Validity of an Online Cognitive Screening Tool for FASD: Testing the Equivalence of BRAIN-online to Neuropsychological Assessment Measures.

BACKGROUND

The diagnostic process for fetal alcohol spectrum disorders (FASD) requires investments in both time and cost. The Brief Assessment of Individual Neurobehavior, online version (BRAIN-online), is a screening tool designed to identify cognitive and behavioral symptoms associated with FASD. BRAIN-online is effective in distinguishing individuals with histories of prenatal alcohol exposure (PAE) and FASD; however, criterion validity of this screening tool has not been established. The goal of this study was to evaluate performance on BRAIN-online against gold-standard methods of measuring cognitive functioning (i.e., in-person neuropsychological assessment).

METHODS

Participants included 157 children (5-17 y) with (AE; n = 101) and without (CON; n = 56) PAE as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) Phases 4 and 5. Individuals completed BRAIN-online and underwent a standardized in-person neuropsychological assessment battery; caregivers completed the BRAIN-online Behavior Questionnaire (BBQ) and a standardized behavioral questionnaire. BRAIN-online measures were matched to in-person measures, and scores were assessed for correlation. In addition, equivalence testing was performed on BRAIN-online measures and their parallel in-person measures. To assess clinical utility, neurobehavioral impairment as defined by clinical guidelines for diagnosing FASD was assessed using BRAIN-online and in-person neuropsychological assessment and compared to FASD diagnoses using sensitivity, specificity, and accuracy analyses.

RESULTS

Seven of the eight BRAIN-online scores were correlated with scores of their corresponding in-person measures, and seven of eight BRAIN-online subtests showed measurement equivalence with parallel in-person neuropsychological assessment measures. BRAIN-online and in-person neuropsychological assessment had similar accuracy rates of classifying FASD, with BRAIN-online having slightly higher sensitivity and slightly lower specificity.

CONCLUSIONS

BRAIN-online subtests are correlated with and show measurement equivalence with gold-standard measures of cognitive functioning. Therefore, BRAIN-online may have clinical utility in identifying individuals who have symptoms associated with FASD and can benefit from comprehensive neuropsychological evaluation.