New Canadian guidelines for diagnosing FASD across the lifespan

January 21, 2016

Leading FASD researchers have updated Canadian diagnostic guidelines, with a cross-lifespan approach that acknowledges the thousands of individuals who have struggled past childhood without benefit of intervention.

The guideline, appearing in late December 2015 in the Canadian Medial Association Journal, provides recommendations specifically aimed at 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 has led to improved capacity for detecting and diagnosing FASD in children and adults.

“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.

Diagnosing FASD remains a complex process. This reality is reflected in the crafting of a guideline intended for health care providers with specialized training and experience, who are part of multidisciplinary diagnostic teams. Family physicians may also find the guideline useful, but a diagnosis of FASD must be made with input from other experienced health care professionals.

Dr. Jocelyn Cook is the lead author of the newly published guidelines, supported by researchers from NeuroDevNet and the Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD), including Drs. Ab Chudley and Courtney Green. The work was funded by the Public Health Agency of Canada.

Key recommendations from the guidelines include:
    •    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 nature of alcohol-induced brain injury and differential diagnoses. The guideline includes an algorithm to help multidisciplinary teams decisions as they diagnose the disorder using the guidelines.

“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,” Dr. Cook said. “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.”

Photo: from England's Lost Children