Fetal Alcohol Syndrome: Referral Considerations

by CDC

(Page 4 of 5)

Providers of medical, educational, and social services often must decide whether to refer a child, person, or family to a specialist for a full FAS diagnostic evaluation. This decision can be difficult. For biologically related family members, social stigma might be associated with any evaluation concerning prenatal alcohol exposure. In adoptive or foster families, alcohol use during pregnancy might be suspected, but direct information might not be available.

The following guidelines were developed to assist service providers in making referral decisions. Each case should be evaluated individually. When in doubt, providers should refer persons for a full evaluation by a multidisciplinary team with experience in evaluating prenatal alcohol exposure.

The following circumstances should prompt a diagnostic referral:

When prenatal alcohol exposure is known, a child should be referred for full FAS evaluation when substantial prenatal alcohol use (i.e., seven or more drinks per week, three or more drinks on multiple occasions, or both) has been confirmed. If substantial prenatal alcohol exposure is known, in the absence of any other positive criteria (i.e., dysmorphia, growth deficits, or CNS abnormalities), the primary health-care provider should document this exposure and monitor the child's ongoing growth and development closely. When information regarding prenatal alcohol exposure is unknown, a child should be referred for full FAS evaluation for any one of the following:

• any report of concern by a parent or caregiver (e.g., foster or adoptive parent) that a child has or might have FAS;.

• presence of all three facial features (i.e., smooth philtrum, thin vermillion border, and small palpebral fissures);.

• presence of one or more of these facial features, with growth deficits in height, weight, or both;.

• presence of one or more facial features, with one or more CNS abnormalities; or.

• presence of one or more facial features, with growth deficits and one or more CNS abnormalities.

In addition to specific features associated with a FAS diagnosis, certain social and family history factors have been associated with prenatal alcohol exposure. The possibility of prenatal alcohol exposure should be considered fully for persons who are experiencing or have experienced one or more of the following:

• premature maternal death related to alcohol use (either disease or trauma),
• living with an alcoholic parent,
• current or previous abuse or neglect,
• current or previous involvement with child protective services agencies (PSAs),
• a history of transient caregiving situations, or
• foster or adoptive placements (including kinship care).

Although such situations might have a negative impact on the development of any child, evidence exists that children with FAS or a related disorder are particularly likely to experience negative situations that involve a dysfunctional family unit, especially if the biologic mother abuses alcohol.

Services for Persons with FAS

For persons with developmental disabilities and their families, diagnosis is never an endpoint. This is particularly true for persons with FAS, their families, and their communities. The diagnostic process (especially the neuropsychologic assessment) should be part of a continuum of care that identifies and facilitates appropriate health-care, education, and community services. Early diagnosis and a stable, nurturing home environment have been identified as strong protective factors for persons with FAS. Limited information is available regarding strategies for interventions specific to persons with FAS. Information available has been gathered primarily from the experience of persons with other disabilities and from that of parents gained through trial and error and shared through informal networks. Treatments currently employed to reduce the risk for adverse effects of FAS have not been evaluated systematically or scientifically. In 2001, CDC provided the first federal funding to develop and test systematic, scientifically developed interventions specific to FAS (e.g., a modified mathematics curriculum or a program to develop peer friendship skills). These projects are in their final stages, and findings will be published.

The learning and life skills affected by prenatal alcohol exposure vary among persons, depending on the amount, timing, and pattern of exposure and on each person's current and past environment. As a result, services needed for persons with FAS and their families vary according to the parts of the brain affected, the person's age or level of maturation, the health or functioning of the family, and the person's overall living environment. Thus, the service needs of affected persons and their families should be individualized. Certain general areas of service and specific services have been identified as helpful to persons with FAS and their families.

About the Author

www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.