ASSESSMENT AND DIAGNOSIS
- Various approaches have been proposed to evaluate individuals for FAS and related conditions. These include:
- Although there is general agreement among these approaches regarding the basic criteria for FAS, there are also some important differences regarding specific thresholds that must be met for the various criteria.
- For example, these approaches may differ regarding what specific criteria to use as thresholds for diminished head circumference or facial dysmorphology.
- Despite such challenges, these approaches offer clinicians and researchers better methods for evaluating individuals with prenatal alcohol exposure that will lead to increased validity and reliability in their diagnostic decisions.
- Prenatal exposure to alcohol should be routinely assessed when obtaining a developmental history during any pediatric or mental health evaluation.
- Children with confirmed or suspected prenatal alcohol exposure, as well as children with features associated with prenatal alcohol exposure, (e.g., facial abnormalities, growth deficiency, developmental delays) should be referred to a multidisciplinary team with expertise in FASDs.
- When evaluating individuals with prenatal alcohol exposure, a comprehensive battery that includes measures of cognitive, academic, adaptive, behavioral, social, and emotional functioning is optimal.
- Such an assessment battery should include measures that have been standardized and normed on diverse samples. Testing results should be interpreted in light of relevant cultural factors, language issues, and environmental experiences.
Components of a multidisciplinary evaluation typically include:
- A physical examination should be conducted to both assess for dysmorphology and for any medical problems, especially those that are frequently associated with prenatal alcohol exposure
- A clinical interview with parents or other caregivers, as well as the patient or client when appropriate to obtain information regarding the individual's history (including information about prenatal alcohol exposure) and their current level of functioning.
- A thorough record review
- Information obtained from teachers, therapists, or other relevant informants either through interviews or questionnaires (e.g., rating scales)
- Behavioral observations
- Standardized testing
- For more comprehensive guidelines on how to conduct multidisciplinary evaluations of individuals with FASDs, please see:
- Clarren, Carmichael Olson, Clarren, & Astley (2000). A child with Fetal Alcohol Syndrome. In M.J. Guralnick (Ed.), Interdisciplinary clinical assessment of young children with developmental disabilities, (pp. 307-326). Baltimore, MA: Paul H. Brookes Publishing Co.
- Paley, B., Schonfeld, A., & O'Connor, M.J. (In press). Evaluation of Fetal Alcohol Spectrum Disorders. In Centers for Disease Control and Prevention (ed.) FASD curriculum framework and instructional resource guide. Atlanta, GA: Department of Health and Human Services.
What are some effective strategies for obtaining information about prenatal alcohol use?
- Non-blaming, non-judgmental approach
- Medical and/or mental health professionals may have negative feelings towards women who use alcohol (or other substances) during pregnancy that may impact the way in which they ask about alcohol use
- It is important to examine one's own biases in order to become more comfortable asking these questions
- Asking questions about prenatal alcohol use in a neutral, non-blaming manner will likely elicit more forthcoming responses
- When asking about use of any substances during pregnancy, frame the question by asking "How much" rather than "Did you…?"
- That is, asking "How much alcohol did you drink during your pregnancy?" is typically more effective than asking "Did you drink alcohol during your pregnancy?"
- Asking HOW MUCH gives a woman permission to acknowledge that she did drink during pregnancy
- Assess prior to pregnancy, prior to pregnancy recognition, and post pregnancy recognition periods separately
- Women are often more likely to acknowledge alcohol use prior to pregnancy and prior to pregnancy recognition than after pregnancy recognition
- Drinking patterns from those earlier time periods are predictive of outcome
- Assess prenatal alcohol use as part of general developmental interview and in the context of asking about health habits before and during pregnancy (including nutrition, exercise, stress, etc.)
- For example, "Now I'm going to ask you some questions about your health habits when you were pregnant…"
- Inquire about more innocuous substances first, and then ask about alcohol and other drugs
- For example, ask about consumption of tea, coffee, and caffeinated sodas first
- Ask about different types of alcohol
- Consumption of beer, wine, and hard alcohol should be assessed separately
- Some women may believe that drinking certain types of alcohol is relatively safe (e.g., wine coolers) during pregnancy, and thus may not consider those beverages when asking about prenatal alcohol use
- If queried about all types of alcohol together, a woman may be more likely to forget or underestimate how much she drank during pregnancy. Asking about consumption of different types of alcohol separately may yield a more accurate estimate.
- Assessing pattern of drinking
- Ask about both typical and maximum consumption - that is, a woman may typically drink a certain amount on most occasions (e.g., 2 drinks), but there also may be occasions where a woman drinks much more than her typical amount (e.g., 5 drinks). Because binge drinking is particularly harmful to the developing fetus, it is important to ask both about how much a woman typically drank on most occasions, as well as the most she drank on any one occasion.
- For example, ask:
- "Women sometimes drink more than their usual amount on some occasions. Before you knew you were pregnant, what was the most number of drinks you drank on any occasion?
- It can be helpful to prompt the woman to think about any special occasions on which she might have consumed more alcohol than usual (e.g., a party, a wedding, on vacation, etc.)
For a sample interview to assess for alcohol use in pregnant women, please click here. This interview can easily be adapted to non-pregnant women as well.
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