Construct and factorial validity of Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (ND-PAE)

Abstract

Background ND-PAE, as a condition needing further study, requires validation. Few studies have assessed the validity of ND-PAE with none using a prospective sample. Methods Fifty-eight children underwent multidisciplinary FASD assessments and were evaluated for ND-PAE using a prospective, clinical approach. Construct and factorial validity of ND-PAE were assessed, and associations between domains and symptoms described. Post hoc analysis assessed external validity of factors. Results ND-PAE demonstrated weak construct validity with variable convergence and divergence within and between symptoms. Factor analysis revealed one strong factor consisting of abilities associated with adaptive behavior and general cognitive ability. Relative contribution of symptoms and domains were variable. Conclusion This study provides an evidence-based approach to assessing ND-PAE symptoms and is a starting point to elucidating its neurobehavioral pattern.

Validation of the ND-PAE Diagnosis in Children with Heavy Prenatal Alcohol Exposure

“…Previous studies have assessed the validity of the diagnosis and have found that the AF domain may be too restrictive ( Kable & Coles, 2018 ). Specifically, requiring two out of four criteria for the AF domain (AF 2/4) may not be necessary, and requiring that one of the two first criteria for adaptive functioning (communication and social communication) is not supported by the literature and therefore may lead to low sensitivity, or fewer true positives ( Sanders et al, 2020 ). Sanders et al (2020) also evaluated construct and factorial validity of the ND-PAE diagnosis and found through principal component analysis (PCA) that symptoms only loaded on one factor, which included neurocognitive and adaptive functioning criteria.…”

“…Specifically, requiring two out of four criteria for the AF domain (AF 2/4) may not be necessary, and requiring that one of the two first criteria for adaptive functioning (communication and social communication) is not supported by the literature and therefore may lead to low sensitivity, or fewer true positives ( Sanders et al, 2020 ). Sanders et al (2020) also evaluated construct and factorial validity of the ND-PAE diagnosis and found through principal component analysis (PCA) that symptoms only loaded on one factor, which included neurocognitive and adaptive functioning criteria. Their assessment of convergent and divergent validity showed that convergence, or the correlation among symptoms, was low among SR symptoms, specifically the correlation between mood regulation and attention symptoms ( Sanders et al, 2020 ).…”

“… Sanders et al (2020) also evaluated construct and factorial validity of the ND-PAE diagnosis and found through principal component analysis (PCA) that symptoms only loaded on one factor, which included neurocognitive and adaptive functioning criteria. Their assessment of convergent and divergent validity showed that convergence, or the correlation among symptoms, was low among SR symptoms, specifically the correlation between mood regulation and attention symptoms ( Sanders et al, 2020 ). Due to the unspecified impairment threshold in the DSM-5, previous studies have assessed symptom severity at 1.0, 1.5, and 2.0 standard deviations (SDs) from the mean ( Kable & Coles, 2018 ; Sanders et al, 2020 ).…”

“…Their assessment of convergent and divergent validity showed that convergence, or the correlation among symptoms, was low among SR symptoms, specifically the correlation between mood regulation and attention symptoms ( Sanders et al, 2020 ). Due to the unspecified impairment threshold in the DSM-5, previous studies have assessed symptom severity at 1.0, 1.5, and 2.0 standard deviations (SDs) from the mean ( Kable & Coles, 2018 ; Sanders et al, 2020 ). Internal validity analyses have shown that the symptoms have a fair internal consistency at both 1.0 and 1.5 SDs ( Sanders et al, 2020 ).…”

“…Due to the unspecified impairment threshold in the DSM-5, previous studies have assessed symptom severity at 1.0, 1.5, and 2.0 standard deviations (SDs) from the mean ( Kable & Coles, 2018 ; Sanders et al, 2020 ). Internal validity analyses have shown that the symptoms have a fair internal consistency at both 1.0 and 1.5 SDs ( Sanders et al, 2020 ). However, these studies have small sample sizes (n < 58).…”