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FASD: Screening and referral

Key points

  • All women of childbearing age should be screened for alcohol use with validated screening tools (e.g., T-ACE, TWEAK, AUDIT) by their health care provider. Women at risk for heavy alcohol use should be offered early brief intervention (e.g., counselling).
  • The purpose of FASD screening is to determine the need for referral and support for the mother and to facilitate referral to a diagnostic clinic.
  • The role of the family physician or primary care health provider in screening for FASD is to:
    • recognize patients with dysmorphic features and/or developmental/learning and behavioural problems that may be due to prenatal alcohol exposure
    • confirm the alcohol history
    • refer the patient to a multidisciplinary diagnostic team with expertise in FASD diagnosis.
  • Abstinence should be recommended to all women during pregnancy.

Screening for alcohol use during pregnancy

The Society of Obstetricians and Gynecologists of Canada recommends discussing alcohol use with all women of childbearing age. Alcohol screening and support for women who are at risk should be considered a routine part of health care.

Health care providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for termination of pregnancy.

Health care providers should offer brief interventions for at-risk drinking and pregnant women should have priority access to withdrawal management and other treatment services.

Read more about the effects of alcohol use in pregnancy.

Identifying who should be referred for assessment and diagnosis

Note: Screening is the first step in the diagnostic process It is not sufficient to establish a diagnosis.

Refer to specialized FASD services for assessment and diagnosis when:

  • the three facial features characteristic of FASD (smooth ridge between the nose and upper lip, thin upper lip, short distance between the inner and outer corners of the eye) are present
  • there is evidence of significant prenatal alcohol exposure
  • there are one or more of the characteristic facial features, growth deficits, and known or probable prenatal alcohol exposure
  • there are one or more the characteristic facial features with pre- or post-natal growth deficits, or both (at or below the tenth percentile), and one or more central nervous system deficits, and known or probable prenatal alcohol exposure.

More about screening 

Certain populations should receive special attention in screening for FASD, including:

  • children seen in neurodevelopmental and/or birth defect clinics
  • children in special education programs
  • children in child care systems (e.g., orphanages, foster care, child welfare/social services)
  • correctional populations
  • youth in juvenile justice programs
  • clients of the mental health care system.

FASD diagnostic clinics

The Canada FASD Research Network (CanFIND) has a list of diagnostic clinics in Alberta, British Columbia, Manitoba, Saskatchewan, and the Yukon and Northwest Territories.

The Fetal Alcohol Spectrum Disorder Ontario Network of Expertise (FASD ONE) provides information about diagnostic services in Ontario. The information is organized by region.

FASD Child Welfare has a online searchable database that can be filtered by province and treatment category.

Screening resources

  • National Screening Tool Kit for Children and Youth Identified and Potentially Affected by FASD (Public Health Agency of Canada, 2012). The toolkit includes links to:
    • Neurobehavioural Screening Tool (for 6–18-year-olds)
    • Maternal Drinking Guide (for at-risk women)
    • Medicine Wheel tool (for 4–14-year-olds and at-risk mothers)
    • FASD Screening & Referral Form for Youth Probation Officers (for youth)
    • Meconium Fatty Acid Ethyl Esters (FAEE) Testing (for newborns and at-risk mothers)