Tools for Screening and Diagnosis

Physicians are often considered the front line of prevention with FASD. Brief interventions are delivered as part of clinical care visits. Effective brief interventions to reduce alcohol misuse include assessment, advice, agreement on goals, assistance to stop drinking, and arrangement of followup or referral for additional assistance. Good evidence shows that assessment or screening, brief intervention, and followup with nondependent alcohol drinkers at risk of alcohol-related health consequences can reduce alcohol consumption. Screening and brief interventions also can identify pregnant women for more intensive intervention. The main goals of the following tools are to increase the identification of individuals with fetal alcohol syndrome (FAS) and to improve the delivery of appropriate services to those individuals and their families. The following tools are also provided to assist physicians with working with women of childbearing years, pregnant and nursing women.

• Guidelines for Referral and Diagnosis of Fetal Alcohol Syndrome Centers for Disease Control and Prevention. 2004. Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Atlanta, GA. Department of Health and Human Services. www.cdc.gov/ncbddd/fas/documents/FAS_guidelines_accessible.pdf
• Fetal Alcohol Syndrome TUTOR, CD This comprehensive tool distributed by the March of Dimes helps health professionals screen and diagnose children with fetal alcohol syndrome. The CD-ROM uses descriptive text, video clips, animations and illustrations to assist users. For Windows and Macintosh. For more information about ordering a copy , click here.

• Preventing Fetal Alcohol Spectrum Disorders Intervention Guides and Resources
  Screening and Brief Clinical Interventions To Reduce Alcohol Use
  Brief interventions are delivered as part of clinical care visits. Effective brief interventions to reduce alcohol misuse include assessment, advice, agreement on goals, assistance to stop drinking, and arrangement of followup or referral for additional assistance. Good evidence shows that assessment or screening, brief intervention, and followup with nondependent alcohol drinkers at risk of alcohol-related health consequences can reduce alcohol consumption. Evidence on the effectiveness of brief intervention for pregnant women is more limited but is sufficient to recommend it. Screening and brief interventions also can identify pregnant women for more intensive intervention. Follow the link above to access further information.

• Double Arc:Double ARC is a non-profit organization founded by the Sisters of Notre Dame in 1992. The focus of Double ARC is addressing the needs of children whose behavior and academic challenges put them at risk of failure. Double ARC also specializes in children with FASD who are challenged in academic areas.

• SAMSHA: Center for Fetal Alcohol Spectrum Disorder, Center for Excellence
• NIAAA: National Institute on Alcohol Abuse and Alcoholism

• The National Center for Education in Maternal and Child Health has produced a set of guidelines for screening for a substance abuse during pregnancy. Their guidelines can be found at http://www.ncemch.org/pubs/PDFs/SubAbuse.pdf.

  What follows is a useful guide to screening for substance abuse during pregnancy. Click on the instrument of choice for the list of specific questions.

   

  Instrument	Features	Strengths	Concerns
  CAGE Cut down Annoyed Guilty Eye Opener	4 questions, not specifically designed for screening pregnant women.	Assess lifetime rather than current alcohol related problems.	Does not identify heavy drinker who have not experienced alcohol related problems. More effective in screening men than women.
  T-ACE Tolerance- Annoyed Cut down Eye Opener	4 questions, one question regarding how many drinks to feel high, three questions from CAGE.	Developed for use in Ob/Gyn practice. More sensitive to risk drinking than CAGE.
  TWEAK Tolerance Worry Eye Opener Amnesia Cut-Down	5 questions, combines questions from the MAST, CAGE, & T-ACE	More sensitive and less specific than the T-ACE. Out performs the MAST or CAGE.
  MAST Michigan Alcoholism Screening Test	25 questions, not specifically designed for screening pregnant women		Does not identify heavy drinkers who have not experienced alcohol related problems. More effective in screening men.
  AUDIT Alcohol Use Disorder Identification Test	10 questions, combines questions about alcohol use directly and on consequences of alcohol use	Its purpose is the early identification of harmful drinking.	Not been evaluated in obstetric population.
  4 P's	4 questions about alcohol or drug use during current pregnancy, in her past, by her partner, and by her parents	Yes or No format, easy to administer and score.	Potential lack of specificity.
  Modified 5P’s	5 questions, about alcohol or drug use during this pregnancy, by her parents, by her partner, in her past, in her previous pregnancy.	Questions about alcohol use during previous pregnancy may help to diagnose FAS in woman’s other children.	Potential lack of specificity.
  TQDH Ten Question Drinking History	10 questions that focus on type and amount of alcohol consumed.	Does not differentiate between beer, wine and liquor.	More than 4 drinks per week is considered risk drinking. Best for women not yet pregnant.

  Citation: Morse B, Gehshan S, Hutchins E. 1997. Screening for a Substance Abuse During Pregnancy: Improving Care, Improving Health. Arlington, VA: National Center for Education in Maternal and Child Health.

  The National Institute on Alchol Abuse and Alcoholism has released updated guidelines for primary care physicians and mental health specialists:

  Helping Patients Who Drink Too Much: A Clinician's Guide 2005

  http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf