An investigation of the utility of the Australian Guide to the Diagnosis of Fetal Alcohol Spectrum Disorder in young children

Abstract

Background: Early diagnosis of children with fetal alcohol spectrum disorder (FASD) assists in implementing critical early support. The challenge lies in having a diagnostic process that enables valid and reliable assessment of domains of functioning in young children, with the added complexity that many children will also have co-occurring exposure to childhood adversity that is likely to impact these domains. Methods:The aim of this study was to test a diagnostic assessment of FASD in young children using the Australian Guide to the Diagnosis of FASD. Ninety-four children (aged 3 to 7 years) with confirmed or suspected prenatal alcohol exposure were referred to two specialist FASD clinics for assessment in Queensland, Australia.Results: There was a significant risk profile with 68.1% (n = 64) children having had contact with child protection services, and most children living in kinship (n = 22, 27.7%) or foster (n = 36, 40.4%) care. Forty-one percent of the children were Indigenous Australians. The majority (64.9%, n = 61) of children met criteria for FASD, 30.9% were classified as "At Risk" for FASD (n = 29), and 4.3% received no FASD diagnosis (n = 4). Only 4 (4%) children were rated as severe for the brain domain. Over 60% of children (n = 58) had two or more comorbid diagnoses. Sensitivity analyses indicated that the removal of comorbid diagnoses in the Attention, Affect Regulation, or Adaptive Functioning domains resulted in a change in 7 of 47 cases (15%) to an "At Risk" designation.Conclusions: These results highlight the complexity of presentation and the extent of impairment in the sample. The use of comorbid diagnoses to substantiate a "severe" designation in specific neurodevelopmental domains raises the question of whether there were false-positive diagnoses. The complexity of determining causal relationships between exposure to PAE and early life adversity on developmental outcomes continues to be a challenge in this young population.

Understanding the impacts of childhood adversity on sleep problems in children with fetal alcohol spectrum disorder: A comparison of cumulative and dimensional approaches

“…The assessment was multidisciplinary and involved pediatricians, clinical and neuropsychologists, occupational therapists and for some, a speech and language therapist. It consisted of comprehensive interviews with primary carers/parents, a full neurodevelopmental assessment, and diagnostic interviews (see Dawe et al, 2023, for full description of assessment process).…”

“…IRSD quintiles were extracted for each child based on the postcode for their school, preschool, or day care facility. The diagnostic outcome of the FASD assessment for each child was obtained following a comprehensive assessment conducted as part of a larger project (Dawe et al, 2023) using the Australian Guide for the Diagnosis of FASD (Elliot & Bower, 2016). The potential diagnoses were as follows: FASD with three sentinel facial features, FASD with less than three sentinel facial features, or the "At Risk of FASD" designation (see Table 1).…”

Prevalence of fetal alcohol spectrum disorder in foster care: A scoping review

“…None of these studies were population-based. Data on the prevalence of infants and children in foster care with FASD were available from: Australia (Dawe et al, 2023), Brazil (Strömland et al, 2015), Canada (Fuchs & Burnside, 2014), Germany (Alex & Feldmann, 2012), Israel (Tenenbaum et al, 2020), and the USA (Chasnoff et al, 2015).…”