Fetal alcohol spectrum disorder: neurodevelopmentally and behaviorally indistinguishable from other neurodevelopmental disorders

Lange, Shannon; Shield, Kevin; Rehm, Jürgen; Anagnostou, Evdokia; Popova, Svetlana · 2019 · DOAJ

DOI: 10.1186/s12888-019-2289-y

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Summary

This study addresses the diagnostic challenges associated with Fetal Alcohol Spectrum Disorder (FASD), specifically the lack of universally accepted criteria and high rates of psychiatric comorbidity that lead to misdiagnosis. The authors aimed to identify a neurodevelopmental profile that is both sensitive and specific to FASD, potentially aiding in accurate identification, prevalence estimation, and targeted intervention planning. The research was motivated by the need to distinguish FASD from other neurodevelopmental disorders that present with similar clinical features. The researchers conducted a secondary analysis of data from the Canadian component of the World Health Organization International Study on the Prevalence of FASD. The sample included 21 children with FASD, 28 children with other neurodevelopmental disorders (primarily ADHD and Autism Spectrum Disorder), and 37 typically developing control children, all aged 7 to 11 years. Neurodevelopmental status was assessed using a standardized test battery including the Wechsler Abbreviated Scales of Intelligence (WASI-II), Wechsler Intelligence Scale for Children (WISC-IV), and NEPSY-II. Behavioral issues were measured via the Child Behavior Checklist (CBCL). Latent Profile Analysis (LPA) was employed to derive discriminative profiles. Two primary analyses were performed: one comparing children with FASD to typically developing controls, and another comparing children with FASD to both typically developing controls and children with other neurodevelopmental disorders. Model fit was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The identified neurodevelopmental profile for FASD consisted of impairments in perceptual reasoning, verbal comprehension, visual-motor speed, motor coordination, processing speed, attention, executive function, visuospatial processing, and language, combined with rule-breaking behavior and attention problems. When compared solely to typically developing children, this profile demonstrated high sensitivity (95.2%) and specificity (89.2%), correctly classifying 91.4% of participants. However, when the comparison included children with other neurodevelopmental disorders, the profile’s specificity dropped significantly to 56.9%. The model failed to reliably distinguish children with FASD from those with ADHD or ASD, as many children with other disorders were incorrectly classified as having the FASD profile. A post-hoc analysis confirmed that IQ alone could not differentiate the groups, despite significant mean differences. The findings conclude that while a neurodevelopmental profile can effectively distinguish children with FASD from typically developing peers, it is not specific enough to differentiate FASD from other neurodevelopmental disorders. This suggests that children with FASD are neurodevelopmentally and behaviorally indistinguishable from those with conditions like ADHD and ASD based on the measures tested. The study questions the uniqueness of the FASD neurodevelopmental profile, implying that current diagnostic approaches relying on such profiles may not be sufficient for distinguishing FASD from other common neurodevelopmental conditions.

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• cognitive impairment