The Role of Developmental-Behavioral Clinicians in FASD Diagnosis and Management: Insights From a National Survey

OBJECTIVE: To examine the role of developmental and behavioral pediatric clinicians in diagnosing and managing Fetal Alcohol Spectrum Disorders (FASD), identify barriers related to diagnostic system variability and clinician preparedness, and propose a functional framework to complement existing diagnostic systems based on findings from the 2023 Society of Developmental and Behavioral Pediatrics (SDBP) survey. METHODS: An anonymous survey of SDBP members assessed diagnostic practices, clinician preparedness, and training needs regarding FASD. Responses were analyzed descriptively to identify patterns in diagnostic system use and perceived training adequacy. RESULTS: Of 913 members surveyed, 199 responded (22%), with 97 reporting active involvement in FASD care. Among these, 34% used the University of Washington 4-Digit Code, 34% used Diagnostic and Statistical Manual of Mental Disorders-5 criteria, and 26% followed the Hoyme guidelines. Only 24% felt "very prepared" to diagnose FASD, whereas 58% desired additional training in both diagnosis and management. The lack of a standardized diagnostic framework contributed to variability in clinical practice and clinician confidence. CONCLUSION: Findings highlight significant gaps in clinician confidence and the lack of standardized diagnostic practices. This article underscores the importance of enhancing FASD education within medical and psychology training and proposes adopting a functional classification system (FASD levels 1, 2, and 3) to bridge existing diagnostic frameworks and promote consistency in care. Strengthening clinician capacity in FASD recognition and management is essential to improving early identification, timely intervention, and long-term outcomes for affected children.