Subject(s)
Algorithms , Fetal Alcohol Spectrum Disorders/diagnosis , Patient Care Team , Practice Guidelines as Topic , Advisory Committees , Alcohol Drinking , Canada , Child , Child, Preschool , Female , Focus Groups , Humans , Infant , Infant, Newborn , Male , Mass Screening , Pregnancy , Referral and ConsultationABSTRACT
As part of the Canadian Association of Paediatric Health Centres Taskforce on FASD Screening commitment to further pilot, validate and evaluate the multiple components of the Canadian FASD Screening Tool Kit, it was deemed necessary that recent developments and/or improvements in FASD screening were identified and considered. In 2008 a literature review of methods for screening for FASD was published until 2006 and identified five tools which met pre-set criteria. A review of all new papers was published from the period January 2006 until July 1, 2013. Out of 1392 papers, two new screening methods met the inclusion criteria: Clarren et al's new norms for palpebral fissure length by age in Canada; and Breiner et al's extension of the Neurobehavioral Screening Test (NST) to age 4 years. Further work is needed to validate these methods in other settings.
Subject(s)
Fetal Alcohol Spectrum Disorders/diagnosis , Fetal Alcohol Spectrum Disorders/therapy , Neuropsychological Tests/standards , Referral and Consultation/standards , Canada/epidemiology , Female , Fetal Alcohol Spectrum Disorders/epidemiology , Health Services Needs and Demand/standards , Health Services Needs and Demand/trends , Humans , Pregnancy , Referral and Consultation/trends , Risk Factors , Surveys and Questionnaires/standardsABSTRACT
BACKGROUND: Fetal alcohol spectrum disorder (FASD) is the most common cause of neurobehavioural handicap in North America. Screening for FASD may facilitate diagnosis and hence management of these children. We present a variety of screening tools for the identification of children at risk for FASD. METHODS: We critically reviewed and evaluated published and practiced methods for their potential of screening suspected cases, their epidemiological characteristics (sensitivity, specificity, positive and negative predictive values) [Phase I], as well as their feasibility [Phase II]. RESULTS: The following five tools were selected for the FASD screening toolkit: screening fatty acid ethyl esters in neonatal meconium, the modified Child Behaviour Checklist, Medicine Wheel tool, Asante Centre Probation Officer Tool, and maternal history of drinking and drug use. CONCLUSIONS: The toolkit for FASD screening aims at screening different populations, from the newborns to youth and at-risk mothers. It is anticipated that the toolkit will facilitate diagnosis of FASD.
Subject(s)
Alcoholism/diagnosis , Fetal Alcohol Spectrum Disorders/diagnosis , Mass Screening/standards , Practice Guidelines as Topic , Pregnancy Complications/diagnosis , Prenatal Exposure Delayed Effects/diagnosis , Alcohol Drinking/prevention & control , Alcoholism/prevention & control , Biomarkers , Canada/epidemiology , Child , Child Behavior Disorders/diagnosis , Developmental Disabilities/diagnosis , Diagnosis, Differential , Esters/analysis , Fatty Acids/chemistry , Female , Fetal Alcohol Spectrum Disorders/epidemiology , Fetal Alcohol Spectrum Disorders/prevention & control , Humans , Infant, Newborn , Meconium/chemistry , Pregnancy , Pregnancy Complications/prevention & control , Substance Abuse DetectionABSTRACT
The diagnosis of fetal alcohol spectrum disorder (FASD) is complex and guidelines are warranted. A subcommittee of the Public Health Agency of Canada's National Advisory Committee on Fetal Alcohol Spectrum Disorder reviewed, analysed and integrated current approaches to diagnosis to reach agreement on a standard in Canada. The purpose of this paper is to review and clarify the use of current diagnostic systems and make recommendations on their application for diagnosis of FASD-related disabilities in people of all ages. The guidelines are based on widespread consultation of expert practitioners and partners in the field. The guidelines have been organized into 7 categories: screening and referral; the physical examination and differential diagnosis; the neurobehavioural assessment; and treatment and follow-up; maternal alcohol history in pregnancy; diagnostic criteria for fetal alcohol syndrome (FAS), partial FAS and alcohol-related neurodevelopmental disorder; and harmonization of Institute of Medicine and 4-Digit Diagnostic Code approaches. The diagnosis requires a comprehensive history and physical and neurobehavioural assessments; a multidisciplinary approach is necessary. These are the first Canadian guidelines for the diagnosis of FAS and its related disabilities, developed by broad-based consultation among experts in diagnosis.