Misattributions and Potential Consequences: The Case of Child Mental Health Problems and Fetal Alcohol Spectrum Disorders.

摘要: Numerous Canadian agencies have prioritized services for people diagnosed with FAS and its broader construct FASD. This prioritization extends to prevention interventions aimed at reducing or eliminating PAE. The many difficulties identified as associated FAS, FASD, PAE is one of the justifications this prioritization. Mental health symptoms disorders are among most commonly highlighted challenges experienced by labelled FASD exposed alcohol in utero. However, extent relation between cluster mental symptom disorder clusters may be inflated secondary least 3 factors: diagnostic criteria overlap etiologic assumptions, referral bias, failure control confounding variables when assessing associations. Lack awareness these factors lead dissemination misinformation, which could adversely distort development provision services.Diagnostic conditions falling under umbrella been operationalized several different guidelines. 2005 guideline1 aimed, part, harmonize aspects 2 leading approaches time, that is, those Institute Medicine2 Washington 4-digit code.3 Guidelines typically include complete syndrome, require positive findings 4 domains: problematic patterns exposure utero (for example, from maternal binge drinking), growth abnormalities low birth weight gestational age), facial dysmorphology short palpebral fissures), CNS neurodevelopment microcephaly birth).2 then go on describe various partial syndromes. In case guideline, following syndromes included: (without confirmed exposure), ARND.1 Difficulties within children high PAE, but who do not classical dysmorphic manifestations, used support inclusion syndromes.4 broadening likely contributes whom present it etiologic. particularly there no consensus a pathognomonic behavioural manifestation Although some propose unique profile linked FASD,5 such profiles based small clinical samples appear independently replicated using nonreferred population. Nevertheless, resulting 10-item screening tool appears receiving national promotion Canada.6Concerns weaknesses operationalization misattribution causal problems) has raised critiques dominant field,2,3 US sources guidelines.7 ARND diagnosis, guidelines, requires "evidence impairment three more hard soft neurologic signs; brain structure; cognition; communication; academic achievement; memory; executive functioning abstract reasoning; attention deficit/hyperactivity; adaptive behavior, social skills, communication."1, p S12 listed domains would also found disorders. uncommon problem clusters. fraction primarily unknown, assume etiology highly problematic.8Complicating picture an variable, odds key direction taken psychiatry reflected contemporary versions DSM, avoid assumptions criteria. …