Article Summary #3: Forty Years of Assessing the Effects of Prenatal Alcohol Exposure

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This Article Summary is part of our new CanFASD Connect series: Top Articles Summary Series. Over the next several months, we will be bringing you summaries of all the recent research papers from our list of the Top FASD Articles of 2019. This is a summary of a recent research paper called Forty Years of Assessing Neurodevelopmental and Behavioral Effects of Prenatal Alcohol Exposure in Infants: What Have We Learned?


Early diagnosis of Fetal Alcohol Spectrum Disorder (FASD) and subsequent intervention are essential to prevent negative outcomes for people with FASD. These negative outcomes can include disruptions in education, social relationships, employment challenges, and conflict with the legal system. More than 50% of children who are eventually diagnosed with FASD demonstrate some form of early neurodevelopmental and behavioural (NDB) difficulties before the age of 3 years. However, most often, diagnosis and intervention efforts are not initiated until the child is well into the school years. At this point, the child may already be experiencing difficulties with learning, classroom behaviour, and creating relationships, and the opportunity for early intervention has been missed.

The delay in identification of children with prenatal alcohol exposure (PAE) may be due to a number of challenges:

  • There are no universally validated screening tools for alcohol use during pregnancy, and some maternal self-reports may be biased.
  • Some health care professionals lack education, resources, and training specific to PAE and FASD.
  • Children with PAE may experience severe adverse socio-environmental factors and unstable living placements, which warrant urgent attention and take priority over early diagnosis and intervention.
  • Current FASD diagnostic guidelines measure areas of functioning that cannot be fully assessed until school-age, such as social, academic, and behaviour skills.

Early life assessment of NDB can facilitate timely and meaningful intervention for young children at risk of negative outcomes. In the current study, researchers reviewed the literature to examine what has been learned over the last forty years about NDB difficulties in children with PAE in the first 2 years of life. The review was focused on three areas of NDB: neurocognition, adaptive behaviour, and self-regulation.

Main Findings

  • The researchers found 31 studies focused on assessing NDB functioning in young children with PAE. The most common assessment tool was the Bayley Scales of Infant Development, a global measure of child development.
  • As a whole, global measures of functioning for infants and young children with PAE provided inconsistent results, and may underestimate the extent of delays experienced by these children.
    • Neurocognition was found to be significantly negatively affected by PAE in half of the studies where this domain was evaluated.
    • Self-regulation was found to be significantly negatively affected by PAE in 75% of the studies where this domain was evaluated.
    • Adaptive behaviour was found to be significantly negatively affected by PAE in only one-third of the studies where this domain was evaluated.
  • The normal developmental variation in early life may pose a particular challenge when it comes to teasing apart the effects of PAE on NDB in young children.


  • Future researchers should aim to expand the current body of knowledge to focus on early intervention for infants with PAE, in order to support healthy development. A special focus should be on understanding and supporting self-regulation, which seems to be an under-recognized area of difficulty in this age group.
  • Additional research is needed to look more in-depth at specific and standardized assessments for young children with PAE, as well as provide an exploration of sex differences in tests, genetic and epigenetic influences on NDB, and the relationship between dose, timing, and frequency of PAE on child outcomes.
  • Parents can benefit from direct instruction and support to develop a positive interaction style, which may play a key role in early intervention for young children with PAE.

Take home message
Assessment of a child’s neurodevelopment and behaviour in the first years of life can facilitate early and meaningful intervention for those at risk of negative outcomes.

Authors: Laura Garrison, Sarah Morley, Christina D. Chambers, and Ludmila N. Bakhireva

Journal: Alcoholism Clinical and Experimental Research

Date: June 6, 2019

Read the full article (not available open access)

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