A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: clarification of the 1996 institute of medicine criteria.
BACKGROUND
The adverse effects of alcohol on the developing human represent a spectrum of structural anomalies and behavioral and neurocognitive disabilities, most accurately termed fetal alcohol spectrum disorders (FASD). The first descriptions in the modern medical literature of a distinctly recognizable pattern of malformations associated with maternal alcohol abuse were reported in 1968 and 1973. Since that time, substantial progress has been made in developing specific criteria for defining and diagnosing this condition. Two sets of diagnostic criteria are now used most widely for evaluation of children with potential diagnoses in the FASD continuum, ie, the 1996 Institute of Medicine (IOM) criteria and the Washington criteria. Although both approaches have improved the clinical delineation of FASD, both suffer from significant drawbacks in their practical application in pediatric practice.


OBJECTIVE
The purpose of this report is to present specific clarifications of the 1996 IOM criteria for the diagnosis of FASD, to facilitate their practical application in clinical pediatric practice.


METHODS
A large cohort of children who were prenatally exposed to alcohol were identified, through active case-ascertainment methods, in 6 Native American communities in the United States and 1 community in the Western Cape Province of South Africa. The children and their families underwent standardized multidisciplinary evaluations, including a dysmorphology examination, developmental and neuropsychologic testing, and a structured maternal interview, which gathered data about prenatal drinking practices and other demographic and family information. Data for these subjects were analyzed, and revisions and clarifications of the existing IOM FASD diagnostic categories were formulated on the basis of the results.


RESULTS
The revised IOM method defined accurately and completely the spectrum of disabilities among the children in our study. On the basis of this experience, we propose specific diagnostic criteria for fetal alcohol syndrome and partial fetal alcohol syndrome. We also define alcohol-related birth defects and alcohol-related neurodevelopmental disorder from a practical standpoint.


CONCLUSIONS
The 1996 IOM criteria remain the most appropriate diagnostic approach for children prenatally exposed to alcohol. The proposed revisions presented here make these criteria applicable in clinical pediatric practice.
Hoyme
H Eugene
HE
Department of Pediatrics, Division of Medical Genetics, H-315, Stanford University School of Medicine, Stanford, CA 94305-5208, USA. gene.hoyme@stanford.edu
May
Philip A
PA
Kalberg
Wendy O
WO
Kodituwakku
Piyadasa
P
Gossage
J Phillip
JP
Trujillo
Phyllis M
PM
Buckley
David G
DG
Miller
Joseph H
JH
Aragon
Alfredo S
AS
Khaole
Nathaniel
N
Viljoen
Denis L
DL
Jones
Kenneth Lyons
KL
Robinson
Luther K
LK
D000014:Abnormalities, Drug-Induced / Q000175:diagnosis; D020751:Alcohol-Induced Disorders / Q000145:classification / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005145:Face / Q000002:abnormalities; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D007198:Indians, North American; D008607:Intellectual Disability / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D018811:Maternal Exposure; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D013019:South Africa; D014481:United States