Prenatal Alcohol Exposure, FASD, and Child Behavior: A Meta-analysis.

CONTEXT Fetal alcohol spectrum disorders (FASD) and prenatal alcohol exposure (PAE) are associated with behavioral difficulties, although there are no published systematic reviews that summarize and critique the literature. OBJECTIVE To describe the behavioral characteristics of children with PAE and/or FASD, assessed using the Achenbach System of Empirically Based Assessments (ASEBA) for school-aged children with parent, teacher, and youth (self-report) forms. DATA SOURCES Electronic literature databases, reference lists, hand-searches. STUDY SELECTION peer-reviewed observational studies. DATA EXTRACTION Study appraisal and data extraction were undertaken by 2 independent assessors. Meta-analyses were performed for parent-rated Internalizing, Externalizing, and Total problems scales. All other ASEBA scales were summarized qualitatively. RESULTS Included were 23 articles; 16 were used in meta-analyses. Pooled results showed higher Total (mean difference 12.1, 95% confidence interval [95% CI] 7.7-16.5), Internalizing (6.3, 95% CI 3.1-9.5), and Externalizing problems scores (12.5, 95% CI 7.9-17.0) in FASD than No FASD; and greater odds of scoring in the "Clinical" range in FASD. Pooled results demonstrated higher problem scores in children with PAE (P > .05). Qualitative summaries of other scales from parents, teachers, and self-report show poorer behavior ratings in children with FASD and PAE on composite Problem and Competence scores and many Syndrome subscales. LIMITATIONS Findings were restricted to behaviors assessed using the ASEBA. The published literature was limited, often with only 1 study reporting on a particular scale. CONCLUSIONS Meta-analysis reveals that FASD and PAE are associated with problematic behavior in many, but not all domains. This clearly affects families, and should be considered in clinical practice by providers.