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. Author manuscript; available in PMC: 2020 Jun 1.
Published in final edited form as: Alcohol Clin Exp Res. 2019 May 2;43(6):1046–1062. doi: 10.1111/acer.14040

Table 1.

Summary of diagnoses within the continuum of fetal alcohol spectrum disorders (FASD). Includes updated diagnostic criteria for FAS, PFAS, ARND and ARBD (Hoyme et al., 2016), as well as recommended criteria for ND-PAE (American Psychiatric Association, 2013).

Diagnostic
Categories		 Required Diagnostic Elements
FAS Fetal alcohol syndrome (FAS; with or without documented exposurea)
  1. Characteristic facial anomalies (including two or more of the following)
    1. Short palpebral fissures
    2. Thin vermilion border
    3. Smooth philtrum
  2. Growth deficiency (prenatal and/or postnatal)
    1. Height and/or weight ≤ 10th percentile for chronological age
  3. Abnormal brain growth (including one or more of the following)
    1. Head circumference ≤ 10th percentile
    2. Brain structure anomalies
    3. Recurrent nonfebrile seizures
  4. Evidence of neurobehavioral impairment (either cognitive or behavioral impairment required)
    1. Cognitive impairment
      1. Presence of global impairment (general conceptual ability, or performance, verbal or spatial IQ ≥ 1.5 SD below the mean) or cognitive impairment in at least one neurobehavioral domain (executive function, learning, memory, or visual-spatial) ≥ 1.5 SD below the mean*.
    2. Behavioral impairment
      1. Evidence of behavioral deficit in at least one domain of self-regulation (mood or behavioral regulation, attention, or impulse control) ≥ 1.5 SD below the mean.
PFAS Partial FAS (PFAS; with documented exposurea)
  1. Characteristic facial anomalies (including two or more of the following)
    1. Short palpebral fissures
    2. Thin vermilion border
    3. Smooth philtrum
  2. Evidence of neurobehavioral impairment (either cognitive or behavioral impairment required)
    1. Cognitive impairment
      1. Presence of global impairment (general conceptual ability, or performance, verbal or spatial IQ ≥ 1.5 SD below the mean) or cognitive impairment in at least one neurobehavioral domain (executive function, learning, memory, or visual-spatial) ≥ 1.5 SD below the mean*.
    2. Behavioral impairment
      1. Evidence of behavioral deficit in at least one domain of self-regulation (mood or behavioral regulation, attention, or impulse control) ≥ 1.5 SD below the mean*.

Partial FAS (PFAS; without documented exposure)
  1. Characteristic facial anomalies (including two or more of the following)
    1. Short palpebral fissures
    2. Thin vermilion border
    3. Smooth philtrum
  2. Growth deficiency or, abnormal brain growth
    1. Height and/or weight ≤ 10th percentile for chronological age, or
    2. Head circumference ≤ 10th percentile brain structure anomalies, or recurrent nonfebrile seizures
  3. Evidence of neurobehavioral impairment (either cognitive or behavioral impairment required)
    1. Cognitive impairment
      1. Presence of global impairment (general conceptual ability, or performance, verbal or spatial IQ ≥ 1.5 SD below the mean) or cognitive impairment in at least one neurobehavioral domain (executive function, learning, memory, or visual-spatial) ≥ 1.5 SD below the mean*.
    2. Behavioral impairment
      1. Evidence of behavioral deficit in at least one domain of self-regulation (mood or behavioral regulation, attention, or impulse control) ≥ 1.5 SD below the mean*.
ARND Alcohol-related neurobehavioral disorder (ARND)

  1. Documented exposurea

  2. Evidence of neurobehavioral impairment (either cognitive or behavioral impairment required)
    1. Cognitive impairment
      1. Presence of global impairment (general conceptual ability, or performance, verbal or spatial IQ ≥ 1.5 SD below the mean) or cognitive impairment in at least two neurobehavioral domains (executive function, learning, memory, or visual-spatial) ≥ 1.5 SD below the mean*.
    2. Behavioral impairment
      1. Evidence of behavioral deficit in at least two domains of self-regulation (mood or behavioral regulation, attention, or impulse control) ≥ 1.5 SD below the mean*.
ARBD Alcohol-related birth defects (ARBD)

  1. Documented exposurea

  2. One or more physical abnormalities that have been demonstrated to be a result of prenatal alcohol exposure through either animal models or human studies
ND-PAE Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE)

  1. Documented exposure to alcohol during gestationa

  2. Evidence of neurocognitive impairment (including one or more of the following)
    1. Global intellectual impairment
    2. Executive functioning deficit
    3. Learning impairment
    4. Visual-spatial reasoning deficit
    5. Memory deficit
  3. Evidence of self-regulation deficit (including one or more of the following)
    1. Mood or behavioral regulation impairment
    2. Attention deficit
    3. Impulse control deficit
  4. Evidence of adaptive functioning deficit (two or more required; ND-PAE diagnosis requires presence of a or b)
    1. Communication impairment
    2. Social communication and interaction deficit
    3. Daily living skills deficit
    4. Motor skills deficit
*

Criteria for children three years or older.

a
In order to establish documented prenatal alcohol exposure during pregnancy one or more of the following is required (Hoyme et al., 2016):
  1. Six or more drinks per week for two or more weeks during pregnancy
  2. Three or more drinks per occasion on two or more occasions during pregnancy
  3. Alcohol-related social or legal problems before/during pregnancy
  4. Evidence of alcohol-use during pregnancy (i.e. blood, breath, urine test)
  5. Documentation of alcohol-exposure during pregnancy or at birth using established biomarkers
  6. Increased risk of drinking during pregnancy determined by the use of a validated screening tool