High rates of missed diagnoses of fetal alcohol syndrome
Ira J. Chasnoff, M.D., from the Children's Research Triangle in Chicago, and colleagues collected data from a sample of 547 children among a population of foster and adopted youth who underwent a comprehensive multidisciplinary diagnostic evaluation. Children were diagnosed with fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, or alcohol-related birth defects using current diagnostic criteria.
The researchers found that 125 of the 156 children and adolescents who met criteria for a diagnosis within the fetal alcohol spectrum had never been diagnosed as affected by prenatal alcohol exposure (missed diagnosis rate, 80.1 percent). Of the 31 children who had been recognized as affected by prenatal alcohol exposure before referral, 10 diagnoses were changed within the spectrum (misdiagnosis rate, 6.4 percent). The diagnoses of the remaining 21 children stayed the same. Significant changes were seen in the rate of mental health diagnoses; in a considerable number of children with fetal alcohol spectrum disorders, objective signs of neurocognitive damage (learning disorders, communication disorders, and intellectual disability) were not recognized.
"Within this clinical sample, 86.5 percent of youth with fetal alcohol spectrum disorders had never been previously diagnosed or had been misdiagnosed," the authors write. "These high rates of missed diagnoses and misdiagnosis have significant implications for intervention and therapeutic services."
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