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Foetal alcohol spectrum disorder: identifying the neurobehavioural phenotype and effective interventions
Gideon Koren1, Irene Zelner, Kelly Nash
1aMotherisk Program, Division of Clinical Pharmacology-Toxicology, Department of Pediatrics bDepartment of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Identifying the neurodevelopmental phenotype of foetal alcohol spectrum disorder (FASD) is challenging. A validated behavioral phenotype and promising interventions offer hope for improving outcomes in affected children.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Public Health
Background:
- Alcohol exposure during pregnancy can cause significant neurodevelopmental dysfunction in children worldwide.
- Diagnosing foetal alcohol spectrum disorder (FASD) is challenging, especially when facial dysmorphology is absent.
- The precise mechanisms of alcohol-related brain damage remain unclear.
Purpose of the Study:
- To describe and validate a behavioral phenotype for FASD.
- To assess the utility of a neurobehavioral screening test for FASD diagnosis.
- To review promising interventions for improving FASD outcomes.
Main Methods:
- Utilized items from the Child Behaviour Checklist to describe and validate the FASD behavioral phenotype.
- Evaluated the sensitivity and specificity of the screening tool in differentiating FASD from ADHD and controls.
- Reviewed intervention studies aimed at improving daily functioning and quality of life for individuals with FASD.
Main Results:
- A distinct behavioral phenotype for FASD was identified and validated.
- The neurobehavioral screening test demonstrated high sensitivity and specificity.
- Intervention studies showed promise in enhancing coping abilities and quality of life for children and adolescents with FASD.
Conclusions:
- A validated neurobehavioral screening test can aid in FASD diagnosis and is an official tool in Canada.
- Emerging interventions hold potential to mitigate the long-term effects of FASD.
- Further research into FASD pathogenesis and effective interventions is warranted.
Purpose Of Review:
Since the first description of the foetal damage of alcohol in 1967, numerous studies have outlined different aspects of neurodevelopmental dysfunction, adversely affecting the lives of children worldwide. Although the cause of the syndrome is sorted out, the pathogenesis of brain damage is far from being clear. In contrast to children exhibiting the full facial dysmorphology, who are relatively easy to diagnose, in those presenting only with alcohol-related neurodevelopmental damage diagnosis is much more challenging due to poor specificity of the brain dysfunction. Hence, identifying the neurodevelopmental phenotype of foetal alcohol spectrum disorder (FASD) is a major challenge.
Recent Findings:
Recently, a behavioural phenotype of FASD has been described and validated using items from the Child Behaviour Checklist. This tool has high sensitivity and specificity in separating children with FASD from those with ADHD and from healthy controls. In parallel, a number of intervention studies show promise in improving the abilities of children and adolescents with the syndrome to cope with daily tasks and improve their quality of life.
Summary:
The neurobehavioural screening test can facilitate screening for FASD and is an official screening tool in the FASD toolkit of the Public Health Agency of Canada. Promising new interventions may attenuate the long-term outcome of these children.
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