Department of Psychology, University of Guelph, Guelph, ON, Canada.
Alcohol Clin Exp Res. 2021 Aug;45(8):1527-1547. doi: 10.1111/acer.14657. Epub 2021 Aug 27.
Fetal alcohol spectrum disorder (FASD) is a prevalent neurodevelopmental disorder that is caused by prenatal alcohol exposure (PAE) and associated with a range of cognitive, affective, and health concerns. Although the identification of FASD can facilitate the provision of interventions and support, and plays a protective role against adverse outcomes, there are high rates of missed detection. The identification of FASD via screening may improve its recognition across settings. The current systematic review examined the available evidence on FASD screening tools and approaches across age groups and settings.
A systematic search was carried out for both peer-reviewed studies and gray literature sources published between January 1990 and May 2020 and was preregistered with PROSPERO (#CRD42019122077). Studies included in the review focused on human applications of FASD screening in children, adolescents, and adults. The quality of the studies was assessed using the QUADAS-2 and GRADE frameworks.
The search yielded 20 screening tools and approaches across 45 studies, broadly characterized in 2 groups. The first group included approaches currently in use that aim to identify individuals at risk of FASD using a range of markers (n = 19) or associated sentinel dysmorphic facial features (n = 6). Another group of studies, characterized as emerging, focused on identifying promising biomarkers of PAE/FASD (n = 20). Overall, we identified limited research supporting the psychometric properties of most screening approaches. The quality review provided evidence of bias due to the common use of case-control designs and lack of adequate reference standards.
Although several FASD screening tools and approaches are available for use across a range of age groups and settings, the overall evidence base supporting their psychometric properties is weak, with most studies demonstrating significant risk of bias. Service providers should exercise caution in selecting and implementing FASD screening tools given these limitations. It is critically important to accurately identify individuals with FASD across ages and settings to support healthy outcomes. Thus, there is a pressing need for additional research in this area, particularly validation studies in large and representative samples using robust methodological approaches.
胎儿酒精谱系障碍（FASD）是一种普遍存在的神经发育障碍，由产前酒精暴露（PAE）引起，并与一系列认知、情感和健康问题相关。尽管 FASD 的识别可以促进干预和支持的提供，并对不良后果起到保护作用，但漏诊率很高。通过筛查来识别 FASD 可以提高其在不同环境中的识别度。本系统评价审查了针对不同年龄组和环境的 FASD 筛查工具和方法的现有证据。
系统检索了 1990 年 1 月至 2020 年 5 月期间发表的同行评议研究和灰色文献来源，并在 PROSPERO（#CRD42019122077）上进行了预先注册。本综述纳入的研究重点是在儿童、青少年和成人中应用 FASD 筛查的人类研究。使用 QUADAS-2 和 GRADE 框架评估研究的质量。
检索结果共包括 45 项研究中的 20 种筛查工具和方法，大致分为两组。第一组包括目前用于识别有 FASD 风险的个体的方法，这些方法使用了一系列标志物（n=19）或相关的明显畸形面部特征（n=6）。另一组研究，被描述为新兴研究，专注于识别 PAE/FASD 的有前途的生物标志物（n=20）。总体而言，我们发现大多数筛查方法的心理测量特性的研究支持有限。质量评价提供的证据表明，由于普遍使用病例对照设计和缺乏适当的参考标准，存在偏倚风险。
尽管有几种 FASD 筛查工具和方法可用于不同年龄组和环境，但支持其心理测量特性的总体证据基础较弱，大多数研究显示出显著的偏倚风险。鉴于这些限制，服务提供者在选择和实施 FASD 筛查工具时应谨慎行事。准确识别各个年龄段和环境中的 FASD 个体对于支持健康结果至关重要。因此，该领域急需进一步的研究，特别是使用稳健的方法学方法在大型和代表性样本中进行验证研究。
