FASD 4-Digit Diagnostic Code TM (2004)    


The most current versions of the FASD 4-Digit Diagnostic Code TM and Lip-Philtrum Guides are the 3rd edition released in 2004. The most recent version of the FAS Facial Photographic Analysis Software is Version 2.0 released in 2012. All clinicians are encouraged to upgrade to this lastest version.

The 1st edition of the FASD 4-Digit Diagnsotic Code was developed by the Washington State FAS Diagnostic and Prevention Network (FAS DPN) in 1997. The 4-Digit Code is a simple, comprehensive, evidence-based method for diagnosing the full spectrum of outcomes observed among individuals with prenatal alcohol exposure. The 4-Digit Diagnostic Code provides more accurate and reproducible diagnoses than the gestalt method due to its use of quantitative, objective measurement scales, and specific case-definitions.

The four digits in the Code reflect the magnitude of expression of the four key diagnostic features of FASD in the following order: (1) growth deficiency, (2) the FAS facial features, (3) central nervous system (CNS) structural and functional abnormalities, and (4) prenatal alcohol exposure. The magnitude of expression of each feature is ranked independently on a 4-point Likert scale with 1 reflecting complete absence of the FASD feature and 4 reflecting a strong "classic" presence of the FASD feature. The 4-Digit Code also documents and ranks all other prenatal and postnatal risk factors that often accompany prenatal alcohol exposure. The 4-Digit Code is used to diagnose individuals across the entire age span (birth through adult).

The 4-Digit Diagnostic Code has been used to diagnose thousands of patients in the WA State FAS DPN clinics over the past 20 years. The 4-Digit Code is designed for use by an interdisciplinary FASD diagnostic team. The University of Washington team includes a medical doctor, 2 psychologists, an occupational therapist, a speech-language pathologist, a social worker, a family advocate, and a public health professional. Click here for a detailed description of the interdisciplinary approach to FASD diagnosis used by the Washington State FAS DPN.

One Example of FAS
 
3
4
4
 
4
   
significant
significant
definite
4  
X
X
 
X
4
high risk
moderate
moderate
probable
3
X
        3
some risk
mild
mild
possible
2           2
unknown
none
none
unlikely
1           1
no risk

Growth
Deficiency

FAS Facial
Features
CNS
Damage
 
Growth
Face
CNS
Alcohol
 
Prenatal
Alcohol
   

Evidence-Base and Validation.

The FASD 4-Digit Code was established from an extensive evidence base that included testing its performance for 4 years in the FASD Clinic on 1,014 patients before its release in 1997. We have continued to extensively test (validate) the performance of the FASD 4-Digit Code on thousands of patients over the past 20 years. The evidence-base that validates the performance of the 4-Digit Code is presented in the following research publications and presentations:

Validation of the FASD 4-Digit Code (Astley 2013)

Astley (2011, 2011a, 2010,2010a, 2010b, 2006, 2004, 2004a)

Astley & Clarren (1995, 1996, 2000, 2001);

Astley et al ( 1999, 2002, 2009a, 2009b, 2009c, 2009d).

The FASD 4-Digit Diagnostic Code is used by FASD diagnostic teams worldwide. Recent international surveys have identified the 4-Digit Code as the most common FASD diagnostic system used worldwide. Over 700 professionals worldwide have completed the FASD 4-Digit Diagnostic Code Online Course.

 


Click here to view this pdf presentation with audio narration by Dr. Astley

(This is a large pdf file (45 MB), so give it a few minutes to fully download)

The presentation above entitled "Validation of the FASD 4-Digit Diagnostic Code" is a comprehensive summary of all evidence published to date validating the performance of the FASD 4-Digit Code.

Dr. Astley presented this talk at the 5th International Conference on FASD (Vancouver BC, March 2013) and the Artic FASD RTC Conference (Alaska, May 2013). The presentation is a pdf file with audio narration of each slide. To listen to the audio, turn your computer speaker on and right mouse click on the audio icon. Select 'Play File' from the menu that drops down.


Free Copy of the Diagnostic Guide

You are welcome to download a free copy of the Diagnostic Guide for Fetal Alcohol Spectrum Disorders: the 4-Digit Diagnostic Code (2004). To order a printed, bound copy of the Diagnostic Guide with tabs for easy reference, click here.