Identifying the neurobehavioral phenotype of fetal alcohol spectrum disorder in young children

Background Most children with Fetal Alcohol Spectrum Disorder (FASD) do not display the typical facial changes, making the diagnosis much more challenging due to poor specificity of the brain dysfunction exhibited by these children. We have recently described and validated a behavioral phenotype of FASD using items from the Child Behavior Checklist (The Neurobehavioral Screening Test, NST). This tool has high sensitivity and specificity in separating children aged 6-13 yrs with FASD from those with ADHD and from healthy controls. Objectives To test the validity of the NST for children aged 4-6 years in order to help facilitate diagnosis of FASD in young children. Methods Children referred to Motherisk for FASD diagnosis are all tested using the Child Behavior Checklist. We compared the scores of children 4-6 yrs diagnosed with FASD to those referred but not receiving a diagnosis, as well as to normal healthy control children of the same age range. Results Out of the 10 items of NST used at age 6-13 years, 3 are not scored in children 4-6 years of age. Using the 7 remaining items, children with FASD endorsed significantly more items (6.7+/-1.3) than healthy controls (2.3+/-1.2), or alcohol- exposed children who were not given an FASD diagnosis (4.7+/- 1.9). Using a cut-off of 5 out of7 items, the NST had a 94% sensitivity and 96% specificity in identifying children with FASD. Nine of 19 children exposed to alcohol with whom an FASD diagnosis could not be confirmed, scored 5 or more on the NST. Conclusions In this pilot study, the NST has shown very high sensitivity and specificity and can be used to identify children who are very likely to be diagnosed with FASD.