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), and
- Prenatal 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.
Links discussed in the Show
