2015 Diagnostic Guideline for FASD Across the Lifespan

The revised Canadian "Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan" was published in CMAJ on December 14, 2015.  The new guideline builds on the original 2005 edition also published through CMAJ, though more specifically addresses assement of infants, young children and adults. 

The new guideline has implications for diagnostic terms and criteria, as well as informing prevention and screening, and support services for individuals prenatally exposed to alcohol.

This page describes some of the key differences made in the 2015 revision.  Please read the full article for more information. 


FASD is now a diagnostic term

Whereas the 2005 guideline identified fetal alcohol spectrum disorder (FASD) as an umbrella term capturing specific diagnoses of FAS, pFAS, and ARND (see glossary), under the 2015 guideline FASD is now a diagnostic term in Canada.

The new two diagnostic terms include:

  • Fetal alcohol spectrum disorder with sentinel facial findings (i.e. short palpebral fissures, smooth philtrum, and thin upper lip, as associated with prenatal alcohol exposure)

  • Fetal alcohol spectrum disorder with no sentinel facial findings


New designation for infants and young children

It has been historically difficult to diagnose infants and young children with FASD as diagnosis requires evaluation of multiple areas of brain functioning, some of which cannot be evaluated until the child reaches school age.  This gap prevents some early intervention which is critical for development.

Under the new guideline, infants and young children can be diagnosed with FASD with sentinel facial findings if they display the three facial characteristics associated with prenatal alcohol exposure, as well as have a small head circumference which indicates differences in brain development.

Infants and young children who do not meet the diagnostic criteria for FASD but have confirmed prenatal alcohol exposure and early signs of developmental concerns can be designated as "At risk for neurodevelopmental disorder and FASD, associated with prenatal alcohol exposure."

This designation is intended to encourage early intervention.  However, it is not a diagnosis of FASD.  A child who receives this designation should be re-assessed by a multidisplinary team when he or she reaches school age to determine if he or she now meets the diagnostic criteria for FASD. 


Growth removed from diagnostic guideline

While delayed growth is significant to understanding of a person's development, it is not as common as once believed and not specific to prenatal alcohol exposure.  If a person displays delayed growth, that is considered in the medical evaluation, but is no longer part of the diagnostic formulation for FASD.


New brain domain called affect regulation

There is a newly added tenth brain domain in the 2015 guideline entitled affect regulation.  This domain is based on emerging research that evidences individuals with prenatal alcohol exposure are predisposed to certain mental health concerns, irrelevant of other biological or environmental factors.  The affect regulation captures anxiety, depressive, and mood dysregulation disorders.  While each can be caused by other factors, they may be considered relevant to prenatal alcohol exposure when seen in combination with other neurodevelopmental areas of FASD.


Redistribution of other brain (neurodevelopmental) domains

Whereas the 2005 guideline considered nine neurodevelopmental areas, the 2015 guideline considers ten domains.  They include:

  • Neuroanatomy/neurophysiology (refers to brain structure)
  • Motor skills (redefined and renamed from hard and soft neurological signs; sensory integration removed from diagnostic criteria, though still relevant to a person's abilities)
  • Cognition
  • Language (renamed from communication)
  • Academic achievement
  • Memory
  • Attention (redefined and renamed from ADHD)
  • Executive function (expanded and clarified, now includes impulse control and hyperactivity)
  • Affect regulation (new domain, reflects anxiety, depressive, and mood dysregulation disorders)
  • Adaptive behaviour, social skills or social communication
See the glossary for more explanation of terms.