Assessing for Fetal Alcohol Spectrum Disorder: A Survey of Assessment Measures Used in Alberta, Canada

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Kelly D Coons-Harding
Katherine Flannigan
Colleen Burns
Hasmukhlal Rajani
Brent Symes


fetal alcohol spectrum disorder, assessment, diagnosis, psychometric testing, clinical practice



The recommended “gold standard” for Fetal Alcohol Spectrum Disorder (FASD) assessment involves a multidisciplinary diagnostic team and comprehensive battery of neuropsychological tests to evaluate functioning across 10 brain domains. The current Canadian Guideline for diagnosis of FASD outlines a list of test measures for assessment; however, very little research exists to explore which specific tools are being used in clinical practice.


The purpose of the current study was to gain a better understanding of the testing measures used by FASD clinicians in Alberta, Canada.



A survey was sent to coordinators of 23 Alberta FASD clinics requesting them to distribute the survey to their diagnostic team members, including physicians, psychologists, speech-language pathologists (SLPs), and occupational therapists (OTs).



A wide range of measures (both direct and indirect; n = 173) to assess brain domains were reported by clinics. Many tests were used to assess function across multiple brain domains. Most of the commonly used tests aligned with those suggested in the Canadian Guideline; however, there were many additional measures being used that were that were not listed in the Guideline.



This study revealed important information about the use of testing measures in FASD assessment and sheds light on the commonalities in practice across clinics in Alberta. Results demonstrate strong convergence of direct and indirect measures to assess brain function. Ultimately, identifying a comprehensive, reliable, and usable testing battery of measures for FASD assessment will improve the clarity and accuracy of the diagnostic process and facilitate advancements in the field, as well as enable comparisons across clinics.


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1. Chudley AE, Conry J, Cook JL, et al. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ 2005;172:S1–S21.
2. Cook JL, Green CR, Lilley CM, et al. Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. CMAJ 2016;188:191–97.
3. Streissguth AP, Barr HM, Kogan J, Bookstein FL. Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Seattle: Fetal Alcohol and Drug Unit; 1996.
4. Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O’Malley K, Young J. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr 2004;25:228–38.
5. Stratton K, Howe C, Battaglia, F. Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment. Washington: National Academy Press; 1996.
6. Astley, SJ, Clarren SK. Diagnostic guide for fetal alcohol syndrome and related conditions: The 4-digit diagnostic code (2nd Ed.). Seattle: University of Washington Publication Services; 1999.
7. Astley, SJ. Diagnostic guide for fetal alcohol spectrum disorders: The 4-digit diagnostic code (3rd Ed.). Seattle: University of Washington Publication Services; 2004.
8. Hoyme HE, Kalberg WO, Elliott AJ, et al. Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders. Pediatrics 2016;138.
9. Watkins, RE, Elliott EJ, Wilkins A, et al. Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia. BMC Pediatr 2013;13.
10. Mattson SN, Crocker N, Nguyen TT. Fetal alcohol spectrum disorders: Neuropsychological and behavioral features. Neuropsychol Rev 2011;21:81–101.
11. McLachlan K, Andrew G, Pei J, Rasmussen C. Assessing FASD in young children: Exploring clinical complexities and diagnostic challenges. J Popul Ther Clin Pharmacol 2015;22:e108–e124.
12. Government of Alberta. Fetal alcohol spectrum disorder (FASD): Year 5 evaluation of the Government of Alberta’s FASD 10-year strategic plan. Overview of key findings and recommendations. Available at:
13. Burns C. Alberta FASD assessment and diagnostic clinic waitlists: 2016 survey results. Cold Lake, Alberta: PolicyWise for Children & Families; 2017.
14. Canada FASD Research Network. Multidisciplinary team training for diagnosis of FASD: An online curriculum. Available at:
15. Government of Alberta. Alberta FASD cross-ministry committee. Available at:
16. Doyle LR, Mattson SN. Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE): Review of evidence and guidelines for assessment. Curr Dev Disord Rep 2015;2:175–86.
17. Lopata C, Smith RA, Volker MA, et al. Comparison of adaptive behavior measures for children with HFASDs. Autism Res Treat 2013;2013:1–10.
18. Toplak ME, West RF, Stanovich KE. Practitioner review: Do performance-based measures and ratings of executive function assess the same construct? J Child Psychol Psyc 2013;54:131–43.
19. Rai, JK. The ecological validity of neuropsychological tests of executive function in children with fetal alcohol spectrum disorder (FASD). Available at:
20. Gross AC, Deling LA, Wozniak JR, Boys CJ. Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders. Child Neuropsychol 2015;21:531–38.
21. Bush SS. Determining whether or when to adopt new versions of psychological and neuropsychological tests: ethical and professional considerations. Clin Neuropsychol 2010;24:7–16.
22. Connor PD, Sampson PD, Bookstein FL, Barr HM, Streissguth, AP. Direct and indirect effects of prenatal alcohol damage on executive function. Dev Neuropsychol 2000;18:331–54.
23. Rasmussen C. Executive functioning and working memory in fetal alcohol spectrum disorder. Alcohol Clin Exp Res 2005;29:1359–67.