Open Access Research article

Health professionals’ perceptions about the adoption of existing guidelines for the diagnosis of fetal alcohol spectrum disorders in Australia

Rochelle E Watkins1*, Elizabeth J Elliott23, Raewyn C Mutch14, Jane Latimer5, Amanda Wilkins14, Janet M Payne1, Heather M Jones1, Sue Miers6, Elizabeth Peadon23, Anne McKenzie1, Heather A D’Antoine7, Elizabeth Russell8, James Fitzpatrick25, Colleen M O’Leary19, Jane Halliday10, Lorian Hayes11, Lucinda Burns12, Maureen Carter13 and Carol Bower1

Author Affiliations

1 Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia

2 Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia

3 The Children’s Hospital at Westmead, Sydney, Australia

4 Department of Health Western Australia, Child and Adolescent Health Service, Perth, Australia

5 The George Institute for Global Health, Sydney, Australia

6 National Organisation for Fetal Alcohol Syndrome and Related Disorders, Adelaide, Australia

7 Menzies School of Health Research, Darwin, Australia

8 Russell Family Fetal Alcohol Disorders Association, Cairns, Australia

9 Centre for Population Health Research, Curtin University, Perth, Australia

10 Public Health Genetics, Genetic Disorders, Murdoch Childrens Research Institute, Melbourne, Australia

11 Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Australia

12 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia

13 Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia

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BMC Pediatrics 2012, 12:69  doi:10.1186/1471-2431-12-69

Published: 14 June 2012



Despite the availability of five guidelines for the diagnosis of fetal alcohol spectrum disorders (FASD), there is no national endorsement for their use in diagnosis in Australia. In this study we aimed to describe health professionals’ perceptions about the adoption of existing guidelines for the diagnosis of FASD in Australia and identify implications for the development of national guidelines.


We surveyed 130 Australian and 9 international health professionals with expertise or involvement in the screening or diagnosis of FASD. An online questionnaire was used to evaluate participants’ familiarity with and use of five existing diagnostic guidelines for FASD, and to assess their perceptions about the adoption of these guidelines in Australia.


Of the 139 participants surveyed, 84 Australian and 8 international health professionals (66.2%) responded to the questions on existing diagnostic guidelines. Participants most frequently reported using the University of Washington 4-Digit Diagnostic Code (27.2%) and the Canadian guidelines (18.5%) for diagnosis. These two guidelines were also most frequently recommended for adoption in Australia: 32.5% of the 40 participants who were familiar with the University of Washington 4-Digit Diagnostic Code recommended adoption of this guideline in Australia, and 30.8% of the 26 participants who were familiar with the Canadian guidelines recommended adoption of this guideline in Australia. However, for the majority of guidelines examined, most participants were unsure whether they should be adopted in Australia. The adoption of existing guidelines in Australia was perceived to be limited by: their lack of evidence base, including the appropriateness of established reference standards for the Australian population; their complexity; the need for training and support to use the guidelines; and the lack of an interdisciplinary and interagency model to support service delivery in Australia.


Participants indicated some support for the adoption of the University of Washington or Canadian guidelines for FASD diagnosis; however, concerns were raised about the adoption of these diagnostic guidelines in their current form. Australian diagnostic guidelines will require evaluation to establish their validity in the Australian context, and a comprehensive implementation model is needed to facilitate improved diagnostic capacity in Australia.