There are a growing number of FASD diagnostic clinics in the U.S., Canada and around the world. Diagnostic clinics using a multidisciplinary model and team approach have been recommended as “best practice” by the CDC (National Center on Birth Defects and Developmental Disabilities, 2004). Of course, not all diagnoses are made in multidisciplinary clinics, but sometimes are given by sole health care practitioners, or are made within a multiaxial mental health assessment (typically as a medical condition). It has been noted that simply giving an FASD diagnosis may be a powerful form of intervention (Carmichael Olson et al., in press*). Certainly, early diagnosis of FASD (before age 6) was found to be a “protective factor” that reduced the odds of many secondary disabilities in lifestyle and daily function in a natural history study of a large group of individuals with FASD (Streissguth et al., 2004).
There are several diagnostic systems in use to identify FAS and the full range of alcohol-related disabilities. There is continuing controversy over diagnostic systems, but over time consensus is being built. Guidelines for diagnosing the full FAS have been published in the U.S. (NCBDD, 2004), and a system covering the wider FASD has been published in Canada (Chudley et al., 2005). One diagnostic system used in the Washington State FAS Diagnostic & Prevention Network (FAS DPN), and in which other clinics have been trained, is the 4-Digit Diagnostic Code (Astley, 2004). Other diagnostic systems are available. Research continues to hone FASD diagnosis, and to establish the clinical reliability, validity and utility of various diagnostic systems. New methods of diagnosis are under investigation though not yet fully realized, such as 3-D modeling of facial features (Fang et al., 2006).
No matter what diagnostic system is being used, FASD diagnostic clinics should ideally have systems of outreach and identification that are sufficient to bring in as many individuals affected by prenatal alcohol exposure as the clinics can handle. But these outreach systems should also ideally document how much FASD diagnosis is needed, so that if necessary the number of clinics can be expanded, and clinic services made more widely available. Ideally also, these diagnostic clinics can offer systematic and comprehensive referrals and recommendations.
• Create more FASD diagnostic clinics, and use these as training sites for pre-service and professional education.
• Systematically document the wide range of recommendations given by experienced multidisciplinary FASD diagnostic teams.
• Continue research that carefully examines different FASD diagnostic systems— to make improvements and to find the systems that best identify who is actually affected by prenatal alcohol exposure.