|Clinicians :: Introduction
This portion of the web site is for physicians, nurses, physical rehabilitation staff, and other health care professionals who are directly involved in diagnosing or treating a person with FASD.
Recognizing, diagnosing and treating FASD is a challenge. Because of this, diagnosis is often done by a team. This section of the web site can help familiarize you with
- the signs of possible FASD
- how to talk with families who are seeking a diagnosis
- diagnostic tools that FASD centers typically use.
FASD is an umbrella term for various diagnostic classifications. Here is a summary of the criteria involved for each diagnosis.
FASD’s related diagnoses are arrived at by a process of exclusion. Some genetic conditions and non-alcohol related developmental disabilities can mimic FASD’s symptoms. Because of this, The Institute of Medicine published its diagnostic guidelines in 1996. Two more recent methods quantify those standards using evidence-based medicine:
- Astley and Clarren’s “ Washington criteria,” published in 2000
- Hoyme’s criteria, published in Pediatrics, in 2005
FASD doesn’t exist in a vacuum; comorbid conditions frequently exist as well. These can include birth defects and/or mental health problems. Appropriate referrals need to be made when this is seen or suspected.
To complicate matters, the manifestations of FASD change as a child grows.
Despite the wide variety of symptoms that may be seen with FASD, the root cause is central nervous system damage—which causes a cascade of impairments that permeate every aspect of the family’s life.
Most children who have FASD live with foster or adoptive parents or other guardians. Important information about the birth mother’s health and drinking habits may not be available to you. Subjective “interview” information from a case worker may not be accurate because people typically downplay their alcohol and drug consumption. This can complicate your evaluation of a child who presents with symptoms of FASD.
Birth mothers often have undiagnosed cases of FASD and/or mental health problems. The Interventions page of this section includes information on screening birth mothers for FASD.
How to Talk to Parents about the Diagnosis
If you are the child’s primary physician, you should be the starting point in the diagnostic process. You may or may not be able to arrive at a diagnosis yourself. Matters relating to FASD often require a team effort. The parents' section of the web site provides a list of documents that parents should try to bring to a diagnostic evaluation.
If you can’t provide a definitive diagnosis, give compassionate guidance regarding who to see next.
If you are responsible for delivering a diagnosis, telling a parent that their child has a pervasive disability is a difficult task. Honesty is the best policy. The diagnosis may not make the family’s life easier or pave the way for increased assistance, but it does bring closure to the search for answers. Parents may express relief in knowing that their child’s problem is not due to their poor parenting, overindulgence, or some other negative trait that well-meaning but misinformed people may have told them. The sooner they have a definitive diagnosis, the better equipped they are to know which interventions and services can serve their child the best.
Getting a diagnosis is both a “high” and a “low” at the same time. The family must face altered expectations and a 24/7 job of nurturing a child who will be challenged in every aspect of his or her life. Grieving for losses is an important part of accepting the situation and determining to do what’s best for the child. Encourage the family to find support for the process that lies ahead; this will not be a one-time occurrence. A few of the most well-known national support and advocacy resources are listed on the Web Links and Downloads page of the Parents' section.
Finally, acknowledge the parents’ efforts. They have been searching for answers and coping strategies for a long time.
FASD Medical Education for Clinicians
It’s important for physicians and other direct caregivers to understand FASD. If it’s misdiagnosed as ADHD or some other condition, medicating for those conditions can worsen FASD’s symptoms. The Centers for Disease Control and Prevention (CDC) now offer FASD courses that are eligible for continuing education credits. In addition, several diagnostic centers in the U.S. offer their own courses. For more information, see the Web Links and Downloads page of this section.