Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

Functional impairment, not FASD

Benjamin J. Klein
CMAJ October 04, 2016 188 (14) 1035-1036; DOI: https://doi.org/10.1503/cmaj.1150122
Benjamin J. Klein
Lansdowne Children’s Centre, Brantford, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

The publication of new guidelines for fetal alcohol spectrum disorder (FASD) raises concerns about the ongoing push for FASD-specific assessment and support programs.1 Many children present with evidence of pervasive brain dysfunction who do not have FASD. Current developmental practice emphasizes interaction of function and environment, not etiologic labels.2

FASD is clinically indistinguishable from other causes of neurobehavioural disorders (e.g., antenatal alcohol or other teratogens, complex trauma, genetic).3 Treatment for neurobehavioural disorders is nonspecific (e.g., environmental supports) and based on function (e.g., cognitive, memory, executive, self-regulation). Emphasizing an etiologic label with no specific treatment is misleading to the public and unethical.

Function-based, nonmedical diagnosis-specific services are compatible with a vigorous public health program in preventing antenatal alcohol exposure. Basing resources on an etiologic label marginalizes individuals with neurobehavioural disabilities without a unifying diagnostic label.

FASD-specific programs will increase wasteful diagnosis-seeking behaviour (as seen in autism spectrum disorder). A universal FASD-specific diagnostic program based on current guidelines is not tenable4 and emphasizes the question of qualification for an FASD diagnosis, which is of low practical clinical relevance. The label of FASD carries potential harm to many through stigmatization and prejudice, particularly for those who are in the “at risk of FASD” category.5 Ironically, FASD-specific programs will exclude many who are affected by antenatal alcohol but do not meet the criteria.

There is no good quality evidence indicating a need to diagnose children early with FASD (as opposed to diagnosing function-based problems). We need equitable, nonetiologic diagnosis-based services for all people with neurobehavioural disorders. Prioritization for assessment and intervention programs should be based on severity of functional disability, not on etiology. Diagnosticians need to focus on functional impairment rather than often futile (and sometimes damaging) attempts to attribute causality.

References

  1. ↵
    1. Cook JL,
    2. Green CR,
    3. Lilley CM,
    4. et al
    ., for the Canada Fetal Alcohol Spectrum Disorder Research Network. Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan. CMAJ 2016;188:191–7.
    OpenUrlFREE Full Text
  2. ↵
    1. Rosenbaum P,
    2. Gorter JW
    . The ‘F-words’ in childhood disability: I swear this is how we should think! Child Care Health Dev 2012;38:457–63.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Malone M,
    2. Koren G
    . Alcohol-induced behavioural problems in fetal alcohol spectrum disorders versus confounding behavioural problems. J Popul Ther Clin Pharmacol 2012;19:e32–40.
    OpenUrl
  4. ↵
    1. Goulden KJ
    . Are FASD guidelines practical and sustainable? CMAJ 2005;173:1070–1.
    OpenUrlFREE Full Text
  5. ↵
    1. McLennan JD
    . Alcohol-exposed? Next. CMAJ 2015;187:682–3.
    OpenUrlFREE Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 188 (14)
CMAJ
Vol. 188, Issue 14
4 Oct 2016
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Functional impairment, not FASD
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Functional impairment, not FASD
Benjamin J. Klein
CMAJ Oct 2016, 188 (14) 1035-1036; DOI: 10.1503/cmaj.1150122

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Functional impairment, not FASD
Benjamin J. Klein
CMAJ Oct 2016, 188 (14) 1035-1036; DOI: 10.1503/cmaj.1150122
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Final consent, advance consent and alleviating suffering in frail adults requesting MAiD
  • Should physicians rethink travel to conferences?
  • Leveling the playing field in long-term care
Show more Letters

Similar Articles

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire