Clinical Toolkit
FASD Learning Modules for Clinicians
Six short modules for clinical teams, with key points and questions to reflect on.
FASD Compass · fasdcompass.co.uk/clinician-learning/
Six short modules for clinicians, GPs, nurses and allied health professionals. Each takes about five to ten minutes and has key points, a question to reflect on and links to the source guidance. Use them for self-directed learning or team teaching.
An educational resource, not a diagnostic tool
These resources support clinical reasoning. They do not score, diagnose or rule out FASD, and they do not decide who should be referred. Diagnosis needs a multidisciplinary assessment using the SIGN 156 criteria.
These modules are not accredited for CPD. You can record your own reflections in your CPD portfolio if your professional body allows it.
1 Recognising possible FASD
Key points
- FASD is common but often missed. Most people with FASD do not have the facial features.
- Consider prenatal alcohol exposure when a child has unexplained neurodevelopmental difficulties, or a profile that is uneven or not responding to usual support.
- Typical patterns include difficulties with memory, executive function, language understanding, attention, regulation and adaptive skills, often with good expressive language that hides the difficulties.
- None of these patterns are specific to FASD. They also occur in ADHD, autism, trauma, language disorder and learning difficulties.
- Children who are looked after or adopted have higher rates of prenatal alcohol exposure. Being in care is not evidence of exposure.
Reflect
A 9-year-old has an ADHD diagnosis and has not responded as expected to medication. Their carers describe forgetting skills from one day to the next. What else would you ask about?
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2 Sensitive history taking
Key points
- Ask every family about alcohol in pregnancy, in the same way you ask about other exposures. This makes it routine rather than accusing.
- Use non-blaming language, such as “when alcohol was consumed during pregnancy”.
- Record the type, amount, pattern, frequency and timing of drinking, and who gave the information.
- Record exposure as confirmed, confirmed absent or unknown. Unknown is not the same as absent.
- Some birth parents may themselves have been affected by prenatal alcohol exposure. Adapt how you share information.
Reflect
How would you ask a birth mother about alcohol in a way that is honest, kind and clear? Practise the words you would use.
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3 Diagnostic frameworks
Key points
- In the UK, SIGN 156 (2019) is the diagnostic guideline. NICE QS204 (2022) sets quality standards for England.
- SIGN 156 uses two diagnostic terms: FASD with sentinel facial features and FASD without sentinel facial features. It also has a designation for people at risk of FASD.
- Pervasive brain dysfunction means severe impairment in three or more of the 10 areas of assessment.
- Older terms such as FAS, pFAS, ARND and ARBD are still used in other countries and in older reports.
- Genetic factors should be considered in all cases.
Reflect
A report from abroad says a child has “partial FAS”. How would you explain the UK terms to the family?
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4 FASD and co-occurring neurodevelopmental conditions
Key points
- Many children with FASD do also have ADHD. FASD and ADHD can both be diagnosed.
- Under SIGN 156, a diagnosis of ADHD (inattentive or combined presentation) meets the criteria for severe impairment in attention.
- Autism, intellectual disability, language disorder, developmental coordination disorder, sleep problems, anxiety and depression are also common.
- Trauma and changes of carer can affect regulation and attachment. SIGN 156 advises not to attribute affect regulation difficulties to alcohol exposure when they are better explained by life events.
- A good formulation names all the contributors. It does not force everything into one diagnosis.
Reflect
How would your formulation and treatment plan change if a child with ADHD were also found to have FASD?
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5 Communication with families
Key points
- Explain what the assessment involves, including photographs, and gain informed consent.
- Share results with the family and, where appropriate, the child or young person, in clear language.
- Give a written or visual summary they can take away and share.
- Parents and carers may feel grief, loss, anger or guilt. Say that these feelings are normal, and offer support.
- Focus on strengths and practical next steps, not only on the diagnosis.
Reflect
How would you share a diagnosis of FASD with a birth mother who is present at the feedback appointment?
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6 Coordinating support
Key points
- Every child with a diagnosis should have a management plan to address their needs (NICE QS204 Statement 5).
- Base the plan on the child’s strengths and difficulties, not on the label alone.
- Share the plan with school, with consent, so it can be built into SEN or ALN support.
- A member of the team should follow up within a specified time to check that recommendations have happened.
- Plan reassessment at transitions, such as starting secondary school and moving to adult services.
Reflect
Who in your service is responsible for following up after an FASD diagnosis, and how would a family know who to contact?
Read more
Further Training
RCPCH and National FASD
See the training links on the Clinicians page, including the RCPCH FASD masterclass and National FASD courses.
Podcast
Listen to clinical conversations on the Early Intervention Matters podcast.
Sources: SIGN 156: https://www.sign.ac.uk/media/1092/sign156.pdf · NICE QS204: https://www.nice.org.uk/guidance/qs204/chapter/Quality-statements · SIGN information for clinicians: https://www.sign.ac.uk/media/1441/information_for_clinicians.pdf · Lange et al. 2016: https://doi.org/10.1016/S0140-6736(15)01345-8
Last reviewed: November 2026 by Dr Inyang Takon, Consultant Neurodevelopmental Paediatrician. For professional education only. Clinical decisions remain with the treating clinician. Follow SIGN 156, NICE QS204 and your local pathways.