Table 1FAS Diagnostic Criteria: Comparison Across the Five Most Current FASD Diagnostic Guidelines

4-Digit Code
(2004)		CDC
(2004)		Canadian
(2005)		Revised IOM
(2005)		IOM
(1996)
GrowthPrenatal and/or postnatal height or weight
< 10th percentile
(Growth Ranks 2-4)		Prenatal and/or postnatal height or weight
< 10th percentile		At least 1 of the following:
  • Prenatal and/or postnatal height or weight < 10th percentile
  • Weight-to-height ratio (<10th percentile)
Prenatal and/or postnatal height or weight
< 10th percentile		At least 1 of the following:
  • Low birth weight
  • Low weight for height
  • Decelerating weight
FaceAll 3 of the following at any age:
  • PFL < 3rd percentile
  • Smooth philtrum Rank 4 or 5
  • Thin upper lip Rank 4 or 5
(Face Rank 4)		All 3 of the following:
  • PFL< 10th percentile
  • Smooth philtrum Rank 4 or 5
  • Thin upper lip Rank 4 or 5
All 3 of the following at any age:
  • PFL < 3rd percentile
  • Smooth philtrum Rank 4 or 5
  • Thin upper lip Rank 4 or 5
2 or more of the following:
  • PFL< 10th percentile
  • Smooth philtrum Rank 4 or 5
  • Thin upper lip Rank 4 or 5
Characteristic pattern that includes features such as short PFL, flat upper lip, flattened philtrum, and flat midface.
CNSAt least 1 of the following:
  • Structural/Neurological: (e.g., OFC <3rd percentile, abnormal structure, seizure disorder, hard signs)
  • Severe Dysfunction: (3 or more domainsa of function with impairment 2 or more SDs below the mean) (CNS Rank 3 and/or 4)
At least 1 of the following:
  • Structural/Neurological: (e.g., OFC < 10th percentile, abnormal structure, seizure disorder, hard/soft signs)
  • Dysfunctionb:
    • 3 or more domains of function with impairment 1 or more SDs below the mean
    • Global deficit (2 or more SDs below the mean)
At least 3 of the following Structure/Neurological/Functional domains with impairmentc:
  • Hard/soft signs, structure, cognition, communication, academic achievement, memory, executive functioning, abstract reasoning, ADD, adaptive behavior, social skills, or communication
At least 1 of the following:
  • Structural
    • OFC< 10th percentile
    • Abnormal structure
At least 1 of the following:
  • Structural/Neurological:
    • Decreased cranial size at birth
    • Abnormal structure (e.g., microcephaly, partial/complete agenesis of the corpus callosum, cerebellar hypoplasia)
    • Neurological hard/soft signs
AlcoholConfirmed or Unknown
(Alcohol Ranks 2, 3 or 4)		Confirmed or UnknownConfirmed or UnknownConfirmed-excessive or UnknownConfirmed-excessive or Unknown
a

4-Digit Code: Domains may include, but are not limited to: executive function, memory, cognition, social/adaptive skills, academic achievement, language, motor, attention, or activity level.

b

CDC: Performance substantially below that expected for an individual's age, schooling, or circumstances, as evidenced by: 1) Global cognitive or intellectual deficits representing multiple domains of deficit (or significant developmental delay in younger children) with performance below the 3rd percentile (2 standard deviations below the mean for standardized testing) or 2) Functional deficits below the 16th percentile (1 standard deviation below the mean for standardized testing) in at least three of the following domains: a) cognitive or developmental deficits or discrepancies b) executive functioning deficits c) motor functioning delays d) problems with attention or hyperactivity e) social skills f) other, such as sensory problems, pragmatic language problems, memory deficits, etc.

c

Canadian: Impairment indicates scores ≥ 2 SDs below the mean, discrepancies of 1.5-2 SDs among subtests, or ≥ 1 SD discrepancy between subdomains.

From: Appendix E, Comparison of Current FASD Diagnostic Systems

Cover of Addressing Fetal Alcohol Spectrum Disorders (FASD)
Addressing Fetal Alcohol Spectrum Disorders (FASD).
Treatment Improvement Protocol (TIP) Series, No. 58.
Center for Substance Abuse Prevention (US).
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