Screening approaches for identifying fetal alcohol spectrum disorder in children, adolescents, and adults: A systematic review

Abstract

Background Fetal alcohol spectrum disorder (FASD) is a prevalent neurodevelopmental disorder that is caused by prenatal alcohol exposure (PAE) and associated with a range of cognitive, affective, and health concerns. Although the identification of FASD can facilitate the provision of interventions and support, and plays a protective role against adverse outcomes, there are high rates of missed detection. The identification of FASD via screening may improve its recognition across settings. The current systematic review examined the available evidence on FASD screening tools and approaches across age groups and settings. Methods A systematic search was carried out for both peer‐reviewed studies and gray literature sources published between January 1990 and May 2020 and was preregistered with PROSPERO (#CRD42019122077). Studies included in the review focused on human applications of FASD screening in children, adolescents, and adults. The quality of the studies was assessed using the QUADAS‐2 and GRADE frameworks. Results The search yielded 20 screening tools and approaches across 45 studies, broadly characterized in 2 groups. The first group included approaches currently in use that aim to identify individuals at risk of FASD using a range of markers (n = 19) or associated sentinel dysmorphic facial features (n = 6). Another group of studies, characterized as emerging, focused on identifying promising biomarkers of PAE/FASD (n = 20). Overall, we identified limited research supporting the psychometric properties of most screening approaches. The quality review provided evidence of bias due to the common use of case–control designs and lack of adequate reference standards. Conclusions Although several FASD screening tools and approaches are available for use across a range of age groups and settings, the overall evidence base supporting their psychometric properties is weak, with most studies demonstrating significant risk of bias. Service providers should exercise caution in selecting and implementing FASD screening tools given these limitations. It is critically important to accurately identify individuals with FASD across ages and settings to support healthy outcomes. Thus, there is a pressing need for additional research in this area, particularly validation studies in large and representative samples using robust methodological approaches.

Toward Effective Identification of FASD

“…11,12,[19][20][21] Identification of FASD via screening has been proposed as an important system-level intervention that may improve early and accurate recognition, and in doing so, improve outcomes and reduce costs associated with misaligned services and later difficulties. 8,10,[22][23][24][25][26] To date, many FASD screening tools and practices have been developed with the overall goal of improving identification of FASD. 24,25,27 This work has been led by both community agencies and researchers, highlighting the development of screening tools and processes as a priority for many stakeholders.…”

“…8,10,[22][23][24][25][26] To date, many FASD screening tools and practices have been developed with the overall goal of improving identification of FASD. 24,25,27 This work has been led by both community agencies and researchers, highlighting the development of screening tools and processes as a priority for many stakeholders. In order to ensure that screening practices are successfully implemented and effective in achieving intended outcomes, a range of factors should be considered.…”

“…In this topical review, 28 we provide a focused overview of the evolving research and clinical literature on identification and screening of FASD through an implementation lens. Drawing from our perspectives in clinical and developmental psychology, we aim to extend findings from recent comprehensive systematic reviews focused on the evidence supporting FASD screening tools, 25,27 and provide an up-to-date and applied synthesis of factors relevant to the successful implementation of FASD identification and screening practices. Applying an implementation science framework 29 we review important considerations to inform a pathway forward toward enhancing evidence-based approaches for identifying FASD, with guidance for the future research and practice.…”

The imperfect fit: Fetal alcohol spectrum disorder as the basis to commit individuals involuntarily as sexually violent predators/persons

“…Given the apparently high number of respondents who may suffer from FASD that the state has petitioned and committed for civil confinement as SVPs, it would be prudent (if not ethically necessary) for all evaluators to screen for FASD. This can be accomplished by completing one of the available FASD screening tools (Grubb et al, 2021;McPherson et al, 2011; http://rffada.org/wp-content/uploads/2010/11/documents_FASD-Screening-Tool-over-18. pdf).…”

Spatiotemporal MicroRNA-Gene Expression Network Related to Orofacial Clefts

“…Orofacial clefts, including cleft lip with/without cleft palate, midline cleft, oblique facial cleft, and transverse facial cleft, severely influence patients’ quality of life due to a list of complications (Suzuki et al 2016; Suzuki et al 2018). Both genetic and environmental factors contribute to the complex etiology of orofacial clefts and dysmorphism (Grubb et al 2021). Despite advances in human genome research and sequencing technology, the causes of nearly 70% of all birth defects remain unknown (Warner et al 2014).…”