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.