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Diagnosing fetal alcohol spectrum disorder: New Canadian guideline

December 14, 2015

Diagnosing fetal alcohol spectrum disorder (FASD) is important to help children and adults, and their families, who have the disorder. A new Canadian guideline published in CMAJ (Canadian Medical Association Journal), provides recommendations for diagnosing FASD, specifically for multidisciplinary diagnostic teams.

FASD is a neurodevelopmental disorder resulting from prenatal alcohol exposure. Individuals with FASD can experience complex behavioural and intellectual problems that persist throughout the lifespan and can become increasingly complicated if unsupported. The need for early and accurate diagnosis is critical for improving outcomes and quality of life.

It is estimated that 1 in 100 people have FASD, translating to more than 330 000 affected individuals in Canada.

Since the publication of the last Canadian guideline in 2005, research in this area has evolved. The new guideline incorporates updated evidence for detecting and diagnosing FASD across the lifespan.

"These new recommendations, based on the latest evidence for diagnosing FASD, will improve how we diagnose the disorder and help individuals and their families," states Dr. Jocelynn Cook, Canada Fetal Alcohol Spectrum Disorder Research Network and the Society of Obstetricians and Gynaecologists of Canada.

The guideline is aimed at health care providers with specialized training and experience in FASD who are part of multidisciplinary diagnostic teams. Family physicians may find the guideline useful, but the diagnosis must be made with input from other experienced health care professionals.

"The Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) played a leadership role in supporting the development of the new Diagnostic Guidelines with funding from the Public Health Agency of Canada. We will continue to support and facilitate research and knowledge exchange on this important initiative," states Audrey McFarlane, Interim Executive Director of CanFASD.

Key recommendations for diagnosis of FASD:
  • Counseling women and their partners about abstinence from alcohol during pregnancy or when planning a pregnancy

  • Screening of all pregnant women and new mothers for alcohol use by trained professionals using tested tools

  • Referring individuals for possible diagnosis if there is evidence of prenatal exposure to alcohol at levels associated with adverse brain function

  • Conducting complete social and medical histories of patients suspected of having FASD

Other recommendations address the sentinel facial features associated with exposure to alcohol during pregnancy, the complex brain injury and differential diagnoses. The guideline includes an algorithm -- a decision-making tool -- to help multidisciplinary teams diagnose the disorder based on the recommendations.

"Just as diagnosing FASD is important, so too is ensuring the patient and their caregivers receive the support they need to obtain necessary services that may improve quality of life," states Dr. Cook. "They will need specialized support from a team of experts such as child development specialists, occupational therapists, speech-language therapists, psychologists and specialized physician supports, depending on their ages."
-end-
For the related online training program "Multidisciplinary Training for Diagnosis of FASD", visit http://www.canfasd.ca.

The authors note that there are still gaps in understanding of FASD and that ongoing research will continue to inform the field and treatments.

Canadian Medical Association Journal

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