Curriculum for Addiction Professionals > Competency 2: Identification of FASD and Diagnosis of FAS > 9a. Diagnostic Procedures

Please Select One 1. Competency Description 2. Pretest 3. Learning Objectives 4. Diagnostic References for FAS 4a. The 4-Digit Diagnostic Code 5. FAS Diagnostic Criteria 5a. Facial Anomalies 5b. Growth Deficiencies 5c. Central Nervous System Defects 6. Common Disorders Associated with Prenatal Alcohol Exposure 7. Signs and Symptoms of FASD That May Be Confused with Other Disorders 8. Specific Areas of the Brain Most Vulnerable to Prenatal Alcohol Exposure 9. Diagnosis 9a. Diagnostic Procedures 9b. Use of Diagnostic Results 9c. Diagnostic Issues and Challenges 10. Issues Related to Professional Values and Ethics 11. Matching Activity 12. Posttest 13. References

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Competency 2: Identification of FASD and Diagnosis of FAS

Diagnosis, Continued

Diagnostic Procedures

Many variables are considered in the diagnosis of an FASD. Only specialists trained in dysmorphology and neurodevelopmental assessment and who understand the effects of prenatal alcohol exposure and are qualified to diagnose these disorders. They will also be able to recognize alternative syndromes and neurodevelopmental conditions.

FASD is not a medical diagnosis but is a descriptive term for various disorders resulting from fetal alcohol exposure to alcohol. FAS is a medical diagnosis included in the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM). The code is 760.71, "noxious influences affecting fetus via placenta or breast milk, specifically alcohol; includes fetal alcohol syndrome."

Because FAS is a medical diagnosis, a trained physician must diagnose it. The medical examination includes:

• Evaluation of the prenatal and birth history and previous medical history
• General physical examination (height, weight, vision, hearing, cardiogram, etc.)
• Evaluation of early and current growth patterns
• Measurement of facial features

Additional tests may include an IQ test and evaluation of:

• Cognitive deficits, such as memory problems, or developmental delay
• Executive functioning deficits, such as problems following multistep directions
• Motor delays or deficits, such as clumsiness or tremors
• Attention deficits and hyperactivity
• Poor social skills, such as interrupting others and misreading cues
• Behavior problems, such as aggression or not finishing tasks

Examples of specific tests clinicians use to assess behavioral functional ability include Conners Rating Scales,¹⁶ Vineland Adaptive Behavior Scales,¹⁷ and Children's Memory Scale.¹⁸

Ideally, input and testing by specialists will be obtained to enhance the diagnosis. These include:

• Geneticist, who can assess genetic influences on the child's condition and rule out the possibility of a genetic syndrome
• Developmental pediatrician, who can look at milestones and behaviors
• Dysmorphologist, who specializes in birth defects
• Speech pathologists, who can assess the child's ability to understand and communicate
• Occupational therapists and physical therapists, who can assess motor functions and adaptive abilities
• Psychologists, who can conduct developmental tests to determine strengths and deficits
• Neurologists and neuropsychologists, who can describe cognitive impairments and explain their causes and evaluate behavioral impairments resulting from brain injury
• Psychiatrists, who can assess signs and symptoms of mental health disorders and suggest medication as appropriate
• Nurses, social workers, and other licensed behavioral health specialists, who can assess family dynamics and other related issues
• Education consultants, who can identify learning disabilities and other issues related to the child's ability to learn and function in a classroom
• Parents familiar with this disorder, who can work with other parents either in training or parent support groups and can help with family support and advocacy

It is also useful to get input from teachers, parents, and caregivers for an accurate diagnosis and understanding of the person's specific pattern of effects and needs. Often, people who interact with the individual on a regular basis can detect problems that specialists might miss. For example, some children with an FASD are affectionate and can be happy, social, and gregarious. These are seen as positive qualities. Behavior not appropriate to a developmental stage is more often detected in school where teachers can compare the behaviors with other children. Others may do well in school but have much more difficulty at home or in social and peer situations.

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