Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia

Abstract

BackgroundFetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia.MethodAn online survey about FASD screening and diagnosis in Australia, which included 23 statements describing criteria for referral for fetal alcohol syndrome (FAS) and FASD based on published recommendations for referral in North America, was sent to 139 health professionals who had expertise or involvement in FASD screening or diagnosis. Survey findings and published criteria for referral were subsequently reviewed by a panel of 14 investigators at a consensus development workshop where criteria for referral were developed.ResultsAmong the 139 health professionals who were sent the survey, 103 (74%) responded, and 90 (65%) responded to the statements on criteria for referral. Over 80% of respondents agreed that referral for specialist evaluation should occur when there is evidence of significant prenatal alcohol exposure, defined as 7 or more standard drinks per week and at least 3 standard drinks on any one day, and more than 70% agreed with 13 of the 16 statements that described criteria for referral other than prenatal alcohol exposure. Workshop participants recommended five independent criteria for referral: confirmed significant prenatal alcohol exposure; microcephaly and confirmed prenatal alcohol exposure; 2 or more significant central nervous system (CNS) abnormalities and confirmed prenatal alcohol exposure; 3 characteristic FAS facial anomalies; and 1 characteristic FAS facial anomaly, growth deficit and 1 or more CNS abnormalities.ConclusionReferral criteria recommended for use in Australia are similar to those recommended in North America. There is a need to develop resources to raise awareness of these criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia.

Australian guide to the diagnosis of foetal alcohol spectrum disorder: A summary

“…Building on a literature review of diagnostic criteria and guidelines from Canada and the USA, Delphi surveys and a consensus workshop using the GRADE approach, an Australian diagnostic instrument was developed in 2012. In 2015–2016, with additional funding from the DoH, a feasibility trial was conducted, and the instrument, guide and e‐learning modules were finalised and harmonised with the new Canadian guideline for diagnosis of FASD .…”

Caregivers of Youth with a Fetal Alcohol Spectrum Disorder: Hopes for Them as Adults

“…A substantial number of cases of FASD remain undiagnosed (Thanh et al 2011). Despite increasing diagnostic capacity (Onoye and Thompson 2017), demand often exceeds supply (Watkins et al 2014), and interventions have focused primarily on affected children. However, adults with FASD are an increasingly recognized group (Tsang et al 2016) with their caregivers as those most likely to provide a stabilizing influence through long-term residential and personal support (Boland et al 2002).…”