Fetal alcohol spectrum disorders screening tools: A systematic review.

Huey and her team hunted for every paper that tested a screen for fetal alcohol spectrum disorders. They kept studies that told how often the screen caught a child who truly had FASD (sensitivity) and how often it correctly cleared a child who did not (specificity).

The final pile held dozens of tools used on kids and adults in clinics, schools, and research labs around the world.

Screens aimed only at full fetal alcohol syndrome worked well: most hit above 90 percent sensitivity. Screens that tried to catch the wider FASD range were shakier, with sensitivity spreading from 40 to 90 percent and many false positives.

No single tool met standard cut-offs for both sensitivity and specificity across all ages and settings.

Bellon-Harn et al. (2020) showed three-quarters of kids with prenatal alcohol exposure also have sensory red flags. A BCBA who uses a pure FASD screen may still miss these sensory needs, so add a sensory profile even if the alcohol screen passes.

Doney et al. (2016) found visual-motor gaps in nearly half of exposed children. Their data sit inside Huey’s review, reminding us that motor tests, not just facial-feature checklists, belong in a full FASD work-up.

Mammarella et al. (2022) asked teachers, doctors, and police how much they actually know about FASD. They reported poor knowledge of diagnostic rules. Huey’s finding that tools vary mirrors this confusion: when criteria differ across screens, frontline staff pick conflicting cut-offs and label kids inconsistently.

You can’t trust one score to rule FASD in or out. Pair any screen with follow-up sensory, motor, and adaptive checks. Document which tool you used so the next provider knows the sensitivity limits. If the child scores near the cut-off, re-test after a short interval or refer for full multidisciplinary assessment.