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Guidelines

Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan

Jocelynn L. Cook, Courtney R. Green, Christine M. Lilley, Sally M. Anderson, Mary Ellen Baldwin, Albert E. Chudley, Julianne L. Conry, Nicole LeBlanc, Christine A. Loock, Jan Lutke, Bernadene F. Mallon, Audrey A. McFarlane, Valerie K. Temple and Ted Rosales; for the Canada Fetal Alcohol Spectrum Disorder Research Network
CMAJ February 16, 2016 188 (3) 191-197; DOI: https://doi.org/10.1503/cmaj.141593
Jocelynn L. Cook
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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  • For correspondence: jcook@sogc.com
Courtney R. Green
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Christine M. Lilley
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Sally M. Anderson
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Mary Ellen Baldwin
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Albert E. Chudley
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Julianne L. Conry
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Nicole LeBlanc
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Christine A. Loock
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Jan Lutke
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Bernadene F. Mallon
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Audrey A. McFarlane
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Valerie K. Temple
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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Ted Rosales
Canada Fetal Alcohol Spectrum Disorder Research Network (Cook, Green, Lutke); Society of Obstetricians and Gynaecologists of Canada (Cook, Green), Ottawa, Ont.; Department of Obstetrics and Gynaecology (Cook), University of Ottawa, Ottawa, Ont.; Department of Biomedical and Molecular Sciences (Green), Queen’s University, Kingston, Ont.; Sunny Hill Health Centre for Children (Lilley), Vancouver, BC; National Institutes of Health (Anderson), Ottawa, Ont.; Fetal Alcohol Spectrum Disorders Clinic (Baldwin), Child Development Services, Alberta Children’s Hospital, Calgary, Alta.; Department of Pediatrics (Chudley), University of Manitoba, Winnipeg, Man.; University of British Columbia (Conry [professor emerita]), Vancouver, BC; Department of Pediatrics (LeBlanc), Dr. Georges-L.-Dumont University Hospital Centre, Université de Moncton and Université de Sherbrooke, Moncton, NB; Department of Pediatrics (Looke), University of British Columbia, Vancouver, BC; Glenrose Rehabilitation Hospital (Mallon), Alberta Health Services, Edmonton, Alta.; Lakeland Centre for Fetal Alcohol Syndrome (McFarlane), Cold Lake, Alta.; Surrey Place Centre (Temple), Toronto, Ont.; Faculty of Medicine (Rosales), Memorial University of Newfoundland, St. John’s, Nfld.
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  • RE: Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan
    Kathryn Page [Ph.D.]
    Posted on: 17 September 2021
  • We need to emphasize functional impairment not FASD diagnosis
    Benjamin J Klein
    Posted on: 05 April 2016
  • Posted on: (17 September 2021)
    Page navigation anchor for RE: Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan
    RE: Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan
    • Kathryn Page [Ph.D.], FASD Consultant, FASD Northern California

    I wonder about the necessity of the multi-disciplinary team. I directed the Santa Clara Valley Medical Center FASD Diagnostic Clinic years ago, and kept thinking about all the kids on our waiting list whose families remained in the dark, trying to discipline or teach in ways that only frustrated everyone. I realize that the extensive map of strengths and weaknesses, the beautifully laid-out test results and recommendations from all our team--this was a great gift to those few kids we could see. (Many of them, I should say. There were parents/caregivers who were unable to absorb this exquisitely detailed information.)

    But my question continues to be this: why is there such a brilliant gold standard for diagnosing FASD where no such requirements exist for other developmental diagnoses? If impairments in the three areas of neurocognitive function, regulation, and adaptive living skills are the basic criteria for diagnosis, why isn't it enough to spot those three, give the diagnosis (yes of course with alcohol established), and let the families go off toward the support, understanding, guidance that can be found through the portals of CanFASD, online groups, conferences and so on?

    In fact the DSM-5 schema for ND-PAE diagnoses seems to support this simplification, along with an implication if not outright recommendation that anyone who is in a position of diagnosing developmental conditions should be able, with commensurate training, also diagnose FASD, r...

    Show More

    I wonder about the necessity of the multi-disciplinary team. I directed the Santa Clara Valley Medical Center FASD Diagnostic Clinic years ago, and kept thinking about all the kids on our waiting list whose families remained in the dark, trying to discipline or teach in ways that only frustrated everyone. I realize that the extensive map of strengths and weaknesses, the beautifully laid-out test results and recommendations from all our team--this was a great gift to those few kids we could see. (Many of them, I should say. There were parents/caregivers who were unable to absorb this exquisitely detailed information.)

    But my question continues to be this: why is there such a brilliant gold standard for diagnosing FASD where no such requirements exist for other developmental diagnoses? If impairments in the three areas of neurocognitive function, regulation, and adaptive living skills are the basic criteria for diagnosis, why isn't it enough to spot those three, give the diagnosis (yes of course with alcohol established), and let the families go off toward the support, understanding, guidance that can be found through the portals of CanFASD, online groups, conferences and so on?

    In fact the DSM-5 schema for ND-PAE diagnoses seems to support this simplification, along with an implication if not outright recommendation that anyone who is in a position of diagnosing developmental conditions should be able, with commensurate training, also diagnose FASD, reserving the MDT and physician for the most complex cases.

    I would love to comments from any of the authors. I'm currently training all the Los Angeles County Mental Health providers who work with the foster system, and will begin Part 2 of this training in December, focusing on screening, diagnosis, and intervention. My mission is to make this information as universally useful as possible, and help get this one large county up and running on diagnosing and serving people with this confounding condition that does so often masquerade as bad behavior, "poor choices", irresponsibility. As you all know.

    Thank you for reading this far, and for any thoughts you have in response.

    Kathryn Page, PhD

    Show Less
    Competing Interests: None declared.

    References

    • 95476
  • Posted on: (5 April 2016)
    Page navigation anchor for We need to emphasize functional impairment not FASD diagnosis
    We need to emphasize functional impairment not FASD diagnosis
    • Benjamin J Klein, Developmental Paediatrician

    The publication of new guidelines for Fetal Alcohol Spectrum Disorder (FASD) raises concerns about the ongoing push for FASD specific assessment and support programs. Legion 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.1

    -FASD is clinically indistinguishable from oth...

    Show More

    The publication of new guidelines for Fetal Alcohol Spectrum Disorder (FASD) raises concerns about the ongoing push for FASD specific assessment and support programs. Legion 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.1

    -FASD is clinically indistinguishable from other causes of neurobehavioural disorders (e.g. antenatal alcohol or other teratogens, complex trauma, genetic, etc.).2

    -Treatment for neurobehavioural disorders is non-specific (e.g. environmental supports), and based on function (i.e. cognitive, memory, executive, self-regulation, etc.).

    -Emphasizing an etiologic label with no specific treatment is misleading to the public and unethical.

    -"Function-based", non-medical diagnosis specific services are compatible with a vigourous public health program in prevention of antenatal alcohol exposure.

    -Basing resources on an etiologic label marginalizes individuals with neurobehavioural disabilities without a unifying diagnostic label.

    -FASD specific programs will create an increase in wasteful diagnosis -seeking behaviour (i.e. as seen in Autism Spectrum Disorder).

    - A universal FASD specific diagnostic program based on current guidelines is not tenable3 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 the "at risk FASD" category.4

    -Ironically, FASD-specific programs will exclude many affected by antenatal alcohol who do not meet 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, non-etiologic diagnosis based services for all individuals with neurobehavioural disorders. Prioritization for assessment and intervention programs should be based on severity of functional disability, not etiology. Diagnosticians need to focus on functional impairment rather than often futile (and sometimes damaging) attempts to attribute causality.

    References

    1. Rosenbaum P, Gorter JW. The 'F-words' in childhood disability: I swear this is how we should think! Child Care Health Dev. Jul 2012;38(4):457-463.

    2. Malone M, Koren G. Alcohol-induced behavioural problems in fetal alcohol spectrum disorders versus confounding behavioural problems. Journal of population therapeutics and clinical pharmacology = Journal de la therapeutique des populations et de la pharamcologie clinique. 2012;19(1):e32-40.

    3. Goulden KJ. Are FASD guidelines practical and sustainable? CMAJ. Oct 25 2005;173(9):1070; author reply 1070-1071.

    4. McLennan JD. Encounters: Alcohol-exposed? Next. CMAJ. 2015;187:682-683.

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
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Canadian Medical Association Journal: 188 (3)
CMAJ
Vol. 188, Issue 3
16 Feb 2016
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Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan
Jocelynn L. Cook, Courtney R. Green, Christine M. Lilley, Sally M. Anderson, Mary Ellen Baldwin, Albert E. Chudley, Julianne L. Conry, Nicole LeBlanc, Christine A. Loock, Jan Lutke, Bernadene F. Mallon, Audrey A. McFarlane, Valerie K. Temple, Ted Rosales
CMAJ Feb 2016, 188 (3) 191-197; DOI: 10.1503/cmaj.141593

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Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan
Jocelynn L. Cook, Courtney R. Green, Christine M. Lilley, Sally M. Anderson, Mary Ellen Baldwin, Albert E. Chudley, Julianne L. Conry, Nicole LeBlanc, Christine A. Loock, Jan Lutke, Bernadene F. Mallon, Audrey A. McFarlane, Valerie K. Temple, Ted Rosales
CMAJ Feb 2016, 188 (3) 191-197; DOI: 10.1503/cmaj.141593
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