Compilation of diagnostic criteria for fetal alcohol spectrum disorders*

FASD		Diagnostic criteria
Fetal alcohol syndrome		At least 2 characteristic facial features Growth retardation Clear evidence of brain involvement Neurobehavioral impairment With or without documented prenatal alcohol exposure
Partial fetal alcohol syndrome		With documented prenatal alcohol exposure: At least 2 characteristic facial features Neurobehavioral impairment
		Without documented prenatal alcohol exposure: At least 2 characteristic facial features Growth retardation or clear evidence of brain involvement Neurobehavioral impairment
Alcohol-related neurodevelopmental disorder		Documented prenatal alcohol exposure Neurobehavioral impairment (This diagnosis cannot be definitively diagnosed in children <3 years of age)
Alcohol-related birth defects (ARBD)		Documented prenatal alcohol exposure At least 1 specific major malformation associated with prenatal alcohol exposure
Neurobehavioral disorder associated with prenatal alcohol exposure^¶		Documented prenatal alcohol exposure Neurobehavioral impairment and onset in childhood Facial features, growth retardation, and clear evidence of brain involvement not necessary (but may be present) Not better explained by other teratogens, genetic or medical conditions, or environmental neglect
Definition of clinical features
Characteristic facial features		Short palpebral fissures^Δ Thin vermillion border (University of Washington Lip-Philtrum rank 4 or 5) Smooth philtrum (University of Washington Lip-Philtrum rank 4 or 5)
Growth retardation		Height and/or weight (adjusted for gestational age) ≤10^th percentile for age, sex, race/ethnicity at any point of time (eg, prenatal or postnatal)
CNS involvement	Clear evidence of brain involvement	For FAS and pFAS	For ND-PAE
		Structural or neurologic involvement (1 of the following): Head circumference ≤10^th percentile for age and sex, or, if weight and height are <10^th percentile, head circumference ≤3^rd percentile Significant structural abnormalities on neuroimaging Hard neurologic signs^◊ Recurrent seizures that are not due to postnatal insult or fever	NA
	Neurobehavioral impairment	Functional abnormalities (1 of the following): Significant global cognitive or intellectual deficits Significant developmental delay^§ Functional deficits^¥ in at least 3 of the following domains: Cognitive or developmental deficits or discrepancies Executive functioning deficits Motor functioning delays Problems with attention or hyperactivity Social skills Other, such as sensory problems, pragmatic language problems, memory deficits, etc Evidence of significant impairment of self-regulation in at least 1 of the following domains: Mood or behavioral regulation impairment Attention deficit Impulse control	Functional impairments/deficits in each of the following domains: Neurocognitive (at least 1): Intellectual disability Executive functioning Learning Memory Visual-spatial reasoning Self-regulation (at least 1): Mood or behavioral regulation Attention Impulse control Adaptive function (at least 2): Communication Social communication and interaction Daily living skills Motor skills

FASD: fetal alcohol spectrum disorder; CNS: central nervous system; FAS: fetal alcohol syndrome; pFAS: partial FAS; ND-PAE: neurobehavioral disorder associated with prenatal alcohol exposure; NA: not applicable.
* Diagnostic criteria may vary geographically. Refer to UpToDate content on diagnosis of fetal alcohol spectrum disorder for details.
¶ Sometimes called "neurodevelopmental disorder associated with prenatal alcohol exposure." This category is similar to alcohol-related neurodevelopmental disorder, but does not overlap completely.
Δ The definition of short palpebral fissures varies according to the diagnostic schema.
◊ "Hard" neurologic signs include abnormal reflexes, abnormal tone, and cranial nerve deficits.
§ The definition of significant developmental delay varies according to the diagnostic criteria.
¥ The definition of functional deficit varies according to the diagnostic criteria.

Data from:

American Psychiatric Association. Neurobehavioral disorder associated with prenatal alcohol exposure. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013. p.798.
Astley SJ. Diagnosis of Fetal Alcohol Spectrum Disorders (FASD): The 4-Digit Diagnostic Code, 3^rd edition. University of Washington Publication Services, Seattle, 2004.
Bertrand J, Floyd RL, Weber MK, et al. National Task Force on Fetal alcohol syndrome and fetal alcohol effect. Fetal alcohol syndrome: Guidelines for referral and diagnosis. Center for Disease Control and Prevention; Atlanta, GA, 2004. Available at: www.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf (Accessed on February 24, 2014).
Hoyme HE, May PA, Kalberg WO, et al. A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: Clarification of the 1996 institute of medicine criteria. Pediatrics 2005; 115:39.
Hoyme HE, Kalberg WO, Elliot AJ, et al. Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders. Pediatrics 2016; 138.
Hagan JF Jr, Balachova T, Bertrand J, et al. Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure. Pediatrics 2016.

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خرید پکیج

Compilation of diagnostic criteria for fetal alcohol spectrum disorders*