Misdiagnosis and Missed Diagnoses in Foster and Adopted Children With Prenatal Alcohol Exposure

Abstract

OBJECTIVE: The purpose of this article is to assess the rate of misdiagnosis and missed diagnoses of fetal alcohol spectrum disorders (FASD) among a population of foster and adopted youth referred to a children's mental health center.METHODS: Data were collected from a sample of 547 children who underwent a comprehensive multidisciplinary diagnostic evaluation. Utilizing current diagnostic criteria, children were diagnosed, as appropriate, with fetal alcohol syndrome, partial fetal alcohol syndrome, alcoholrelated neurodevelopmental disorder, or alcohol-related birth defects. Changes in rates of alcohol exposure-related diagnoses and cooccurring mental health disorders pre-and postassessment were analyzed by using McNemar's test for dependent proportions.RESULTS: Among 156 children and adolescents who met criteria for a diagnosis within the fetal alcohol spectrum, 125 had never been diagnosed as affected by prenatal alcohol exposure, a missed diagnosis rate of 80.1%. Of the 31 who had been recognized before referral as affected by prenatal alcohol exposure, 10 children's FASD diagnoses were changed within the spectrum, representing a misdiagnosis rate of 6.4%. The remaining 21 (13.5%) children's diagnoses stayed the same. There also were significant changes in the rate of mental health diagnosis, and learning disorders, communication disorders, and intellectual disability, objective signs of neurocognitive damage, were not recognized in a significant number of children with FASD.CONCLUSIONS: Within this clinical sample, 86.5% of youth with FASD had never been previously diagnosed or had been misdiagnosed. These high rates of missed diagnoses and misdiagnosis have significant implications for intervention and therapeutic services. WHAT'S KNOWN ON THIS SUBJECT:Researchers speculate that children with fetal alcohol spectrum disorders often are not recognized or diagnosed correctly. WHAT THIS STUDY ADDS:This is the first study to assess the rate of missed diagnoses and misdiagnosis in foster and adopted children with fetal alcohol spectrum disorders.

Prevalence of alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorders among the general and Aboriginal populations in Canada and the United States

“…The main reason is that, unfortunately, many individuals with FASD are unrecognized and/or misdiagnosed (Elias, 2013;O'Connor et al, 2006). A recently conducted study reported that within their sample 87% of youths with FASD had never been previously diagnosed or had been misdiagnosed (Chasnoff et al, 2015). There are several barriers to the early recognition been found to co-occur in individuals with FASD, which likely "mask" the FASD diagnosis (Popova et al, 2016).…”

Fetal Alcohol Spectrum Disorders

“…20 A recent study among a population of foster and adopted youth referred to a children's mental health center reported a FASD misdiagnosis rate of 6.4% and a missed diagnoses rate of 80.1%. 21 FAS is the FASD with the most explicit diagnostic criteria, so it only represents a fraction of individuals affected by PAE. FASDs other than FAS are more challenging to diagnose, so the true FASD prevalence remains unknown and the actual impact underappreciated.…”

“…Any history of adoption, especially from an environment of socioeconomic impoverishment, whether domestic or international, and any history of involvement with a US child social services system can indicate a higher likelihood of having had PAE and a need for careful screening for FASD. 21,49,81 A history of involvement with child protective services related to parental substance use or to child neglect, abuse, or abandonment is a strong marker for risk, as is a history of any out-of-home or foster care placement, including kinship care. 81 Many people are not aware of the requirement for health care providers to report FASD to child protective service systems.…”

Fetal Alcohol Spectrum Disorder (FASD): A call on mental health treatment professionals to become informed

“…For this reason, it is never safe to drink alcohol when trying to get pregnant or during pregnancy. FASD can include a wide range of cognitive (e.g., intelligence, executive functions, shortand long-term memory, and attention), social (e.g., communication skills and gullibility), physical (e.g., reduced height and weight, and smaller head size), and adaptive impairments (e.g., decision making and problem-solving abilities) [10][11][12][13][14]. Of critical concern is the disruption of immune system development that leads to increased risk of disease and infection throughout the exposed individual's life [15], with deleterious effects of FASD presenting not only in the individual, but also on the family and in the community.…”