A Critique of the New Canadian Fetal Alcohol Spectrum Disorder Guideline

A new Fetal Alcohol Spectrum Disorder (FASD) guideline was published in the Canadian Medical Association Journal in 2016. This is relevant to the mental health field as mental health symptoms and psychiatric disorders are often identified as associated with and/or part of FASD presentations. Unfortunately, the new guideline has not advanced understanding of the interface between FASD and mental health problems; rather it may contribute to additional confusion. For example, a new recommendation to include additional mental health symptoms, such as anxiety and affect dysregulation, as manifestations contributing to a diagnosis of FASD is particularly concerning given the paucity of evidence supporting this assertion and the potential to distort delivery of mental health interventions for mental health problems. In addition, the guideline recommendation for introducing an "at risk for FASD" designation is not without risk. An appeal is made for greater scrutiny in the construction of diagnostic criteria and guidelines and for a more careful delineation of causal relationships and comorbidities to better inform the delivery of evidence-based mental health care.