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BMJ Open. 2012; 2(5): e001918.
Published online Oct 26, 2012. doi:  10.1136/bmjopen-2012-001918
PMCID: PMC3488737
Consensus diagnostic criteria for fetal alcohol spectrum disorders in Australia: a modified Delphi study
Rochelle E Watkins,1 Elizabeth J Elliott,2,3,4 Raewyn C Mutch,1,5 Janet M Payne,1 Heather M Jones,1 Jane Latimer,4 Elizabeth Russell,6 James P Fitzpatrick,2,4 Lorian Hayes,7 Lucinda Burns,8 Jane Halliday,9 Heather A D'Antoine,10 Amanda Wilkins,1,5 Elizabeth Peadon,2,3 Sue Miers,11 Maureen Carter,12 Colleen M O'Leary,1,13 Anne McKenzie,1 and Carol Bower1
1Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
2Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
3The Children's Hospital at Westmead, Sydney, New South Wales, Australia
4The George Institute for Global Health, Sydney, New South Wales, Australia
5Department of Health Western Australia, Child and Adolescent Health Service, Perth, Australia
6Russell Family Fetal Alcohol Disorders Association, Cairns, Queensland, Australia
7Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
8National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Victoria, Australia
9Public Health Genetics, Genetic Disorders, Murdoch Childrens Research Institute, Melbourne, Australia
10Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, South Australia, Australia
11National Organisation for Fetal Alcohol Syndrome and Related Disorders, Adelaide, Australia
12Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia
13Centre for Population Health Research, Curtin University, Perth, Western Australia, Australia
Correspondence to Dr Rochelle E Watkins; rwatkins/at/ichr.uwa.edu.au
Received August 14, 2012; Accepted September 26, 2012.
Abstract
Objective
To evaluate health professionals' agreement with components of published diagnostic criteria for fetal alcohol spectrum disorders (FASD) in order to guide the development of standard diagnostic guidelines for Australia.
Design
A modified Delphi process was used to assess agreement among health professionals with expertise or experience in FASD screening or diagnosis. An online survey, which included 36 Likert statements on diagnostic methods, was administered over two survey rounds. For fetal alcohol syndrome (FAS), health professionals were presented with concepts from the Institute of Medicine (IOM), University of Washington (UW), Centers for Disease Control (CDC), revised IOM and Canadian diagnostic criteria. For partial FAS (PFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD), concepts based on the IOM and the Canadian diagnostic criteria were compared.
Setting/participants
130 Australian and 9 international health professionals.
Results
Of 139 health professionals invited to complete the survey, 103 (74.1%) responded, and 74 (53.2%) completed one or more questions on diagnostic criteria. We found consensus agreement among participants on the diagnostic criteria for FAS, with the UW criteria most commonly endorsed when compared with all other published criteria for FAS. When health professionals were presented with concepts based on the Canadian and IOM diagnostic criteria, we found consensus agreement but no clear preference for either the Canadian or IOM criteria for the diagnosis of PFAS, and no consensus agreement on diagnostic criteria for ARND. We also found no consensus on the IOM diagnostic criteria for ARBD.
Conclusions
Participants indicated clear support for use of the UW diagnostic criteria for FAS in Australia. These findings should be used to develop guidelines to facilitate improved awareness of, and address identified gaps in the infrastructure for, FASD diagnosis in Australia.
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