Accommodating the Fetal Alcohol Spectrum Disorders in the Diagnostic and Statistical Manual of Mental Disorders (dsm V)

The umbrella term Fetal Alcohol Spectrum Disorder embraces several mental and behavioral manifestations of prenatal alcohol exposure as its etiology. There is sufficient reason to involve a classification system like the Diagnostic and Statistical Manual of Mental Disorders (DSM) in spite of technical and procedural difficulties. The significance of this inclusion would not only make the advantages of classification visible for clinical and research utility, it could shape the future of the DSM in adopting an etiology based classification system. he world wide prevalence of alcohol use in pregnancy, a requirement for the current diagnostic characterization of Fetal Alcohol Spectrum Disorder (FASD), varies between 2% to 25%. These varied rates depend on the level of use of alcohol such as binge drinking (more than five drinks on one occasion) as compared to frequent use (more than seven drinks a week), occasional use, the population studied and the setting of the study. These rates may not be totally reflective of the indicators of the progressive incidence of FASD, despite its preventability and current efforts on public education. The composite estimates of binge drinking in the non pregnant child bearing women (20%), drinking at any time during pregnancy (14-25%), alcohol use throughout pregnancy (5-9%), alcohol exposure to the newborn in early pregnancy (25%), and the unplanned pregnancy rates (50%) coupled with the increasing alcohol use among women in the context of their changing social status are more reliable indicators. According to the World Health Organization (WHO), in recognition of this global health problem, alcohol use among women is rising progressively in many countries due to changing gender roles. The need for a viable diagnostic framework is thus premised not only for identification and prevention but on the realization of the implications of these pointers to increased prevalence of FASD. Development of a Diagnostic System for FASD The term Fetal Alcohol Spectrum Disorder is not a diagnosis but an umbrella terminology adopted to reflect the wide range of affectation and manifestations in individuals prenatally exposed to alcohol. The term implies physical, mental, behavioural and learning disabilities with lifelong implications. Its effect is not limited to the individual but affects the mother, the family and the community. Since the description of the prototype disorder, Fetal Alcohol Syndrome in 1973, sub syndromal forms, various differentials and difficult to identify variants of the syndrome have prompted the revision of the various diagnostic classifications. The term Fetal Alcohol Effects (FAE) referred to other forms of the manifestations without the full accompaniment of the prototype Fetal Alcohol Syndrome. FAE was meant for those patients who did not have the full characteristics of FAS including the facial dysmorphology or for those who only possess the partial manifestations usually the central nervous systems effects. The usage of the term, Fetal Alcohol Effects was broad and its definition, vague. It originated from the term, Suspected Fetal Alcohol Effects. This all-encompassing term soon fell out of favour due to its lack of specificity. The Institute of Medicine (IOM) attempted to resolve the difficulty by introducing the Institute of Medicine Classification System in 1996. T Accommodating the fetal alcohol spectrum disorders in the diagnostic and statistical manual of mental disorders (DSM V) J FAS Int 2006;4:e23 December 12, 2006 © The Hospital for Sick Children. 2006. 2 TABLE 1 Institute of Medicine (IOM) Diagnostic Criteria for FAS and Alcohol Related Effects Category Terminology 1 FAS with confirmed maternal