people aged 10–17 years 11 months and sentenced to detention in WA were eligible. All assess-ments were completed by a multidisciplinary team comprising a speech and language pathologist, occupational therapist, neuropsychologist and a paediatrician.
Results
In all, 103 young people completed the comprehensive clinical paediatric assessment, with maximum num-ber of males (93%) and Aboriginal Australians (73%). One in two participants reported someone close to them, or themselves, having experienced a frightening event with associated symptoms of post-traumatic stress. One-third (36%) of participants had experienced suicide of a family member. Half of the young people had one or no parent (53%), an incarcerated sibling (44%) or an incarcerated family member (57%). One-fifth of participants talked about experiences of emotional neglect (20%), physical neglect (19%), physical abuse (21%) and suicidal ideation (18%). More than half (60%) of participants were 1 year or more behind their school-year grade according to their chronological age, and 73% reported waking tired. Polysubstance use was common, including cigarettes (82%), marijuana (76%), alcohol (66%) and methamphetamine (36%). Almost two-thirds (64%) had abnormal neuromotor findings, 47% reported head injury without hospitalisation, 38% had prior musculoskeletal injuries, 29% had impaired motor skills and 15% had abnormal visual fields.
Conclusion
Comprehensive clinical paediatric assessment of young people sentenced to detention in WA found signif-icant psychosocial and physical difficulties. The findings of multiple and serious impairments and health issues, through completion of comprehensive clinical paediatric and multidisciplinary health and neuro-developmental assessments for this study, support their routine provision to all young people on entry to systems of juvenile justice.
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How to Cite
Mutch, R., Freeman, J., Kippin, N., Safe, B., Pestell, C., Passmore, H., Hamilton, S., Shield, H., Argiro, E., Rainsford, C., Condon, C., Gigilia, R., Watkins, R., Marriot, R., & bower, carol. (2022). Comprehensive Clinical Paediatric Assessment of Children and Adolescents Sentenced to Detention in Western Australia. Journal of Fetal Alcohol Spectrum Disorder, 4(1), e16-e31. https://doi.org/10.22374/jfasd.v4i1.22
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3. Australian Institute of Health and Welfare (AIHW). Youth detention population in Australia. In: Welfare AIoHa, editor. Bulletin 138, Cat. No. AUS 210 ed. Canberra, Australia: AIHW; 2016, December.
4. Australian Institute of Health and Welfare (AIHW). Children's headline indicators. Canberra, Australia: AIHW; 2017. Available from: https://www.aihw.gov.au/reports/children-youth/childrens-headline-indicators/contents/dynamic-data-displays.
5. Kinner S, Degenhardt L, Coffey C, et.al. Complex health needs in the youth justice system: A survey of community-based and custodial offenders. J Adolesc Health. 2014;54(5):521–6.
6. Kinner S, Young J. Understanding and improving the health of people who experience incarceration: An overview and synthesis. Epidemiol Rev. 2018;40(1):4–11.
7. Hughes N, Ungar M, Fagan A, et al. Health determinants of adolescent criminalisation. Lancet Child Adolesc Health. 2020;4(2):151–62.
8. Borschmann R, Coffey C, Moran P, et al. Self-harm in young offenders. Suicide Life Threat Behav. 2014;44(6):641–52.
9. Borschmann R, Janca E, Carter A, et al. The health of adolescents in detention: A global scoping review. Lancet Public Health. 2020;5(2):e114–26.
10. Hughes N, Chitsabesan P, Bryan K, et al. Language impairment and comorbid vulnerabilities among young people in custody. J Child Psychol Psychiatry. 2017;58(10):1106–13.
11. Hughes N, Williams W, Chitsabesan P, et.al. The prevalence of traumatic brain injury among young offenders in custody: A systematic review. J Head Trauma Rehabil. 2015, March–April;30(2):94–105.
12. Hughes N, Clasby B, Chitsabesan P, et.al. A systematic review of the prevalence of foetal alcohol syndrome disorders among young people in the criminal justice system. Cogent Psychol. 2016;3:1–8.
13. Hughes N, Williams H, Chitsabesan P, et.al. Nobody made a connection: The prevalence of neurodisability in young people who offend. www.childrenscommissioner.gov.uk. London: Children’s Commissioner for England; 2012 October.
14. Brinkley-Rubinstein L, Allen S, Rich J. Incarceration and the health of detained children. Lancet Public Health. 2020;5(2):e76–7.
15. Haysom L, Indig D, Moore E, et.al. Intellectual disability in young people in custody in New South Wales, Australia—Prevalence and markers. J Intellect Disabil Res. 2014;58(11):1004–14.
16. Heffernan E, Andersen K, Davidson F, et.al. PTSD among Aboriginal and Torres Strait Islander people in custody in Australia: Prevalence and correlates. J Trauma Stress. 2015;28(6):523–30.
17. Heffernan E, Director Q, Andersen K, et al. Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons. Med J Aust. 2012;197(1):37–41.
18. Webb C, Hayes A, Grasso D, et.al. Trauma-focused cognitive behavioral therapy for youth: Effectiveness in a community setting. Psychol Trauma Theory Res Pract Policy. 2014;6(5):555–62.
19. Phillips N, Milne B, Silsbury C, et al. Addressing adolescent substance use in a paediatric health-care setting. J Paediatr Child Health. 2014;50(9):726–31.
20. The health and well-being of incarcerated adolescents [press release]. Sydney 2011.
21. Melton G, Pagliocca P. Treatment in the juvenile justice system: Directions for policy and practice. In: Cocozza JJ, editor. Responding to the mental health needs of youth in the juvenile justice system. Seattle, WA: National Coalition for the Mentally Ill in the Criminal Justice System; 1992, pp. 107–29.
22. McKinlay A, Corrigan J, Horwood L, et.al. Substance abuse and criminal activities following traumatic brain injury in childhood, adolescence, and early adulthood. J Head Trauma Rehabil. 2014, November–December;29(6):498–506.
23. Moore E, Indig D, Haysom L. Traumatic brain injury, mental health, substance use, and offending among incarcerated young people. J Head Trauma Rehabil. 2014;29(3):239–47.
24. Kenny D, Press A. Violence classifications and their impact on observed relationships with key factors in young offenders. Psychol Public Policy Law. 2006;12(1):86–105.
25. Butler T, Belcher J, Champion U, et.al. The physical health status of young Australian offenders. Aust N Z J Public Health. 2008;32(1):73–80.
26. Haysom L, Indig D, Byun R, et.al. Oral health and risk factors for dental disease of Australian young people in custody. J Paediat Child Health. 2015;51(5):545–51.
27. Atkinson J. Trauma trails, recreating song lines: The transgenerational effects of trauma in indigenous Australia. In: Press S, editor. North Melbourne 2002.
28. Cappell C, Heiner R. The intergenerational transmission of family aggression. J Fam Violence. 1990;5:135–52.
29. Human Rights and Equal Opportunity Commission (HRaEO). Bringing them home. Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families. Sydney, Australia: HRaEO; 1997.
30. Daly A, Smith D. Reproducing exclusion or inclusion? Implications for the wellbeing of indigenous Australian children. Paper No. 253/2003. Canberra, Australia: Australian National University (ANU); 2003 January.
31. Borschmann R, Thomas E, Moran P, et al. Self-harm following release from prison: A prospective data linkage study. Aust N Z J Psychiatry. 2017;51(3):250–9.
32. Barnert E, Perry R, Morris R. Juvenile incarceration and health. Acad Pediatr. 2016;16(2):99–109.
33. Moore E, Gaskin C, Indig D. Childhood maltreatment and post-traumatic stress disorder among incarcerated young offenders. Child Abuse Negl. 2013;37(10):861–70.
34. Moore E, Gaskin C, Indig D. Attempted suicide, self-harm, and psychological disorder among young offenders in custody. J Correction Health Care. 2015;21(3):243–54.
35. Johnston I, Williams M, Butler T, et.al. Justice targets in closing the gap: Let's get them right. Aust N Z J Public Health. 2019;43(3):201–3.
36. Popova S, Lange S, Bekmuradov D, et.al. Fetal alcohol spectrum disorder prevalence estimates in correctional systems: A systematic literature review. Can J Public Health. 2011;102(5):336–40.
37. Fast D, Conry J, Loock C. Identifying fetal alcohol syndrome among youth in the criminal justice system. J Develop Behav Pediatr. 1999;20(5):370–2.
38. Murphy A, Chittenden M. Time out II: A profile of BC youth in custody. Vancouver, BC: McCreary Centre Society; 2005.
39. Rojas E, Gretton H. Background, offence characteristics, and criminal outcomes of Aboriginal youth who sexually offend: a closer look at Aboriginal youth intervention needs. Sex Abuse. 2007;19:257–83.
40. Rojas J, Coker T. The cause and consequence of mental health problems among at-risk youth. J Adolesc Health. 2015;57(5):453–4.
41. Smith A, Cox K, Poon C, et.al. Time out III: A profile of BC youth in custody. Vancouver, BC: McCreary Centre Society; 2013.
42. McLachlan K. Fetal alcohol spectrum disorder in Yukon Corrections. Final Report to Yukon Justice: Estimating the Prevalece of FASD, Mental Health, and Substance Use Problems in the Justice System. Yukon, Canada: Policy and Communications Unit, Department of Justice, Government of Yukon; 2017.
43. Bower C, Watkins R, Mutch R, et.al. Prevalence of fetal alcohol spectrum disorder among young people in youth detention in western Australia. BMJ Open. 2018.
44. Bower C, Watkins R, Mutch R, et al. Fetal alcohol spectrum disorder and youth justice: A prevalence study among young people sentenced to detention in western Australia. [Erratum appears in BMJ Open. 2018, Apr 12;8(4):e019605corr1; PMID: 29654055]. BMJ Open. 2018;8(2):e019605.
45. Hamilton S, Maslen S, Best D, et al. Putting ‘justice’ in recovery capital: Yarning about hopes and futures with young people in detention. Int J Crime Justice Soc Democracy. 2020;9(2):20–36.
46. Hamilton S, Maslen S, Watkins R, et al. ‘That thing in his head’: Aboriginal and non-Aboriginal Australian caregiver responses to neurodevelopmental disability diagnoses. Sociol Health lln. 2020;n/a(n/a).
47. Passmore H, Giglia R, Watkins R, et al. Study protocol for screening and diagnosis of fetal alcohol spectrum disorders (FASD) among young people sentenced to detention in western Australia. BMJ Open. 2016;6(6):e012184.
48. Bower C, Elliot E. Australian guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD). Report to the Australian Government of Health; 2016.
49. Kippin N, Leitao S, Watkins R, et al. Language diversity, language disorder, and fetal alcohol spectrum disorder among youth sentenced to detention in western Australia. Int J Law Psychiatry. 2018;no pagination specified.
50. Freeman J, Condon C, Hamilton S, et.al. Challenges in accurately assessing prenatal alcohol exposure in a study of Fetal Alcohol Spectrum Disorder in a youth detention center. Alcohol Clin Exp Res. 2018, November;
51. Kelly E, Li B, Adams M. Diagnostic accuracy of tuning fork tests for hearing loss: A systematic review. Otolaryngol Head Neck Surg. 2018;159(2):220–30.
52. Wahid N, Hogan C, Attia M. Weber test. Treasure Island, FL: StatPearls Publishing; 2021 [Updated Feb 9, 2021]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526135/.
53. Kinner S, Degenhardt L, Coffey C, et al. Substance use and risk of death in young offenders: A prospective data linkage study. Drug Alcohol Rev. 2015;34(1):46–50.
54. Goldhagen J, Shenoda S, Oberg C, et al. Rights, justice, and equity: A global agenda for child health and wellbeing. Lancet Child Adolesc Health. 2020;4(1):80–90.
55. Goldhagen J, Mercer R, Robinson G, et.al. Establishing a child rights, health equity, and social justice-based practice of pediatrics. J Pediatr. 2015;166(4):1098–9 e3.
56. Owen M, Goldhagen J. Children and solitary confinement: A call to action. Pediatrics. 2016;137(5):05.
57. General Comment No. 24 (2019) on children’s rights in the child justice system, (2019).
58. Royal Australasian College of Physicians (RACP). RACP submission to the Council of Attorneys General Working Group reviewing the age of criminal responsibility. Australia: RACP; 2019. Available from: https://www.racp.edu.au/docs/default-source/advocacy-library/b-20190729racp-submission-cag-review_final-gm-approved.pdf?sfvrsn=b384e61a_6.
59. Olson H, Streissguth A, Sampson P, et.al. Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence. J Am Acad Child Adolesc Psychiatry. 1999;36:1187–94.
60. Olsson C, Coffey C, Toumbourou J, et.al. Family risk factors for cannabis use: A population-based survey of Australian secondary school students. Drug Alcohol Rev. 2003;22(2):143–52.
61. Ogloff J, Pfeifer J, Shepherd S, et.al. Assessing the mental health, substance abuse, cognitive functioning, and social/emotional well-being needs of aboriginal prisoners in Australia. J Correct Health Care. 2017;23(4):398–411.
62. Ogloff J, Talevski D, Lemphers A, et.al. Co-occurring mental illness, substance use disorders, and antisocial personality disorder among clients of Forensic Mental Health Services. Psychiatr Rehabil J. 2015;38(1):16–23.
63. Indig D, Haysom L. Smoking behaviours among young people in custody in New South Wales, Australia. (Special Issue:Tackling tobacco use in socially disadvantaged groups: A time for action.). Drug Alcohol Rev. 2012;31(5):631–7.
64. Indig D, Vecchiato C. Drug and alcohol use among juvenile detainees: Findings from the 2009 NSW young people in custody health survey. Paper No. 326. Drug Alcohol Rev. 2009;28(Sup 1):A62–3.
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