Evaluation of the Neurobehavioral Screening Tool in Children with Fetal Alcohol Spectrum Disorders (FASD)

Main Article Content

Michael-Anne LaFrance
Kaitlyn McLachlan
Kelly Nash
Gail Andrew
Christine Loock
Tim F Oberlander
Gideon Koren
Carmen Rasmussen

Keywords

Neurobehavioral screening tool, fetal alcohol spectrum disorder, prenatal alcohol exposure, screening

Abstract

Background


There is a growing need for validated tools to screen children at risk of fetal alcohol spectrum disorder s (FASD). The Neurobehavioral Screening Tool ( NST) is one of several promising screening measures for FASD , though further evidence is needed to establish the tool’s psychometric utility.


Objective


To assess the predictive accuracy of the NST among children with an FASD diagnosis, with prenatal alcohol exposure (PAE) but no FASD diagnosis, and typically developing controls .


Method


The NST was completed by caregivers of children ages 6 to 17 , including 48 with FASD, 2 2 with PAE , and 32 typically developing non - exposed controls . Predictive accuracy coefficients were calculated using Nash et al. (2006) criteria , and compared against controls. An alternative scoring scheme was also investigated to determine optimum referral thresholds using item - level total scores.


Results


The NST yielded 62.5% sensitivity for participants with FASD and 50% for PAE. Specificity values were 100% with no typically developing control scoring positive . Within the FASD group there was a trend for higher sensitivity among adolescents aged 12 to 17 (70.8%) compared with children aged 6 to 11 years (54.2%) , p = 0.23 .


Conclusion


The findings support a growing body of literature evidencing psychometric promise for the clinical utility of the NST as an FASD screening tool, though further research on possible age - effects is warranted. The availability of a validated clinical screening tool for FASD, such as the NST, would aid in accurately screening a large number of children and lead to a timelier diagnostic referral.

Abstract 114 | PDF Downloads 33

References

1. Chudley A, Conry J, Cook J, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. C anadian Medical Association Journal. 2005;172:S1 - S21.
2. 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 R eviews 2009;15:176 - 192.
3. Rasmussen C, Andrew G, Zwaigenbaum L, Tough S. Neurobehavioral outcomes of children with Fetal Alcohol Spectrum Disorder: A Canadian perspective. Pediatrics & Child Health 2008;13(3):185 - 191.
4. Fast D, Conry J, Loock C. Identifying fe tal alcohol syndrome among youth in the criminal justice system. Journal of Developmental and Behavioral Pediatrics 1999;20:370 - 372.
5. O'Connor MJ, Shah B, Whaley S, Cronin P, Gunderson B, Graham J. Psychiatric illness in a clinical sample of children with p renatal alcohol exposure. American Journal of Drug and Alcohol Abuse Nov 2002;28(4):743 - 754.
6. Pei J, Denys K, Hughes J, Rasmussen C. Mental h ealth i ssues in Fetal Alcohol Spectrum Disorder. Journal of Mental Health 2011;20(5):438 - 448.
7. Streissguth A, Bookste in 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 Aug 2004;25(4):228 - 238.
8. Yates W, Cadoret R, Troughton E, Stewart M, G uinta T. Effects of fetal alcohol exposure on adult symptoms of nicotine, alcohol, and drug dependence. Alcohol Clin Exp Res 1998;22(4):914 - 920.
9. Goh Y, Chudley A, Clarren S, et al. Development of Canadian screening tools for fetal alcohol spectrum disorder . The Canadian Journal of Clinical Pharmacology 2008;15(2):344 - 366.
10. Nash K, Rovet J, Greenbaum R, Fantus E, Nulman I, Koren G. Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential. Archi ves of Women's Mental Health 2006;9:181 - 186.
11. CAPHC. The Screening Tools. National Screening Tool Kit for Children and Youth Identified and Potentially Affected by FASD 2012; http://ken.caphc.org/xwiki/bin/view/FASDScreen ingToolkit/National+Screening+Tool+Kit+for+C hildren+and+Youth+Identified+and+Potentially+ Affected+by+FASD .
12. Achenbach T, Res corla L. Manual for ASEBA school - age forms and profiles. Burlington, VT: University of Vermont, Research Centre for Children, Youth & Families; 2001.
13. Nash K, Koren G, Rovet J. A differential approach for examining the behavioral phenotype of fetal alcohol spectrum disorders. J Popul Ther Clin Parmacol 2011;18(3):e440 - e453.
14. Reynolds JN, Weinberg J, Clarren S, et al. Fetal Alcohol Spectrum Disorders: Gene - environment interactions, predictive biomarkers, and the relationship between structural alterations in t he brain and functional outcomes. Semin Pediatr Neurol 2011;18(1):49 - 55.
15. Astley S. Diagnostic Guide for Fetal Alcohol Spectrum Disorders:The 4 - Digit Diagnostic Code. 3rd ed. Seattle, WA: University of Washington Publication Services; 2004.
16. Greenbaum R. Soc ioemotional functioning in children with alcohol related neurodevelopmental disorder (ARND): Profile on the Child Behavior Checklist (CBCL) [Unpublished Master's Thesis]. Toronto: Department of Human Development and Applied Psychology Ontario Institute for Studies in Eduation/University of Toronto; 2000.
17. Baron RM, Kenny DA. The moderator - mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations . Journal of Personality and Social Psychology 1986;51 :1173 - 1182.
18. MedCalc Software. MedCalc: Diagnostic test evaluation. 2013; http://www.medcalc.org/calc/diagnostic_test.php
19. Coggins TE, Timler GR, Olswang LB. A state of double jeopardy: impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school - age children with fetal alcohol spectrum disorder. Lang Speech Hear Serv Sch Apr 2007;38(2):117 - 127.
20. Olson HC, Oti R, Gelo J, Beck S. "Family Matters": Fe tal alcohol spectrum disorders and the family. Developmental Disabilities Reviews 2009;15(3):235 - 249.
21. 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.
22. Streissguth AP, Barr HM, Kogan J, Bookstein FL. 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.
23. 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:e 494 - e499.
24. Silver E, Smith W, Banks S. Constructing actuarial devices for predicting recidivism: A comparison of methods. Crim Justice and Behav 2000;27:733 - 764.
25. Moffit TE, Caspi A, Dickson N, Silva P, Stanton W. Childhood onset versus adolescent onset anti social conduct problems in males: Natural history from ages 3 to 18 years. Dev Psychopathology 1996;8:399 - 424.
26. Ruchkin V, Koposov R, Vermeiren R, Schwab - Stone M. Psychopathology and age at onset of conduct problems in juvenile delinquents. J Clin Psychiat 2003;64:913 - 920.
27. Castro Y, Carbonell JL , Anestis J. The influence of gender role on the prediction of antisocial bahaviour and somatization. International Journal of Social Psychiatry 2011 ; 58 : 409 - 416.
28. Berkout OV, Young JN, Gross AM. Mean girls and bad boy s: Recent research on gender differences in conduct disorder. Aggression and Violent Behavior 2011 ; 16 (6): 503 - 511.
29. Maughan B, Rowe R, Messer J, Goodman R, Meltzer H. Conduct disorder and oppositional defiant disorder in a national sample: developmental epid emiology. Journal of Child Psychology and Psychiatry 2004 ; 45 (3) : 609 - 621 .