Fetal Alcohol Spectrum Disorder-Issues of Misdiagnosis and Missed Diagnosis in Black Youth: A Case Report.

Fetal alcohol spectrum disorder (FASD) is an umbrella term used to describe the set of conditions that result from prenatal alcohol exposure (PAE) that lead to cognitive impairment, neurodevelopmental delays, socioemotional and behavioral problems, medical complications, and/or secondary disabilities. In addition, various internalizing and externalizing disorders share similar symptoms with FASD, resulting in misdiagnoses and/or missed diagnosis of FASD. This is amplified for Black youths due to the later onset of referral for assessment and lower frequency of referral to specialty clinics. This clinical case report depicts a misdiagnosis and a missed diagnosis of FASD in a 10-year-old African American patient, who was referred for neuropsychological evaluation. Diagnoses at the time of referral included attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and disruptive mood dysregulation disorder (DMDD). Upon completion of a comprehensive evaluation, the patient's diagnoses changed to neurodevelopmental disorder associated with prenatal alcohol exposure, intellectual disability (ID), ADHD, and unspecified depressive disorder, leading to referral to appropriate interventions. The goal of this clinical case report is to increase clinician understanding of FASD and its clinical presentation, inform clinicians about the diagnostic and systemic factors that contribute to misdiagnosis and missed diagnosis of FASD, and to demonstrate the importance of an accurate diagnosis of FASD. By depicting the diagnostic challenges in an African American youth, the authors hope to bring awareness to the racial and ethnic disparities in the diagnosis of neurodevelopmental disabilities, specifically FASD in minority youth.