Competency 2: Identification of FASD and Diagnosis of FAS
Diagnostic References for FAS
In the past decade or so, researchers and clinicians have worked to develop diagnostic criteria for FASD. In 1996, the Institute of Medicine published a report that included various categories of these disorders and criteria for identifying them. Criteria included specific facial features, growth deficiency, central nervous system (CNS) damage, and maternal drinking history. The table summarizes the Institute of Medicine's classification scheme.1
| Criteria | ||||
|---|---|---|---|---|
| Condition | Face | Size | CNS | Documented History of Maternal Drinking |
| FAS I | X | X | X | X |
| FAS II | X | X | X | |
| Partial FAS | X | X | ||
| X | X | |||
| X | X | |||
| X | X | X | ||
| X | X | X | ||
| X | X | X | ||
| Alcohol-related neurodevelopmental disorder (ARND) | X | X | ||
Although the Institute of Medicine's scheme was helpful, experts attempted to refine the criteria. In 2004, the Centers for Disease Control and Prevention (CDC) published Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis.2 The guidelines specified types of instruments to be used (e.g., Lip-Philtrum Guide for measuring thinness of upper lip and smoothness of philtrum; brain imaging). They also noted specific scores for certain measures (e.g., postnatal height at or below the 10th percentile, head circumference at or below the 10th percentile). In addition, the guidelines note conditions with similar symptoms, so that clinicians can rule these out before diagnosing FAS.
Currently, CDC is using a collaborative database of neurodevelopmental data from five intervention studies to explore the nature of individuals who could be considered in the diagnostic category of alcohol-related neurodevelopmental disorder (ARND). They are also looking at data from a prospective cohort study of 5-year-olds in Denmark. However, at this time, the only diagnostic category with scientific evidence to support clinical criteria is FAS. As future data and science are available, these guidelines can be refined and expanded to delineate other conditions resulting from prenatal alcohol exposure.
