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To the Editor.—
I commend Hoyme and his colleagues for their report in the January 2005 issue of Pediatrics, "A Practical Clinical Approach to Diagnosis of Fetal Alcohol Spectrum Disorders: Clarification of the 1996 Institute of Medicine Criteria."1 As the authors point out, diagnosis of fetal alcohol syndrome (FAS) and other disorders resulting from prenatal exposure to alcohol is very challenging. Lack of specificity in descriptions of initial diagnostic criteria for FAS has added to the challenges. The authors bring much needed attention to the dangers of prenatal exposure to alcohol and the importance of early identification and intervention. We now recognize that FAS represents the tip of the iceberg and that there is a continuum of negative outcomes associated with prenatal exposure to alcohol, referred to as fetal alcohol spectrum disorders. An important contribution of Hoyme et al is drawing attention to the fact that no gold standard exists for the diagnosis of the full spectrum of disorders. To gain a better understanding of the full range of effects that can manifest when a child is exposed prenatally to alcohol, physicians, scientists, and other clinicians must be updated continually on diagnostic considerations that reflect new scientific findings.
Last year, the Centers for Disease Control and Prevention's (CDC's) National Center on Birth Defects and Developmental Disabilities, in collaboration with the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effects, published Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis2. These guidelines represent the deliberations of clinicians, researchers, parents, and representatives of governmental and nongovernmental organizations whose main goals were to increase the identification of individuals with FAS and incorporate this information into training of pediatricians and other health professionals. These guidelines were intentionally developed to harmonize with other diagnostic systems currently in use in this country and abroad (eg, Canada). Several aspects of the criteria set out by Hoyme et al are consistent with the CDC guidelines as well as other systems currently in use. It is encouraging to see that many aspects of the diagnosis of FAS across these diagnostic systems converge despite differences across some of the criteria thresholds.
The CDC recognizes that there is a great need for science-based information to facilitate diagnostic criteria for additional related disorders beyond FAS such as alcohol-related neurodevelopmental disorder. Information provided by Hoyme and his colleagues provides a much needed contribution to that effort. However, the need still exists for research and continuous refinement of the diagnostic criteria for FAS and related conditions so that affected individuals and their families can receive important services that enable them to achieve healthy lives and reach their full potential.
On December 4, 2004, the Surgeon General released an updated version of an earlier warning that women who are pregnant, or may become pregnant, should not drink alcohol. The CDC is pleased to provide continuing support for the expansion and refinement of scientific descriptions for FAS and other disorders related to prenatal exposure to alcohol through ongoing work with the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effects and the federal Interagency Coordinating Committee on Fetal Alcohol Syndrome. These efforts are enhanced by the information that Hoyme and his colleagues gathered from their diagnostic experiences with children who had prenatal alcohol exposure.
Preventing all adverse outcomes associated with prenatal alcohol exposure remains a primary goal of the CDC as well as the entire US Department of Health and Human Services as stated in the Healthy People 2010 objectives. The CDC is committed to working with other federal agencies, professional groups, nonprofit organizations, and the public to achieve this goal. Similarly, we are committed to enhanced early identification of individuals with FAS and related disorders to ensure their access to appropriate services. Information provided by Hoyme et al, the CDC guidelines for referral and diagnosis, the University of Washington's 4-digit system,3 and other diagnostic approaches are all important steps toward that goal. Our efforts to coordinate and integrate these clinical profiles to the greatest extent possible will result in increased clarity and enhanced ability of practicing clinicians to recognize and assist individuals with prenatal alcohol-related deficits and disorders.
REFERENCES
Related articles in Pediatrics:
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