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Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis

From the Children's Hospital, Health Sciences Centre, Departments of Pediatrics and Child Health and Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Man. (Chudley); the Department of Educational and Counselling Psychology and Special Education, University of British Columbia; Asante Centre for Fetal Alcohol Syndrome, Maple Ridge, B.C. (Conry); the Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ont. (Cook); the Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, B.C. (Loock); the Provincial Medical Genetics Program; the Department of Pediatrics, Memorial University of Newfoundland, St. John's, Nfld. (Rosales); and the Department of Pediatrics, Georges Dumont Hospital, Moncton, N.B. (LeBlanc).

Correspondence to: Dr. Jocelynn L. Cook, FASD Team, Public Health Agency of Canada, Division of Childhood and Adolescence, Jeanne Mance Bldg. 9th flr, Tunney's Pasture, Address Locator 1909C2, Ottawa ON K1A 0K9; jocelynn{at}primus.ca

THE DIAGNOSIS OF FETAL ALCOHOL SPECTRUM DISORDER (FASD) is complex and guidelines are warranted. A subcommittee of the Public Health Agency of Canada's National Advisory Committee on Fetal Alcohol Spectrum Disorder reviewed, analysed and integrated current approaches to diagnosis to reach agreement on a standard in Canada. The purpose of this paper is to review and clarify the use of current diagnostic systems and make recommendations on their application for diagnosis of FASD-related disabilities in people of all ages. The guidelines are based on widespread consultation of expert practitioners and partners in the field. The guidelines have been organized into 7 categories: screening and referral; the physical examination and differential diagnosis; the neurobehavioural assessment; and treatment and follow-up; maternal alcohol history in pregnancy; diagnostic criteria for fetal alcohol syndrome (FAS), partial FAS and alcohol-related neurodevelopmental disorder; and harmonization of Institute of Medicine and 4-Digit Diagnostic Code approaches. The diagnosis requires a comprehensive history and physical and neurobehavioural assessments; a multidisciplinary approach is necessary. These are the first Canadian guidelines for the diagnosis of FAS and its related disabilities, developed by broad-based consultation among experts in diagnosis.

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