The form below was developed by the Washington State FAS Diagnostic and Prevention Network (FAS DPN), and is part of the 4-Digit Diagnostic Code (Astley, 2004). The caregivers of all patients receiving an FASD diagnostic evaluation in the Washington State FAS DPN clinics participate in a 2-hour interview with the pediatrician and psychologist. The purpose of the interview is to identify areas of significant delay/impairment across a wide array of functional domains.

The article Profile of the First 1,400 Patients Receiving Diagnostic Evaluations for Fetal Alcohol Spectrum Disorder at the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network, by Dr. Susan Astley (2010), provides a graphical summary of the first 1,400 caregiver interviews conducted by the FAS DPN clinics. Presented is the proportion of patients classified by the pediatrician as “significantly delayed/impaired” in behaviors addressed in a 2-hour, structured caregiver interview administered jointly by the pediatrician and psychologist during the FASD diagnostic evaluation. This graphical presenta-tion illustrates the cumulative increase in impairment as one advances across the FASD diagnostic groups. The illustration is color-dependent and too complex to present in this TIP. However, readers are encouraged to access the article at the following link: http://depts.washington.edu/fasdpn/pdfs/astley-profile-2010.pdf