Main Article Content
Fetal alcohol spectrum disorder, screening, attention deficit hyperactivity disorder, oppositional defiant, conduct disorder
In 2006, Nash and colleagues published results suggesting that individual items from the Child Behavior Checklist (CBCL) could be used as a screening tool that was highly sensitive in differentiating children with FASD from controls and children with Attention Deficit Hyperactivity Disorder (ADHD). Since many of the items referred to features of Oppositional Defiant/Conduct Disorder (ODD/CD), it was not clear whether the items reflected comorbidity with ODD/CD, or were unique to children with FASD.
The present study sought to replicate the results of our 2006 paper using a new and larger sample, which also includes a group of children diagnosed with ODD/CD.
Retrospective psychological chart review was conducted on 56 children with FASD, 50 with ADHD, 60 with ODD/CD, and 50 normal control (NC) children. Receiver operating characteristic curve (ROC) analysis of CBCL items discriminating FASD from NC was used to compare FASD to the ADHD and ODD/CD groups.
ROC analyses showed scores of a) 3 or higher on 10 items differentiated FASD from NC with a sensitivity of 98%, specificity of 42% and b) 2 or higher on 5 items reflecting oppositional behaviors differentiated FASD from ADHD with a sensitivity of 89% and specificity of 42%.
Our findings partially replicate the results of our 2006 study and additionally elucidate the behavioural differences between children with FASD and those with ODD/CD. The proposed screening tool is currently the only tool available that is empirically derived and able to differentiate children with FASD from children with clinically similar profiles.
2. Jacobson SW, Jacobson JL, Soko Rl, Chiodo LM, Corobana R. Maternal age, alcohol abuse history and quality of parenting as moderators of the effects of prenatal alcohol exposure on 7.5- year intellectual function. Alcohol Clin Exp Res 2004;28:1732-1745
3. Rasmussen C. Executive functioning and working memory in fetal alcohol spectrum disorder. Alcohol Clin Exp Res 2005;29:1359-67.
4. Mattson SN, Riley EP. Parent ratings of behavior in children with heavy prenatal alcohol exposure and IQ-matched controls. Alcohol Clin Exp Res 2000; 24:226-31.
5. Niccols A. Fetal alcohol syndrome and the developing socio-emotional brain. Brain Cogn 2007;65:135-42.
6. Coles CD, Platzman KA, Raskind-Hood CL, et al. A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder. Alcohol Clin Exp Res 1997;21:150 -161.
7. Brown RT, Coles CD, Smith IE, Platzman KA, Erickson S, Falek A. Effects of prenatal alcohol exposure at school age II: Attention and behavior. Neurotox Teratol 1991;13:369-376.
8. Burden MJ, Jacobson JL, Westerlund A, Lundhal LH, Morrison A, Dodge NC, Klorman R, Nelson CA, Avison MJ, Jacobson SW. An event-related potential study of response inhibition in ADHD with and without prenatal alcohol exposure. Alcohol Clin Exp Res 2010;34:617-627.
9. O’Malley KD, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Can J Psychiatry 2002;47:349-54.
10. Oesterheld JR, Kofoed LRF, Fogas B, Wilson A, Fiechtner H. Effectiveness of methylphenidate in native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: A controlled pilot study. J Child Adolesc Psychopharmacol 1998;8:39-48.
11. Steinhausen HC, Willms J, Spohr HL. Longterm psychopathological and cognitive outcome of children with fetal alcohol syndrome. J Am Acad Child Adolesc Psychiatry 1993;32:990-4.
12. O’Connor MJ, Shah B, Whaley S, Cronin P, Gunderson B, Graham J. Psychiatric illness in a clinical sample of children with prenatal alcohol exposure. Am J Drug Alcohol Abuse 2002;28:743-54.
13. Famy B, Streissguth A, Unis A. Mental illness in adults with fetal alcohol syndrome of fetal alcohol effects. Am J Psychiatry 1998;155:552- 554.
14. Fryer SL, McGee CL, Matt GE, Riley EP, & Mattson SN. Evaluation of psychopathological conditions in children with heavy prenatal alcohol exposure. Pediatrics 2007;119:733-41.
15. Bhatara V, Loudenberg R, Ellis R. Association of attention deficit hyperactivity disorder and gestational alcohol exposure: an exploratory study. J Atten Disord 2006;9:512-22.
16. Schonfeld AM, Mattson, SN, Riley EP. Moral maturity and delinquency after prenatal alcohol exposure. J Stud Alcohol 2005;66:545-54.
17. Stade B, Ungar WJ, Stevens B, Beyene J, Koren G. The burden of prenatal exposure to alcohol: measurement of cost. J FAS Int 2006;4:e5.
18. Streissguth AP, Barr HM, Kogan J, Bookstein FL. Final report: understanding the occurrence of secondary disabilities in clients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE). Seattle: University of Washington Publication Services; 1996.
19. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ 2005;172(5 Suppl):S1-S21.
20. Beck AT, Ward C, Mendelson M. Beck Depression Inventory (BDI). Arch Gen Psychiatry 1961;4:561-571.
21. Russell M, Martier SS, Sokol RJ, Mudar P, Bottoms S, Jacobson S, Jacobson J. Screening for pregnancy risk-drinking. Alcohol Clin Exp Res 1994;18:1156-1161.
22. Streissguth AP, Bookstein FL, Barr HM, Press S, Sampson PD. A fetal alcohol behavior scale. Alcohol Clin Exp Res 1998;22:325-333.
23. 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. Arch Womens Ment Health 2006;9:181-6.
24. Greenbaum R. Socioemotional functioning in children with alcohol related neurodevelopmental disorder (ARND): Profile on the Child Behavior Checklist (CBCL). Unpublished master’s thesis. Ontario Institute for Studies in Education/University of Toronto, Toronto, Ontario, Canada; 2000.
25. Astley SJ, Clarren SK. Diagnosing the full spectrum of fetal alcohol-exposed individuals: introducing the 4-digit diagnostic code. Alcohol 2000;35(4):400-10.
26. Institute of Medicine (IOM) of the National Academy of Sciences Committee to study Fetal Alcohol Syndrome. (1996). Diagnosis and Clinical Evaluation of Fetal Alcohol Syndrome. In Strattion, K., Howe, C., & Battaglia, F. (Eds.). Fetal Alcohol Syndrome Diagnosis, Epidemiology, Prevention, and Treatment (pp. 63-81) Washington, D.C.: National Academy Press.
27. Astley SJ, Aylward EH, Carmichael Olson H, Kerns K, Brooks A, Coggins TE, et al. Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Alcoholism Clin Exp Res 2009;33:1671-1689.
28. Achenbach T & Rescolora A. Child Behavior Checklist for 6-18 Years. Burlington VT: ASEBA Products; 2001.
29. Greenbaum RL, Stevens SA, Nash K, Rovet J. Social cognitive and emotion processing abilities of children with fetal alcohol spectrum disorders: A comparison with attention deficit hyperactivity disorder. Alcohol Clin Exp Res 2009;31:670-682.
30. Rasmussen C, Talwar V, Loomes C, Andrew G. Brief Report: Lie-telling in children with fetal alcohol spectrum disorder. J Pediatr Psychol 2008;33:220-225.
31. Thomas SE, Kelly SJ, Mattson SN, Riley EP. Comparison of social abilities of children with fetal alcohol syndrome to those of children with similar IQ scores and normal controls. Alcoholism Clin Exp Res 1998;22(2):528-533.
32. Whaley SE, O'Connor MJ, Gunderson B. Comparison of the adaptive functioning of children prenatally exposed to alcohol to a nonexposed clinical sample. Alcoholism Clin Exp Res 2001;25: 1018-1024.
33. Nulman I, O’Hayon B, Gladstone J, Koren G. The effects of alcohol on the fetal brain: the nervous system tragedy. In: Slikker W, Chang LW, editors. Handbook of Developmental Neurotoxicology. Academic Press, San Diego: Academic Press; 1998: p. 567-86.
34. Gtazke-Kopp LM, Beauchaine TP. Direct and passive prenatal nicotine exposure and the development of externalizing psychopathology. Child Psychiatry & Human Development 2007; 38:255-269.