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Consensus diagnostic criteria for fetal alcohol spectrum disorders in Australia: a modified Delphi study
  1. Rochelle E Watkins1,
  2. Elizabeth J Elliott2,3,4,
  3. Raewyn C Mutch1,5,
  4. Janet M Payne1,
  5. Heather M Jones1,
  6. Jane Latimer4,
  7. Elizabeth Russell6,
  8. James P Fitzpatrick2,4,
  9. Lorian Hayes7,
  10. Lucinda Burns8,
  11. Jane Halliday9,
  12. Heather A D'Antoine10,
  13. Amanda Wilkins1,5,
  14. Elizabeth Peadon2,3,
  15. Sue Miers11,
  16. Maureen Carter12,
  17. Colleen M O'Leary1,13,
  18. Anne McKenzie1,
  19. Carol Bower1
  1. 1Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
  2. 2Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  3. 3The Children's Hospital at Westmead, Sydney, New South Wales, Australia
  4. 4The George Institute for Global Health, Sydney, New South Wales, Australia
  5. 5Department of Health Western Australia, Child and Adolescent Health Service, Perth, Australia
  6. 6Russell Family Fetal Alcohol Disorders Association, Cairns, Queensland, Australia
  7. 7Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  8. 8National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Victoria, Australia
  9. 9Public Health Genetics, Genetic Disorders, Murdoch Childrens Research Institute, Melbourne, Australia
  10. 10Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, South Australia, Australia
  11. 11National Organisation for Fetal Alcohol Syndrome and Related Disorders, Adelaide, Australia
  12. 12Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia
  13. 13Centre for Population Health Research, Curtin University, Perth, Western Australia, Australia
  1. Correspondence to Dr Rochelle E Watkins; rwatkins{at}


Objective To evaluate health professionals' agreement with components of published diagnostic criteria for fetal alcohol spectrum disorders (FASD) in order to guide the development of standard diagnostic guidelines for Australia.

Design A modified Delphi process was used to assess agreement among health professionals with expertise or experience in FASD screening or diagnosis. An online survey, which included 36 Likert statements on diagnostic methods, was administered over two survey rounds. For fetal alcohol syndrome (FAS), health professionals were presented with concepts from the Institute of Medicine (IOM), University of Washington (UW), Centers for Disease Control (CDC), revised IOM and Canadian diagnostic criteria. For partial FAS (PFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD), concepts based on the IOM and the Canadian diagnostic criteria were compared.

Setting/participants 130 Australian and 9 international health professionals.

Results Of 139 health professionals invited to complete the survey, 103 (74.1%) responded, and 74 (53.2%) completed one or more questions on diagnostic criteria. We found consensus agreement among participants on the diagnostic criteria for FAS, with the UW criteria most commonly endorsed when compared with all other published criteria for FAS. When health professionals were presented with concepts based on the Canadian and IOM diagnostic criteria, we found consensus agreement but no clear preference for either the Canadian or IOM criteria for the diagnosis of PFAS, and no consensus agreement on diagnostic criteria for ARND. We also found no consensus on the IOM diagnostic criteria for ARBD.

Conclusions Participants indicated clear support for use of the UW diagnostic criteria for FAS in Australia. These findings should be used to develop guidelines to facilitate improved awareness of, and address identified gaps in the infrastructure for, FASD diagnosis in Australia.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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