title: Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia.
abstract: BACKGROUND
  Fetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia.
  
  
  METHODS
  An online survey about FASD screening and diagnosis in Australia, which included 23 statements describing criteria for referral for fetal alcohol syndrome (FAS) and FASD based on published recommendations for referral in North America, was sent to 139 health professionals who had expertise or involvement in FASD screening or diagnosis. Survey findings and published criteria for referral were subsequently reviewed by a panel of 14 investigators at a consensus development workshop where criteria for referral were developed.
  
  
  RESULTS
  Among the 139 health professionals who were sent the survey, 103 (74%) responded, and 90 (65%) responded to the statements on criteria for referral. Over 80% of respondents agreed that referral for specialist evaluation should occur when there is evidence of significant prenatal alcohol exposure, defined as 7 or more standard drinks per week and at least 3 standard drinks on any one day, and more than 70% agreed with 13 of the 16 statements that described criteria for referral other than prenatal alcohol exposure. Workshop participants recommended five independent criteria for referral: confirmed significant prenatal alcohol exposure; microcephaly and confirmed prenatal alcohol exposure; 2 or more significant central nervous system (CNS) abnormalities and confirmed prenatal alcohol exposure; 3 characteristic FAS facial anomalies; and 1 characteristic FAS facial anomaly, growth deficit and 1 or more CNS abnormalities.
  
  
  CONCLUSIONS
  Referral criteria recommended for use in Australia are similar to those recommended in North America. There is a need to develop resources to raise awareness of these criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia.
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, Australia. rochelle.watkins@telethonkids.org.au.
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Watkins
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
authors.forename: Amanda
authors.initials: A
authors.lastname: Wilkins
authors.forename: Jane
authors.initials: J
authors.lastname: Latimer
authors.forename: Jane
authors.initials: J
authors.lastname: Halliday
authors.forename: James P
authors.initials: JP
authors.lastname: Fitzpatrick
authors.forename: Raewyn C
authors.initials: RC
authors.lastname: Mutch
authors.forename: Colleen M
authors.initials: CM
authors.lastname: O'Leary
authors.forename: Lucinda
authors.initials: L
authors.lastname: Burns
authors.forename: Anne
authors.initials: A
authors.lastname: McKenzie
authors.forename: Heather M
authors.initials: HM
authors.lastname: Jones
authors.forename: Janet M
authors.initials: JM
authors.lastname: Payne
authors.forename: Heather
authors.initials: H
authors.lastname: D'Antoine
authors.forename: Sue
authors.initials: S
authors.lastname: Miers
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Russell
authors.forename: Lorian
authors.initials: L
authors.lastname: Hayes
authors.forename: Maureen
authors.initials: M
authors.lastname: Carter
authors.forename: Carol
authors.initials: C
authors.lastname: Bower
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D001291:Attitude of Health Personnel; D001315:Australia; D032921:Consensus; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis* / Q000209:etiology; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008425:Maternal Behavior; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis / Q000209:etiology; D012017:Referral and Consultation / Q000592:standards*; D012307:Risk Factors