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Behavior in Children with Fetal Alcohol Spectrum Disorders in Remote Australia: A Population-Based Study

Tsang, Tracey W. PhD*,†; Carmichael Olson, Heather PhD; Latimer, Jane PhD; Fitzpatrick, James PhD*,†,§; Hand, Marmingee BAppSc, BEdu; Oscar, June BBus; Carter, Maureen**; Elliott, Elizabeth J. MD*,†,††,‡‡

Journal of Developmental & Behavioral Pediatrics: September 2017 - Volume 38 - Issue 7 - p 528–537
doi: 10.1097/DBP.0000000000000463
Original Articles

Objective: To document behavior in children residing in very remote Western Australian communities as rated by parent/caregivers and teachers. We hypothesized that children with fetal alcohol spectrum disorders (FASD) would have higher rates of problematic behavior than children without FASD.

Methods: The Child Behavior Checklist (CBCL; n = 97), and Teacher Report Form (TRF; n = 106) were used in this population-based study. Raw scores, proportions scoring within “Normal/Borderline/Clinical” ranges, and frequencies of Critical items were determined. Mann–Whitney U and χ2 tests were used for between-group comparisons.

Results: Children were aged from 7.5 to 9.6 years, and 19% had FASD. Academic performance was commonly rated in the “Borderline/Clinical” range (73%). Teacher-rated scores were poorer in the FASD group on 15 scales encompassing total and internalizing problems, adaptive function, academic performance, attention, withdrawn/depressed, social problems, posttraumatic stress, thought problems, and sluggish cognitive tempo (p < .05). More children in the FASD group had scores in the “Borderline/Clinical” range on 11 TRF scales (p < .05). “Physically attacks people” was the most prevalent Critical item endorsed by teachers for the total cohort (22%). “Talks about killing self” was endorsed by teachers more often in the FASD group (14%) than the Non-FASD group (1%; p = .03). There were no significant differences between groups in parent-reported CBCL scores after adjustment for multiple comparison testing.

Conclusion: This study demonstrates that children with FASD have more teacher-reported behavioral impairment than children without FASD. In remote Australian communities, academic performance is poor.

*The University of Sydney, Discipline of Child and Adolescent, Sydney Medical School, New South Wales, Australia;

Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia;

Department of Psychiatry and Behavioral Sciences, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA;

§Alcohol and Pregnancy & FASD, Telethon Kids Institute, Perth, Western Australia, Australia;

Fitzroy Valley District High School, Fitzroy Crossing, Western Australia, Australia;

Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia;

**Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia;

††The Sydney Children's Hospital Networks (Westmead), Westmead, New South Wales, Australia;

‡‡The Australian Paediatric Surveillance Unit, Kids' Research Institute, Westmead, New South Wales, Australia.

Address for reprints: Tracey W. Tsang, PhD, Kids' Research Institute (FASD Research Australia), Locked Bag 4001, Westmead, NSW 2145, Australia; e-mail: tracey.tsang@sydney.edu.au.

Disclosure: The Lililwan Project was supported by the National Health and Medical Research Council of Australia (NHMRC; Project Grant #: 1024474); the Australian Government Department of Health and Ageing; the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs; Save the Children Australia; and the Foundation for Alcohol Research and Education. Pro bono support was provided by M&C Saatchi, Blake Dawson Solicitors, and the Australian Human Rights Commission. T. W. Tsang was funded by a NHMRC Project Grant (#: 1024474). H. Carmichael Olson receives salary support from the University of Washington School of Medicine and Seattle Children's Research Institute. J. Latimer was supported by an Australian Research Council Future Fellowship (#: 0130007). E. J Elliott was supported by NHMRC Australia Practitioner Fellowships (#: 457084 and 1021480). The authors declare no conflict of interest.

Received November 13, 2016

Accepted April 26, 2017

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