Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code
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Astley, Susan J
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University of Washington
Abstract
The FASD 4-Digit Code is used by an interdisciplinary team to diagnose fetal alcohol spectrum disorders. Briefly, the 4 digits of the FASD 4-Digit Code reflect the magnitude of expression of the 4 key diagnostic features of FASD, in the following order: 1) growth deficiency, 2) FAS facial phenotype, 3) CNS structural/functional abnormalities, and 4) prenatal alcohol exposure (Figure 2A). The magnitude of expression of each feature is ranked independently on a 4-point Likert scale, with 1 reflecting complete absence of the FASD feature and 4 reflecting a strong “classic” presence of the FASD feature. Each Likert rank is specifically case defined. There are a total of 102 4-Digit Codes that fall broadly under the umbrella of FASD. These codes cluster under four clinically meaningful FASD diagnostic subcategories: fetal alcohol syndrome (FAS): Diagnostic Categories A and B; Partial FAS (PFAS): Diagnostic Category C; Static Encephalopathy/Alcohol-Exposed (SE/AE): Diagnostic Categories E and F; and Neurobehavioral Disorder/Alcohol-Exposed (ND/AE): Diagnostic Categories G and H.
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Key attributes of the FASD 4-Digit Code:
1. Greatly increases diagnostic precision and accuracy through the development of objective, quantitative measurement scales (e.g., Lip-Philtrum Guides), facial analysis software, and specific, operational case definitions.
2. Diagnoses the full spectrum of outcomes across the lifespan.
3. Was developed empirically using a large, representative, population-base.
4. Offers an intuitively logical numeric approach to reporting outcomes and exposure that reflects the true diversity and continuum of disability observed in individuals with prenatal alcohol exposure.
5. Uses the universal language of numbers, thus facilitating ease of reporting worldwide. The numeric base also allows rapid and easy update of large datasets as diagnostic criteria are refined.
6. Establishes a method for case-defining the highly variable, nonspecific CNS dysfunction that typifies FASD, by quantifying the breadth and magnitude of dysfunction (number of domains of function 2 or more SDs below the mean) without unduly constraining which domains must be impaired.
7. Establishes diagnostic subclassifications that capture the full spectrum of FASD without inferring alcohol is the sole causal agent.
8. Documents all other prenatal and postnatal adverse exposures and events that can also impact outcome.
9. Provides a quantitative measurement and reporting system (the 4-Digit Code) that can be used independent of the diagnostic nomenclature.
10. Has received extensive assessment/validation of its performance.
11. Was designed for use by an interdisciplinary FASD diagnostic team.
12. Is readily taught to interdisciplinary teams through an Online Course, thus greatly expanding the availability of diagnostic services worldwide.
13. Qualifies patients for intervention services that produce improved outcomes.
14. Receives high satisfaction/confidence ratings from families and clinicians
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Astley SJ. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code. 3rd edition (2004), University of Washington Publication Services, Seattle WA.