Differentiating Fetal Alcohol Spectrum Disorders From Attention‐Deficit Hyperactivity Disorder and Reviewing Diagnostic Guidelines

Abstract

Individuals with prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders (FASDs) present a range of neurodevelopmental deficits (e.g., inattention, hyperactivity, and executive dysfunction) which have shown marked overlap with attention‐deficit/hyperactivity disorder (ADHD), making differential diagnosis challenging. While rates of comorbidity are high, evidence has suggested there are important distinctions between neurodevelopmental phenotypes. To understand these distinctions, we evaluated whether proposed neurobehavioral disorder associated with prenatal alcohol exposure (ND‐PAE) criteria in the appendix of the Diagnostic and Statistical Manual for Mental Disorders (Fifth Edition) can differentiate FASD from ADHD. We conducted systematic searches across three databases (Medline, PsycINFO, PubMed) to identify studies comparing behavioral and cognitive functioning between FASD, ADHD, and healthy controls (HCs). Outcomes indicated FASD individuals have greater magnitude neurodevelopmental deficits than ADHD; however, no differences were found regarding the pattern of deficit because of methodological limitations, such as low I2. Moreover, outcomes supported adaptive and neurocognitive (executive functioning) criteria but did not support self‐regulation criteria. These findings collectively underscore a need for clinicians to consider the magnitude of deficits presented to facilitate accurate recognition of PAE. Further research characterizing ND‐PAE criteria and differences in the magnitude of deficits between disorders may ultimately support more accurate differential diagnosis.