Fetal Alcohol Syndrome (FAS)
Fetal alcohol syndrome is recognised as being at the higher end on a continuum of disorders which can be attributed to prenatal alcohol exposure. These disorders come under the umbrella of Fetal Alcohol Spectrum Disorders (FASD) (Mattson, Crocker & Nguyen, 2011; Riley, Infante & Warren, 2011; University of Washington, 2004).
• Fetal Alcohol Syndrome (FAS)
• Partial Fetal Alcohol Syndrome (pFAS)
• Alcohol Related Birth Defects (ARBD)
• Alcohol Related Neurodevelopmental Disorder (ARND)
As stated in Fetal Alcohol Syndrome: Guidelines for referral and diagnosis, the definition for FASD is as follows:
Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis. (Bertrand et al., 2004, pp. 4)
http://www.addictiontreatment.org/news/fetal-alcohol-syndrome
This definition was established by a committee put together by the Institute of Medicine to discuss FAS and its diagnosis, epidemiology, prevention and treatment. This committee further stated, “that FAS, ARBD, and ARND are a completely preventable set of birth defects and neurodevelopmental abnormalities, that FAS is arguably the most common known non-genetic cause of mental retardation, and that FAS, ARBD, and ARND constitute a major public health concern” (Stratton, Howe, & Battaglia, 1996). Acknowledging the risk alcohol consumption plays in birth defects, some do warn against the "moral panic" caused by such statements, stating that much improvement needs to occur with regard to research methods to assist in developing far more accurate estimates of FAS (Armstrong & Abel, 2000).
Fetal Alcohol Syndrome is best diagnosed within a multi-disciplinary approach and can include input by many, i.e. general practitioner, paediatrician, psychologist, psychiatrist, neurologist, and social worker. A framework for FAS diagnosis and services which assists in providing an overview to the cycle involved in diagnosis and treatment is attached to this site. As stated previously, the effects that FAS can have on an individual include possible physical, mental, behavioural, and learning deficits (U.S. Department of Health and Human Services, n.d.). There are a number of syndromes that have similar features to FAS and this increases the difficulty in achieving a correct diagnosis. To complicate matters further, comorbidity with disorders such as autism, conduct disorder, oppositional defiant disorder, anxiety disorders, adjustment disorders, sleep disorders and depression can occur (Riley, Infante & Warren, 2011). See Mattson, Crocker & Nguyen (2011) for patterns of neuropsychological impairments in children with FASD and ADHD.
There have been a number of diagnostic schemas created and utilised in the diagnosis of FAS, however it is the 4-Digit Diagnostic Code that is most often used (University of Washington), and in fact taught to medical and allied health professionals in the United States (as viewed in the Competency-Based
Curriculum Development Guide). The 4-Digit Diagnostic code allows for a full assessment to be undertaken by a multi-disciplinary team of professionals, resulting in a more specific assessment being made rather than the earlier more “gestalt” approaches. The 4-Digit code 4444 indicates a diagnosis of FAS, at the most extreme end of the FASD, and a code of 1111 would indicate normal development, no signs of facial deformities, no CNS concerns and no prenatal exposure to alcohol (University of Washington).
A number of tools are provided to assist medical and allied health professionals in forming their diagnosis (e.g., Lip-Philtrum Guide; Racial norms) but perhaps the most comprehensive is the 4-Digit Diagnostic Code Diagnostic Guide.
See: depts.washington.edu/fasdpn/pdfs/guide2004.pdf for a copy of the Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-digit diagnostic code (3rd Ed.).
