Prenatal Alcohol Exposure, FASD, and Child Behavior: A Meta-analysis

Abstract

CONTEXT: Fetal alcohol spectrum disorders (FASD) and prenatal alcohol exposure (PAE) are associated with behavioral difficulties, although there are no published systematic reviews that summarize and critique the literature. OBJECTIVE:To describe the behavioral characteristics of children with PAE and/or FASD, assessed using the Achenbach System of Empirically Based Assessments (ASEBA) for schoolaged children with parent, teacher, and youth (self-report) forms.DATA SOURCES: Electronic literature databases, reference lists, hand-searches.STUDY SELECTION: peer-reviewed observational studies. DATA EXTRACTION:Study appraisal and data extraction were undertaken by 2 independent assessors. Meta-analyses were performed for parent-rated Internalizing, Externalizing, and Total problems scales. All other ASEBA scales were summarized qualitatively. RESULTS:Included were 23 articles; 16 were used in meta-analyses. Pooled results showed higher Total (mean difference 12.1, 95% confidence interval [95% CI] 7.7-16.5), Internalizing (6.3, 95% CI 3.1-9.5), and Externalizing problems scores (12.5, 95% CI 7.9-17.0) in FASD than No FASD; and greater odds of scoring in the "Clinical" range in FASD. Pooled results demonstrated higher problem scores in children with PAE (P > .05). Qualitative summaries of other scales from parents, teachers, and self-report show poorer behavior ratings in children with FASD and PAE on composite Problem and Competence scores and many Syndrome subscales. LIMITATIONS:Findings were restricted to behaviors assessed using the ASEBA. The published literature was limited, often with only 1 study reporting on a particular scale.CONCLUSIONS: Meta-analysis reveals that FASD and PAE are associated with problematic behavior in many, but not all domains. This clearly affects families, and should be considered in clinical practice by providers.

Emotional Understanding in School-Aged Children with Fetal Alcohol Spectrum Disorders: A Promising Target for Intervention

“…Although the sample was demographically diverse, most children had clinically significant behavior problems and those with intellectual disabilities were purposefully excluded. Therefore, the data range may have been restricted in some ways and generalizability of findings possibly reduced (although behavioral difficulties are common in the FASD population 33 ).…”

Testing the programming of temperament and psychopathology in two independent samples of children with prenatal substance exposure

“…The association between prenatal substance exposure and childhood internalizing behaviors has received relatively less attention, though research has shown drug exposure to be associated with increased internalizing behaviors (Robinson et al, 2008; Tsang et al, 2016). Furthermore, prenatal substance exposure has been shown to affect the development of problem behavior in children as young as 3 and 5 years old, as well as the trajectory of adjustment difficulties across early childhood (Bada et al, 2007; LaGasse et al, 2012; Lester et al, 2009).…”

Dietary choline levels modify the effects of prenatal alcohol exposure in rats

“…Physical effects include reduced birth weight, facial dysmorphology (long, flat philtrum, low nasal bridges, short palpebral fissures, thin upper lips, ear malformations, flattened maxilla, and epicanthal folds), as well as muscular, cardiac, and skeletal malformations (Feldman et al, 2012; Hofer and Burd, 2009). Prenatal alcohol exposure can also lead to neuropathology in a variety of brain regions (Donald et al, 2015; Riley et al, 2011) that affect an array of behavioral and cognitive domains, leading to learning impairments, attention deficits, motor dysfunction, altered social behavior, mood disorders, and changes in sleep and stress responses (Kelly et al, 2000; Mattson et al, 2011; Moore et al, 2014; Riley et al, 2011; Tsang et al, 2016). …”