A Multisite Neurobehavioral Assessment of Fetal Alcohol Spectrum Disorders

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Project Summary This request for a renewal of funding is in response to the NIH/NIAAA funding opportunity entitled, “Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD)” (RFA-AA-17-007). The overarching aim of the current proposal is to develop, validate, and implement clinically novel and innovative measurement tools to accurately identify children who are affected by prenatal alcohol exposure. The proposed study is relevant to the overall objective of the CIFASD funding opportunity “to accelerate specific areas of research related to the translation of new or improved capabilities in FASD clinical case recognition.” This is critical need. While there has been a concerted research effort since the initial clinical delineation of fetal alcohol syndrome (FAS), understanding the full spectrum of effects of prenatal alcohol exposure remains incomplete, hindering effective intervention. Although individuals with prenatal alcohol exposure may experience significantly impairing functional difficulties, identification of these individuals is inadequate. High rates of missed diagnoses and misdiagnosis result in lost opportunities for intervention and misunderstanding of the etiology of observed difficulties. Development of accurate and specific identification tools will improve diagnostic capability and clinical decision-making regarding treatment. To this end, during previous funding periods we substantially enhanced the understanding of the specificity of effects of prenatal alcohol exposure to increase identification of alcohol-affected youth. Our hierarchical CIFASD Decision Tree, developed and validated on over 800 subjects, indicates that administration of just 4 measures can distinguish alcohol-affected youth from nonexposed controls with and without behavioral concerns or conditions with accuracy rates of >80%. While a significant step forward, the Decision Tree was developed and validated in a research sample with a high risk of alcohol effects. One aim of the current proposal is to develop and test an electronic version of the Decision Tree (the eTree) in lower risk, international, population-based, and clinic-based samples. Another aim of the proposal, in line with the specific RFA goal to use innovative technologies to screen for dysmorphology and/or neurobehavioral deficits to aid in the identification of alcohol-exposed individuals, is the development and implementation of the FASD Online Neurobehavioral Screen (FONS), a web-based neurobehavioral assessment tool for use with subjects recruited via a web portal (cf. Foroud U01). The FONS will measure domains known to be affected in FASD, including those represented in diagnostic criteria for neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). The eTree and the FONS will be validated using laboratory-based in-person neuropsychological assessment of children with histories of prenatal alcohol exposure and non-exposed controls with and without behavioral concerns or conditions. The results of the proposed research will fulfill our research goals, improve recruitment, and most importantly accurately identify individuals affected by prenatal alcohol exposure, leading to improved clinical diagnosis and intervention.