FAS Screening in Foster Care    

In 1996, the FAS DPN developed the FAS Facial Photographic Analysis Software (Astley & Clarren, 1996, 2001; Astley et al., 2002; Astley, 2004). The software is used to measure the magnitude of expression of the three facial features of FAS (small eyes, a smooth philtrum and a thin upper lip). FAS is characterized by growth deficiency, a unique cluster of minor facial anomalies, central nervous system damage/dysfunction and prenatal alcohol exposure. The FAS face is the only feature that is unique to FAS, thus it serves as an ideal feature to use for screening at-risk populations.

From 1999 to 2009, the FAS Facial Photographic Analysis Software has been used to screen all children entering long term care in the King County Foster Care Passport Program. Standardized digital facial photographs are obtained and measured by the University of Washington FAS DPN Clinic. Children who present with all three FAS facial features (defined by a Rank 4 Face in the FASD 4-Digit Diagnostic Code) screen positive for FAS and receive a full diagnostic evaluation at the Clinic using the FASD 4-Digit Diagnostic Code. Over 2,000 children have been screened to date, with 98% participation of the eligible population. The prevalence of FAS in this foster care population is 1 out of every 100.

Foster Care FAS Screening Results (Astley et al., 2002)
FAS Prevalence:
  • 1/100
    (or 10-times the prevalence in the general population)
Screening Tool Performance:
  • 100% Sensitivity
  • 99.8% Specificity
  • 85.7% Predictive Value Positive
  • 100% Predictive Value Negative

FAS Prevention

Data from this Foster Care FAS Screening Program are used to track the prevalence of FAS over time in this population-based sample. The prevalence of maternal drinking during pregnancy in Washington State declined significantly from 1993 to 1998 (PRAMS, 1999) as did the prevalence of FAS among these foster children born from 1993 to 1998 (Astley, 2004). These observations strongly support that fetal alcohol syndrome prevention efforts in Washington State are working. For more details, go to the Prevention and Surveillance sections of this website.