title: Prenatal Alcohol Exposure, FASD, and Child Behavior: A Meta-analysis.
abstract: BACKGROUND
  Fetal alcohol spectrum disorders (FASD) and prenatal alcohol exposure (PAE) are associated with behavioral difficulties, although there are no published systematic reviews that summarize and critique the literature.
  
  
  OBJECTIVE
  To describe the behavioral characteristics of children with PAE and/or FASD, assessed using the Achenbach System of Empirically Based Assessments (ASEBA) for school-aged children with parent, teacher, and youth (self-report) forms.
  
  
  METHODS
  Electronic literature databases, reference lists, hand-searches.
  
  
  METHODS
  peer-reviewed observational studies.
  
  
  METHODS
  Study appraisal and data extraction were undertaken by 2 independent assessors. Meta-analyses were performed for parent-rated Internalizing, Externalizing, and Total problems scales. All other ASEBA scales were summarized qualitatively.
  
  
  RESULTS
  Included were 23 articles; 16 were used in meta-analyses. Pooled results showed higher Total (mean difference 12.1, 95% confidence interval [95% CI] 7.7-16.5), Internalizing (6.3, 95% CI 3.1-9.5), and Externalizing problems scores (12.5, 95% CI 7.9-17.0) in FASD than No FASD; and greater odds of scoring in the "Clinical" range in FASD. Pooled results demonstrated higher problem scores in children with PAE (P > .05). Qualitative summaries of other scales from parents, teachers, and self-report show poorer behavior ratings in children with FASD and PAE on composite Problem and Competence scores and many Syndrome subscales.
  
  
  CONCLUSIONS
  Findings were restricted to behaviors assessed using the ASEBA. The published literature was limited, often with only 1 study reporting on a particular scale.
  
  
  CONCLUSIONS
  Meta-analysis reveals that FASD and PAE are associated with problematic behavior in many, but not all domains. This clearly affects families, and should be considered in clinical practice by providers.
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The George Institute for Global Health, and tracey.tsang@sydney.edu.au.
authors.forename: Tracey W
authors.initials: TW
authors.lastname: Tsang
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The George Institute for Global Health, and Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Physiotherapy Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia;
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Lucas
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Washington;
authors.forename: Heather
authors.initials: H
authors.lastname: Carmichael Olson
authors.affiliation: Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Sao Paulo, Brazil;
authors.forename: Rafael Z
authors.initials: RZ
authors.lastname: Pinto
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The George Institute for Global Health, and 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.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
mesh_terms: D002648:Child; D002652:Child Behavior; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology*; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology / Q000209:etiology / Q000523:psychology