Letter to the Editor Regarding Coles, Gailey, Mulle, Kable, Lynch, and Jones (2016): A Comparison Among 5 Methods for the Clinical Diagnosis of Fetal Alcohol Spectrum Disorders.

IN THIS LETTER to the Editor, I discuss a study conducted by Coles and colleagues (2016) that took on the important task of comparing the outcomes of 5 fetal alcohol spectrum disorder (FASD) diagnostic systems when retroactively applied to the records of 1,581 patients. Valid comparisons require valid administration of each diagnostic system. The purpose of this Letter to the Editor is to share with readers the methods used, but not reported, that influenced the outcomes of this study. These additional details will allow readers to more accurately interpret this study. Coles and colleagues (2016) applied 5 FASD diagnostic systems: Emory, FASD 4-Digit Code, CDC, Canadian, and Hoyme (Astley, 2004, 2013; Bertrand et al., 2004; Blackston et al., 2005; Chudley et al., 2005; Coles et al., 1997; Hoyme et al., 2005) to the records of 1,581 patients. These patients received an evaluation at the Emory clinic for alcoholand drug-exposed children between 1995 and 2011. Fifty-two percent of the population had a confirmed prenatal alcohol exposure and 46% of the population was African American. Data from records collected at the patient’s evaluation were used to retrospectively render FASD diagnoses in accordance with the criteria for each diagnostic system. The purpose of their study was to compare the prevalence of fetal alcohol syndrome (FAS), partial FAS (pFAS), and alcohol-related neurodevelopmental disorder (ARND) across the 5 different diagnostic systems. The authors reported the percent of alcohol-related diagnoses by diagnostic system as follows: