Application of a Minimum Prenatal Alcohol Exposure Threshold for Diagnosis of Fetal Alcohol Spectrum Disorder: A Retrospective Chart Review

ABSTRACT Introduction International guidelines for diagnosing fetal alcohol spectrum disorder (FASD) differ regarding the required level of prenatal alcohol exposure (PAE). The Australian Guidelines for Assessment and Diagnosis of Fetal Alcohol Spectrum Disorder (2025) introduce a minimum PAE threshold, unlike the 2016 Guide to FASD Diagnosis, which allowed for diagnosis at any exposure level. This retrospective case review evaluates whether applying the minimum PAE threshold would alter diagnostic outcomes for individuals previously assessed for FASD at a specialist neurodevelopmental clinic in Queensland. Methods Records of 81 individuals assessed between February 2019 and May 2024 were reviewed. PAE information was re‐categorised according to the 2025 guideline thresholds. Diagnostic outcomes were then compared to original assessments. Results All individuals previously diagnosed with FASD without three sentinel facial features had PAE in at least the moderate–high range, thereby meeting the minimum PAE threshold. Those identified as ‘at risk of FASD’ were also found to have at least moderate–high PAE. Discussion and Conclusions Concerns have been raised that introducing a minimum PAE threshold could reduce FASD diagnoses. However, this study shows that applying the 2025 criteria retrospectively did not alter diagnostic outcomes for this specific cohort. These findings suggest the updated guidelines may not significantly impact diagnosis rates in similar specialist clinical settings. Further research is needed to assess the broader implications across other service delivery contexts.