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It is a lifelong neurodevelopmental condition requiring evidence of prenatal exposure and impairment across multiple domains. Early diagnosis and support improve outcomes, yet FASD often remains unrecognised, especially in adults. National guidance from NICE, SIGN and DHSC outlines GP-relevant steps for identification, referral, clinical coding, and management to ensure records are recognised and care is tailored.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/fetal-alcohol-spectrum-disorder-fasd-how-primary-care-can-make-a-difference/446172/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/fetal-alcohol-spectrum-disorder-fasd-how-primary-care-can-make-a-difference/446172.png","ImageObject",300,407,{"name":92,"@type":93},"Angel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What causes fetal alcohol spectrum disorder (FASD) and how is it diagnosed?","Question",{"text":113,"@type":114},"FASD results from prenatal alcohol exposure. Diagnosis requires evidence of prenatal alcohol exposure and significant impairment in three or more neurodevelopmental domains.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why can FASD be missed, especially in adults?",{"text":118,"@type":114},"FASD is often unrecognised because the classic sentinel facial features occur in only up to 10% of cases, and adults may not be diagnosed earlier despite significant prevalence.",{"name":120,"@type":111,"acceptedAnswer":121},"How can primary care practices improve outcomes for people with suspected or confirmed FASD?",{"text":122,"@type":114},"Practices can follow national guidance to identify and support people, document diagnoses reliably in electronic records, use appropriate clinical codes, and ensure management plans including annual disability check-ups.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},446172,1790887633,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":39,"preview_page_count":4},687207412472,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Editorials  \nFetal alcohol spectrum disorder (FASD):  \nhow primary care can make a difference  \nCheryl McQuire, Lou Millington, Amy Dillon, Andy Boyd, James Parsonage, Raja Mukherjee, Sandra I Butcher and Patricia D Jackson  \nAround 4% of the UK population are living with fetal alcohol spectrum disorder (FASD) because of prenatal alcohol exposure.1,2 For a typical GP practice of 10 000 patients this means at  \nleast 400 people with FASD per practice. Or, equivalently, this is one child in each class of 25–30 pupils.3 Among vulnerable groups, including people who have been through the care system, are homeless, have addiction problems, or interface regularly with the justice system, prevalence is much higher with studies suggesting 20–40% may be living with FASD.4 Despite its significant prevalence and the fact that early diagnosis and support can dramatically improve outcomes, FASD often goes unrecognised, especially in adults.  \nWhat is fetal alcohol spectrum disorder?  \nFASD is a lifelong neurodevelopmental condition resulting from prenatal alcohol exposure. Diagnosis requires evidence of prenatal alcohol exposure and significant impairment in three or more of the following domains: motor skills, neuroanatomy or neurophysiology, cognition, language, academic achievement, memory, attention, executive function (including impulse control and hyperactivity), affect regulation, and adaptive behaviour, social skills, or social communication.5,6  \nHistorically, diagnosis of FASD focused on three sentinel facial features—smooth philtrum, thin upper lip, and short palpebral fissures. When all three are present, they are so specific to prenatal alcohol exposure that confirmation of exposure through other sources (for example, reliable clinical observation, screening, self-report, alcohol treatment history) is not required. However, these facial features only occur in up to 10% of cases, making FASD largely an ‘invisible’ condition. Where sentinel facial  \nfeatures are absent, reliable evidence of maternal alcohol use during pregnancy is essential for diagnosis.5,6  \nWith over 400 associated comorbidities spanning 18 of the 22 International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) chapters,4 primary care clinicians will be faced with FASD across the lifespan in multiple contexts. Keen awareness can help mitigate the disproportionate health and social impacts.  \nAdvances in national guidance and implications for GPs  \nRecent landmark guidance from the National Institute for Health and Care Excellence (NICE Quality Standard for FASD, QS04),5 Scottish Intercollegiate Guidelines Network (SIGN 156:  \nChildren and Young People Exposed Prenatally to Alcohol),6 and Department of Health and Social Care (DHSC Health Needs Assessment for FASD)7 provides clear, GP-relevant steps to identify and support people with suspected or confirmed FASD.  \nBy following national guidance and reliably documenting diagnoses in electronic patient records, practices can improve individual patient care, generate accurate local prevalence data, and contribute to national research and commissioning. Those living with FASD tell us that having this diagnosis recognised in their records is crucial. Without it, people living with FASD have to repeatedly explain their condition, which can lead to frustrating and uncomfortable conversations. As one person with FASD explained in our recent knowledge mobilisation work:8  \n\n| Box 1. Recommendations for the role of GPs in fetal alcohol spectrum disorder (FASD) prevention, diagnosis, clinical coding, and management |\n| --- |\n| • Give women and their supporters clear and consistent advice on avoiding alcohol throughout pregnancy and when planning pregnancy, consistent with Chief Medical Officers’ Guidance (2016) .9\u003Cbr>• Actively consider prenatal alcohol exposure as a possible underlying cause for neurodevelopmental delay, or unexplained departures from a typical developmental pr","cbCaipnmG7UjlbyK","https://ap.wps.com/l/cbCaipnmG7UjlbyK","pdf",1444046,"English","# What is fetal alcohol spectrum disorder?\n## Historical diagnostic features and evidence requirements\n# Advances in national guidance and implications for GPs\n## Guidance sources and clinical record documentation\n# The role of GPs\n## Prevention, diagnosis, and management actions\n# Guidance and referral pathways\n## Referral for children and young people","[{\"question\":\"What causes fetal alcohol spectrum disorder (FASD) and how is it diagnosed?\",\"answer\":\"FASD results from prenatal alcohol exposure. Diagnosis requires evidence of prenatal alcohol exposure and significant impairment in three or more neurodevelopmental domains.\"},{\"question\":\"Why can FASD be missed, especially in adults?\",\"answer\":\"FASD is often unrecognised because the classic sentinel facial features occur in only up to 10% of cases, and adults may not be diagnosed earlier despite significant prevalence.\"},{\"question\":\"How can primary care practices improve outcomes for people with suspected or confirmed FASD?\",\"answer\":\"Practices can follow national guidance to identify and support people, document diagnoses reliably in electronic records, use appropriate clinical codes, and ensure management plans including annual disability check-ups.\"}]","Fetal alcohol spectrum disorder (FASD) - how primary care can make a difference | PDF",1790714376]