Fetal alcohol spectrum disorder: A national diagnostic tool and a guide to its use


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Content type
Short article

October 2018


Nick Heyes

This short article has been written as an update for health professionals on the national diagnostic tool for fetal alcohol spectrum disorder (FASD). For further information on FASD, see CFCA publications:

Exposure to alcohol in utero can cause a range of neurodevelopmental issues for individuals, such as problems with memory, language and social skills, as well as certain facial abnormalities. The term FASD has been used since 2000 as a catch-all, non-diagnostic term to describe the full range of birth defects and developmental issues caused by prenatal exposure to alcohol (McLean & McDougall, 2014). In Australia, the labelling and diagnosis of these symptoms has been inconsistent, which has meant that FASD has often gone undiagnosed (Bower & Elliott, 2016; McLean & McDougall, 2014). The introduction of a national diagnostic tool in 2016 aimed to address this.

Developing a national diagnostic tool

In 2010, the then Commonwealth Department of Health and Ageing commissioned Professor Carol Bower and Professor Elizabeth Elliott and the Australian FASD Collaboration to develop a national diagnostic tool for FASD and a related guide. The development of this tool aimed to assist clinicians in the diagnosis, management and referral of FASD, and contribute to the prevention of FASD through raising awareness of the potential harms of alcohol during pregnancy. 

In 2015, following a systematic literature review, an evaluation of existing guidelines from other countries and a consultation process, a draft diagnostic tool and a guide to its use were trialed in Australia. Following this trial, the draft Australian tool and guide were reviewed and revised, including harmonisation with the recently revised Canadian guidelines for FASD diagnosis. The Australian guide to the diagnosis of FASD was released in May 2016.

A new guide to diagnose FASD

The Australian guide to the diagnosis of FASD is a diagnostic instrument and a guide to its use. It provides health professionals with the knowledge and confidence to make a FASD diagnosis, and provide referral advice and resources to support those diagnosed with FASD and their carers.

The new guide adopts FASD as a diagnostic term for severe neurodevelopmental impairments resulting from exposure to alcohol in utero. Under this sit two sub-categories:

  • FASD with three sentinel facial features
  • FASD with less than three sentinel facial features.

See Table 1 below for the diagnostic criteria of these categories. These definitions are also discussed in greater detail in the Australian guide.

The Australian guide emphasises the neurological aspect of FASD, simplifies diagnostic categories and criteria, and is consistent with the Canadian guidelines (Bower & Elliott, 2016).

Diagnostic criteriaDiagnostic categories
FASD with 3 sentinel facial featuresFASD with < 3 sentinel facial features
Prenatal alcohol exposureConfirmed or unknown Confirmed

Neurodevelopmental domains

  • Brain structure/Neurology
  • Motor skills
  • Cognition
  • Language
  • Academic achievement
  • Memory
  • Attention
  • Executive function, impulse control and hyperactivity
  • Affect regulation
  • Adaptive behaviour, social skills or social communication
Severe impairment in at least 3 neurodevelopmental domainsSevere impairment in at least 3 neurodevelopmental domains

Sentinel facial features

  • Short palpebral fissure
  • Smooth philtrum
  • Thin upper lip
Presence of 3 sentinel facial featuresPresence of 0, 1 or 2 sentinel facial features

Source: Bower and Elliott, 2016, p. 5.

Upcoming event

The second Australasian Fetal Alcohol Spectrum Disorder Conference is being held 21–22 November 2018 in Perth, WA. More information is available on the conference website.

Further information and resources

Further information about FASD is available at FASD Hub Australia. The website provides information on FASD prevention, diagnosis and support, including tools and resources for health and other professionals, parents, carers, researchers and policy makers. The website also hosts a series of e-learning modules designed to provide further information and guidance for health professionals involved in FASD diagnosis.


Bower, C., & Elliott, E. J. (2016). Report to the Australian Government Department of Health: Australian guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD). Retrieved from <www.fasdhub.org.au/siteassets/pdfs/australian-guide-to-diagnosis-of-fasd_all-appendices.pdf>.

McLean, S., & McDougall, S. (2014). Fetal alcohol spectrum disorders: Current issues in awareness, prevention and intervention (CFCA Paper No. 29). Melbourne: Australian Institute of Family Studies. Retrieved from <aifs.gov.au/cfca/publications/fetal-alcohol-spectrum-disorders-current-issues-awareness-prevention-and>.



The author would like to thank Heather Jones from the Telethon Kids Institute for assistance in developing this article, and Professor Carol Bower for reviewing the article.

Image credit: © GettyImages/ NataliaDeriabina