Fetal alcohol spectrum disorder and the neurobehavioural screening tool: evaluating the effect of maternal depression

The behaviour of children diagnosed with a Fetal Alcohol Spectrum Disorder (FASD) is characterized by very complex and pervasive neurobehavioural effects. In contrast to children exhibiting the full facial dysmorphology who are relatively easy to assess and diagnose, those children presenting with Alcohol Related Neurodevelopmental Disorder (ARND) are much more challenging to diagnose due to poor specificity of the brain dysfunction; hence identifying the neurodevelopmental phenotype of FASD is extremely challenging. In 2006 the Neurobehavioral Screening Tool (NST) was developed, which derived from a selection of 10 questions from the Child Behavior Checklist (CBCL) developed by Achenbach. The NST is an official screening tool in the FASD toolkit of the Public Health Agency of Canada, and has been shown to identify a phenotypical neurobehavioral pattern in children affected by FASD with high sensitivity and specificity. A challenge in the interpretation of screening results has been ascertaining the potential influence of maternal psychiatric morbidity. The most common psychiatric morbidity among mothers who consume alcohol in excess during pregnancy is depression.

The purpose of this study was to examine the influence of maternal depression, evidenced by clinical diagnosis, and use of antidepressant drugs, on the typical behavioural presentation displayed by children diagnosed with an FASD.

Endorsement rates of NST items among children diagnosed with an FASD reported in three previous studies (n=134) and the typically developing healthy control children from these studies (n=112) were compared with the prospectively collected results of children born to and reared by mothers suffering from clinical depression (n=49) and additional typyically developing healthy control children (n=22).

In this study, none of the children born to the mothers suffering from clinical depression screened positive on the NST, however a significant number of these caregivers reported that their child was hyperactive. The mother's level of depression as indicated by her CES-D score was also shown to correlate with the child's conduct, namely, lying/cheating and disobedience at home.

These results indicate that the sensitivity and specificity of the NST are not significantly affected by maternal depression, however endorsement rates of items measuring impulse control, oppositional behaviours and conduct may be influenced. Further studies are needed to examine the potential effects of other maternal psychopathologies on endorsement rates.