Diagnosis+and+Physical+Characteristics

 According to Drugs, Society, & Human Behavior there are 3 primary criteria that are used for diagnosing FAS (Fetal Alcohol Syndrome):
 * Fetal alcohol syndrome (FAS) refers to a constellation of physical abnormalities that cause a reduced size in newborn babies, a change in standard features of the face and behavior and cognition problems, in children whose mothers drank heavily during pregnancy. (Institute of Medicine, National Academy Press, 1996) ||
 * Growth retardation occurring before and/ or after birth.
 * A pattern of abnormal features of the face and head, including small head circumference, small eyes, or evidence of retarded formation of the mid facial area, including a flattened bridge and short length of the nose and flattening of the vertical groove between the nose and mouth (the philtrum).
 * Evidence of CNS abnormality, including abnormal neonatal behavior neonatal behavior, mental retardation, or other evidence of abnormal neurobehavioral development. (Carl L. Hart & Charles Ksir, 2011)

Expanding from the previous diagnosis criteria the CDC (Centers for Disease Control) states that when a healthcare professional is diagnosing FAS they look for the following signs and symptoms:

**Abnormal facial features** There are 3 distinct facial features that a person with FAS will show. A smooth ridge between the nose and upper lip (smooth philtrum), a thin upper lip and a short distance between the inner and outer corners of the eyes making the eyes appear wide spaced. (Centers for Disease Control and Prevention, 2010)

**Growth problems** Children born with FAS have can have height and weight issues that are lower than normal (At or below the 10th percentile). These growth issues can occur even before birth. These growth problems can resolve themselves early in life. (Centers for Disease Control and Prevention, 2010)

**Central nervous system problems** The CNS (central nervous system) consists of the brain and spinal cord. It controls all the workings of the body. When there is a problem with part of the nervous system, a person can have trouble moving, speaking, or learning. They can also have problems with memory, senses, or social skills. There are 3 categories of CNS problems:

__Structural__ FAS can cause structural differences in the brain. Signs of this are:
 * Smaller-than-normal head size for a person’s over all height and weight (at or below the 10th percentile).
 * Significant changes in the structure of the brain, seen using MRIs or CT scans.

__Neurological__ When here is a problem with the nervous system that is not linked to another cause. Examples include poor coordination, muscle control and problems with sucking as a baby.

__Functional__ Ability to function is well below what is expected for their age, schooling, or circumstances. To be diagnosed with FAS a person must have: Or
 * Cognitive deficits or significant developmental delay in children who are too young for an IQ test.
 * Problems in at least 3 of the following areas:


 * 1) __Cognitive deficits (e.g., low IQ) or developmental delays__ - Examples include specific learning disabilities (especially math), poor grades in school, performance differences between verbal and nonverbal skills, and slowed movements or reactions.
 * 2) __Executive functioning deficits__ - These deficits involve the thinking processes that help a person manage life tasks. Such deficits include poor organization and planning, lack of inhibition, difficulty grasping cause and effect, difficulty following multistep directions, difficulty doing things in a new way or thinking of things in a new way, poor judgment, and inability to apply knowledge to new situations.
 * 3) __Motor functioning delays__ - These delays affect how a person controls his or her muscles. Examples include delay in walking (gross motor skills), difficulty writing or drawing (fine motor skills), clumsiness, balance problems, tremors, difficulty coordinating hands and fingers (dexterity), and poor sucking in babies.
 * 4) __Attention problems or hyperactivity__ - A child with these problems might be described as “busy,” overly active, inattentive, easily distracted, or having difficulty calming down, completing tasks, or moving from one activity to the next. Parents might report that their child’s attention changes from day to day (e.g., “on” and “off” days).
 * 5) __Problems with social skills__ - A child with social skills problems might lack a fear of strangers, be easily taken advantage of, prefer younger friends, be immature, show inappropriate sexual behaviors, and have trouble understanding how others feel.
 * 6) __Other problems__- Other problems can include sensitivity to taste or touch, difficulty reading facial expression, and difficulty responding appropriately to common parenting practices (e.g., not understanding cause-and-effect discipline) (Centers for Disease Control and Prevention, 2010)

**Alcohol use during pregnancy** Confirming alcohol use during pregnancy can strengthen the case for FAS diagnosis. Confirming absence of alcohol would rule out the FAS diagnosis. Knowing whether a mother drank during pregnancy is helpful but confirmed use is not needed if the child meets the other criteria. (Centers for Disease Control and Prevention, 2010)

**Summary: Criteria for FAS Diagnosis** A diagnosis of FAS requires the presence of all three of the following findings:

> >
 * 1) All three facial features
 * 1) Growth deficits
 * 1)  Central nervous system problems. A person could meet the central nervous system criteria for FAS diagnosis if there is a problem with the brain structure, even if there are no signs of functional problems. (Centers for Disease Control and Prevention, 2010)



Characteristic facial features in a child with fetal alcohol spectrum disorders. Findings may include a smooth philtrum, thin upper lip, upturned nose, flat nasal bridge and midface, epicanthal folds, small palpebral fissures, and small head circumference. (Wattendorf DJ, Muenke M. 2005)



Characteristic facial features in children of different ethnicities with fetal alcohol spectrum disorders. (A) Child of Northern European descent. (B) Native American child. (C) Black child. (D) Biracial child (white, black). (Wattendorf DJ, Muenke M. 2005)



Characteristic features of an ear of a child with fetal alcohol spectrum disorders. Note the underdeveloped upper part of the ear parallel to the ear crease below (“railroad track” appearance). (Wattendorf DJ, Muenke M. 2005)



Characteristic features of a hand of a child with fetal alcohol spectrum disorders. Note the curved fifth finger (clinodactyly) and the upper palmar crease that widens and ends between the second and third fingers (“hockey stick” crease). (Wattendorf DJ, Muenke M. 2005)