Development and validation of a postnatal risk score that identifies children with prenatal alcohol exposure

Abstract

Background This study aimed to develop an efficient and easily calculable risk score that can be used to identify an individual's risk of having been exposed to alcohol prenatally. Methods Data for this study were collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, Phases 2 and 3. Two cohorts (ages 5 to 17 years) completed a comprehensive neurobehavioral battery and a standard dysmorphology exam: a development cohort (DC; n = 325) and a comparative cohort (CC; n = 523). Both cohorts included two groups: those with histories of heavy prenatal alcohol exposure (AE‐DC, n = 121; AE‐CC, n = 177) and a control group that included subjects with minimal or no prenatal alcohol exposure (CON‐DC, n = 204; CON‐CC, n = 346). Behavioral assessments and physical exam data were combined using regression techniques to derive a risk score indicating the likelihood of prenatal alcohol exposure. Subjects were then divided into two subgroups: (1) low risk and (2) high risk. Chi‐square (χ2) determined classification accuracy and ROC curves were produced to assess the predictive accuracy. Correlations between risk scores and intelligence quotient and executive function scores were calculated. Results Subjects were accurately classified in the DC (χ2 = 78.61, p < 0.001) and CC (χ2 = 86.63, p < 0.001). The classification model also performed well in the DC (ROC = 0.835 [SE = 0.024, p < 0.001]) and CC (ROC = 0.786 [SE = 0.021, p < 0.001]). In the AE‐CC and CON‐CC, there were modest but significant associations between the risk score and executive function (AE‐CC: r = −0.20, p = 0.034; CON‐CC: r = −0.28, p < 0.001) and intelligence quotient (AE‐CC: r = −0.20, p = 0.034; CON‐CC: r = −0.28, p < 0.001). Conclusion(s) The risk score significantly distinguished alcohol‐exposed from control subjects and correlated with important cognitive outcomes. It has significant clinical potential and could be easily deployed in clinical settings.

Validation of the FASD‐Tree as a screening tool for fetal alcohol spectrum disorders

“…We previously described two tools for identifying youth with histories of PAE: (1) a decision tree based on the results of a physical examination and parent questionnaires (Goh et al, 2016) that had ≥80% classification accuracy, and (2) a risk score based on the same data that had 67% to 79% classification accuracy (Bernes et al, 2022). The risk score and an updated version of the decision tree were combined in an automated web‐based screening tool called the FASD‐Tree.…”

“…The second tool was a risk score ranging from 0 to 5 that was developed using the same clinical data. We previously showed the risk score accurately identified youth with PAE (overall classification accuracy rates of 67% to 79%) and correlated with the critical outcomes of overall ability (measured by IQ score) and executive functioning (Bernes et al, 2022). The goal of this study was to test the accuracy of the FASD‐Tree, a web‐based tool that incorporates both an updated version of the decision tree and the risk score from our previous studies, as a screening tool for FASD.…”

Fetal alcohol spectrum disorders

“…Porting this software to tablets or online websites will broaden access to relevant neurocognitive testing. For example, the FASD-Tree 288 provides a dichotomous indication and a risk score for FASD, considering both neurobehaviour and dysmorphology, and successfully discriminates between children with and without PAE with a high predictive value 289 .…”

Current considerations for fetal alcohol spectrum disorders: identification to intervention

“…There are a number of attempts to help improve screening and identification, such as the development and validation of a postnatal risk score that helps accurately identify children with prenatal alcohol exposure [25 ▪▪ ] as well as a clinical decision tree [26]. Further, there are promising results found using telemedicine to improve access and accuracy of physical, and cognitive examinations of children with FASD [27,28], which can improve access.…”

“…Use of initial screenings can indicate that an individual requires a broad multidisciplinary assessment to confirm the diagnosis [29,30]. However, even within broad, comprehensive assessments, there are continued debates over the threshold of what would qualify as a weakness (1 or 1.5 SD), how to best address not knowing a prenatal alcohol exposure history and how to achieve the best sensitivity and specificity in identifying those in need [25 ▪▪ ,26,31]. A recent study described the validation of the FASD-Tree as a screening tool for FASD.…”