The confirmation of a diagnosis and creation of a pediatric medical home care and treatment plan for an individual with an FASD often requires coordination of multiple physicians, non-physician clinicians, allied health, educational, and support service professionals. Referral to one or more specialists may be necessary if it is not clear whether diagnostic criteria for an FASD are met. Referrals for a diagnostic evaluation and/or needed services will depend on the available resources in your geographic area.
Primary care pediatricians are expected to work with a team when possible to make diagnoses in the FASD spectrum, especially for Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (ND-PAE). Primary care providers can seek training to be able to make diagnoses under the FASD umbrella. View the Common Diagnostic Approaches page for an overview of diagnostic schema for FASD. Contact the FASD REAL Champions Network for additional guidance and training to support decision-making and the referral process.
When a diagnosis, or identification that a diagnostic evaluation is necessary, the medical home pediatrician can convene an interprofessional team, generate the needed referrals, and monitor progress. Pediatricians are the trusted point of contact to coordinate the recommendations of the care team professionals, communicate information to the family, and ensure follow up treatment.
Potential members of team-based care for an individual with an FASD may include:
- Referral to a developmental-behavioral pediatrician may be necessary in complex presentations when subspecialty expertise is needed to assess and diagnose developmental and behavioral difficulties including FASDs. These subspecialist pediatricians often have training in recognizing genetic syndromes which enables them to evaluate facial dysmorphology if a clinical geneticist is not available.
- Referral to a geneticist may be necessary when there is a need to screen for potential genetic conditions that may present with symptoms similar to those of an FASD.
- The psychologist/neuropsychologist with appropriate training and experience may conduct a neurocognitive/psychological evaluation considering cognition, executive function, socio-emotional function, adaptive skills, academic achievement, and self-regulation within the context of the individual’s family/community. For children experiencing mental health issues such as depression or anxiety, a referral to a psychiatrist may be warranted.
- Referral to a neurologist is appropriate to assess for central nervous system abnormalities, such as a seizure disorder, sleep issues or focal neurologic deficits.
- A social worker may conduct an assessment of the individual’s and family’s strengths and challenges, serve as a family advocate for services and resources, and facilitate counseling services and connection to community resources.
Early Intervention Services
- Early intervention services provide families with children from birth to 36 months of age with appropriate developmental assessment, monitoring, services, and support to assist in maximizing the potential of a child with developmental delays. Currently 46 states (and Washington, D.C.) recognize the diagnosis of FAS as a diagnosed condition which provides immediate eligibility for services.
Educational Specialist and/or School Function Evaluator
- Educational specialists and/or school function evaluators perform an assessment of an individual’s academic abilities and achievement and develop an educational plan with accommodations. Educational specialists can help advocate for families as they navigate the Special Education system.
- A family therapist facilitates improved parenting skills, family function, and positive relationships within the family.
- An occupational/physical therapist evaluates an individual’s fine motor, gross motor, and adaptive functioning, as well as sensory integration, and provides therapeutic intervention when indicated.
- A speech-language pathologist assesses an individual’s receptive, expressive, pragmatic and written language skills.
American Academy of Pediatrics