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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
T Achenbach L Rescorla (2001) Manual for the ASEBA School-Age Forms and Profiles University of Vermont, Research Center for Children Youth & Families Burlington(VT)
SJ Astley (2004) Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code EditionNumber3 University of Washington Seattle, WA
J Biederman MC Monuteaux E Kendrick KL Klein SV Faraone (2005) ArticleTitleThe CBCL as a screen for psychiatric comorbidity in paediatric patients with ADHD Arch Dis Child 90 1010–1015 Occurrence Handle16177156 Occurrence Handle1:STN:280:DC%2BD2MrgsVensg%3D%3D Occurrence Handle10.1136/adc.2004.056937
H Carmichael Olson BA Morse C Huffine (1998) ArticleTitleDevelopment of psychopathology: Fetal Alcohol Syndrome and related conditions Semin Clin Neuropsychiatry 3 262–284
Centers for Disease Control and Prevention (2004) Fetal Alcohol Syndrome: Guidelines for referral and diagnosis. Department of Health and Human Services.
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].
C Coles A Platzman C Raskin-Hood R Brown A Falek I Smith (1997) ArticleTitleA comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder Alcohol Clin Exp Res 21 150–161 Occurrence Handle9046388 Occurrence Handle1:STN:280:ByiC1MfjtlA%3D Occurrence Handle10.1111/j.1530-0277.1997.tb03743.x
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.
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.
R Greenbaum I Nulman J Rovet G Koren (2002) ArticleTitleThe Toronto experience in diagnosing alcohol related neurodevelopmental disorder (ARND): a unique profile of deficits and assets Can J Clin Pharmacol 9 215–225 Occurrence Handle12584580 Occurrence Handle1:STN:280:DC%2BD3s%2Fntlajuw%3D%3D
JJ Hudziak W Copeland C Stanger M Wadsworth (2004) ArticleTitleScreening for DSM-IV externalizing disorders with the Child Behaviour Checklist: a receiver-operating characteristic analysis J Child Psychol Psychiatry 45 IssueID7 1299–1307 Occurrence Handle15335349 Occurrence Handle10.1111/j.1469-7610.2004.00314.x
BibInstitutionalEditorNameInstitute of Medicine, National Academy of Science K Stratton C Howe F Battaglia (Eds) (1996) Fetal Alcohol Syndrome: diagnosis, epidemiology, prevention, and treatment National Academy Press Washington, DC
K Jones D Smith (1973) ArticleTitleRecognition of the fetal alcohol syndrome in early infancy Lancet 2 999–1001 Occurrence Handle4127281 Occurrence Handle1:STN:280:CSuD38rnsVY%3D Occurrence Handle10.1016/S0140-6736(73)91092-1
JL Nanson M Hisock (1990) ArticleTitleAttention deficits in children exposed to alcohol prenatally Alcohol Clin Exp Res 14 656–661 Occurrence Handle2264593 Occurrence Handle1:STN:280:By6D1M%2Fit1A%3D Occurrence Handle10.1111/j.1530-0277.1990.tb01223.x
PD Sampson AP Streissguth FL Bookstein RE Little SK Clarren P Dehaene JW Hanson JM Graham SuffixJr (1997) ArticleTitleIncidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder Teratology 56 317–326 Occurrence Handle9451756 Occurrence Handle1:CAS:528:DyaK1cXjtlyitA%3D%3D Occurrence Handle10.1002/(SICI)1096-9926(199711)56:5<317::AID-TERA5>3.0.CO;2-U
RJ Sokol SuffixJr V Delaney-Black B Nordstrom (2003) ArticleTitleFetal alcohol spectrum disorder JAMA 290 2996–2999 Occurrence Handle14665662 Occurrence Handle1:CAS:528:DC%2BD3sXpvVKhur8%3D Occurrence Handle10.1001/jama.290.22.2996
Stade B, Ungar W, Stevens B, Koren G (2006) The cost of FAS in Canada. www.nursing.utoronto.ca/research/conferences.
K Stratton C Howe F Battaglia (1996) Fetal Alcohol Syndrome: Diagnosis, epdidemiology, prevention and treatment SeriesTitleInstitute of Medicine National Academy Press Washington, DC
A Streissguth (1997) Fetal Alcohol Syndrome Paul Brooks Baltimore, MD
AP Streissguth FL Bookstein HM Barr S Press PD Sampson (1998) ArticleTitleA fetal alcohol behaviour scale Alcohol Clin Exp Res 22 325–333 Occurrence Handle9581636 Occurrence Handle1:STN:280:DyaK1c3ktVOlug%3D%3D Occurrence Handle10.1111/j.1530-0277.1998.tb03656.x
AP Streissguth FL Bookstein HM Barr PD Sampson K O’Malley JK Young (2004) ArticleTitleRisk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects J Dev Behav Pediatr 25 228–238 Occurrence Handle15308923 Occurrence Handle10.1097/00004703-200408000-00002
About this article
Cite this article
Nash, K., Rovet, J., Greenbaum, R. et al. Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential. Arch Womens Ment Health 9, 181–186 (2006). https://doi.org/10.1007/s00737-006-0130-3
- Keywords: FASD; ADHD; screening; child behavior checklist; alcohal; ethanol; pregnancy.