Archives of Women's Mental Health

, Volume 9, Issue 4, pp 181–186 | Cite as

Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential

  • K. Nash
  • J. Rovet
  • R. Greenbaum
  • E. Fantus
  • I. Nulman
  • G. Koren
Original contribution

Summary

Background: In most cases of Fetal Alcohol Spectrum Disorder (FASD), the pathognomonic facial features are absent making diagnosis challenging, if not impossible, particularly when no history of maternal drinking is available. Also because FASD is often comorbid with Attention Deficit Hyperactivity Disorder (ADHD), children with FASD are frequently improperly diagnosed and receive the wrong treatment. Since access to psychological testing is typically limited or non-existent in remote areas, other diagnostic methods are needed to provide necessary interventions.

Objectives: To determine if a characteristic behavioural phenotype distinguishes children with FASD from typically developing children and children with ADHD and use this information to create a screening tool for FASD diagnosis.

Methods: Parents and caregivers completed the Child Behavior Checklist (CBCL), a well-established standardized tool for evaluating children’s behavioural problems. Results from 30 children with Fetal Alcohol Syndrome or Alcohol-Related Neurodevelopmental Disability, 30 children with ADHD, and 30 typically developing healthy children matched for age and socioeconomic status with FASD were analyzed. Based on our previous work, 12 CBCL items that significantly differentiated FASD and control groups were selected for further analyses. Stepwise discriminant function analysis identified behavioural characteristics most strongly differentiating groups and Receiver Operating Characteristics (ROC) curve analyses determined sensitivity and specificity of different item combinations.

Results: Seven items reflecting hyperactivity, inattention, lying and cheating, lack of guilt, and disobedience significantly differentiated children with FASD from controls. ROC analyses showed scores of 6 or higher on these items differentiated groups with a sensitivity of 86%, specificity of 82%. For FASD and ADHD, two combinations of items significantly differentiated groups with high sensitivity and specificity (i) no guilt, cruelty, and acts young (sensitivity = 70%; specificity = 80% (ii) acts young, cruelty, no guilt, lying or cheating, steals from home, and steals outside (sensitivity = 81%; specificity = 72%). These items were used to construct a potential FASD screening tool.

Conclusions: Our findings identifying the behavioural characteristics differentiating children with FASD from typically developing children or children with ADHD have the potential for development of an empirically derived tool for FASD tool to be used in remote areas where psychological services are not readily available. This technique may speed up diagnosis and intervention for children without ready access to formal assessments.

Keywords: FASD; ADHD; screening; child behavior checklist; alcohal; ethanol; pregnancy. 

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References

  1. Achenbach, T, Rescorla, L 2001Manual for the ASEBA School-Age Forms and ProfilesUniversity of Vermont, Research Center for Children Youth & FamiliesBurlington(VT)Google Scholar
  2. Astley, SJ 2004Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code3University of WashingtonSeattle, WAGoogle Scholar
  3. Biederman, J, Monuteaux, MC, Kendrick, E, Klein, KL, Faraone, SV 2005The CBCL as a screen for psychiatric comorbidity in paediatric patients with ADHDArch Dis Child9010101015PubMedCrossRefGoogle Scholar
  4. Carmichael Olson, H, Morse, BA, Huffine, C 1998Development of psychopathology: Fetal Alcohol Syndrome and related conditionsSemin Clin Neuropsychiatry3262284Google Scholar
  5. Centers for Disease Control and Prevention (2004) Fetal Alcohol Syndrome: Guidelines for referral and diagnosis. Department of Health and Human Services.Google Scholar
  6. Chudley AE, Contry J, Cook JL, Loock C, Rosales T, LeBlanc N (2005) Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ 172 [Suppl 5].Google Scholar
  7. Coles, C, Platzman, A, Raskin-Hood, C, Brown, R, Falek, A, Smith, I 1997A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorderAlcohol Clin Exp Res21150161PubMedCrossRefGoogle Scholar
  8. Greenbaum R (2000) Socioemotional functioning in children with alcohol related neurodevelopmental disorder (ARND): Profile on the Child Behavour Checklist (CBCL) Unpublished master’s thesis, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.Google Scholar
  9. Greenbaum R (2004) Socioemotional functioning and language impairment in children with prenatal alcohol exposure: A comparison with Attention Deficit Hyperactivity Disorder. PhD Thesis, University of Toronto, Toronto, Ontario, Canada.Google Scholar
  10. Greenbaum, R, Nulman, I, Rovet, J, Koren, G 2002The Toronto experience in diagnosing alcohol related neurodevelopmental disorder (ARND): a unique profile of deficits and assetsCan J Clin Pharmacol9215225PubMedGoogle Scholar
  11. Hudziak, JJ, Copeland, W, Stanger, C, Wadsworth, M 2004Screening for DSM-IV externalizing disorders with the Child Behaviour Checklist: a receiver-operating characteristic analysisJ Child Psychol Psychiatry4512991307PubMedCrossRefGoogle Scholar
  12. Institute of Medicine, National Academy of ScienceStratton, KHowe, CBattaglia, F eds. 1996Fetal Alcohol Syndrome: diagnosis, epidemiology, prevention, and treatmentNational Academy PressWashington, DCGoogle Scholar
  13. Jones, K, Smith, D 1973Recognition of the fetal alcohol syndrome in early infancyLancet29991001PubMedCrossRefGoogle Scholar
  14. Nanson, JL, Hisock, M 1990Attention deficits in children exposed to alcohol prenatallyAlcohol Clin Exp Res14656661PubMedCrossRefGoogle Scholar
  15. Sampson, PD, Streissguth, AP, Bookstein, FL, Little, RE, Clarren, SK, Dehaene, P, Hanson, JW, Graham, JM,Jr 1997Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorderTeratology56317326PubMedCrossRefGoogle Scholar
  16. Sokol, RJ,Jr, Delaney-Black, V, Nordstrom, B 2003Fetal alcohol spectrum disorderJAMA29029962999PubMedCrossRefGoogle Scholar
  17. Stade B, Ungar W, Stevens B, Koren G (2006) The cost of FAS in Canada. www.nursing.utoronto.ca/research/conferences.
  18. Stratton, K, Howe, C, Battaglia, F 1996Fetal Alcohol Syndrome: Diagnosis, epdidemiology, prevention and treatmentNational Academy PressWashington, DCGoogle Scholar
  19. Streissguth, A 1997Fetal Alcohol SyndromePaul BrooksBaltimore, MDGoogle Scholar
  20. Streissguth, AP, Bookstein, FL, Barr, HM, Press, S, Sampson, PD 1998A fetal alcohol behaviour scaleAlcohol Clin Exp Res22325333PubMedCrossRefGoogle Scholar
  21. Streissguth, AP, Bookstein, FL, Barr, HM, Sampson, PD, O’Malley, K, Young, JK 2004Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effectsJ Dev Behav Pediatr25228238PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • K. Nash
    • 1
  • J. Rovet
    • 1
    • 3
  • R. Greenbaum
    • 4
  • E. Fantus
    • 1
  • I. Nulman
    • 2
    • 3
  • G. Koren
    • 2
    • 3
  1. 1.Psychology DepartmentThe Hospital for Sick ChildrenTorontoCananda
  2. 2.Motherisk Program, The Hospital for Sick ChildrenTorontoCananda
  3. 3.Department of PediatricsUniversity of TorontoTorontoCananda
  4. 4.The Hincks-Dellcrest CentreTorontoCananda

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