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An investigation of the utility of the Australian Guide to the diagnosis of fetal alcohol spectrum disorder in young children
Journal article   Open access   Peer reviewed

An investigation of the utility of the Australian Guide to the diagnosis of fetal alcohol spectrum disorder in young children

Sharon Dawe, Elizabeth Eggins, Joseph Betts, Heidi Webster, Tania Pomario, Jessica Doak, Ned Chandler-Mather, Denise Hatzis, Haydn Till, Paul Harnett, …
Alcoholism: Clinical and Experimental Research, Vol.47(3), pp.486-500
2023
DOI: https://doi.org/10.1111/acer.15012
PMID: 36810987
Appears in  UniSC Diversity and Inclusion Research Collection
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Abstract

neurodevelopment fetal alcohol spectrum disorder prenatal alcohol exposure UniSC Diversity Area - Disability and Inclusion UniSC Diversity Area - Life Stages
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.

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