Identifying and diagnosing FASD requires a trained multidisciplinary team
A single medical test that can be used to diagnose FASD does not exist. The diagnostic process is rather complex and requires a trained multidisciplinary team. Healthcare professionals, including medical professionals and psychologists, have a key role in this process. It is therefore crucial to train them to identify and spot people with FASD.
Healthcare professionals have an important role in the identification of individuals at risk of FASD, in referring them to further assessments, and in diagnosing the potential effects of prenatal exposure to alcohol. However, studies have pointed out that healthcare professionals lack knowledge and experience to identify and diagnose conditions within the FASD spectrum (Payne et al., 2005; Howlett et al., 2019; Elliott et al., 2006). The studies also show that only a minority of healthcare professionals are trained in the follow-up of patients with FASD. Education and training of healthcare professionals is therefore important.
The training of healthcare professionals is also important in order for them to be able to understand that many risk factors may be responsible for the individual’s clinical picture. Crucially, healthcare professionals need to be able to differentiate FASD from other disorders. Often, the challenge of diagnosing conditions within the FASD spectrum and differentiating conditions from other disabilities lies in the inability to confirm prenatal exposure to alcohol. Without information on this exposure, it is hard to differentiate FASD from other disorders that manifest in ways similar to FASD. Healthcare professionals can and should be trained to have a conversation with mothers (and their partners) about the possibility of prenatal alcohol exposure. It can also be challenging to identify individuals who do not show the outward signs of prenatal alcohol exposure yet exhibit cognitive and behavioural deficits commonly seen in individuals with FASD (Chudley et al., 2007).
Diagnosing conditions within the FASD spectrum is a complex medical diagnostic process. Because of the complexity and broad array of outcomes observed in prenatally alcohol-exposed individuals, the accurate and comprehensive assessment of physical and neurodevelopmental effects requires a multidisciplinary clinical team. The team can consist of, for example, paediatricians, other relevant physicians, dysmorphologists, psychologists, and speech-language pathologists with complementary experience, qualifications, and skills needed for the diagnosing process (Hoyme, et al., 2016). The healthcare professionals involved in the diagnostic process need training to use the diagnostic guidelines accurately. The multidisciplinary team also has an important role in sharing the assessment results and making intervention or treatment recommendations to the affected individuals and their families. In addition, this is not just an educational and a training issue, but also a question of capacity. The limited capacity and expertise, and the need to involve a multidisciplinary team in the process of diagnosing conditions within FASD, can lead to only a fraction of those affected to be assessed and diagnosed (Chudley et al., 2005).
Research has shown that healthcare professionals may understand the benefits of the diagnosis within the FASD spectrum but can be concerned about the stigma attached to a FASD diagnosis. This can affect their willingness to engage in FASD-related work. Training for healthcare professionals is therefore necessary: it can increase their knowledge and understanding of FASD. Additionally, training can provide a catalyst to change attitudes towards drinking alcohol during pregnancy and FASD, and reduce the stigma attached to the topic. Training can also prepare healthcare professionals to discuss the diagnosis with the affected individuals and their families. Moreover, a diagnosis within the FASD spectrum concerns not only the affected individual but also the biological mother. Training is key to handling the ethical issues related to FASD (Bagley & Badry, 2019; Elliott et al., 2006; Payne et al., 2005).