From the Guidelines
Screening for Fetal Alcohol Spectrum Disorders (FASD) should involve a comprehensive approach, including maternal alcohol use assessment, physical examination, and neurodevelopmental assessments, as outlined in the updated clinical guidelines for diagnosing FASD 1. When screening for FASD, healthcare providers should first assess maternal alcohol use during pregnancy using tools like the T-ACE, TWEAK, or AUDIT questionnaires. For children, a physical examination should look for characteristic facial features, including short palpebral fissures, thin vermilion border of the upper lip, and smooth philtrum, as well as growth deficiencies and head circumference measurements 1. Neurodevelopmental assessments are crucial and should include tests of:
- Cognitive function
- Language skills
- Motor coordination
- Behavior regulation
- Adaptive functioning The 4-Digit Diagnostic Code system can help classify FASD severity based on growth deficiency, facial features, brain dysfunction, and prenatal alcohol exposure. Early screening is vital, as early intervention can significantly improve outcomes for affected children, and should involve a multidisciplinary team including pediatricians, neuropsychologists, speech therapists, and occupational therapists to evaluate the full range of potential impairments associated with prenatal alcohol exposure 1.
From the Research
Screening Methods for FASD
Some screening methods for Fetal Alcohol Spectrum Disorder (FASD) include:
- Neurobehavioral Screening Tool (NST) which has demonstrated 72% to 73% sensitivity and 34% to 36% specificity in identifying FASD 2
- Fetal alcohol syndrome (FAS) screening tools that perform well in identifying individuals at risk of FAS 3
- Screening approaches that aim to identify individuals at risk of FASD using a range of markers or associated sentinel dysmorphic facial features 4
- Emerging screening tools that focus on identifying promising biomarkers of prenatal alcohol exposure (PAE)/FASD 4, 3
Characteristics of FASD Screening Tools
The performance characteristics of FASD screening tools vary, and they are linked to different diagnostic criteria 3. Some studies have identified limitations in the psychometric properties of most screening approaches, with a high risk of bias due to the common use of case-control designs and lack of adequate reference standards 4.
Need for Further Research
There is a need for additional research to identify biomarkers unique to FASD and to guide the development of accurate FASD screening tools 4, 3, 2. Further research is also needed to establish a valid neurobehavioral tool with a possible focus on antisocial behaviors and emotional regulation problems 2.