Two Recent Approaches to FASD Diagnosis

The Prevention Conversation: A Shared Responsibility Project

f28df-1445359631870Overview

Over the last 50 years, a significant amount of research and clinical expertise has been devoted to characterizing the effects of prenatal alcohol exposure on the developing fetus. Simultaneously, a variety of systems and approaches have also emerged to provide diagnostic guidance for the related diagnoses.

Fetal Alcohol Spectrum Disorder (FASD) is now widely used to describe the resultant sequelae associated with prenatal alcohol exposure. Despite ongoing pressure to develop a consensus around diagnostic approaches for FASD, different multidisciplinary diagnostic systems continue to emerge.

Recently, significant differences in diagnostic sensitivity and specificity were revealed after comparing the 2005 Canadian diagnostic guidelines and the Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnosis Neurobehavioural disorder
associated with prenatal alcohol exposure (ND-PAE).

Although considerable overlap was identified between both sets of criteria, the neurobehavioural domains assessed for a ND-PAE diagnosis limited the identification of patients with FASD.

Similarly, two recent…

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One comment

  • “Moving forward, universal agreement on a diagnostic system for FASD would provide the opportunity to more accurately determine the true prevalence and incidence of FASD on a national and international scale, as well as the comparison of data sets from different diagnostic centres.”
    I agree, hence the following-

    With the development of epigenetics showing the contribution of pre conceptual and pre natal alcohol to physical and neurological developmental impairments, both in the immediate offspring and future generations, the following is proposed –

    The present nomenclature FAS, FASD, ARND be replaced by the following

    Diagnosis – Alcohol Related Developmental Disabilities. [ARDD]

    Diagnostics

    Alcohol origin
    1- Paternal pre conceptual
    2- Maternal pre conceptual
    3- Maternal pre natal

    Full Physical and neuropsychological testing , as in the Canadian Guidelines and the Washington 4- Digit Code.

    Neuroimaging
    Genetic/Epigenetic correlations
    DSM correlations.

    The degree to which Neuroimaging, the Genetic/Epigenetic and DSM correlations add weight to the diagnosis to be determined.

    Barry Stanley
    May 17th, 2016
    Updated 19th. Oct. 2016, 4th April, 2017.

    Alcohol Related Developmental Disabilities.

    1- There are now a number of fasd diagnostic guidelines that differ to some degree. This
    proposal would include all of them and avoid confusion.

    2- The proposed diagnostic term would embrace all the new developments of our understanding
    of the effects of prenatal and pre conceptual alcohol.
    Elimination of “fetal” would allow inclusion of the effects of alcohol consumption by the
    adolescent, whose brains development is still continuing. It would also help to reduce the stigma
    suffered by birth mothers.

    3- The new diagnostic term would include those consequences of prenatal alcohol exposure
    that are not included in the various diagnostic processes, especially sensory disabilities that
    plague those who were exposed to prenatal alcohol. It would allow for the inclusion of
    epigenetics and functional imaging, and no doubt other diagnostic tools yet to be discovered.

    3- “Disabilities” is the term increasingly being used, by governments, agencies and individuals,
    to describe the developmental consequences of prenatal alcohol exposure.

    4- The Ontario Provincial Government and the Canadian Federal Government are increasingly
    referring to “developmental disabilities” without reference to the role of alcohol. Adoption of this
    proposal will ensure that the role of alcohol remains in focus, in spite of any governmental
    efforts to the contrary.

    Summary –
    Alcohol Related Developmental Disabilities is inclusive.
    FASD[S] is exclusive.

    Barry Stanley. April 4th. 2017

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