Curriculum for Addiction Professionals > Competency 2: Identification of FASD and Diagnosis of FAS > 4a. The 4-Digit Diagnostic Code
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,
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
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
and confirmed absence of prenatal alcohol exposure.