title: A Decision Tree to Identify Children Affected by Prenatal Alcohol Exposure.
abstract: OBJECTIVE
  To develop and validate a hierarchical decision tree model that combines neurobehavioral and physical measures to identify children affected by prenatal alcohol exposure even when facial dysmorphology is not present.
  
  
  METHODS
  Data were collected as part of a multisite study across the US. The model was developed after we evaluated more than 1000 neurobehavioral and dysmorphology variables collected from 434 children (8-16 years of age) with prenatal alcohol exposure, with and without fetal alcohol syndrome, and nonexposed control subjects, with and without other clinically-relevant behavioral or cognitive concerns. The model subsequently was validated in an independent sample of 454 children in 2 age ranges (5-7 years or 10-16 years). In all analyses, the discriminatory ability of each model step was tested with logistic regression. Classification accuracies and positive and negative predictive values were calculated.
  
  
  RESULTS
  The model consisted of variables from 4 measures (2 parent questionnaires, an IQ score, and a physical examination). Overall accuracy rates for both the development and validation samples met or exceeded our goal of 80% overall accuracy.
  
  
  CONCLUSIONS
  The decision tree model distinguished children affected by prenatal alcohol exposure from nonexposed control subjects, including those with other behavioral concerns or conditions. Improving identification of this population will streamline access to clinical services, including multidisciplinary evaluation and treatment.
authors.affiliation: Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Goh
authors.affiliation: Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA.
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Doyle
authors.affiliation: Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA.
authors.forename: Leila
authors.initials: L
authors.lastname: Glass
authors.affiliation: Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, CA.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Jones
authors.affiliation: Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Riley
authors.affiliation: Department of Psychiatry and Behavior Sciences, Emory University School of Medicine, Atlanta, GA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
authors.forename: Claire D
authors.initials: CD
authors.lastname: Coles
authors.affiliation: Sanford Research and Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD.
authors.forename: H Eugene
authors.initials: HE
authors.lastname: Hoyme
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Kable
authors.affiliation: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina Nutrition Research Institute, Kannapolis, NC; Center on Alcoholism, Substance Abuse, and Addictions, The University of New Mexico, Albuquerque, NM.
authors.forename: Philip A
authors.initials: PA
authors.lastname: May
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions, The University of New Mexico, Albuquerque, NM.
authors.forename: Wendy O
authors.initials: WO
authors.lastname: Kalberg
authors.affiliation: Developmental Cognitive Neuroimaging Laboratory, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA; Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Sowell
authors.affiliation: Department of Psychiatry, University of Minnesota, Minneapolis, MN.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Wozniak
authors.affiliation: Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA. Electronic address: sarah.mattson@sdsu.edu.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Mattson
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003663:Decision Trees; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D009483:Neuropsychological Tests; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis* / Q000209:etiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014481:United States
keywords: clinical identification; fetal alcohol spectrum disorders (FASD); fetal alcohol syndrome (FAS); prenatal alcohol exposure; screening tool