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Assessing neurodevelopmental impairment

In FASD, 10 domains of neurodevelopment have been identified that reflect areas of brain function known to be affected by prenatal alcohol exposure based on evidence from human and animal research and clinical experience. The following domains should be assessed as part of the diagnostic evaluation for FASD:

  1. Brain structure/Neurology
  2. Motor skills
  3. Cognition
  4. Language
  5. Academic achievement
  6. Memory
  7. Attention
  8. Executive function, including impulse control and hyperactivity
  9. Affect regulation
  10. Adaptive behaviour, social skills or social communication

The clinical cut-off for severe impairment is defined either as a global score or a major subdomain score on a standardised validated neurodevelopmental scale that is 2 or more standard deviations below the mean (≤2 SD) or less than the 3rd percentile (<3rd PC). Clinical judgement should be used to determine whether severe impairment is present is a range of situations.

Detailed information is available in Section B of the Australian Guide to the diagnosis of FASD. Table 3 in this section includes the criteria for severe impairment in each domain and the definition, considerations and direct assessment.