Table 2

Watkins et al6 recommendations for Australian FASD diagnostic categories and criteria

Diagnostic category
Diagnostic criteria*FASpFASND-AE
Requirements for diagnosisRequires all 4 of the following criteria to be met:Requires confirmed PAE, the presence of 2 of the 3 characteristic FAS facial anomalies at any age, and CNS criteria to be met:Requires confirmed PAE and CNS criteria to be met:
Confirmed or unknownConfirmedConfirmed
Facial anomaliesPresence of all 3 of the following facial anomalies at any age:

  1. Short palpebral fissure length (2 or more SDs below the mean)

  2. Smooth philtrum (rank 4 or 5 on the UW Lip-Philtrum Guide44)

  3. Thin upper lip (rank 4 or 5 on the UW Lip-Philtrum Guide44)

Presence of any 2 of the following facial anomalies† at any age:

  1. Short palpebral fissure length (2 or more SDs below the mean)

  2. Smooth philtrum (rank 4 or 5 on the UW Lip-Philtrum Guide44)

  3. Thin upper lip (rank 4 or 5 on the UW Lip-Philtrum Guide44)

No anomalies required‡
Growth deficitPrenatal or postnatal growth deficit indicated by birth length or weight ≤10th centile adjusted for gestational age, or postnatal height or weight ≤10th centileNo deficit required‡No deficit required‡
CNS abnormalityAt least 1 of the following:

  1. Clinically significant structural abnormality (eg, occipital–frontal circumference ≤3rd centile, abnormal brain structure), or neurological abnormality (seizure disorder or hard neurological signs); and/or

  2. Severe dysfunction (impairment in 3 or more domains of function, 2 or more SDs below the mean)§

  • *Appropriate reference charts should be used, and other causes of growth deficit and CNS abnormality excluded.

  • †Based on the presence of two of the three characteristic FAS facial features, the observed impairments cannot be causally linked to PAE.

  • ‡Not required for diagnosis but may be present.

  • §Assessment of dysfunction based on evidence from standard validated assessments instruments interpreted by qualified professionals.

  • CNS, central nervous system; FAS, fetal alcohol syndrome; FASD, fetal alcohol spectrum disorder; ND-AE, neurodevelopmental disorder-alcohol exposed; PAE, prenatal alcohol exposure; pFAS, partial FAS; UW, University of Washington.