Screening for fetal alcohol syndrome: is it feasible and necessary?

Abstract

The potential to utilize screening strategies to improve the identification and outcome of persons with fetal alcohol syndrome (FAS) is reviewed. FAS is a condition where screening and surveillance activities would be appropriate. Development of FAS screening and surveillance programs is encouraged because the disorder is expensive. People with FAS have poor outcomes as adults with less than 10% living independently. Several useful tools and models are available. Screening would improve ascertainment and prevalence estimates. Early identification could improve access to services and long term outcome, secondary disabilities and, by extension, excess disability in affected children could be decreased. Lastly, mothers who are at the highest risk to have additional children with FAS could be identified and offered treatment. While both screening and surveillance activities are discussed, the principle focus of this article is a review of the screening process. Two screening tools and several screening methodologies for FAS are available. Since no test will be appropriate in all settings, screening tests need to be selected depending on the setting and population of interest. Screening for FAS should be conducted in a variety of settings and in populations of both high and moderate risk. The results would also provide important data to influence public policy development and resource allocation. Appropriate evaluation of the efficacy, efficiency and effectiveness of FAS screening tools and methodologies would be important before utilization in screening programs.

Prevention of Secondary Conditions in Fetal Alcohol Spectrum Disorders: Identification of Systems-Level Barriers

“…Screening high-risk individuals for FASD, such as children in the child welfare, criminal justice, and special education systems, would increase the number of individuals who are recognized and diagnosed. Several studies documenting higher rates of FASD in these systems have demonstrated screening can be effectively implemented [34-36]. Once diagnosed, families need to be able to qualify for and access appropriate services for their children.…”

Interventions in FASD: we must do better

“…A second and equally problematic area is in the diagnosis of FASD. The lack of routine population or clinic‐based screening efforts results in under referral of high‐risk infants and children for evaluation (Burd et al . 2000).…”

A staged screening strategy for prenatal alcohol exposure and maternal risk stratification

“…In previous publications we have articulated the need for multiple screening efforts in a variety of settings. 8,14,15 In Figure 1 we depict a screening process that has the following features: 1) it is brief; 2) the steps are incremental and more time and effort are required as the risk for an adverse outcome increases; 3) the process builds on previous data collected in the chart; and 4) it ends with intervention recommendations based on a comprehensive data set that allows for risk-based intervention and ongoing follow-up that does not require that all screening steps be repeated.…”