TABLE 5

Results for Parent/Caregiver-rated Total, Internalizing, and Externalizing Problems Composite Scores Used in Meta-analyses Only (n = 16 studies)

ReferenceAlcohol Exposure / FASD Guideline UsedaComparison GroupAlcohol-Exposed Group Scores, Mean (SD) or OR (CI)Comparison Group ScoresCovariates Controlled Forb
Brown et al 199124Stopped drinking in Trimester 2: NR drinks/week (n = 23)No PAE: 0 drinks/week (n = 22)Internalizing problems (T score):Internalizing problems (T score):Caregiver’s current alcohol consumption
Continued drinking: NR drinks/week (n = 23)Stopped drinking: 54.86 (10.24)No PAE: 55.8 (9.86)
Continued drinking: 57.15 (8.41)[P not significant]
Externalizing problems (T score):Externalizing problems (T score):
Stopped drinking: 57.33 (8.88)No PAE: 58.90 (10.32)
Continued drinking: 60.75 (7.65)[P not significant]
Total problems (T score):Total problems (T score):
Stopped drinking: 57.48 (9.91)No PAE: 59.00 (9.52)
Continued drinking: 61.05 (8.33)[P not significant]
Ernhart et al 199521FAS: Criteria from the Fetal Alcohol Study Group of the Research Society on Alcoholism (n = 5)No FAS (n = 221)FAS (T score):No FAS (T score):Prenatal marijuana exposure; excluded those with prenatal narcotic exposure.
Internalizing problems: 59.14 (11.35)Internalizing problems: 60.9 (9.1)
Externalizing problems: 63.4 (9.77)Externalizing problems: 62.9 (9.4)
Total problems: 63.28 (9.91)Total problems: 63.3 (9.2)[P values NR]
Olson et al 199817FAS: Gestalt method from IOM (n = 9 [boys: 3; girls: 6])Total problems (% clinical [T score>63]):NANone
FAS (boys): 66.7%
FAS (girls): 100%
Mattson and Riley 200035PAE (±FAS): Growth retardation, CNS dysfunction, and facial dysmorphology; PAE definition NR (n = 33)Control (n = 33)PAE (±FAS) (T score):Control (T score):Group, gender, estimated SES, verbal IQ
Internalizing problems: 58.90 (12.56)Internalizing problems: 51.10 (12.74); [P = .019]
Externalizing problems: 66.50 (13.87)Externalizing problems: 53.60 (12.22); [P = .001]
Total problems: 67.90 (10.61)Total problems: 53.30 (12.79); [P < .001]
Sood et al 200132Low PAE: >0 to <4.3 drinks/week (n = 323)No PAE: 0 drinks/week (n = 117)PAE (Clinical range OR (95%CI)):NANone
Moderate/heavy PAE: ≥4.3 drinks/week(n = 66)Internalizing problems: 1.6 (0.9 to 3.1)
OR calculated using PAE (present/absent)Externalizing problems: 1.7 (1.0 to 3.2)
Total problems: 1.8 (1.0 to 3.0)
Paley et al 200618FAS: 4-digit diagnostic code; PAE defined as ≥8.51 drinks/week or ≥3.65 drinks/occasion (n = 100)NAFAS (T score):NANone
Internalizing problems: 63.47 (10.29)
Externalizing problems: 68.04 (9.65)
Franklin et al 200814FASD: 4-digit diagnostic code (n = 44)NAFASD (T score):NANone
Internalizing problems: 66.90 (8.60)
 Normal (<60): 20.5%
 Borderline (60–63): 13.6%
 Clinical (>63): 65.9%
Externalizing problems: 70.10 (9.20)
 Normal (<60): 15.9%
 Borderline (60–63): 9.1%
 Clinical (>63): 75.0%
Total problems: 71.90 (7.50)
 Normal (<60): 9.1%
 Borderline (60–63): 4.5%
 Clinical (>63): 86.4%
Greenbaum et al 200915FASD: Motherisk Program ARND diagnostic criteria checklist (n = 33)Control (n = 34)FASD (T score):Control (T score):SES, tobacco exposure, abuse, adoption/foster home history; ADHD
Internalizing problems: 50.60 (22.40)Internalizing problems: 53.4 (11.66); [p not significant]
Externalizing problems: 67.60 (22.98)Externalizing problems: 47.30 (12.25); [P = .001]
Astley 201019All groups had PAE confirmed at any level and were diagnosed with the 4-digit diagnostic code.Normal CNS/PAE: PAE at any level (n = 331–500)FAS/PFAS (T score):Normal CNS/PAE (T score):None
FAS/PFAS: n = 37–51Internalizing problems: 63.4 (10.1)Internalizing problems: 60.8 (14.1); [P = .014]
Externalizing problems: 69.1 (9.9)Externalizing problems: 60.3 (13.2); [P < .0001]
Total problems: 71.4 (8.9)Total problems: 61.9 (12.7); [P < .0001]
O’Leary et al 201029PAE- Late preg:Abstinent:Internalizing problems (Adjusted OR (95%CI) for T score ≥ 60):NAMaternal age, ethnicity, parity, marital status, income, smoking and illicit drug use (incl. tranquilizers, sleeping tablets) during preg, postnatal depression; anxiety, stress, family functioning, parenting scales, family tension due to alcohol misuse, age of completion of CBCL.
Low: < 5 drinks/week and ≤0.71–1.43 drinks/d (n = NR)None: n = NRLow: 1.12 (0.8 to 1.56)
Moderate: ≤ 5 drinks/week (n = NR)Moderate: 1.34 (0.82 to 2.19)
Heavy: ≥4.3–27.1 drinks/week (n = NR)Heavy: 1.36 (0.5 to 3.71)
Externalizing problems (Adjusted OR (95%CI) for T score ≥ 60):
Low: 1.04 (0.77 to 1.4)
Moderate: 1.27 (0.84 to 1.93)
Heavy: 1.31 (0.62 to 2.79)
Total problems (Adjusted OR (95%CI) for T score ≥ 60):
Low: 0.97 (0.7 to 1.34)
Moderate: 1.42 (0.9 to 2.23)
Heavy: 1.39 (0.57 to 3.41)
Robinson et al 201031PAE 34 wk:No PAE: 0 drinks/week:Internalizing problems (Adjusted OR (95%CI) for T score ≥ 60):NAMaternal age and education, family income, presence of biological father in family home, stressful events in preg, prenatal cigarette smoking, child’s age at each follow-up
Occasional: (n = 427)No PAE (34 wk): (n = 1579)Occasional: 1.06 (0.82 to 1.37)
Light: (n = 310)Light: 0.86 (0.61 to 1.2)
Moderate: (n = 38)Moderate: 0.49 (0.16 to 1.49)
Heavy: (n = 16)Heavy: 1.21 (0.49 to 2.95)
Externalizing problems Adjusted OR (95%CI) for T score ≥ 60):
Occasional: 1.22 (0.92 to 1.62)
Light: 0.77 (0.56 to 1.05)
Moderate: 0.53 (0.19 to 1.44)
Heavy: 1.24 (0.40 to 3.86)
Total problems (Adjusted OR (95%CI) for T score ≥ 60):
Occasional: 1.24 (0.93 to 1.65)
Light: 0.88 (0.63 to 1.23)
Moderate: 0.48 (0.20 to 1.14)
Heavy: 1.19 (0.30 to 4.68)
Fagerlund et al 201113FASD: Revised IOM diagnostic criteria (n = 73)No FASD (n = 40)FASD (T score):No FASD (T score):None
Internalizing problems: 53.92 (10.22)Internalizing problems: 44.80 (8.08); [P < .0001]
 Normal (<60): 70.4%- Normal (<60): 92.5%
 Borderline (60–63): 11.3%- Borderline (60–63): 5.0%
 Clinical (>63): 18.3%- Clinical (>63): 2.5%
Externalizing problems: 53.59 (10.77)Externalizing problems: 43.75 (8.66); [P < .0001]
 Normal (<60): 73.2%- Normal (<60): 95.0%
 Borderline (60–63): 12.7%- Borderline (60–63): 5.0%
 Clinical (>63): 14.1%- Clinical (>63): 0%
Total problems: 56.69 (8.89)Total problems: 42.10 (8.76); [P < .0001]
 Normal (<60): 57.7%- Normal (<60): 97.5%
 Borderline (60–63): 19.7%- Borderline (60–63): 2.5%
 Clinical (>63): 22.5%- Clinical (>63): 0%
Jirikowic et al 201216FASD: 4-digit diagnostic code (n = 52)NAFASD (T score):NANone
Total problems: 70.90 (6.00)
Graham et al 201326CIFASD Dysmorphology Core diagnostic criteria; >4 drinks/occasion ≥1/week, or >13 drinks/week:Control (n = 102)FAS/heavy PAE (no ADHD) (T score):Control (T score):ADHD
FAS/heavy PAE (no ADHD): n = 35Internalizing problems: 55.91 (10.17)Internalizing problems: 45.76 (9.31); [P < .05]
Externalizing problems: 55.86 (10.35)Externalizing problems: 43.99 (9.39); [P < .05]
Stevens et al 201320All groups had PAE confirmed at any level.PAE (no FASD): n = 50FASD (T score):PAE (no FASD) (T score):None
FASD: Canadian guidelines (n = 98)Internalizing problems: 62.02 (10.16)Internalizing problems: 57.60 (10.89); [P < .05]
OR (95%CI): 2.52 (1.19 to 5.31)Externalizing problems: 63.62 (11.63); [P < .05]
Externalizing problems: 71.15 (8.93)Total problems: 63.70 (11.41); [P < .05]
OR (95%CI): 4.58 (2.18 to 9.62)
Total problems: 70.32 (7.34)
OR (95%CI): 2.94 (1.42 to 6.11)
Ware et al 201334PAE+no ADHD: Heavy PAE = >4 drinks ≥1/week or ≥13 drinks/week throughout preg (n = 52)Control: n = 133PAE+no ADHD (T score):Control (T score):Race, ethnicity, home placement, gender.
Internalizing problems: 55.47 (10.65)Internalizing problems: 45.52 (9.39); [P < .001]
Externalizing problems: 56.02 (9.81)Externalizing problems: 43.05 (9.1); [P < .001]
Total problems: 56.59 (10.56)Total problems: 41.72 (10.24); [P < .001:]
  • ±, with or without; ARND, alcohol related neurodevelopmental disorder; CIFASD, Collaborative initiative on fetal alcohol spectrum disorders; CNS, central nervous system; IOM, Institute of Medicine; NA, not applicable; NR, not reported; PFAS, partial fetal alcohol syndrome; preg, pregnancy; SES, socioeconomic status; yo, years old.

  • Where provided, P values between groups are presented in square brackets.

  • Data were extracted only for PAE/FASD groups and their comparison groups (without PAE/FASD), and also for groups assessed using the ASEBA school-aged forms (which excludes groups assessed using the ASEBA pre-school forms).

  • Appendix 3 contains the detailed results for Total, Internalizing, and Externalizing problems scores for all subgroups within each study included in this review, as reported by parents/caregivers and teachers.

  • a This column reports either PAE levels (as reported in the articles) or FASD diagnostic guidelines used.

  • b Covariates controlled for in analysis of ASEBA outcomes specifically, which does not take into account whether covariates were controlled for in other aspects of the article which were not extracted for this review.