Online Course: (2004) FASD 4-Digit Diagnostic Code    

FAS is a permanent birth defect syndrome caused by maternal consumption of alcohol during pregnancy. FASD is the leading known cause of mental retardation and developmental disabilities and is entirely preventable. Learn an interdisciplinary clinical approach to diagnosing FASD using the (2004) 4-Digit Diagnostic Code. The 4-Digit Code is a validated diagnostic system used worldwide. This online course includes case studies, animations, practice sessions and self-assessment.

  • The Online Course is open for registration.
  • Earn 2 Continuing Education Units (CEU).
  • The Course was developed by Susan J. Astley Hemingway, Ph.D. and the University of Washington FAS DPN Clinical Team.

Click here to view an introductory video of the Online Course.

The video requires Windows Media Player software to view. If you are using a computer with Microsoft's Windows operating system, you may already have this software loaded in your computer. If you do not have this software, or the version you have is outdated, a free copy of the software can be downloaded from Microsoft.

Click here to view the Course Evaluation by students who have completed the course. Over 1,000 professionals worldwide have completed the course through 2017.



To register for the 4-Digit Diagnostic Code Online Course:

  1. Complete and submit the Order Form.
    The Order Form allows you to:

    Register for the Course and purchase the Course Materials.
    The Course Materials include:

  2. The FASD Diagnostic Guide (2004) with a Caucasian and African American Lip-Philtrum Guide.
    You are welcome to purchase a hard-copy of these Guides using the Order Form. You may also download a free copy of the FASD Diagnostic Guide (2004) by clicking here.

    To begin the Course, you must pay the registration fee. You may purchase the Course Materials at anytime during the Course (e.g., at the time of Registration or after you have started the Course).

  1. Upon receipt of your Order Form and Registration Fee, we will email you your User ID. This ID will provide you access to the Online Course.
The Online Course:
  • Consists of an individual-start, self-paced, fully online program. The course includes readings, exercises, quizzes and video segments of an actual FAS Diagnostic Evaluation. This 20-hour course is designed for completion in 4 weeks. Students may complete the course in less time or may take up to 16 weeks. Students may start the course on any date.

  • Presents an overview of current assessment and diagnostic strategies for FASD.

  • Introduces the role of interdisciplinary clinical teams in the screening and diagnosis of FAS, based on the model of the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network (FAS DPN). The network comprises four community-based clinics linked by the core clinical/research/training clinic at the Center on Human Development and Disability at the University of Washington in Seattle. A typical interdisciplinary team includes a pediatrician, psychologist, speech and language pathologist, occupational therapist, and a family/maternal advocate.

  • Provides detailed training and practice in the use of the (2004) FASD 4-Digit Diagnostic Code. The four digits of the code reflect the magnitude of expression of the four key diagnostic features of FASD:

    • Growth deficiency,
    • The FAS facial features,
    • CNS damage/dysfunction, and
    • Prenatal alcohol exposure.

The code is generated by first recording key clinical data on a standardized FASD Diagnostic Form and following specific case-definitions to generate each digit. 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. Each Likert rank is specifically case-defined.

  • Provides training and practice in the use of the FAS Facial Photographic Analysis Software (Version 2.0. 2016). Developed by Susan Astley Hemingway Ph.D., this software has been used to accurately measure the full continuum of expression of the FAS facial features in over 10,000 individuals, birth to adult, evaluated in the FASD screening and diagnostic programs conducted by the Washington State FAS Diagnostic & Prevention Network: This software:

    • Is designed for use by health care and research professionals.
    • Provides a user-friendly, inexpensive, objective method for analyzing digital facial photographs obtained in a clinical or research setting.
    • Allows users to import a digital facial photograph and measure the magnitude of expression of the key facial features of FAS using the 4-Digit Diagnostic Code (Astley, 2004).

  • Enables participants to:

    • Understand the full spectrum of outcomes associated with prenatal alcohol exposure.
    • Recognize the importance of an interdisciplinary approach to FASD screening and diagnosis.
    • Use the (2004) FASD 4-Digit Diagnostic Code.
    • Use the (2016) FAS Facial Photographic Analysis Software.

  • Presents over 8 hours of streaming video of an actual FASD Diagnostic evaluation conducted by the University of Washington FASD Interdisciplinary Diagnostic team using the 4-Digit Code. The 9 year old patient will receive a diagnosis of FAS. All phases of the evaluation are presented:
    • Parent interview;
    • Assessment of the child by the SLP, psychologist, and OT;
    • Measurement of the facial features directly and with the FAS Facial photographic analysis software;
    • Team derivation of the 4-Digit Code and intervention plan,
    • Team sharing the diagnosis with the parents.


Computer and Printer Requirements for the Online Course

We have made every effort to design this course to be User Friendly. This course does require the student have access to a computer system that reflects today's computing technology (see recommendations below). If you discover that this Online Course does not run adequately on your computer system, we will be happy to refund your Course Registration Fee.

To take this Online Course we recommend the following hardware and software:

  • Web Browser
    This course performs most optimally in Internet Explorer. Other browsers (e.g., Mozilla, Netscape, etc) should also work, but those browsers may encounter some problems translating the code.

  • Computer:
    We recommend the following system requirements:

    Pentium4; 2.0 GHz processor; 512 MB RAM; 1280 x 1024 monitor, 32-bit color.
    Adobe Reader software (to view pdf files). Download the most current free version for Windows 2000/XP by going to the link provided here.
    QuickTime software (to view movie files). Download most current free version for Windows 2000/XP by going to the link provided here.
    Please note: this Online Course was not tested on a MacIntosh Computer.
  • Printer
    Students will need access to a printer to print a hard copy of the Exercise Forms. You will be asked to complete the forms in pencil as you progress through the lessons.

  • Software - Operating System
    If you choose to use the "FAS Facial Photographic Analysis Software", please review the computer specifications required for the software.

Who will Benefit from the Online Course?
  • This course is intended for clinical and research professionals engaged in the screening and/or diagnosis of individuals with prenatal alcohol exposure. Those who will benefit most are members of interdisciplinary FASD diagnostic teams. Team members typically include, but are not limited to, medical doctors, psychologists, speech-language pathologists, occupational therapists, and social workers. This course can also serve as continuing education for individuals seeking updated training on the FASD 4-Digit Diagnostic Code. This online course compliments the 2-Day FASD Diagnostic Training for Interdisciplinary Teams.
How does this Online Course Differ from the 2-Day FASD Team Training?
  • This Online Course provides more in-depth instruction on how to use the FASD 4-Digit Diagnostic Code and FAS Facial Photographic Analysis Software. The course is self-paced and can be taken in the convenience of your own office/home. The course provides detailed training and practice sessions with self-assessment to confirm your level of competency. It also includes video segments of an actual FAS Diagnostic Evaluation.

  • The 2-Day FASD Diagnostic Training for Interdisciplinary Teams provides a broader overview of the interdisciplinary approach to screening, diagnosis, and prevention of FASD using the 4-Digit Diagnostic Code. The 2-Day Course provides you with direct interaction and instruction from the FAS DPN Diagnostic Team. Trainees directly observe two actual FASD diagnostic evaluations. The 2-Day Training is intended to compliment the Online Course.
Recommended Training Options

Our training recommendations below are based on the principle that training is important, but can be time consuming and expensive. To this end, we offer training online and onsite, at cost or free.

  • For Interdisciplinary Teams seeking to establish a FASD Diagnostic Clinic in their Community:

    • We recommend all team members complete the FASD 4-Digit Code Online Course prior to attending the 2-Day Training to confirm their competency in the use of the 4-Digit Diagnostic Code.
    • Optional: We also recommend all (or a core subset of) team members attend the 2-Day FASD Diagnostic Training for Interdisciplinary Teams. The 2-Day Training will allow your team to observe the FAS DPN interdisciplinary FASD diagnostic team conduct two FASD diagnostic evaluations using the FASD 4-Digit Code.

  • For individual professionals seeking initial or updated, in-depth training on the use of the 4-Digit Diagnostic Code:

  • For new team members joining an already existing FASD Diagnostic Team:

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