Competency 2: Identification of FASD and Diagnosis of FAS
Diagnosis, Continued
Diagnostic Issues and Challenges
Several issues arise in obtaining a diagnosis of an FASD. Women who already have given birth to a child with an FASD are more likely to have another child with an FASD. Counselors need to keep this in mind when working with mothers of children with an FASD. These mothers may need additional support and education to help prevent them from having more children with an FASD.
When an FASD is suspected, it is important to refer individuals for diagnosis. Signs that may indicate the need for assessment include:
- Sleeping, breathing, or feeding problems
- Small head or facial or dental anomalies
- Heart defects or other organ dysfunction
- Deformities of joints, limbs, and fingers
- Slow physical growth before or after birth
- Vision or hearing problems
- Mental retardation or delayed development
- Behavior problems
If clients mention that their children have these signs or symptoms, it might help to gently broach the subject of an assessment. A limited number of experts are available who specialize in FASD evaluation. Depending on the community, services might be available from a developmental pediatrician, an FASD clinic, a genetics clinic, or another specialist. The National Organization on Fetal Alcohol Syndrome maintains a Web-based directory of FASD services at www.nofas.org/resource/directory.aspx.
As individuals get older, diagnosis can create challenges. Physical features may change over time, there may be catch-up growth, and cumulative environmental influences may distort the evaluation of brain function. An adolescent or adult may experience traumatic head injury, alcohol and drug abuse, and mental health problems.19
Although tests for various domains are readily available, they are often not sensitive to real-life issues faced by adolescents and adults. In addition to the data required for the diagnosis, an assessment must include additional components such as functional literacy and math skills, employability, and quality of life, which fall within the domain of adaptive skills. The clinician should not rely solely on the self-report of the individual prenatally exposed to alcohol. The history and abilities of the individual must be verified by a reliable source.19
