A differential approach for examining the behavioral phenotype of fetal alcohol spectrum disorders

Background In 2006, Nash and colleagues published results suggesting that individual items from the Child Behavior Checklist (CBCL) could be used as a screening tool that was highly sensitive in differentiating children with FASD from controls and children with Attention Deficit Hyperactivity Disorder (ADHD). Since many of the items referred to features of Oppositional Defiant/Conduct Disorder (ODD/CD), it was not clear whether the items reflected comorbidity with ODD/CD, or were unique to children with FASD. Objectives The present study sought to replicate the results of our 2006 paper using a new and larger sample, which also includes a group of children diagnosed with ODD/CD. Methods Retrospective psychological chart review was conducted on 56 children with FASD, 50 with ADHD, 60 with ODD/CD, and 50 normal control (NC) children. Receiver operating characteristic curve (ROC) analysis of CBCL items discriminating FASD from NC was used to compare FASD to the ADHD and ODD/CD groups. Results ROC analyses showed scores of a) 3 or higher on 10 items differentiated FASD from NC with a sensitivity of 98%, specificity of 42% and b) 2 or higher on 5 items reflecting oppositional behaviors differentiated FASD from ADHD with a sensitivity of 89% and specificity of 42%. Conclusion Our findings partially replicate the results of our 2006 study and additionally elucidate the behavioural differences between children with FASD and those with ODD/CD. The proposed screening tool is currently the only tool available that is empirically derived and able to differentiate children with FASD from children with clinically similar profiles.