FASD Elephant (TM) #004: Other FASD Diagnoses

Each key feature of FASD can vary widely across individuals exposed to prenatal alcohol. While consensus exists for the diagnosis of FAS across diagnostic systems (see last podcast), minor variations among the systems lead to differences in definitions and cut-off criteria for other diagnoses across the FASD continuum. The FASD conditions of Partial FAS (PFAS) and Alcohol-Related Neurodevelopmental Disorder (ARND) are reviewed today, as well as the University of Washington's 4-Digit Code designations of Static Encephalopathy and Neurobehavioral Disorder, which are essentially refinements of ARND. Partial FAS (PFAS)This diagnosis is easiest to explain and, in all practical purposes, the same as FAS. Central nervous system damage is present at the same level as FAS, and these individuals have the same functional disabilities but "look" less like FAS. Here are the criteria: Moderate to severe FAS facial features are present (small eyes, flattened philtrum, thinned upper lip),Central nervous system (CNS) damage is severe (either structural or neurological problems, or problems in three or more functional brain domains), andPrenatal alcohol exposure is confirmed. Alcohol-Related Neurodevelopmental Disorder (ARND)This is where the diagnostics become muddy to the average layperson, so I want to keep it basic. For an ARND diagnosis, an individual must have confirmed prenatal alcohol exposure and evidence of clinically significant impairment in three or more of the following Ten Brain Domains: Achievement, Adaptive Behavior, Attention, Cognition/IQ, Communication/Language, Executive Functioning, Memory, Motor Skills, Sensory Integration/Soft Neurological Signs, and/or Social Communication. Growth deficiency and FAS facial features may be mild or nonexistent, and are irrelevant to the diagnosis. Static Encephalopathy and Neurobehavioral DisorderThe 4-Digit Code separates ARND into "Static Encephalopathy," which literally means non-progressive brain damage, and "Neurobehavioral Disorder," which requires that only two Brain Domains are clinically impaired.Additional Notes

The problem with FASD conditions is not about the facial features or growth deficiency. It is about the CNS damage that then creates functional problems in an individual's life. That is why the assessment of the Ten Brain Domains is so important and the most germain aspect to an FASD Evaluation: to find out how to help an individual function better.

Don't worry about getting caught up in the specifics all the diagnoses. Just know that if an individual had moderate to severe prenatal alcohol exposure AND has functional problems, then an FASD condition (disability) may be present.

This leads to another question that someone asked last week at a workshop I gave: "I had a few drinks before I knew I was pregnant, but stopped in the second month. My kid has terrific grades, but has low attention skills and poor social skills [Adaptive Behavior problems, from the Ten Brain Domains perspective].

Does this mean he has FASD?" No. While there is no recommended safe level of drinking alcohol while pregnant, this situation does not result in an automatic FASD diagnosis. The attention skills and behavior problems would have to be severe, and the most important thing is missing: A diagnostic team would need to be convinced that the problems were related to the alcohol exposure. Attention and social skills can be affected by so many factors in life (e.g., genetics, peer group, parenting style, etc.) that this are not diagnostic.

I would like to caution everyone not to "over-diagnose" just as much as I want to caution everyone to be knowledgeable about the potential negative effects of prenatal alcohol exposure.

Next week, we will review the Ten Brain Domains, which will start giving a better idea of what exactly CNS damage is. Until then....

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