Assessing fasd in young children: Exploring clinical complexities and diagnostic challenges

Background Children with fetal alcohol spectrum disorders (FASD) experience a range of cognitive, emotional, and behavioral challenges. Early assessment, diagnosis, and intervention are critical protective factors against adverse outcomes in FASD. However, FASD evaluations can be challenging in preschoolers and limited guidance is available to inform practice. Objectives We sought to describe the clinical presentation of preschool aged children assessed for FASD. Challenges encountered during the assessment process were also evaluated in order to inform the development of future diagnostic guidelines for clinicians undertaking FASD assessments in very young children. Methods Retrospective file information was coded for 72 children aged one to five assessed through the Glenrose Rehabilitation Hospital FASD Program using a structured coding manual. The sample included children who received an FASD diagnosis, children whose diagnosis was deferred, and children who did not receive an FASD diagnosis. Diagnostic findings, neurobehavioural functioning, past adversities and other clinical factors, and assessment recommendations were examined. Use of neurobehavioral assessment measures was also assessed. Results Young children diagnosed with FASD showed significant neurobehavioral impairment though clinical needs were high across the entire sample. High rates of pre- and postnatal adversity were seen in all children assessed. Use of objective tests to assess neurobehavioral functioning was limited, particularly among younger children. Conclusions Irrespective of diagnostic outcome, preschool aged children referred for FASD assessments presented with complex clinical profiles and significant needs. Findings highlight the challenges faced by clinicians and underscore the need for guidelines to direct clinical practice and training for interdisciplinary teams assessing preschool aged children with PAE.