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Diagnosis, Assessment, and Treatment of Fetal Alcohol Spectrum Disorders: A Review of Clinical and Cost-Effectiveness and Guidelines

Published on: May 3, 2017
Project Number: RC0880-000
Product Line: Rapid Response
Research Type: Other Diagnostics
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the diagnostic test accuracy of tools or tests for the diagnosis and/or assessment of fetal alcohol spectrum disorder in individuals of any age?
  2. What is the clinical utility of diagnosis and/or assessment of fetal alcohol spectrum disorder in individuals of any age?
  3. What is the clinical effectiveness of the treatment of fetal alcohol spectrum disorder in individuals of any age?
  4. What is the cost-effectiveness of diagnosis and/or assessment of fetal alcohol spectrum disorder in individuals of any age?
  5. What is the cost-effectiveness of the treatment of fetal alcohol spectrum disorder in individuals of any age?
  6. What are the evidence-based guidelines associated with the diagnosis/assessment of and treatment for fetal alcohol spectrum disorder in individuals of any age?

Key Message

Preliminary evidence from ten diagnostic test accuracy studies indicated that a variety of tests or tools, including a decision tree model, checklist, test battery, narrative analysis tool, and computer-assisted landmark-based morphometric face analysis, showed promise as diagnostic tools in comparison to reference standards of unknown accuracy. Overall, there was insufficient evidence to suggest an optimal diagnostic test for FASD, and there remains no gold standard for FASD diagnosis. No evidence for the clinical utility or cost-effectiveness of diagnosis and/or assessment of FASD in individuals of any age was identified. Limited evidence from three systematic reviews and one primary study suggested that multi-dimensional treatment strategies (that include physical, mental health, behavioural, cognitive, and/or pharmacologic components) that are individually tailored for patients may be clinically effective. A single economic analysis indicated that the use of an FASD Service Network may result in cost-savings by preventing secondary disabilities (such as crime, homelessness, and mental health problems), however this analysis was based on model components that were estimated from the literature and effectiveness studies are needed. One evidence-based Canadian guideline was identified that provides recommendations regarding the diagnosis of FASD. Based on predominantly high-quality evidence, the guidelines provide strong recommendations for multi-disciplinary diagnosis based on criteria related to facial features, prenatal alcohol exposure, and neurodevelopmental effects.

Tags

pediatrics, diagnosis, fetal alcohol syndrome, needs assessment, Assessment, Diagnostic, Treating, FASD, Screening, Treatment