Table 1

Diagnostic criteria based on the Canadian guidelines for the diagnosis of fetal alcohol spectrum disorders42

Diagnostic categoryFetal alcohol syndromePartial fetal alcohol syndromeNeurodevelopmental disorder–alcohol exposed
Diagnostic criteriaRequires all four criteria below to be metRequires confirmed prenatal alcohol exposure, the presence of two of the three characteristic facial anomalies at any age and CNS criteria to be metRequires confirmed prenatal alcohol exposure and CNS criteria to be met
Prenatal alcohol exposureConfirmed or unknownConfirmedConfirmed
Facial anomaliesPresence of all three of the following facial anomalies at any age:
  • Short palpebral fissure length (≤2 SDs below the mean using the Hall charts43)

  • Smooth philtrum (rank 4 or 5 on the UW Lip-Philtrum Guide*)

  • Thin upper lip (rank 4 or 5 on the UW Lip-Philtrum Guide)

Presence of any two of the following facial anomalies at any age:
  • Short palpebral fissure length (≤2 SDs below the mean)

  • Smooth philtrum (rank 4 or 5 on the UW Lip-Philtrum Guide)

  • Thin upper lip (rank 4 or 5 on the UW Lip-Philtrum Guide)

No anomalies required
Growth deficitPrenatal or postnatal growth deficit indicated by birth length or weight ≤10th percentile adjusted for gestational age or postnatal height or weight ≤10th percentileNo deficit requiredNo deficit required
Central nervous system (CNS) abnormalitySignificant CNS dysfunction (evidence of impairment in three or more of the following CNS domains):
  • Hard and soft neurological signs; seizure disorder; gross and fine motor functioning; articulation, phonology and motor speech

  • Cognition (IQ or uneven cognitive profile)

  • Memory

  • Executive functioning and abstract reasoning

  • Communication (expressive and receptive language)

  • Attention deficit/hyperactivity +/− other behavioural problems; abnormal sensory processing

  • Visual motor integration

  • Adaptive behaviour/social skills/social communication

  • Academic achievement

  • CNS structure (including head circumference ≤3rd percentile or other structural CNS abnormality)

  • * The University of Washington (UW) Lip-Philtrum Guide is a 5-point Likert scale with representative photographs of lip and philtrum combinations with ranks 1–3 within normal limits and ranks 4 and 5 outside normal limits.