Last year in the Northern Territory, 86% of those in prison and 96% of those in juvenile detention were Indigenous. In Western Australia, Indigenous people account for only 3% of the population, but 40% of prisoners.

It is unacceptable to ignore the intellectual capacity of a person facing the court and it’s vital to ensure that youth put behind bars have been properly assessed before sentencing. This is particularly important for Australians affected by fetal alcohol spectrum disorders (FASD). These occur throughout society and in high levels in some Indigenous communities.

The capacity to screen for prenatal alcohol exposure – as well as to diagnose FASD – must urgently be increased. This echoes recent calls by Perth Children’s Court magistrate Catherine Crawford for clinicians to assess children and youth before sentencing, so the court understands their cognitive limitations.

Cognitive limitations

Fetal alcohol spectrum disorders are a group of preventable conditions resulting from exposure to alcohol in the womb. Alcohol readily crosses the mother’s placenta, entering the circulation of the developing fetus with devastating effects.

Significantly, it can disrupt brain development and that of other organs, causing lifelong problems. These include developmental delay, intellectual and memory impairment, as well as a range of behavioural, emotional and mental health disorders.

People with FASD can suffer from attention-deficit hyperactivity disorders (ADHD), communication disorders, poor impulse control, disobedience and hostility issues, and learning difficulties.

They often struggle to distinguish right from wrong and fail to learn from mistakes. Few with FASD will live and work independently. Many have mental health and substance misuse problems.

It is no surprise that many also come in contact with the law. An adolescent living with a FASD in Canada or the United States, for instance, is estimated to have a 19 times higher risk of incarceration than someone without a FASD.

Despite this, the condition remains poorly recognised and few obtain a diagnosis prior to offending. Offenders with FASD are often poor witnesses and fail to understand why they have been detained. Unable to negotiate the justice system, they are adversely influenced by others and often enter a cycle of re-offending.

FASD and the justice system

Rosie Fulton, a 21-year-old Aboriginal woman with FASD and significant intellectual impairment, was arrested last year after stealing and crashing a car. Declared unfit to stand trial, Rosie was sent to Western Australia’s Kalgoorlie Prison for lack of alternative accommodation.

She stayed in jail for 21 months with no trial or conviction. Only after her story broke, mounting pressure on the health ministers of Western Australia and the Northern Territory led to Rosie being transferred to supervised community accommodation close to her family in Alice Springs.

In Australia, we don’t know how many people deemed “unfit to plead” are in prison and how many have cognitive impairment, as we lack recent data regarding rates of FASD in prisons. US studies suggest up to 60% of young people with FASD will at some time enter the juvenile justice system.

Another study, conducted in a forensic mental health facility in Canada, showed 23% of resident youth had one type of FASD. This figure may be higher in vulnerable Australian populations, particularly in some remote regions where alcohol use in pregnancy is prevalent.

The economic impact of incarcerating people with FASD is huge. In Canada, the direct cost to the correctional system between 2011 and 2012 was CAD$17.5 million for youth and CAD$356.2 million for adults.

Screening for FASD

Diagnosing FASD is a challenge because as children get older, a firm history of prenatal alcohol exposure may be elusive. With age, the characteristic facial features (small eye openings, a thin upper lip and flat philtrum, the area between the upper lip and base of the nose) of fetal alcohol syndrome – a subset of FASD – diminish, and growth deficits correct.

Thorough assessment by a physician, a psychologist and, if necessary, allied health professionals, can identify impairments required for a FASD diagnosis, whether fetal alcohol syndrome or a neuro-developmental disorder associated with prenatal alcohol exposure. Such impairments can be in IQ, communication, memory, motor and executive function, and other areas.

In Canada, youth probation officers are using a tool for screening young offenders for FASD, and identifying the need for referral and assessment.

Another tool for health professionals with accompanying guidelines for assessing and diagnosing people with FASD is being developed in Australia. This will standardise the diagnostic approach.

Tools such as these are necessary to increase screening and diagnostic capacity in the justice and health systems. If a diagnosis is known, the associated behavioural and cognitive deficits can be taken into account when considering the reliability of evidence given by an offender, the supervision required in detention, and the sentence.

Appropriate care

There has been a call for better legal support for people with vulnerabilities in their journey through the criminal justice system. Consideration should be given to the defence of diminished responsibility in conditions such as FASD.

And alternative models of care need to be found to avoid imprisonment of those unable to plead. As identified in the case of Rosie Fulton, this poses a significant challenge, particularly in remote Australia where alternative accommodation is not readily available and would be costly to establish.

But prison is far more costly. In Canada, the justice system accounts for 40% of the total costs of FASD (including health and education). And Australia’s Senate inquiry on justice reinvestment heard that the estimated cost of detaining a juvenile offender in New South Wales in 2010–11 was much higher ($A652 per day) than the cost of supervision in the community ($A16.73 per day).

To end the cycle of re-offending, we urgently need evidence-based strategies to ensure offenders with FASD are recognised early and receive the care they deserve.

This article first appeared on ‘The Conversation’ on 13 October 2015.

“My baby boy was crying all the time and we weren’t getting much sleep – that’s when things started to go a bit downhill,” Ms Palmbas said.

“I couldn’t sleep even though I was so tired, and I was worrying all the time about every little detail about him; I was stressing over everything.

“It got to the point where I couldn’t cope and I remember ringing up my husband one day at work and said, ‘You have to come home from work’.

“I couldn’t do it anymore. I was crying all the time, I was beside myself and I didn’t want to be alone with the baby. It was horrible.”

Ms Palmbas became incapacitated, unable to live her everyday life and complete simple tasks. Her mind was swarming with negative and terrifying thoughts.

“I was having these horrible thoughts that I was going to hurt my child and that scared the life out of me – I thought I had turned into a monster who wanted to hurt this child she’s longed for,” she said.

“I didn’t know who I was and I didn’t know what was going on. I had these strange thoughts and thought they must be real. I honestly thought I was going crazy.

“I felt terrified all the time and I was in a constant state of panic. It was intense and debilitating.”

When Ms Palmbas attended a mothers’ group, everyone seemed to be coping and having it all together, which made her feel isolated in her experience.

“When it’s not spoken about, you just think that it’s just you,” she said.

“It makes it even harder when you think you’re really alone and no one understands you or is going through anything similar.”

Running away crossed Ms Palmbas’ mind many times.

“I thought I’d just pack my baby up and take him to one of my family members and just drive off, and everyone would live all the better for not having me around,” she said.

“I was just a wreck and absorbed in my thoughts in this deep dark hole. I couldn’t see any way out.”

This article first appeared on ‘ABC’ on 8 October 2015.

The national survey of 5500 children aged 9 to 13 highlighted the significant gap in wellbeing between mainstream kids and those who have a disability, are Indigenous, are young carers or from poor backgrounds.

Thirty per cent of children fall into one or more of these marginalised groups, and they rate their health worse, are less happy at school and have lower levels of family cohesion than their peers. Children with a disability are the worst off overall.

“There is a lot of diversity in wellbeing among young Australian children,” Flinders University associate professor Gerry Redmond, who led the study, said. “We need to focus on why some children are doing a lot less well than others.”

The gap between marginalised and mainstream kids is particularly pronounced by the time they reach year 8.

The Government-funded Australian Child Wellbeing Project surveyed children in years 4, 6 and 8 from 180 schools. Students were asked about their family, living arrangements, school, health, friendship, material wellbeing and bullying. It is the first national survey of children in the middle years, and the findings will be presented at the Australian Social Policy Conference on Monday.

Overall, most children report high life satisfaction and are optimistic about their future. More than 90 per cent of children are in good health. Children nominated family as the most important factor for having a good life, followed by health and friends. Those with a big support network were healthier, more engaged with school and less likely to be bullied.

However, some children are struggling more than their peers. One in five kids report being bullied once a week, with year 4 students experiencing the highest levels of bullying. Bullying included being ignored, being teased, having lies told about them, and people ganging up on them.

Children from marginalised groups were more likely to be bullied, and those with a disability the most bullied of all. The more often children are bullied, the more likely they are to miss school.

“I get the impression, talking to teachers, that this kind of non-physical bullying, like exclusion and telling tales, is extremely difficult to counter,” Professor Redmond said.

Sixty per cent of all children who were bullied reported two or more health issues, including frequent headaches, stomach aches, dizziness, feeling nervous, or having difficulty going to sleep. These complaints are often symptoms of stress.

A quarter of young people have a family member who has a disability, chronic illness, mental illness or drug or alcohol addiction. These young people experience significantly more health complaints than their peers.

“These health problems may be associated with worries about their family, and their direct caring responsibilities,” Professor Redmond said. “They’re worrying about these things that are normally seen as adult issues.”

Mainstream kids score an average life satisfaction of 85/100, while marginalised children score between 64 and 70. Similarly, mainstream children have a health score of 90/100, compared to marginalised kids, who score between 72 and 81.

Professor Redmond said his study provided the hard evidence policy-makers and schools need to act to better help these kids. “Young people in these groups are marginalised, but they actually comprise a large proportion of all young people,” he said.

“This should give policy-makers extra impetus to reduce the disadvantage they experience, and improve their lives.”

This article first appeared on ‘Brisbane Times’ on 25 September 2015.

Researchers from Queen’s University discovered evidence of emotional load-sharing between partners in a close relationship. In the study, Ph.D. candidate Jessica Lougheed, found that a strong relationship with a loved one can help ease stress when placed in difficult situations.

In the study, Lougheed and co-authors measured the stress levels of 66 adolescent girls during a spontaneous speech task. Before the speech performance, the participants and their mothers rated the quality of their relationship.

During the speeches, researchers tracked the participants’ level of stress via galvanic skin response (measuring the level of skin perspiration). To account for the effect of physical rather than purely emotional closeness, the participants’ mothers were instructed either to hold or not hold their daughters’ hand.

The researchers found that physical closeness allowed the participants to manage their stress more efficiently, regardless of how close the mother-daughter pair reported being.

However, when physical contact was removed from the equation, only the participants who reported higher relationship quality showed signs of load-sharing.

“Our results suggest that we are better equipped to overcome challenging situations when we are closer — either physically or in terms of how we feel in our relationships — to people we trust,” said Lougheed.

“We were somewhat surprised to find that mothers’ stress did not vary by physical closeness,” Lougheed said. “After all, it can be stressful for parents to watch their children perform, but being able to offer physical comfort might have lessened the mothers’ stress.

“Thus, emotional load-sharing in this context was not a function of the mothers’ stress level, and we expect that it occurred instead through the daughters’ perceptions of how stressful it was to give a speech. That is, higher physical and/or relationship closeness helped the daughters feel like they could overcome the challenging situation.”

The findings are important as they suggest physical contact can overcome some difficulties associated with relatively low relationship quality, or that being in a high-quality relationship is helpful for managing emotions in the same way as the physical comfort of a loved one.

Researchers warn, however, that the study was a very specific instance with unique characteristics.

Specifically, Lougheed said the general level of relationship quality was relatively high in their sample, and that physical contact may function very differently in distressed families.

She also cautioned against generalizing these results to other partnerships — such as a relationship between romantic partners, platonic friends, and other family members — and suggest that more research be done to determine the effect of socioeconomic status and gender, among other factors.

The study appears in the journal Emotion.

This article first appeared on ‘Psych Central’ on 15 September 2015.