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Neurocognitive Function and Fetal Alcohol Spectrum Disorder in Offenders with Mental Disorders

Mansfield Mela, Katherine Flannigan, Tara Anderson, Monty Nelson, Sudheej Krishnan, Chibuike Chizea, Sarah Takahashi and Rohan Sanjanwala
Journal of the American Academy of Psychiatry and the Law Online June 2020, 48 (2) 195-208; DOI: https://doi.org/10.29158/JAAPL.003886-20
Mansfield Mela
Dr. Mela is Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Flannigan is a Research Associate, Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada. Ms. Anderson is Research Coordinator, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Nelson is in private practice, Edmonton, Alberta, Canada. Mr. Krishnan is with Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada. Dr. Chizea is with Public Health and Preventive Medicine, Postgraduate Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. Dr. Takahashi is a Clinician, Aboriginal Child and Youth Mental Health, Ministry of Children and Family Development, Victoria, British Columbia, Canada. Dr. Sanjanwala is a Research Associate, Cardiac Science Program, H. Asper Institute, Saint Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. This work was supported by an AIER Grant from the American Academy of Psychiatry and the Law, by a grant from the Center for Forensic Behavioural Science and Justice Studies at the University of Saskatchewan, and by the Department of Psychiatry Intramural Award at the University of Saskatchewan.
MB, BS, MSc
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Katherine Flannigan
Dr. Mela is Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Flannigan is a Research Associate, Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada. Ms. Anderson is Research Coordinator, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Nelson is in private practice, Edmonton, Alberta, Canada. Mr. Krishnan is with Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada. Dr. Chizea is with Public Health and Preventive Medicine, Postgraduate Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. Dr. Takahashi is a Clinician, Aboriginal Child and Youth Mental Health, Ministry of Children and Family Development, Victoria, British Columbia, Canada. Dr. Sanjanwala is a Research Associate, Cardiac Science Program, H. Asper Institute, Saint Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. This work was supported by an AIER Grant from the American Academy of Psychiatry and the Law, by a grant from the Center for Forensic Behavioural Science and Justice Studies at the University of Saskatchewan, and by the Department of Psychiatry Intramural Award at the University of Saskatchewan.
PhD
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Tara Anderson
Dr. Mela is Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Flannigan is a Research Associate, Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada. Ms. Anderson is Research Coordinator, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Nelson is in private practice, Edmonton, Alberta, Canada. Mr. Krishnan is with Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada. Dr. Chizea is with Public Health and Preventive Medicine, Postgraduate Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. Dr. Takahashi is a Clinician, Aboriginal Child and Youth Mental Health, Ministry of Children and Family Development, Victoria, British Columbia, Canada. Dr. Sanjanwala is a Research Associate, Cardiac Science Program, H. Asper Institute, Saint Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. This work was supported by an AIER Grant from the American Academy of Psychiatry and the Law, by a grant from the Center for Forensic Behavioural Science and Justice Studies at the University of Saskatchewan, and by the Department of Psychiatry Intramural Award at the University of Saskatchewan.
MSc
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Monty Nelson
Dr. Mela is Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Flannigan is a Research Associate, Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada. Ms. Anderson is Research Coordinator, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Nelson is in private practice, Edmonton, Alberta, Canada. Mr. Krishnan is with Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada. Dr. Chizea is with Public Health and Preventive Medicine, Postgraduate Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. Dr. Takahashi is a Clinician, Aboriginal Child and Youth Mental Health, Ministry of Children and Family Development, Victoria, British Columbia, Canada. Dr. Sanjanwala is a Research Associate, Cardiac Science Program, H. Asper Institute, Saint Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. This work was supported by an AIER Grant from the American Academy of Psychiatry and the Law, by a grant from the Center for Forensic Behavioural Science and Justice Studies at the University of Saskatchewan, and by the Department of Psychiatry Intramural Award at the University of Saskatchewan.
PhD
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Sudheej Krishnan
Dr. Mela is Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Flannigan is a Research Associate, Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada. Ms. Anderson is Research Coordinator, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Nelson is in private practice, Edmonton, Alberta, Canada. Mr. Krishnan is with Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada. Dr. Chizea is with Public Health and Preventive Medicine, Postgraduate Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. Dr. Takahashi is a Clinician, Aboriginal Child and Youth Mental Health, Ministry of Children and Family Development, Victoria, British Columbia, Canada. Dr. Sanjanwala is a Research Associate, Cardiac Science Program, H. Asper Institute, Saint Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. This work was supported by an AIER Grant from the American Academy of Psychiatry and the Law, by a grant from the Center for Forensic Behavioural Science and Justice Studies at the University of Saskatchewan, and by the Department of Psychiatry Intramural Award at the University of Saskatchewan.
MA, MPhil
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Chibuike Chizea
Dr. Mela is Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Flannigan is a Research Associate, Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada. Ms. Anderson is Research Coordinator, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Nelson is in private practice, Edmonton, Alberta, Canada. Mr. Krishnan is with Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada. Dr. Chizea is with Public Health and Preventive Medicine, Postgraduate Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. Dr. Takahashi is a Clinician, Aboriginal Child and Youth Mental Health, Ministry of Children and Family Development, Victoria, British Columbia, Canada. Dr. Sanjanwala is a Research Associate, Cardiac Science Program, H. Asper Institute, Saint Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. This work was supported by an AIER Grant from the American Academy of Psychiatry and the Law, by a grant from the Center for Forensic Behavioural Science and Justice Studies at the University of Saskatchewan, and by the Department of Psychiatry Intramural Award at the University of Saskatchewan.
MB, BS, MPH
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Sarah Takahashi
Dr. Mela is Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Flannigan is a Research Associate, Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada. Ms. Anderson is Research Coordinator, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Nelson is in private practice, Edmonton, Alberta, Canada. Mr. Krishnan is with Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada. Dr. Chizea is with Public Health and Preventive Medicine, Postgraduate Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. Dr. Takahashi is a Clinician, Aboriginal Child and Youth Mental Health, Ministry of Children and Family Development, Victoria, British Columbia, Canada. Dr. Sanjanwala is a Research Associate, Cardiac Science Program, H. Asper Institute, Saint Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. This work was supported by an AIER Grant from the American Academy of Psychiatry and the Law, by a grant from the Center for Forensic Behavioural Science and Justice Studies at the University of Saskatchewan, and by the Department of Psychiatry Intramural Award at the University of Saskatchewan.
MA
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Rohan Sanjanwala
Dr. Mela is Professor, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Flannigan is a Research Associate, Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada. Ms. Anderson is Research Coordinator, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Dr. Nelson is in private practice, Edmonton, Alberta, Canada. Mr. Krishnan is with Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada. Dr. Chizea is with Public Health and Preventive Medicine, Postgraduate Education, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. Dr. Takahashi is a Clinician, Aboriginal Child and Youth Mental Health, Ministry of Children and Family Development, Victoria, British Columbia, Canada. Dr. Sanjanwala is a Research Associate, Cardiac Science Program, H. Asper Institute, Saint Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada. This work was supported by an AIER Grant from the American Academy of Psychiatry and the Law, by a grant from the Center for Forensic Behavioural Science and Justice Studies at the University of Saskatchewan, and by the Department of Psychiatry Intramural Award at the University of Saskatchewan.
MD, MPH
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    Figure 1.

    Subject clinical diagnoses. PTSD, posttraumatic stress disorder; ODD, oppositional defiant disorder; ADD/ADHD, attention deficit disorder/attention deficit hyperactivity disorder; TBI, traumatic brain injury; CD, conduct disorder. *For subjects with FASD, a diagnosis of TBI/brain damage required an incident above and beyond the damage caused by PAE.

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    Figure 2.

    Subject offense histories.

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    Figure 3.

    Neurocognitive testing profile of all subjects. FS, full-scale (n = 36); VCI, verbal comprehension index (n = 36); PRI, perceptual reasoning index (n = 36); WMI, working memory index (n = 36); PSI, processing speed index (n = 36); RCFT, Rey Complex Figure Test (n = 35); CVLT, California Verbal Learning Test (n = 32); GDS, Gordon Diagnostic System (n = 19); WCST, Wisconsin Card Sorting Test (n = 31); CW, Color Word (n = 34); PPVT, Peabody Picture Vocabulary Test (n = 19); EVT, Expressive Vocabulary Test (n = 35); FTT, Finger Tapping Test (n = 19); GPT, Grooved Pegboard Test (n = 19); HDT, Hand Dynamometer Test (n = 19); WRAT, Wide Range Achievement Test (n = 19).

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    Figure 4.

    Comparison of neurocognitive profile between the FASD and No-FASD groups (*P < .05, **P < .01). FS, full-scale; VCI = verbal comprehension index; PRI, perceptual reasoning index; WMI, working memory index; PSI, processing speed index; RCFT, Rey Complex Figure Test; CVLT, California Verbal Learning Test; WCST, Wisconsin Card Sorting Test; CW, Color Word; EVT, Expressive Vocabulary Test.

Tables

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    Table 1

    Neurocognitive Tests and Domains Assessed

    Domain of FunctioningTest
    CognitionWechsler Adult Intelligence Scale, Fourth Ed. (WAIS-IV)
    Memory
        VerbalCalifornia Verbal Learning Test, Third Ed. (CVLT-III)
        VisualRey Complex Figure Test and Recognition Trail (RCFT)
    AttentionGordon Diagnostic System: Vigilance and Distractibility (GDS)
    Executive functionWisconsin Card Sorting Test, Fourth Ed. (WCST-IV)
    Stroop Color-Word Switching Test (Stroop C-W)
    LanguagePeabody Picture Vocabulary Test, Fourth Ed. (PPVT-IV)
    Expressive Vocabulary Test, Second Ed. (EVT-II)
    Motor
        Speed and controlFinger Tapping Test (FTT)
        DexterityGrooved Pegboard Test (GPT)
        Grip strengthHand Dynamometer Test (HDT)
    Adaptive functionAdaptive Behavior Assessment System, Second Ed. (ABAS-II)
    AcademicsWide Range Achievement Test (WRAT)
    • View popup
    Table 2

    Participant Demographics

    Male82.2
    Mean age, y (range = 19–66)41.8
    Caucasian48.9
    FASD confirmed26.6
    Has children35.7
    Living arrangements
        Alone41.9
        With a roommate23.3
        With relatives20.9
        With a spouse7.0
        Care home7.0
    Relationship status
        Single72.7
        Divorced15.9
        Married6.8
        Common-law4.5
    Highest level of education
        Less than high school9.8
        High school56.1
        Technical or some university26.8
        Completed university7.3
    Employment status
        Employed full time14.0
        Employed part time11.6
        Full-time student7.0
        Sick/disability leave23.3
        Unemployed41.9
        Retired2.3
    • Data are presented as percentages, except for mean age. FASD, fetal alcohol spectrum disorder.

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    Table 3

    Rates of Comorbid Diagnoses in the FASD and No-FASD Groups

    Diagnosis% of GroupPEffect Size
    FASDNo FASD
    Anxiety60.065.2.825.042
    Depression60.047.8.622.093
    Substance misuse40.033.3.775.053
    Post-traumatic stress disorder20.026.1.776.054
    Oppositional defiant disorder40.021.7.393.162
    ADD/ADHD25.025.01.000.000
    TBI/Brain damage*16.724.2.858.083
    Attachment issues40.013.0.154.270
    Conduct disorder20.016.7.858.033
    • ↵* For participants with FASD, a diagnosis of TBI/brain damage required an incident above and beyond the damage caused by prenatal alcohol exposure.

    • FASD, fetal alcohol spectrum disorder; ADD/ADHD, attention deficit disorder and attention deficit hyperactivity disorder; TBI, traumatic brain injury.

    • View popup
    Table 4

    Offense Histories in the FASD and No-FASD Groups

    FASDNo FASDPEffect Size
    Mean number of offenses2.334.21.213.036
    History of repeat offending, % of group50.072.7.153.213
    Offense type, % of group
        Violent crimes50.045.5.787.040
        Sex crimes25.027.3.879.023
        Property/vehicle crimes41.757.6.344.141
        Obstruction/breaches25.036.4.475.107
        Drug crimes8.321.2.318.149
        Nonviolent crimes against persons8.321.2.318.149
    • FASD group: n = 12 subjects; No-FASD group: n = 33 subjects. FASD, fetal alcohol spectrum disorder.

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Journal of the American Academy of Psychiatry and the Law Online: 48 (2)
Journal of the American Academy of Psychiatry and the Law Online
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Neurocognitive Function and Fetal Alcohol Spectrum Disorder in Offenders with Mental Disorders
Mansfield Mela, Katherine Flannigan, Tara Anderson, Monty Nelson, Sudheej Krishnan, Chibuike Chizea, Sarah Takahashi, Rohan Sanjanwala
Journal of the American Academy of Psychiatry and the Law Online Jun 2020, 48 (2) 195-208; DOI: 10.29158/JAAPL.003886-20

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Neurocognitive Function and Fetal Alcohol Spectrum Disorder in Offenders with Mental Disorders
Mansfield Mela, Katherine Flannigan, Tara Anderson, Monty Nelson, Sudheej Krishnan, Chibuike Chizea, Sarah Takahashi, Rohan Sanjanwala
Journal of the American Academy of Psychiatry and the Law Online Jun 2020, 48 (2) 195-208; DOI: 10.29158/JAAPL.003886-20
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