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Fetal Alcohol Spectrum Disorder in Children

  • Published: 2009-03-23 (Revised/Updated 2014-03-14) : JoAnn Collins.
  • Synopsis: Fetal Alcohol Syndrome has the most consensus among medical professionals and has a ICD-9 or ICD-10 diagnosis.

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Quote: "Fetal Alcohol Syndrome has the most consensus among medical professionals and has a ICD-9 or ICD-10 diagnosis."

Do you know a child who may have received a prenatal exposure to alcohol? Have you adopted a child or do you work with a child that may have the affects of prenatal exposure to alcohol

Would you like to know what the 4 key features of this disorder is? This article will discuss the 4 key features of FASD, which you can use to help a child in your life!

The Center for Disease Control (CDC) has a document entitled: Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. This document established a general consensus among medical professionals, on what constitutes a diagnosis in the USA.

There is some disagreement among medical professionals about children that have some of the four key features but not all of them.

Fetal Alcohol Syndrome has the most consensus among medical professionals and has a ICD-9 or ICD-10 diagnosis. The complete evaluation to determine diagnosis should include an assessment of the child's central nervous system, speech/language, and fine motor skills which are assessed by an occupational therapist. After the testing is complete the team should work together to interpret the data of each key feature that was assessed, and develop a multi disciplinary report to diagnose this in a child.

Partial FAS have a confirmed history of prenatal exposure, but may lack growth deficiency of the complete facial stigmata. The following criteria must be met for a diagnosis: Growth deficiency-may range from normal to deficient, facial features - Two or three specific facial features present, CNS damage-clinically significant, neurological impairment in three or more of the Ten Brain Domains, and a confirmed prenatal exposure.

The four main features are:

1. Growth deficiency - this is defined as significantly below average height, weight, or both due to prenatal alcohol exposure. Criteria are less specific in the diagnostic system. Low weight to height measurement, or decelerating weight not due to poor nutrition.

Growth deficiency is ranked as follows by the: 4 digit diagnostic code:

Severe: Height and weight at or below the 3rd percentile.

Moderate: Either height or weight at or below the 3rd percentile, but not both.

Mild: Either height or weight or both between the 3rd and tenth percentile.

None: both above the tenth percentile.

2. Specific facial features - Three characteristic craniofacial abnormalities are visible in children with FAS. The 3 facial features are:

A smooth philtrum: The digit or groove between the nose and upper lip flattens with increased alcohol exposure.

Thin vermilion: The upper lip thins with increased exposure.

Small palpebral fissures:eye width shortens with increased exposure.

3. Central Nervous System damage - is the primary key feature of any diagnosis. The prenatal exposure can damage the brain across a continuum;from subtle impairments, to more severe impairments. The 4-digit diagnostic code gives four rankings for CNS damage:

Definite: Structural impairments or neurological impairments

Probable: Significant dysfunction of two standard deviations or worse in three or more functional domains.

Possible: Mild to moderate dysfunction of two standard deviations or worse in one or two functional domains.

Unlikely: No evidence of CNS damage.

4. Documented prenatal exposure to alcohol - can be determined by interviews of the biological mother, other family members, court records, as well as chemical dependency treatment records.

Some children with FAS are adopted and it may be difficult to determine if the biological mother used alcohol during the pregnancy. So a determination of unknown exposure is often used for these children. The diagnosis of FAS can still be determined with an unknown exposure if the child has the other three key features.

It is sometimes difficult to determine why a child has a disability, so understanding this information could be critical to being able to help the child learn. Many children with this syndrome require intensive special education services to help them learn and have a happy and fulfilled life.

By understanding this condition you will be able to help a child in your life that is showing the affects of this disorder.

Reference: JoAnn Collins is the mother of two adults with disabilities, and has helped families navigate the special education system, as an advocate, for over 15 years. She is a presenter and author of the book "Disability Deception; Lies Disability Educators Tell and How Parents Can Beat Them at Their Own Game" The book has a lot of resources and information to help parents fight for an appropriate education for their child. For a free E newsletter entitled "The Special Education Spotlight" send an E mail to:

For more information on the book, testimonials about the book, and a link to more articles go to:

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