Consensus diagnostic criteria for fetal alcohol spectrum disorders in Australia: a modified Delphi study

Abstract

ObjectiveTo evaluate health professionals' agreement with components of published diagnostic criteria for fetal alcohol spectrum disorders (FASD) in order to guide the development of standard diagnostic guidelines for Australia.DesignA modified Delphi process was used to assess agreement among health professionals with expertise or experience in FASD screening or diagnosis. An online survey, which included 36 Likert statements on diagnostic methods, was administered over two survey rounds. For fetal alcohol syndrome (FAS), health professionals were presented with concepts from the Institute of Medicine (IOM), University of Washington (UW), Centers for Disease Control (CDC), revised IOM and Canadian diagnostic criteria. For partial FAS (PFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD), concepts based on the IOM and the Canadian diagnostic criteria were compared.Setting/participants130 Australian and 9 international health professionals.ResultsOf 139 health professionals invited to complete the survey, 103 (74.1%) responded, and 74 (53.2%) completed one or more questions on diagnostic criteria. We found consensus agreement among participants on the diagnostic criteria for FAS, with the UW criteria most commonly endorsed when compared with all other published criteria for FAS. When health professionals were presented with concepts based on the Canadian and IOM diagnostic criteria, we found consensus agreement but no clear preference for either the Canadian or IOM criteria for the diagnosis of PFAS, and no consensus agreement on diagnostic criteria for ARND. We also found no consensus on the IOM diagnostic criteria for ARBD.ConclusionsParticipants indicated clear support for use of the UW diagnostic criteria for FAS in Australia. These findings should be used to develop guidelines to facilitate improved awareness of, and address identified gaps in the infrastructure for, FASD diagnosis in Australia.

Involving consumers and the community in the development of a diagnostic instrument for fetal alcohol spectrum disorders in Australia

“…This was included in the survey as follows “Alcohol exposure should be assessed alongside other lifestyle factors including diet, physical exercise and smoking” . Of the 103 health professionals who completed the survey, 92% agreed with this statement [27]. …”

“…The modified Delphi process is described in Watkins et al [27]. Members of the Collaboration were asked to identify individuals known to have expertise or experience in the screening or diagnosis of FASD for recruitment to the Delphi study panel.…”

“…The FASD Project consisted of a systematic literature review; Community Conversations; a Delphi study; a consensus development workshop; and diagnostic and consumer subgroup meetings. We report here the consumer and community contributions to the FASD Project; findings from the Delphi study component have been reported separately [25-27]. …”

Study protocol for screening and diagnosis of fetal alcohol spectrum disorders (FASD) among young people sentenced to detention in Western Australia

“…The formal neuropsychology assessment battery was chosen to adequately cover the domains used to determine whether there is functional CNS dysfunction (ie, 2 SD below the mean) in three or more domains. As per Australian diagnostic criteria, 6 63 the domains assessed are intellectual functioning/cognition, attention/activity levels/sensory, executive functions, memory, social skills/adaptive functioning/social communication and academic functioning. The domains of language and motor ability are more thoroughly assessed by the speech pathologist and occupational therapist on the team.…”

Fetal Alcohol Spectrum Disorders (FASD): an Approach to Effective Prevention

“…Several initiatives have been undertaken to achieve a consensus on establishing diagnoses within the spectrum of FASD [15]. The Institute of Medicine (IOM) of the USA published a first consensus in 1996 which was revised in 2005 and recently updated [11, 16, 17].…”