Miller A R
Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Developmental Neurosciences & Child Health, Child & Family Research Institute, Vancouver, BC, Canada; Sunny Hill Health Centre for Children, Vancouver, BC, Canada.
Child Care Health Dev. 2013 Nov;39(6):810-5. doi: 10.1111/cch.12017. Epub 2013 Jan 7.
Prenatal alcohol exposure is a risk factor for neurologically based cognitive and adaptive disability. Diagnostic nomenclature for prenatally exposed children with cognitive and adaptive disability who lack features for foetal alcohol syndrome (FAS) or partial FAS includes the terms alcohol-related neurodevelopmental disorder (ARND) and foetal alcohol spectrum disorder(s) (FASD). Although these terms are now widely used, this paper argues that both are problematic. ARND is flawed by unjustifiably turning a risk factor into a causal factor and shrouding the result in terminological ambiguity, while FASD is not appropriate as a clinical label, and its use as a proxy for ARND deflects critical attention from the causal inferencing that is integral to diagnosing children with an alcohol-related teratogenic condition. Existing nomenclature is at odds with logical and evidence-based diagnosing and also has implications for interpretation of epidemiological data. Diagnostic nomenclature that is not tightly linked to causal inference is preferable at the present stage of this field's development.
产前酒精暴露是导致基于神经学的认知和适应性残疾的一个风险因素。对于那些缺乏胎儿酒精综合征（FAS）或部分FAS特征但有认知和适应性残疾的产前暴露儿童，其诊断术语包括酒精相关神经发育障碍（ARND）和胎儿酒精谱系障碍（FASD）。尽管这些术语现在被广泛使用，但本文认为两者都存在问题。ARND存在缺陷，它不合理地将一个风险因素转变为一个因果因素，并在术语上造成模糊不清，而FASD作为一个临床标签并不合适，将其用作ARND（的替代）会使关键注意力从对患有酒精相关致畸病症儿童进行诊断所必需的因果推断上转移开。现有的术语与基于逻辑和证据的诊断不一致，也对流行病学数据的解释有影响。在该领域发展的现阶段，与因果推断没有紧密联系的诊断术语更为可取。
