title: Soft neurological signs and prenatal alcohol exposure: a population-based study in remote Australia.
abstract: To identify soft neurological signs (SNS) in a population-based study of children living in remote Aboriginal communities in the Fitzroy Valley, Western Australia, born between 2002 and 2003 and explore the relationship between SNS, prenatal alcohol exposure (PAE), and fetal alcohol spectrum disorders (FASD).
  
  
  
  The presence of SNS was assessed using the Quick Neurological Screening Test, 2nd edition (QNST-2), which has a total maximum score of 140. Higher scores indicated more SNS. 'Severe discrepancy' was defined as scores less than or equal to the fifth centile while 'moderate discrepancy' represented scores from the sixth to the 24th centile. Children were assigned FASD diagnoses using modified Canadian FASD diagnostic guidelines.
  
  
  
  A total of 108 of 134 (80.6%) eligible children (mean age 8y 9mo, SD=6mo, 53% male) were assessed. The median QNST-2 Total Score for all participants was within the normal category (19.0, range 4-66). However, the median QNST-2 Total Score was higher in children with than without (1) PAE (r=0.2, p=0.045) and (2) FASD (r=0.3, p=0.004). Half (8/16) of children scoring 'moderate discrepancy' and all (2/2) children scoring 'severe discrepancy' had at least three domains of central nervous system impairment.
  
  
  
  SNS were more common in children with PAE or FASD, consistent with the known neurotoxic effect of PAE. The QNST-2 is a useful screen for subtle neurological dysfunction indicating the need for more comprehensive assessment in children with PAE or FASD.
authors.affiliation: Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Lucas
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Latimer
authors.affiliation: Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: James P
authors.initials: JP
authors.lastname: Fitzpatrick
authors.affiliation: School of Public Health, Curtin University, Perth, WA, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Doney
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Watkins
authors.affiliation: Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Tracey W
authors.initials: TW
authors.lastname: Tsang
authors.affiliation: Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Jirikowic
authors.affiliation: Seattle Children's Research Institute and University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Carmichael Olson
authors.affiliation: Marninwarntikura Women's Resource Centre, Fitzroy Crossing, WA, Australia.
authors.forename: June
authors.initials: J
authors.lastname: Oscar
authors.affiliation: Nindilingarri Cultural Health Services, Fitzroy Crossing, WA, Australia.
authors.forename: Maureen
authors.initials: M
authors.lastname: Carter
authors.affiliation: Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
mesh_terms: D001315:Australia / Q000453:epidemiology; D002648:Child; D015331:Cohort Studies; D018672:Community Health Planning; D005080:Exercise Test; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000208:ethnology / Q000503:physiopathology*; D018709:Statistics, Nonparametric