FETAL ALCOHOL SPECTRUM DISORDER AND THE NEUROBEHAVIOURAL SCREENING TOOL: EVALUATING THE EFFECT OF MATERNAL DEPRESSION
Main Article Content
Keywords
Neurobehavioural Screening Tool, Fetal Alcohol Spectrum Disorder, prenatal alcohol exposure, behavioural phenotype, maternal depression, screening
Abstract
Background
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 ch allenging. In 2006 the Neurobehavioural Screening Tool (NST) was developed, which derived from a selection of 10 questions from the Child Behaviour 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 neurobehavioural 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.
Objective
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.
Methods
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 typically developing healthy control children (n=22) .
Results
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.
Conclusion
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.
References
2. Jacobson SW, Jacobson JL, Sokol RJ, Chiodo LM, Corobana R. Maternal age, alcohol abuse history, and quality of parenting as moderators of the effects of prenatal alcohol exposure on 7.5 - year intellectual function. Alcohol Clin Exp Res 2004;28(11):1732 – 1745.
3. Rasmussen C. Executive functioning and working memory in fetal alcohol spectrum disorder. Alcohol Clin Exp Res 2005;29(8):1359 – 1367.
4. Mattson SN, Riley EP. Parent Ratings of Behavior in Children with Heavy Prenatal Alcohol Exposure and IQ - Matched Controls. Alcohol Clin Exp Res 2000;24(2):226 – 231.
5. Niccols A. Fetal alcohol syndrome and the developing socio-emotional brain. Brain Cogn 2007;65(1):135 – 142.
6. O’Malley KD, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention - deficit hyperactivity disorder. Can J Psychiatry Rev Can Psychiatr 2002;47( 4):349 – 354.
7. Oesterheld JR, Kofoed L, Tervo R, Fogas B, Wilson A, Fiechtner H. Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: a controlled pilot study. J Child Adolesc Psychopharmacol 1998;8(1):39 – 48.
8. Steinhausen HC, Willms J, Spohr HL. Long - term psychopathological and cognitive outcome of children with fetal alcohol syndrome. J Am Acad Child Adolesc Psychiatry 1993;32:990 – 994.
9. O’Connor MJ, Shah B, Whaley S, Cronin P, Gu nderson B, Graham J. Psychiatric illness in a clinical sample of children with prenatal alcohol exposure. Am J Drug Alcohol Abuse 2002;28:743 – 754.
10. Famy C, Streissguth AP, Unis AS. Mental illness in adults with fetal alcohol syndrome or fetal alcohol effects. Am J Psychiatry 1998;155:552 – 554.
11. Achenbach T, Rescolora A. Child Behavior Checklist for 6 - 18 Years. 2001. Available at: http://www.aseba.org/forms/schoolagecbcl.pdf.
12. Nash K, Rovet J, Greenbaum R, Fantus E, Nulman I, Koren G. Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential. Arch Womens Ment Health 2006;9(4):181 – 186.
13. Goh YI, Chudley AE, Clarren SK, et al. Development of Canadian screening tools for fetal alcohol spectrum disorder. Can J Clin Pharmacol J Can Pharmacol Clin 2008;15 (2):e344 – e366.
14. Nash K, Koren G, Rovet J. A differential approach for examining the behavioural phenotype of fetal alcohol spectrum disorders. J Popul Ther Clin Pharmacol 2012;18(3):e440 – 453.
15. Fryer SL, McGe e CL, Matt GE, Riley EP, Mattson SN. Evaluation of psychopathological conditions in children with heavy prenatal alcohol exposure. Pediatrics 2007;119:e733 – e741.
16. Greenbaum RL, Stevens SA, Nash K, Koren G, Rovet J. Social cognitive and emotion processing a bilities of children with fetal alcohol spectrum disorders: a comparison with attention deficit hyperactivity disorder. Alcohol Clin Exp Res 2009;33(10):1656 – 1670.
17. Rasmussen C, Talwar V, Loomes C, Andrew G. Brief report: lie - telling in children with fetal alcohol spectrum disorder. J Pediatr Psychol 2008;33(2):220 – 225.
18. Nash K, Stevens S, Rovet J, Fantus E, Nulman I, Sorbara D, Koren G. Towards identifying a characteristic neuropsychological profile for fetal alcohol spectrum disorders. Analysis of the Motherisk FASD clinic. J Popul Ther Clin Pharmacol 2013;20(1):e44 - 52.
19. Stevens SA, Nash K, Fantus E, Nulman I, Rovet J, Koren G. Towards identifying a characteristic neuropsychological profile for fetal alcohol spectrum disorders. 2. Specific caregiver - and tea cher - rating. J Popul Ther Clin Pharmacol 2013;20(1):e53 - 62.
20. Thomas SE, Kelly SJ, Mattson SN, Riley EP. Comparison of social abilities of children with fetal alcohol syndrome to those of children with similar IQ scores and normal controls. Alcohol Clin Exp Res 1998;22(2):528 – 533.
21. LaFrance MA, McLachlan K, Nash K, Andrew G, Loock C, Oberlander TF, Koren G, Rasmussen C. Evaluation of the neurobehavioural screening tool in children with fetal alcohol spectrum disorders (FASD). J Popul Ther Clin Pharmacol 2014; 2 1(2):e197 - 210. Epub 2014 May.
22. Procopio DO, Saba L, Walter H, Lesch O, Skala K, Schlaff G, et al. Genetic markers of co - morbid depression and alcoholism in women. Alcohol Clin Exp Res 2013;37:894 - 904.
23. Nulman I, Rovet J, Stewart DE, Wolpin J, Pace - Asciak P, Shuhaiber S, Koren G. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 2002 Nov;159(11):1889 - 95.
24. Beeber LS, Schwartz TA, Martinez MI, Holditch - Davis D , Bledsoe SE, Canuso R, Lewis VS. Depressive symptoms and compromised parenting in low - income mothers of infants and toddlers: distal and proximal risks. Res Nurs Health 2014; 37(4):276 - 91.