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To be diagnosed with fetal alcohol syndrome (FAS), a child would meet all of the following criteria:

  • Growth deficiency.
  • A unique cluster of minor facial anomalies, such as small eyes, smooth philtrum (the vertical groove above the lips) and a thin upper lip.
  • Central nervous system damage, including structural (damage to the physical structure of the brain), neurological (damage to the normal operation of the brain and nervous system), and/or functional (behavioral) impairment.
  • Record of prenatal alcohol exposure.

When the child has the classic facial anomalies, the other symptoms and signs are usually present and significant, and the child is diagnosed with fetal alcohol syndrome.

When the characteristic facial anomalies are not present, the other characteristics can still be present and profound. That is when the terminology can get confusing and it may be hard to diagnose the cause of the child's problems. Prenatal alcohol exposure can cause behavioral, cognitive, and psychological problems. Signs and symptoms of an FASD are similar to some mental illnesses. In many cases, the signs and symptoms of an FASD go unrecognized or are misdiagnosed as a mental illness or brain injury. Individuals with an FASD may also receive multiple diagnoses, such as attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and anxiety disorder.

Therefore, it is important to determine whether the symptoms are a result of prenatal alcohol exposure or have another root cause.

Deciding if a child has FAS or a related fetal alcohol spectrum disorder (FASD) condition takes several steps. There is no one test to diagnose FAS or FASD, and many other disorders can have similar symptoms. Only trained professionals can diagnose a disorder from the FASD spectrum. Ideally, diagnosis is done by a team that may include:

  • Geneticists
  • Developmental pediatricians
  • Neurologists
  • Dysmorphologists (physicians specializing in birth defects)
  • Education consultants
  • Psychologists, psychiatrists, and social workers
  • Occupational therapists
  • Speech and language specialists

Who Should Perform an Evaluation of a Person Diagnosed With / Suspected of Having an FASD?

FASD causes brain and CNS (central nervous system) impact/damage. It is lifelong and permanent. It affects each person's functioning in unique ways; no two individuals affected by prenatal alcohol exposure in exactly the same way.

Neuropsychologists are highly trained professionals specializing in the study of brain and behavior using techniques that go beyond the standard psychological evaluations.

Neuropsychologists are able to make inferences about presence or absence of brain dysfunction, including strengths and weaknesses.A neuropsychological assessment is the most “accurate and valid” means to determine the extent of an individual's cognitive (mental comprehension) impairment and in the detection of neuropsychiatric (brain-based emotional or behavior) disorders and dysfunctions.

Standard psychological and psycho-educational evaluations using standardized test batteries, while useful, are not sensitive to the effects of brain damage and are not designed to identify changes in a person’s neurocognitive functioning over time; in addition, they do not go beyond determination of I.Q or academic level.

A comprehensive neuropsychological assessment should be complemented by medical evaluations, including genetic screening and neurological evaluations, to identify or rule out other conditions that may cause similar or overlapping signs or symptoms as FASD, including seizure disorders, cerebral palsy, and certain genetic conditions. However, neuropsychological assessments offers more detailed information about higher cognitive functioning, and help families make planning and treatment decisions for their loved one affected by prenatal alcohol exposure..

Useful Links

Centers for Disease Control and Prevention: Fetal Alcohol Spectrum Disorders (FASDs)
Wikipedia, fetal alcohol spectrum disorder
Fetal Alcohol Spectrum Disorders (FASD): The Basics 
Diagnosis of FASD in the Adolescent Years
Valerie Lipow,
Jul 31, 2012, 3:22 PM