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Competency 2: Identification of FASD and Diagnosis of FAS

Diagnostic References for FAS, Continued

Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code

The University of Washington's Fetal Alcohol Syndrome Diagnostic and Prevention Network has developed the Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code.3 This guide attempts to address certain diagnostic limitations. A major concern was that diagnostic terms, such as ARND, implied that alcohol exposure caused the birth defect or neurobehavioral disorder in an individual patient.

To address concerns related to causation, the 4-Digit Code uses terms that report prenatal alcohol exposure. Patient outcomes are not described as alcohol effects or alcohol-related outcomes. The 4-Digit Code also requires that all other adverse prenatal and postnatal exposures and events be documented. These serve as important risk factors that must be considered when deriving a diagnosis and intervention plan.

The four digits in the 4-Digit Diagnostic Code reflect the magnitude of expression of four key diagnostic features of FASD in the following order: (1) growth deficiency, (2) FAS facial phenotype, (3) CNS abnormalities, and (4) prenatal alcohol exposure. The magnitude of expression of each feature is ranked independently on a 4-point Likert scale. A ranking of 1 reflects complete absence of the FAS feature and 4 reflects a strong "classic" presence of the FAS feature. In other words, the clinician ranks each feature on a scale of 1 to 4, depending on its strength or severity.

An example of the 4-Digit Code is 4444, which reflects the strongest expression of FAS (significant growth deficiency, all three FAS facial features, structural/neurological evidence of CNS damage, and confirmed prenatal exposure to high levels of alcohol). At the opposite end of the scale is the 4-Digit Code 1111. This code reflects typical growth, none of the three FAS facial features, no evidence of CNS abnormalities, and confirmed absence of prenatal alcohol exposure.

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