Screening for fetal alcohol syndrome in primary schools: A feasibility study

Background: This project was undertaken as a feasibility study to determine the possibility of screening for fetal alcohol syndrome (FAS) in early sch ool-age children for epidemiological and interventional purposes. Methods: All elementary schools in two counties in Washington State were as ked to screen first graders for possible FAS. A child was screen positive i f found to be growth deficient, to have certain specific facial abnormaliti es, or have a known history of substantial alcohol exposure in gestation. A ll screen-positive children were invited to "special diagnostic clinics" fo r final diagnosis and treatment planning. Results: In County A, virtually all students were screened. In County B onl y about 25% of children were screened. This difference was related to the n umber of schools that agreed to participate in the project and the methods employed by each county to obtain parental permission. In each county, only about one-half of the screen-positive children were seen in the special cl inics for diagnostic considerations. Only one of the seven children found t o have FAS had been diagnosed previously. The minimal prevalence of FAS in County A was 3.1 in 1,000 students. The minimal prevalence of FAS in County B could not be calculated. The most efficient component in the screening p rocess leading to a diagnosis of FAS was finding the specific facial featur es of the disorder. The diagnosis of FAS was generally helpful in improving educational planning. Conclusions: This study demonstrated that population-based FAS screening wi thin a school system may be possible, but participation is dependent on loc al trust and understanding of the project before its inception within the s chools and the community at large. Teratology 63.3-10, 2001. (C) 2001 Wiley -Liss, Inc.