{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:53:11Z","timestamp":1790949191445,"version":"4.1.0"},"reference-count":29,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:00:00Z","timestamp":1661817600000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,8,12]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Canadian fetal alcohol spectrum disorder (FASD) guidelines encourage an age-specific interdisciplinary diagnostic approach. However, there is currently no standard-of-care regarding FASD diagnosis disclosure and few studies document Canadian FASD clinical capacity. Our objectives were to describe clinical capacity (defined as skills and resources) for FASD assessment, diagnosis, disclosure and support in Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>Data were drawn from the CanDiD study, a cross-sectional investigation of Canadian FASD clinical capacity. Forty-one clinics participated in the study. Data were collected in 2021 on the number and types of health professionals included in the assessment and diagnostic teams, the presence (or absence) of a minor patient when the FASD diagnosis is disclosed to parents\/guardians, who is responsible for the diagnosis disclosure, the use of explanatory tools, and the types of support\/counselling services available. The proportion of clinics that follow the Canadian interdisciplinary diagnostic guidelines by age group is described among participating clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 21, 13 and 7 specialised FASD clinics were in Western\/Northern, Central and Atlantic Canada, respectively. The number of referrals per year surpassed the number of diagnostic assessments completed in all regions. Approximately, 60% of clinics who diagnosed FASD in infants and preschool children (n=4\/7 and 15\/25, respectively) followed the interdisciplinary guidelines compared with 80% (n=32\/40) in clinics who diagnosed school-aged children\/adolescents. Diagnostic reporting practices were heterogeneous, but most used an explanatory tool with children\/adolescents (67%), offered support\/counselling (90\u201395%) and used case-by-case approach (80%) when deciding who would disclose the diagnosis to the child\/adolescent and when.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Limited diagnostic capacity and lack of FASD resources across Canada highlights a critical need for continued FASD support. This study identifies gaps in assessment, diagnosis and reporting practices for FASD in children\/adolescents across Canada.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-065005","type":"journal-article","created":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T11:45:00Z","timestamp":1661859900000},"page":"e065005","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Canadian clinical capacity for fetal alcohol spectrum disorder assessment, diagnosis, disclosure and support to children and adolescents: a cross-sectional study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-4017","authenticated-orcid":false,"given":"Erika N.","family":"Dugas","sequence":"first","affiliation":[{"name":"Vitalit\u00e9 Health Network, Moncton, New Brunswick, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martine","family":"Poirier","sequence":"additional","affiliation":[{"name":"Vitalit\u00e9 Health Network, Moncton, New Brunswick, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Basque","sequence":"additional","affiliation":[{"name":"Vitalit\u00e9 Health Network, Moncton, New Brunswick, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Bouhamdani","sequence":"additional","affiliation":[{"name":"Vitalit\u00e9 Health Network, Moncton, New Brunswick, Canada"},{"name":"University of Sherbrooke Faculty of Medicine and Health Sciences, Sherbrooke, Quebec, Canada"},{"name":"Centre de Formation M\u00e9dicale du Nouveau-Brunswick, Universit\u00e9 de Moncton, Moncton, New Brunswick, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure","family":"LeBreton","sequence":"additional","affiliation":[{"name":"Vitalit\u00e9 Health Network, Moncton, New Brunswick, Canada"},{"name":"University of Sherbrooke Faculty of Medicine and Health Sciences, Sherbrooke, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Leblanc","sequence":"additional","affiliation":[{"name":"Vitalit\u00e9 Health Network, Moncton, New Brunswick, Canada"},{"name":"University of Sherbrooke Faculty of Medicine and Health Sciences, Sherbrooke, Quebec, Canada"},{"name":"Centre de Formation M\u00e9dicale du Nouveau-Brunswick, Universit\u00e9 de Moncton, Moncton, New Brunswick, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,8,30]]},"reference":[{"key":"2025121403150152000_12.8.e065005.1","unstructured":"CanFASD . Canadian FASD Research Network - FASD Basic Information, 2021. Available: https:\/\/canfasd.ca\/wp-content\/uploads\/2019\/11\/FASD-Basic-Information.pdf"},{"key":"2025121403150152000_12.8.e065005.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-046071"},{"key":"2025121403150152000_12.8.e065005.3","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1001\/jamapediatrics.2017.1919","article-title":"Global prevalence of fetal alcohol spectrum disorder among children and youth: a systematic review and meta-analysis","volume":"171","author":"Lange","year":"2017","journal-title":"JAMA Pediatr"},{"key":"2025121403150152000_12.8.e065005.4","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.1111\/add.15036","article-title":"Alcohol use in pregnancy and its impact on the mother and child","volume":"115","author":"Oei","year":"2020","journal-title":"Addiction"},{"key":"2025121403150152000_12.8.e065005.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01345-8"},{"key":"2025121403150152000_12.8.e065005.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0043024"},{"key":"2025121403150152000_12.8.e065005.7","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1040302"},{"key":"2025121403150152000_12.8.e065005.8","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.141593"},{"key":"2025121403150152000_12.8.e065005.9","first-page":"e153","article-title":"Diagnostic issues affecting the epidemiology of fetal alcohol spectrum disorders","volume":"21","author":"Farag","year":"2014","journal-title":"J Popul Ther Clin Pharmacol"},{"key":"2025121403150152000_12.8.e065005.10","unstructured":"SJ A , SK C . Diagnostic guide for fetal alcohol syndrome and related conditions: the 4-Digit Diagnostic Code.. In: 2Nd. Seattle: University of Washington Publication Services, 1999."},{"key":"2025121403150152000_12.8.e065005.11","article-title":"Comparison of the FASD 4-Digit code and Hoyme et al. 2016 FASD diagnostic guidelines","volume":"4","author":"Astley","year":"2017","journal-title":"Adv Pediatr Res"},{"key":"2025121403150152000_12.8.e065005.12","unstructured":"Fetal Alcohol Spectrum Disorder (FASD) , 2022. Available: https:\/\/www.sign.ac.uk\/patient-and-public-involvement\/patient-publications\/fetal-alcohol-spectrum-disorder-fasd\/ [Accessed July 12, 2022]."},{"key":"2025121403150152000_12.8.e065005.13","unstructured":"Fetal Alcohol Spectrum Disroder (FASD) - A booklet for parents carers and families of children and young people exposed to alcohol during pregnancy 2022 https:\/\/www.sign.ac.uk\/media\/1145\/pat156_fasd.pdf"},{"key":"2025121403150152000_12.8.e065005.14","unstructured":"Bower C , Elliott E . on behalf of the Steering Group. Report of the Australian Government Department of Health: \"Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD) 2020."},{"key":"2025121403150152000_12.8.e065005.15","unstructured":"World Health Organization . Health workforce, 2022. Available: https:\/\/www.who.int\/health-topics\/health-workforce#tab=tab_1 [Accessed July 13, 2022]."},{"key":"2025121403150152000_12.8.e065005.16","first-page":"e494","article-title":"The Canadian guidelines and the interdisciplinary clinical capacity of Canada to diagnose fetal alcohol spectrum disorder","volume":"18","author":"Clarren","year":"2011","journal-title":"J Popul Ther Clin Pharmacol"},{"key":"2025121403150152000_12.8.e065005.17","unstructured":"HAS-Sant\u00e9 . Haute Autorit\u00e9 de Sant\u00e9: Annoncer une mauvaise nouvelle (\u00c9valuation et am\u00e9lioration des pratiques), 2008. Available: https:\/\/www.has-sante.fr\/portail\/jcms\/c_698028\/fr\/annoncer-une-mauvaise-nouvelle https:\/\/www.has-sante.fr\/portail\/jcms\/c_698028\/fr\/annoncer-une-mauvaise-nouvelle"},{"key":"2025121403150152000_12.8.e065005.18","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/S0140-6736(18)33201-X","article-title":"Communication with children and adolescents about the diagnosis of their own life-threatening condition","volume":"393","author":"Stein","year":"2019","journal-title":"Lancet"},{"key":"2025121403150152000_12.8.e065005.19","unstructured":"Statistics Canada . Table 17-10-0005-01 population estimates on July 1st, by age and sex, 2022. Available: https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1710000501 [Accessed April 26, 2022]."},{"key":"2025121403150152000_12.8.e065005.20","doi-asserted-by":"publisher","DOI":"10.1002\/ddrr.68"},{"key":"2025121403150152000_12.8.e065005.21","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s10803-020-04545-w","article-title":"Teacher-Reported prevalence of FASD in kindergarten in Canada: association with child development and problems at home","volume":"51","author":"Pei","year":"2021","journal-title":"J Autism Dev Disord"},{"key":"2025121403150152000_12.8.e065005.22","first-page":"e223","article-title":"Building clinical capacity for fetal alcohol spectrum disorder diagnoses in Western and Northern Canada","volume":"15","author":"Clarren","year":"2008","journal-title":"Can J Clin Pharmacol"},{"key":"2025121403150152000_12.8.e065005.23","doi-asserted-by":"publisher","DOI":"10.1097\/00004703-200408000-00002"},{"key":"2025121403150152000_12.8.e065005.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-7213-3","article-title":"Population-Based prevalence of fetal alcohol spectrum disorder in Canada","volume":"19","author":"Popova","year":"2019","journal-title":"BMC Public Health"},{"key":"2025121403150152000_12.8.e065005.25","first-page":"57","article-title":"Overview of fetal alcohol spectrum disorders for mental health professionals","volume":"12","author":"Clarke","year":"2003","journal-title":"Can Child Adolesc Psychiatr Rev"},{"key":"2025121403150152000_12.8.e065005.26","unstructured":"Streissguth AP , Barr HM , Kogan J . Understanding the occurence of secondary disabilities in clients with fetal alcohol syndrome (Fas) and fetal alcohol effects (Fae). Sciences DoPaB, 1996."},{"key":"2025121403150152000_12.8.e065005.27","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1111\/jpc.14443","article-title":"Delivering bad news","volume":"55","author":"Nunn","year":"2019","journal-title":"J Paediatr Child Health"},{"key":"2025121403150152000_12.8.e065005.28","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4103\/0973-1075.68401","article-title":"'BREAKS' protocol for breaking bad news","volume":"16","author":"Narayanan","year":"2010","journal-title":"Indian J Palliat Care"},{"key":"2025121403150152000_12.8.e065005.29","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.5-4-302"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-065005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T11:15:12Z","timestamp":1765710912000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-065005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8,30]]},"published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.1136\/bmjopen-2022-065005"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-065005","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8]]}}}