In Fetal Alcohol Spectrum Disorder: Comorbidity Determines Complexity

Burd, Larry; Klug, Marilyn G.; O'Connell, Angela; Palme, Amanda; Sandstrom, Anne

doi:10.1007/978-3-030-73628-6_9

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…The initial criteria for diagnosis is determination of prenatal alcohol exposure. The diagnostic criteria and the methodology for diagnosis has been presented in detail in [ 14 ]. In brief, each child with a diagnosis of FASD had an exposure assessment which consisted of the One-Question Screen “When was your last drink?”, and a Maternal Risk Score and a dosimetry assessment [ 14 – 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…The diagnostic criteria and the methodology for diagnosis has been presented in detail in [ 14 ]. In brief, each child with a diagnosis of FASD had an exposure assessment which consisted of the One-Question Screen “When was your last drink?”, and a Maternal Risk Score and a dosimetry assessment [ 14 – 16 ]. This data is then reviewed and a five item Likert scale is used to assess clinician confidence in exposure.…”

Section: Methodsmentioning

confidence: 99%

“…The dosimetry assessment collects data on drinking days per week, drinks per drinking day, number of binge episodes (four or more standard drinks on an occasion), what is a drink(s) and days per week for cigarette smoking and number of cigarettes per smoking day. The second criterion includes meeting the neurobehavioral phenotype for FASD [14,17]. This included assessment of relevant records for previous intellectual testing, neuropsychological testing, adaptive behavior testing, assessment for attention deficit hyperactivity disorder, speech and language testing, memory testing, executive function testing, vision and The number of young children with fetal alcohol spectrum disorder (FASD) and non-FASD comparison children who had or did not have one of the seven E-FAST risk factors included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

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Screening for fetal alcohol spectrum disorder in infants and young children

Fleming

Sheridan

Waite

et al. 2023

Adv. Drug Alcohol Res.

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Introduction: With an estimated prevalence of up to five percent in the general population, fetal alcohol spectrum disorders (FASD) are the most common neurodevelopmental disorder and more prevalent than autism. Early identification and subsequent early intervention have the potential to improve developmental trajectory of children with FASD. In addition, new research suggests supplementation with choline may ameliorate the developmental impairments associated with prenatal alcohol exposure. Availability of a screening tool with acceptable epidemiologic performance criteria may be clinical useful in identification of young children at increased risk for FASD. In this paper we describe the Early Fetal Alcohol Spectrum Disorder Screening Test (E-FAST) to identify young children at increased risk for an FASD.Methods: We developed the E-FAST dataset from previously published studies, comprised of 281 children under 5 years of age, 180 (64.1%) were diagnosed with FASD and 101 (35.9%) were non-FASD.Analysis: The analysis identified seven useful variables (prenatal alcohol exposure, ADHD (Attention Deficit Hyperactivity Disorder), foster care or adopted, small OFC (occipital frontal circumference), communication impairments, impaired social skills, and cognitive deficits. All variables were categorized as yes/no for ease of use in a screening tool. Risk ratios for each of the seven indicators were estimated using two-way table analyses. Weights for each variable were estimated based on the relative strength of their odds ratios.Results: The average age was 2.7 years of age (S.D. 1.29) and ranged from infant (6.4%) to 4 years old (35.9%). Maternal alcohol use alone had a sensitivity of 0.97, specificity 0.65, and accuracy 0.86. For the combined seven variables, sensitivity was 0.94, specificity 0.74, and accuracy 0.87. Thus, the seven-item E-FAST screen had acceptable epidemiologic screening characteristics.Discussion: In the United States, up to 547 infants with FASD are born each day which far exceeds the capacity of multidisciplinary diagnostic clinics. During routine clinical management of infants and young children the use of an evidence-based screening tool provides a time efficient means to exclude large numbers of young children from further follow-up for FASD. Conversely, a positive screen identifies a smaller number of children at increased risk for FASD requiring more intensive evaluation and follow-up.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Screening for fetal alcohol spectrum disorder in infants and young children

Fleming

Sheridan

Waite

et al. 2023

Adv. Drug Alcohol Res.

Self Cite

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Fetal Alcohol Spectrum Disorder and the Corrections System

Burd

2022

Fetal Alcohol Spectrum Disorder

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Comparing rates of agreement between different diagnostic criteria for fetal alcohol spectrum disorder: A systematic review

Myers,

Burd,

Klug

et al. 2024

Alcohol, Clinical and Experimental Research

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Diagnostic accuracy is important in systems used to diagnose common disorders such as Fetal Alcohol Spectrum Disorder (FASD). Currently, no comprehensive study has examined rates of agreement between different diagnostic criteria for FASD. This study estimates the likelihood that a diagnosis of FASD using one set of diagnostic criteria will result in the same diagnosis when compared to different diagnostic criteria. A systematic review was conducted to identify articles reporting on the comparison of two or more diagnostic criteria for a diagnosis of FASD. Inclusion criteria required that the study present data that estimated agreement for a diagnosis of FASD or no‐FASD between two or more FASD criteria using two‐by‐two tables or presented data that could be used to generate the tables. Meta‐analyses with confidence intervals were included to demonstrate variability in the estimates. Standardized measures of agreement were assessed using the kappa statistic with 95% confidence intervals and the phi coefficient as a measure of correlation between binary outcomes. The search identified six studies reporting on eight different FASD diagnostic criteria. The studies compared agreement between 17 different pairings of the criteria. For individual children, agreement ranged from 53.7% to 91%. The agreement between the eight different diagnostic criteria ranged from 59.4% to 89.5%. The kappa statistic found that five associations had a kappa ranging from 0.6 to 0.8. This study illustrates that comparisons of multiple pairs of diagnostic criteria are likely to result in considerable variation in diagnoses of FASD for individual children and between different criteria. The lack of agreement between these commonly used systems is likely to affect clinical care and studies where diagnosis is a key variable. Large‐scale multicenter research is needed to examine factors contributing to variation in diagnostic outcomes.

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In Fetal Alcohol Spectrum Disorder: Comorbidity Determines Complexity

Cited by 4 publications

References 33 publications

Screening for fetal alcohol spectrum disorder in infants and young children

Screening for fetal alcohol spectrum disorder in infants and young children

Fetal Alcohol Spectrum Disorder and the Corrections System

Comparing rates of agreement between different diagnostic criteria for fetal alcohol spectrum disorder: A systematic review

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