Identifying fetal alcohol spectrum disorder among South African children at aged 1 and 5 years
Related Experiment Video
Updated: Dec 8, 2025
The Use of Trace Eyeblink Classical Conditioning to Assess Hippocampal Dysfunction in a Rat Model of Fetal Alcohol Spectrum Disorders
Published on: August 5, 2017
Adriane Wynn1, Mary Jane Rotheram-Borus2, Emily Davis2
1Division of Infectious Diseases and Global Public Health, University of California at San Diego, 9500 Gilman Drive, La Jolla, CA 92024, USA.
Insights
Early screening for Fetal Alcohol Spectrum Disorders (FASD) is possible at 1.5 years old, but diagnosis rates increase by age 5. Repeated screenings are crucial for identifying all children with FASD and initiating early intervention.
Area of Science:
- Pediatrics
- Neurodevelopmental Disorders
- Public Health
Background:
- Fetal Alcohol Spectrum Disorders (FASD) represent a significant global health challenge.
- Early intervention is key to mitigating developmental deficits associated with FASD.
- However, achieving an early diagnosis for FASD remains a persistent challenge.
Purpose of the Study:
- To investigate the feasibility of screening and diagnosing Fetal Alcohol Spectrum Disorders (FASD) in children at 1.5 years of age compared to 5 years.
- To assess the developmental trajectory of FASD symptoms and diagnostic criteria over time.
- To identify maternal risk factors associated with positive FASD screenings.
Main Methods:
- A population-based cohort of 1258 pregnant women was recruited, with follow-up assessments at multiple time points up to 5 years post-birth.
- A two-step diagnostic process involving initial screening by a paraprofessional followed by physician evaluation was employed.
- Maternal characteristics were compared between children with positive and negative FASD screenings.
Main Results:
- The prevalence of positive FASD screenings significantly increased from 6.8% at 1.5 years to 14.8% at 5 years.
- Approximately one-quarter of children who screened positive and underwent physician evaluation received an FASD diagnosis; however, half did not complete this second stage.
- Mothers of children with positive FASD screenings were more likely to have lower income, less education, experience partner violence, and report depressed mood.
Conclusions:
- Screening and diagnosis for FASD are achievable at both 1.5 and 5 years of age.
- The evolving nature of FASD characteristics necessitates repeated screenings for comprehensive identification and timely intervention.
- Challenges in referral completion for diagnostic confirmation highlight the need for integration with primary healthcare systems to improve access to care.
Background:
Fetal Alcohol Spectrum Disorders (FASD) are a global health concern. Early intervention mitigates deficits, yet early diagnosis remains challenging. We examined whether children can be screened and meet diagnoses for FASD at 1.5 years compared to 5 years post-birth.
Methods:
A population cohort of pregnant women in 24 neighborhoods (N = 1258) was recruited and 84.5 %-96 % were reassessed at two weeks post-birth, 0.5 years, 1.5 years, 3 years, and 5 years later. A two-step process was followed to diagnose FASD; first, a paraprofessional screened the children and then a physician evaluated the child. We evaluated FASD symptoms at 1.5 vs. 5 years. We also examined maternal differences in children receiving a positive FASD screening (n = 160) with those who received a negative FASD screening.
Results:
Screening positive for FASD more than doubled from 1.5 years to 5 years (from 6.8 % to 14.8 %). About one quarter of children who screened positive and were evaluated by a physician, were diagnosed as having a FASD. However, half did not complete the 2nd stage screening. Compared to mothers of children with a negative FASD screening, mothers of children with a positive FASD screening were less likely to have a high school education and more likely to have lower incomes, have experienced interpersonal partner violence, and have a depressed mood. Mothers of children who did not follow up for a 2nd stage physician evaluation were more like to live in informal housing compared to those who followed-up (81.3 % vs. 62.5 %, p = 0.014).
Conclusions:
We found that children can be screened and diagnosed for FASD at 1.5 and 5 years. As FASD characteristics develop over time, repeated screenings are necessary to identify all affected children and launch preventive interventions. Referrals for children to see a physician to confirm diagnosis and link children to care remains a challenge. Integration with the primary healthcare system might mitigate some of those difficulties.
Related Concept Videos
01:29Intellectual Disability
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....
01:19Autism Spectrum Disorder
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.