Because admission of<unk>  use during pregnancy can stigmatize birth mothers, many are reluctant to admit to drinking or to provide an accurate report of the quantity they drank. This complicates diagnosis and treatment of the syndrome. As a result, diagnosis of the severity of<unk>  relies on protocols of observation of the child's physiology and behavior rather than maternal self-reporting. Presently, four<unk>  diagnostic systems that diagnose FAS and other<unk>  conditions have been developed in North America: * The Institute of Medicine's guidelines for FAS, the first system to standardize diagnoses of individuals with prenatal<unk>  exposure; * The University of Washington's "The 4-Digit Diagnostic Code", which ranks the four key features of<unk>  on a Likert scale of one to four and yields 256 descriptive codes that can be categorized into 22 distinct clinical categories, ranging from FAS to no findings; * The Centers for Disease Control's<unk><unk>  Syndrome: Guidelines for Referral and Diagnosis", which established consensus on the diagnosis FAS in the U.S. but deferred addressing other<unk>  conditions; and * Canadian guidelines for<unk>  diagnoses, which established criteria for diagnosing<unk>  in Canada and harmonized most differences between the IOM and University of Washington's systems. Each diagnostic system requires that a complete<unk>  evaluation includes an assessment of the four key features of<unk> , described below. A positive finding on all four features is required for a diagnosis of FAS. However, prenatal<unk>  exposure and central nervous system damage are the critical elements of the<unk>  of<unk> , and a positive finding in these two features is sufficient for an<unk>  diagnosis that is not "full-blown FAS". While the four diagnostic systems essentially agree on criteria for<unk><unk>  syndrome (FAS), there are still differences when full criteria for FAS are not met. This has resulted in differing and evolving nomenclature for other conditions across the<unk>  of<unk> , which may account for such a wide variety of terminology. Most individuals with deficits resulting from prenatal<unk>  exposure do not express all features of FAS and fall into other<unk>  conditions. The Canadian guidelines recommend the assessment and descriptive approach of the "4-Digit Diagnostic Code" for each key feature of<unk>  and the terminology of the IOM in diagnostic categories, excepting ARBD. Thus, other<unk>  conditions are partial expressions of FAS. However, these other<unk>  conditions may create disabilities similar to FAS if the key area of central nervous system damage shows clinical deficits in two or more of ten domains of brain functioning. Essentially, even though growth deficiency and/or FAS facial features may be mild or nonexistent in other<unk>  conditions, yet clinically significant brain damage of the central nervous system is present. In these other<unk>  conditions, an individual may be at greater risk for adverse outcomes because brain damage is present without associated visual cues of poor growth or the "FAS face" that might ordinarily trigger an<unk>  evaluation. Such individuals may be misdiagnosed with primary mental health disorders such as ADHD or oppositional defiance disorder without appreciation that brain damage is the underlying cause of these disorders, which requires a different treatment paradigm than typical mental health disorders. While other<unk>  conditions may not yet be included as an ICD or DSM-IV-TR diagnosis, they nonetheless pose significant impairment in functional behavior because of underlying brain damage.<unk><unk>  syndrome The following criteria must be fully met for an FAS diagnosis: # Growth deficiency: Prenatal or postnatal height or weight (or both) at or below the 10th percentile # FAS facial features: All three FAS facial features present # Central nervous system damage: Clinically significant structural neurological, or functional impairment # Prenatal<unk>  exposure: Confirmed or Unknown prenatal<unk>  exposure<unk><unk>  syndrome (FAS) is the first diagnosable condition of<unk>  that was discovered. FAS is the only expression of<unk>  that has garnered consensus among experts to become an official ICD-9 and ICD-10 diagnosis. To make this diagnosis or determine any<unk>  condition, a multi-disciplinary evaluation is necessary to assess each of the four key features for assessment. Generally, a trained physician will determine growth deficiency and FAS facial features. While a qualified physician may also assess central nervous system structural abnormalities and/or neurological problems, usually central nervous system damage is determined through psychological, speech-language, and occupational therapy assessments to ascertain clinically significant impairments in three or more of the Ten Brain Domains. Prenatal<unk>  exposure risk may be assessed by a qualified physician, psychologist, social worker, or chemical health counselor. These professionals work together as a team to assess and interpret data of each key feature for assessment and develop an integrative, multi-disciplinary report to diagnose FAS (or other<unk>  conditions) in an individual. Partial FAS Partial FAS (pFAS) was previously known as atypical FAS in the 1997 edition of the "4-Digit Diagnostic Code". People with pFAS have a confirmed history of prenatal<unk>  exposure, but may lack growth deficiency or the complete facial stigmata. Central nervous system damage is present at the same level as FAS. These individuals have the same functional disabilities but "look" less like FAS. The following criteria must be fully met for a diagnosis of Partial FAS: # Growth deficiency: Growth or height may range from normal to deficient # FAS facial features: Two or three FAS facial features present # Central nervous system damage: Clinically significant structural, neurological, or functional impairment in three or more of the Ten Brain Domains # Prenatal<unk>  exposure: Confirmed prenatal<unk>  exposure<unk><unk>  effects<unk><unk>  effects (FAE) is a previous term for<unk> -related neurodevelopmental disorder and<unk> -related birth defects. It was initially used in research studies to describe humans and animals in whom teratogenic effects were seen after confirmed prenatal<unk>  exposure (or unknown exposure for humans), but without obvious physical anomalies. Smith (1981) described FAE as an "extremely important concept" to highlight the debilitating effects of brain damage, regardless of the growth or facial features. This term has fallen out of favor with clinicians because it was often regarded by the public as a less severe disability than FAS, when in fact its effects can be just as detrimental.<unk> -related neurodevelopmental disorder<unk> -related neurodevelopmental disorder (ARND) was initially suggested by the Institute of Medicine to replace the term FAE and focus on central nervous system damage, rather than growth deficiency or FAS facial features. The Canadian guidelines also use this diagnosis and the same criteria. While the "4-Digit Diagnostic Code" includes these criteria for three of its diagnostic categories, it refers to this condition as static encephalopathy. The behavioral effects of ARND are not necessarily unique to<unk>  however, so use of the term must be within the context of confirmed prenatal<unk>  exposure. ARND may be gaining acceptance over the terms FAE and ARBD to describe<unk>  conditions with central nervous system abnormalities or behavioral or cognitive abnormalities or both due to prenatal<unk>  exposure without regard to growth deficiency or FAS facial features. The following criteria must be fully met for a diagnosis of ARND or static encephalopathy: # Growth deficiency: Growth or height may range from normal to minimally deficient # FAS facial features: Minimal or no FAS facial features present # Central nervous system damage: Clinically significant structural, neurological, or functional impairment in three or more of the Ten Brain Domains # Prenatal<unk>  exposure: Confirmed prenatal<unk>  exposure;0<unk> -related birth defects<unk> -related birth defects (ARBD), formerly known as possible<unk><unk>  effect (PFAE), was a term proposed as an alternative to FAE and PFAE. The IOM presents ARBD as a list of congenital anomalies that are linked to maternal<unk>  use but have no key features of<unk> . PFAE and ARBD have fallen out of favor because these anomalies are not necessarily specific to maternal<unk>  consumption and are not criteria for diagnosis of<unk> . The Canadian guidelines recommend that ARBD should not be used as an umbrella term or diagnostic category for<unk> . Exposure Prenatal<unk>  exposure is determined by interview of the biological mother or other family members knowledgeable of the mother's<unk>  use during the pregnancy (if available), prenatal health records (if available), and review of available birth records, court records (if applicable), chemical dependency treatment records (if applicable), chemical biomarkers, or other reliable sources. Exposure level is assessed as confirmed exposure, unknown exposure, and confirmed absence of exposure by the IOM, CDC and Canadian diagnostic systems. The "4-Digit Diagnostic Code" further distinguishes confirmed exposure as High Risk and Some Risk: * High Risk: Confirmed use of<unk>  during pregnancy known to be at high blood<unk>  levels (100 mg/dL or greater) delivered at least weekly in early pregnancy. * Some Risk: Confirmed use of<unk>  during pregnancy with use less than High Risk or unknown usage patterns. * Unknown Risk: Unknown use of<unk>  during pregnancy. * No Risk: Confirmed absence of prenatal<unk>  exposure. Confirmed exposure Amount, frequency, and timing of prenatal<unk>  use can dramatically impact the other three key features of<unk> .
Fetal alcohol spectrum disorder
Attention deficit hyperactivity disorder
Fetal hydantoin syndrome
Williams syndrome
Congenital rubella syndrome
Neonatal encephalopathy
Fetal trimethadione syndrome
Fetal warfarin syndrome