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Rationale

CAREGIVER SCREENING FOR FASD USING THE CHILD BEHAVIOR CHECKLIST (CBCL) AND THE CONNER’S PARENT RATING SCALE (CPRS) ELLEN FANTUS, JOANNE ROVET, KELLY NASH, RACHEL GREENBAUM,DONNA SORBARA, IRENA NULMAN, GIDEON KOREN The Hospital for Sick Children, Toronto. Rationale.

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Rationale

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  1. CAREGIVER SCREENING FOR FASD USING THE CHILD BEHAVIOR CHECKLIST (CBCL) AND THE CONNER’S PARENT RATING SCALE (CPRS) ELLEN FANTUS, JOANNE ROVET, KELLY NASH, RACHEL GREENBAUM,DONNA SORBARA, IRENA NULMAN, GIDEON KOREN The Hospital for Sick Children, Toronto

  2. Rationale • Cognitive problems extensively studied in children with FASD • Behavioral sequelae less well studied in children with FASD • FASD associated with high risk of mental health problems in adults • Children with FASD often misdiagnosed with Attention Deficit Hyperactivity Disorder (ADHD) • Therefore need to identify full spectrum of behavioural disorders in children with FASD

  3. Rationale (cont’d) • Caregiver questionnaires provide useful information on behavioural characteristics of children with disorders • Several studies using caregiver questionnaires with FASD have provided inconsistent results

  4. Past Studies • Steinhausen et al (1993) • CBCL to FAS adolescents • Elevated scores on hyperactivity and anxiety but not aggression or delinquency scales • Roebuck et al (1999) • Personality Inventory for Children (PIC) to FAS/ARND and control children • Elevated scores on scales of delinquency, psychosis, emotional lability, social withdrawal, and social problems • Mattson et al (2000) • CBCL to FAS/ARND children • Elevated scores on aggression, delinquency, social, thought, and attention problems • Greenbaum et al (2004; Greenbaum, 1999) • CBCL to FASD and matched control children • FASD higher incidence of clinically elevated externalizing behaviour problems with clinically elevated scores on attention, thought processing, social functioning, delinquency, and aggression scales

  5. Motherisk Follow-up Clinic • Founded in 1996 • Over 200 children (aged 3-17) with known and suspected alcohol exposure have received a comprehensive neuropsychological and medical evaluation • FASD diagnosis provided when indicated • Ongoing data base of results to identify behavioural phenotype in FASD

  6. Early Results • Preliminary data analysis on children assessed from November 1998 to September 2002 revealed significant findings on 2 caregiver questionnaires • On CBCL, most children showed clinical elevations on attention problems, delinquency, and aggression scales • On CPRS, most children met criteria for DSM-IV diagnosis for ADHD

  7. OBJECTIVES • To compare FASD with ADHD • To compare and contrast results from CBCL and CPRS • To identify the behavioural phenotype in FASD • To determine utility of these questionnaires in telehealth diagnosis

  8. DESIGN • Matched pairs analysis of ARND and ADHD on CBCL and CPRS

  9. TEST MEASURES

  10. TEST MEASURES

  11. CBCL 48 ARND/ADHD pairs matched for age and sex 7-11 years of age ADHD from 3 studies in Rovet lab in same time period Conners 35 ARND/ADHD pairs matched for age, sex, and socioeconomic status (SES) 7-11 years of age ADHD from 2 studies in Rovet lab in same time period Participants

  12. CBCL Broad Band Scale Scores p<.05 p<.001

  13. Cases with Elevated CBCL Broad-band Scales (a) T-score > 63 p<.05 p<.005 (b) T-score>70 P<.10 P<.05 P<.05

  14. CBCL Narrow-band Scale Scores p<.001 p<.01 p<.05

  15. Individual Items on Rule-Breaking Scale p<.001 p<.05 p<.05 p<.001

  16. Cases with Elevated CBCL Narrow-band Scales p<.01 (a) T-score >63 p<.05 p<.05 100 (b) T-score >70 90 80 70 p<.01 p<.10 60 Proportion of Cases in Group 50 p<.01 40 30 p<.05 20 10 0 AnxDepr WithdDepr Somatic SocialProb ThoughtProb AttnProb RuleBreaking Aggressive ARND (n=48) ADHD (n=48)

  17. Conner’s Parent Rating Scale (CPRS) Results for ARND and ADHD Groups p<.05 p<.05 p<.01 p<.05 p<.01

  18. CPRS DSM-IV ADHD Scales p<.05

  19. CPRS Scales Involving Significant Group Differences p<.05 p<.05 p<.01 p<.05 p<.01

  20. Cases with Clinically Elevated (T>70) CPRS Scores p<.10 p<.10 p<.10 p<.01

  21. Summary of Findings • FASD distinct from and more severely affected than ADHD • On CBCL, FASD have more externalizing problems (rule breaking, social problems,aggressive), whereas ADHD have more somatic complaints and more internalizing problems • CBCL item analysis showed FASD highly likely to be cruel, lack guilt, steal, lie, and act young • On CPRS, FASD more oppositional, hyperactive, impulsive, emotionally labile whereas ADHD more psychosomatic and have more internalizing problems

  22. Conclusion • Caregiver questionnaires can be used as a screening tool to identify children with FASD • Identification of high risk cases in remote locations can lead to primary interventions • Early intervention may circumvent secondary disabilities in underserviced areas. • Treatment programs to address their specific needs

  23. Future Directions • Need to develop targeted treatment programs to deal with their specific needs within their community • Need further research comparing with other psychiatric populations e.g., ODD/CD • Need to disentangle effects of alcohol from genetic psychiatric susceptibility and environmental factors

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