Diagnostic Standards

The diagnostic criteria for FASD, which were initially standardized by the Fetal Alcohol Group of the Research Society on Alcoholism (Rosett 1980) and later modified by Sokol and Clarren (1989), are the following:

1 . Prenatal or postnatal growth deficiency or either (weight, length, or both below the 10th percentile when corrected for gestational age).

2 . Central nervous system (CNS) disorders , including neurological abnormality, developmental delay, intellectual impairment, and structural abnormalities.

3 . A distinctive pattern of facial anomalies , including short palpebral fissures (eye openings); a thin upper lip; an elongated, flattened midface; and an indistinct philtrum (the zone between the nose and the mouth).

Maternal alcohol use during pregnancy should be documented to confirm a FASD diagnosis (Aase 1994).

Despite consensus regarding these criteria , researchers and clinicians continue to experience considerable difficulty in diagnosing FASD, in large part because none of the characteristic abnormalities is specific to the diagnosis (Aase 1994). A person who is otherwise healthy may display one or two of the diagnostic traits.

Furthermore, specific facial abnormalities can be subtle and difficult to recognize; their expression can change as a person ages (Aase 1994; Streissguth et al. 1991); and their severity may vary among individuals as well as among different racial and ethnic groups (Abel and Sokol 1991; Ernhart et al. 1989; May 1991; Sokol et al. 1986).