Main Article Content

Kaitlyn McLachlan
Gail Andrew
Jacqueline Pei
Carmen Rasmussen


Fetal alcohol spectrum disorder, preschool, assessment



Children with fetal alcohol spectrum disorder s (FASD) experience a range of cognitive, emotional, and behavioral challenges. Early assessment, diagnosis, and intervention are critical protective factors against adverse outcomes in FASD. However, FASD evaluations can be challenging in preschoolers and limited guidance is available to inform practice.


We sought to describe the clinical presentation of preschool aged children assessed for FASD. Challenges encountered during the assessment process were also evaluated in order to inform the development of future diagnostic guidelines for clinicians undertaking FASD assessments in very young children.


Retrospective file information was coded for 72 children aged one to five assessed through the Glenrose Rehabilitation Hospital FASD Program using a structured coding manual. The sample included children who received an FASD diagnosis, children whose diagnosis was deferred, and children who did not receive an FASD diagnosis. Diagnostic findings, neurobehavioural functioning, past adversities and other clinical factors, and assessment recommendations were examined. Use of neurobehavioral assessment measures was also assessed.


Young children diagnosed with FASD showed significant neurobehavioral impairment though clinical needs were high across the entire sample. High rates of pre- and postnatal adversity were seen in all children assessed. Use of objective tests to assess neurobehavioral functioning was limited, particularly among younger children.


Irrespective of diagnostic outcome, preschool aged children referred for FASD assessments presented with complex clinical profiles and significant needs. Findings highlight the challenges faced by clinicians and underscore the need for guidelines to direct clinical practice and training for interdisciplinary teams assessing preschool aged children with PAE.

Abstract 671 | PDF Downloads 325


1. Chudley A, Conry J, Cook J, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Canadian Medical Association Journal 2005;172:S1 -S21.
2. Streissguth A, Barr H, Kogan J, Bookstein F. Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE): Final Report to the Centers for Disease Control and Prevention. Seattle: University of Washington, Fetal Alcohol and Drug Unit ;1996.
3. May P, Gossage J, Kalberg W, et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Developmental Disabilities Research Reviews 2009;15:176 -192.
4. Stratton K, Howe C, Battaglia F. Fetal alcohol syndrome: diagnosis, epidemiology, prevention, and treatment. Washington, D.C.: National Academy Press; 1996.
5. Astley S. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4 -Digit Diagnostic Code. 3rd ed. Seattle, WA: University of Washington Publication Services; 2004.
6. Cook J, Green C, Lilley C. FASD: Guidelines for Diagnosis Across the Lifespan. 6th International Conference on Fetal Alcohol Spectrum Disorder. Research, Results, and Relevance, 2015: Integrating Research, Policy and Promising Practice Aroung the World . 2015; Vancouver, BC.
7. Phillips DA, Shonkoff JP. From Neurons to Neighborhoods: The Science of Early Childhood Development. National Academies Press; 2000.
8. Rasmussen C, Benz J, Pei J, et al. The impact of an ADHD co-morbidity on the diagnosis of FASD. Can J Clin Pharmacol 2010 Winter;17(1):e165 -76 Epub 2010 Apr 6. 2010.
9. Garner AS, Shonkoff JP, Siegel BS, et al. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics 2012;129(1):e224 -e231.
10. Streissguth A, Bookstein F, Barr H, Sampson P, O'Malley K, Young J. Risk factors for adverse life outcomes in Fetal Alcohol Syndrome and Fetal Alcohol Effects. Journal of Developmental & Behavioral Pediatrics 2004;25(4):228 -238.
11. Carmichael Olson H, Sampson P, Barr H, Streissguth A, Bookstein F. Prenatal exposure to alcohol and school problems in late childhood: A longitudinal prospective study. Development and Psychopathology 1992;4:341 -359.
12. Alyward GP. Infant and early neuropsychology. New York: Plenum Press; 1997.
13. Anderson P. Assessment and development of executive function (EF) during childhood. Child Neuropsychol 2002;8(2):71 -82.
14. Carlson SM. Developmentally sensitive measures of executive function in preschool children. Dev Neuropsychol 2005;28(2):595 -616.
15. Fuhs MW, Day JD. Verbal ability and executive functioning development in preschoolers at head start. Dev Psychol 20 11;47(2):404- 416.
16. Garon NC, Bryson SE, Smith IM. Executive Function in preschoolers: A review using an integrative framework. Psychological Bulletin. 2008;134(1):31 -60.
17. Heffelfinger AK, Koop JI. A description of preschool neuropsychological assessment in the P.I.N.T. clinic after the first 5 years. Clin Neuropsychol 2009;23(1):51 -76.
18. Heffelfinger AK, Mrakotsky CM. Cognitive Development. New York: Guildford Press; 2006.
19. Mrakotsky CM, Heffelfinger AK. Neuropsychological Assessment. New York: Guildford Press; 2006.
20. Fuglestad AJ, Whitley ML, Carlson SM, et al. Executive functioning deficits in preschool children with Fetal Alcohol Spectrum Disorders. Child Neuropsychol 2014; 1-16.
21. Gross AC, Deling LA, Wozniak JR, Boys CJ. Objective measures of executive functioning are highly discrepant with parent- report in fetal alcohol spectrum disorders. Child Neuropsychology 2014(ahead-of-print); 1-8.
22. Toplak ME, West RF, Stanovich KE. Practitioner review: Do performance-based measures and ratings of executive function assess the same construct? J Child Psychol Psyc 2013;54(2):131 - 143.
23. Rasmussen C. Risk and Protective Factors for Secondary Disabilities Among Children with Fetal Alcohol Spectrum Disorder and Prenatal Alcohol Exposure. Paper presented at: Presentation given at Research Society on Alcoholism Conference 2012; San Francisco, CA.
24. Popova S, Lange S, Burd L, Chudley AE, Clarren SK, Rehm J. Cost of fetal alcohol spectrum disorder diagnosis in Canada. PloS one. 2013;8(4):e60434.
25. Jirikowic T, Gelo J, Astley S. Children and youth with fetal alcohol spectrum disorders: Summary of intervention recommendations after clinical diagnosis. Am J Intellect Dev Disabil 2010;48(5):330 -344.
26. Dube SR, Felitti VJ, Dong M , Giles WH, Anda RF. The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Prev Med 2003;37(3):268 - 277.
27. Noland JS, Singer LT, Arendt RE, Minnes S, Short EJ, Bearer CF. Executive functioning in preschool-age children prenatally exposed to alcohol, cocaine, and marijuana. Alcohol Clin Exp Res 2003;27(4):647 -656.
28. Janzen L, Nanson J, Block G. Neuropsychological evaluation of preschoolers with Fetal Alcohol Syndrome. Neurotoxicol and T eratol 1995;28:273 - 279.
29. Kodituwakku PW. Defining the behavioral phenotype in children with fetal alcohol spectrum disorders: a review. Neurosci and B iobehav R 2007;31(2):192 -201.
30. Mattson SN, Crocker N, Nguyen TT. Fetal alcohol spectrum disorders: neuropsychological and behavioral features. Neuropsychol R ev 2011;21(2):81 -101.
31. Pei J, Job J, Kully -Martens K, Rasmussen C. Executive function and memory in children with fetal alcohol spectrum disorder. Child Neuropsychol 2011;17:290 -309.
32. Rasmussen C, Bisanz J. Executive functioning in children with fetal alcohol spectrum disorder: Profiles and age- related differences. Child Neuropsychol 2009;15(3):201 -215.
33. Rasmussen C, Horne K, Witol A. Neurobehavioral functioning in children with Fetal Alcohol Spectrum Disorder. Child Neuropsychol 2006;12:1 -16.
34. Wyper K, Rasmussen C. Language impairments in children with fetal alcohol spectrum disorders. Can J Clin Pharmacol 2011;18(2):364- 376.
35. Majnemer A. Benefits of an early intervention for children with developmental disabilities. Sem Ped Neurol 1998;5(1):62 -69.
36. McCabe PC, Altamura M. Emprically validated strategies to improve social and emotional competence of preschool children. Psychol Schools 2011;48(5):513 -540.
37. Paley B, O'Connor MJ. Behavioral inte rventions for children and adolescents with fetal alcohol spectrum disorders. Alcohol Res Health 2011;34(1):64 -75.
38. Astley S. Profile of the first 1400 patients receiving diagnostic evaluations for fetal alcohol spectrum disorder at the Washington State Fet al Alcohol Syndrome Diagnostic & Prevention Network. Can J Clin Pharmacol 2010;17(1):e132- 164.
39. Davis K, Desrocher M, Moore T. Fetal alcohol spectrum disorder: A review of neurodevelopmental findings and interventions. J Dev Phys Disabil 2011;23:143 -167.
40. Riley EP, Infante MA, Warren KR. Fetal alcohol spectrum disorders: An overview. Neuropsychol Rev 2011;21(2):73 -80.
41. Astley S, Bailey D, Talbot C, Clarren S. Fetal alcohol syndrome (FAS) primary prevention through fas diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol Alcohol 2000;35(1):509 -519.
42. Wengal T, Hanlon- Dearman A, Fjeldsted B. Sleep and sensory characteristics in young children with fetal alcohol spectrum disorder. J Dev Behav Pediatr 2011;32:384 -392.
43. Clarren S, Lutke J, Sherbuck M. The Canadian Guidelines and the interdisciplinary clinical capacity of Canada to diagnose fetal alcohol spectrum disorder. J Dev Behav Pediatr 2011;18:e494 -e499.
44. Hanlon -Dearman A, Green CR, Andrew G, LeBlanc N, Cook JL. Anticipatory guidance for children and adolescents with Fetal Alcohol Spectrum Disorder (FASD): Practice points for primary health care providers. J Popul Ther Clin Pharmaco l 2014;22(1):e27 -56.

Most read articles by the same author(s)