Developing a Valid Regional Prevalence Estimate for Fetal Alcohol Spectrum Disorders in an Urban Setting

Introduction: Based on previous work in other countries, a cross-sectional, active case ascertainment approach has been used to estimate the prevalence of Fetal Alcohol Spectrum Disorders (FASD) among school children in a large urban city, as part of the Collaboration for Fetal Alcohol Spectrum Disorders Prevalence study (CoFASP).

Methods: The primary sample was drawn from 4,400 first-grade children attending elementary schools in the San Diego Unified School District between 2012 and 2014. Children who screened positive on either growth or neurodevelopmental concerns and an additional random sample of screen-negative children were further evaluated with a dysmorphological evaluation and a neurobehavioral testing battery and their mothers completed a comprehensive interview. The specific neurobehavioral measures for the study were selected to focus on those aspects of neurodevelopment that are characteristically affected by prenatal alcohol exposure, including global and specific cognitive measures, measures of executive functioning and memory, adaptive functioning , academic achievement and emotional and behavioral development. Criteria for cutoffs were established to be consistent with current methods for the diagnosis of FASD and with empirical evidence of effects of prenatal alcohol exposure on neurodevelopment. In addition, the criteria were examined in relation to the diagnostic guidelines for Neurobehavioral Disorder-Prenatal Alcohol Exposure (ND-PAE) recently proposed in the Diagnostic and Statistical Manual, 5^th Edition (DSM-5).

Results: As of November, 2015, a total of 918 children were eligible for and have completed some or all components of the comprehensive evaluation at the San Diego site.   Evidence from each domain of data collection are reviewed by the study team as each child completed the comprehensive assessment, and a preliminary FASD classification was assigned based on previously agreed-upon criteria applied across the CoFASP consortium.

Conclusions: The results from this site as well as the other sites in the Consortium will be combined with appropriate attention to weighting in order to develop a composite estimate that may be generalizable to similar populations and settings and can help inform public health prevention strategies.