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Fetal Alcohol Spectrum Disorder (FASD) is a diagnostic term used to describe a range of lifelong effects associated with prenatal alcohol exposure (PAE), including physical, social, emotional, and behavioural impairment. An early FASD diagnosis is essential in mitigating adverse outcomes and connecting individuals and their families with appropriate supports and resources to improve outcomes.
While there have been several approaches developed for FASD diagnosis, the updated Canadian diagnostic guideline, published in December 2015, is now widely used by clinics across Canada. According to the Guideline, the ‘brain’ domain is assessed through the evaluation of 10 domains of functioning including:
- motor skills;
- academic achievement;
- executive functioning;
- affect regulation; and
- adaptive behaviour.
The Guideline states that the majority of the brain domains should be assessed using direct measures, including tests and physical measurements. Indirect measures (such as a clinical interview, observation, etc.) should only be used when direct measures are not practical. Due to the complex nature of FASD diagnosis, the Guideline recommends that clinics use a multidisciplinary approach and utilize a battery of tests to accurately diagnose FASD. The 2015 Guideline suggests a number of tests and assessment measures that can be used to measure “brain” function, but clinics may choose to use different tools depending on factors like client demographics, their own personal preference, and the testing circumstances.
The researchers surveyed 19 clinics providing diagnostic services in Alberta, Canada to examine the consistencies and differences in clinical practice. The goal of this study is to bring awareness to areas where measures may be lacking and to identify tools being used in the diagnostic process, including those that are not suggested in the current Canadian guideline.
- There is a wide variety of measures being used across clinics, but there was also substantial overlap across practices.
- The most commonly reported measures used by clinics are consistent with those suggested in the 2015 Guideline, providing evidence that all clinicians had implemented the Canadian recommendations; however, many additional tools were also reported.
- The domains most consistently tested across clinics were cognition, adaptive behaviour and executive functions, while motor skills was the least consistent.
- Some clinics reported the use of outdated and abbreviated tests, which can impact the reliability of test interpretation and conclusions drawn from data.
- Clinicians should consider using both direct and indirect measures to ensure the results are objective but easily translated into practical recommendations.
- Clinicians involved in FASD diagnosis need ongoing training to ensure consistency in diagnosis and to stay up to date on the most current and reliable measures and practices.
- More research should be done to develop a comprehensive and reliable set of psychological tests to increase consistency and accuracy during the FASD diagnostic process, including measures currently used by clinics that are not included in the Canadian guideline.
Take home message
Currently, there is great variety of measures used for FASD diagnosis and assessment among clinicians. These findings highlight the importance of using up-to-date and reliable measures during the assessment process and encouraging on-going training for professionals to ensure consistency in diagnosis. Keeping up with the current best practices is critical in ensuring early and accurate diagnosis for individuals with FASD.
Authors: Kelly D. Coons-Harding, Katherine Flannigan, Colleen Burns, Hasmukhlal Rajani, Brent Symes
Journal: Journal of Population Therapeutics & Clinical Pharmacology
Published: 23 January 2019
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