Steps to Diagnosis

The steps and processes required to diagnose children with FASD will vary from case to case, depending on the access to resources and available local health services. Typically, paediatric and allied health services work together in multidisciplinary teams to establish the evidence required for a diagnosis, including functional capacity. This multidisciplinary team will usually include a paediatrician, neuropsychologist, occupational and/or physiotherapist, speech pathologist, nurse and social worker trained to work with children.

All Health professionals,including those without access to a multidisciplinary team, can provide vital observations that inform the diagnosis, including a history of prenatal alcohol exposure, growth parameters and identified birth defects. Diagnosis can give parents, carers and early childhood educators insights into why a child responds in certain ways, and provide an evidence base from which to plan interventions. Refer to The Australian Guidelines for Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder shown below.

Australian Guidelines for Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder - 2025 - FULL VERSION

Developed to support Australian health practitioners involved in the assessment and diagnosis of FASD across the lifespan (Released 13 May 2025) View FULL Guidelines

Australian Guidelines for Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder - 2025 - BRIEF VERSION

An abridged version of the above guidelines including an Overview, Assessment Principles, Diagnostic Criteria and Diagnostic Algorithm. View BRIEF Guidelines

Three-step approach to diagnosis

1. Screening and referral

Parents, caregivers, early childhood educators and health professionals concerns about a child’s development, learning or behaviour should be followed by referral to health-based services for screening and assessment, including screening for prenatal alcohol exposure and other causes of developmental delay. In young children, speech pathologists or occupational therapists are often the first to recognise concerns.

2. Multidisciplinary assessment and diagnosis

A multidisciplinary team conducts an intake meeting and makes a series of assessments including a detailed family, medical and obstetric history; physical examination; laboratory investigations and multidisciplinary assessment prior to a diagnosis. Early childhood educators and parents and carers can inform this process by providing feedback on the child in the school or pre-school environment. Guidance for educators can be found in the resources below.

3. Therapeutic supports and strengthening family capacity

Feedback is provided to the families and educators. The multidisciplinary team of health professionals makes recommendations for health and educational supports and ongoing therapies. Ongoing observation enables tailored adjustments as individual needs change over time.

FASD Diagnostic Criteria and Assessment Process Fact Sheet

Download the interactive fact sheet

This guide is designed to support health professionals to make assessments that may result in a FASD diagnosis. It outlines the diagnostic criteria and assessment process.
Adapted from the Australian Guidelines for Assessment and Diagnosis of FASD (April 2025).

Key links:

Fetal alcohol spectrum disorder (FASD)
and complex trauma

A resource for educators

Fetal alcohol spectrum disorder (FASD) and early life trauma

What early childhood educators need to know

FASD Diagnostic criteria

Items A to E below explore the criteria for consideration of a FASD diagnosis as outlined in the Australian Guidelines for Assessment and Diagnosis for FASD.

Confirmed prenatal alcohol exposure

If all 3 sentinel facial features are present, they can be used as a proxy for prenatal alcohol exposure, because they are highly sensitive and specific for FASD.

Neurodevelopmental impairment

This impairment must be clinically significant or severe and involve at least 3 of the 9 functional domains shown in the Domains of neurodevelopment.

Support required

The neurodevelopmental impairments identified through diagnosis require support.

Developmental period

The onset of the impairment is in the developmental period throughout childhood.

Attribution to another condition or exposure

The presentation is not better attributed to another condition or exposure. This requires exclusion of: genetic, metabolic, and neurodegenerative conditions; familial developmental delay; and prenatal and postnatal exposures that may impair neurodevelopment.

Additional diagnostic requirements

Clinicians are asked to specify if the following are present and document details including the measurement, percentile rank, SD, or Z-score:

Sentinel facial features (short palpebral fissure, thin upper lip, flat philtrum)
Microcephaly
Growth deficit

They are also asked to document:

Associated features, e.g. epilepsy, birth defects, structural brain defects, vision and hearing difficulties and sleep disorder, and
Co-morbidities, including conditions specified in the DSM-5 should be recorded e.g. ADHD, ASD, anxiety, depression, PTSD

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