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A modified Delphi study of screening for fetal alcohol spectrum disorders in Australia

Rochelle E Watkins1*, Elizabeth J Elliott234, Jane Halliday56, Colleen M O’Leary17, Heather D’Antoine8, Elizabeth Russell9, Lorian Hayes10, Elizabeth Peadon23, Amanda Wilkins111, Heather M Jones1, Anne McKenzie1, Sue Miers12, Lucinda Burns13, Raewyn C Mutch111, Janet M Payne1, James P Fitzpatrick24, Maureen Carter14, Jane Latimer4 and Carol Bower1

Author affiliations

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

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

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

4 The George Institute for Global Health, Sydney, Australia

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

6 Department of Paediatrics, University of Melbourne, Melbourne, Australia

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

8 Menzies School of Health Research, Charles Darwin University, Darwin, Australia

9 Russell Family Fetal Alcohol Disorders Association, Cairns, Australia

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

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

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

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

14 Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia

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Citation and License

BMC Pediatrics 2013, 13:13  doi:10.1186/1471-2431-13-13

Published: 25 January 2013



There is little reliable information on the prevalence of fetal alcohol spectrum disorders (FASD) in Australia and no coordinated national approach to facilitate case detection. The aim of this study was to identify health professionals’ perceptions about screening for FASD in Australia.


A modified Delphi process was used to assess perceptions of the need for, and the process of, screening for FASD in Australia. We recruited a panel of 130 Australian health professionals with experience or expertise in FASD screening or diagnosis. A systematic review of the literature was used to develop Likert statements on screening coverage, components and assessment methods which were administered using an online survey over two survey rounds.


Of the panel members surveyed, 95 (73%) responded to the questions on screening in the first survey round and, of these, 81 (85%) responded to the second round. Following two rounds there was consensus agreement on the need for targeted screening at birth (76%) and in childhood (84%). Participants did not reach consensus agreement on the need for universal screening at birth (55%) or in childhood (40%). Support for targeted screening was linked to perceived constraints on service provision and the need to examine the performance, costs and benefits of screening.

For targeted screening of high risk groups, we found highest agreement for siblings of known cases of FASD (96%) and children of mothers attending alcohol treatment services (93%). Participants agreed that screening for FASD primarily requires assessment of prenatal alcohol exposure at birth (86%) and in childhood (88%), and that a checklist is needed to identify the components of screening and criteria for referral at birth (84%) and in childhood (90%).


There is an agreed need for targeted but not universal screening for FASD in Australia, and sufficient consensus among health professionals to warrant development and evaluation of standardised methods for targeted screening and referral in the Australian context. Participants emphasised the need for locally-appropriate, evidence-based approaches to facilitate case detection, and the importance of ensuring that screening and referral programs are supported by adequate diagnostic and management capacity.