Article Summary: Diagnosis of Preschoolers with PAE

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This is a summary of the recent article Ten years of evidence for the diagnostic assessment of preschoolers with prenatal alcohol exposure that is featured in CanFASD’s Top FASD Articles of 2020. For a complete understanding of the subject matter, read the full paper (available open access).


Early intervention and diagnosis are key to improving outcomes for people with FASD. Although there is some research on FASD assessment and diagnosis for school-aged children and adolescents, there is limited research with preschool-aged kids. Assessing preschoolers with prenatal alcohol exposure (PAE) can be challenging, and clinicians are often cautious about diagnosing FASD in this young population.

Clinicians in Canada follow the recommendations of the 2015 Canadian FASD Diagnostic Guideline in order to assess and diagnose FASD. However, young children may not meet the FASD diagnostic criteria outlined in these guidelines because the tests that are currently used to assess neurodevelopmental domains may not be sensitive to the differences between ages. As a result, diagnosis in preschoolers is often deferred, which can mean that children and their families aren’t able to access early interventions and supports. Therefore, the purpose of this study was to understand how clinicians assess preschoolers with PAE and identify factors that support early diagnosis of FASD to potentially improve assessment of preschoolers in the future.


The researchers in this study looked at clinical assessment data from 340 children aged 3-6 years who visited the Manitoba FASD Centre from 2005 to 2016. They found:

  • Almost half the children in the sample with confirmed PAE met the criteria for diagnosis of FASD;
  • Preschoolers who met the criteria for an FASD diagnosis had more global development impairment than those with PAE who did not meet diagnostic criteria. They also had poorer language skills, more challenges with executive functioning and adaptive functioning, and significant deficits in motor skills;
  • Preschoolers with PAE had significant sensory processing differences, although the Canadian Guideline currently does not include sensory processing as a domain for assessment of FASD;
  • In combination, clinically significant deficits in communication, motor skills, and sensory processing are predictive of an FASD diagnosis in preschoolers with PAE.

Early intervention is key to supporting positive outcomes for individuals with FASD. When assessing preschoolers with PAE, specialized assessment of communication, motor skills, cognitive development, sensory processing, and neurobehavioral functioning should be considered.

Future research is needed to identify appropriate FASD assessment procedures for preschool-aged children; better understand the impact of PAE on preschoolers who were exposed to other complex risk factors; and understand the experience of preschoolers across their lifespan who were assessed at different clinics.

This research can help inform future updates of the Canadian FASD Diagnostic Guideline.

Journal: Journal of Population Therapy and Clinical Pharmacology

Authors: Ana Hanlon-Dearman, Shelley Proven, Kellsey Scheepers, Kristene Cheung, Sandra Marles, and The MB FASD Centre Team

Date: 27 July 2020

Read the full article (available open access)

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