{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:09:46Z","timestamp":1792062586170,"version":"4.4.0"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,10,1]]},"abstract":"<jats:p>OBJECTIVE. The 4-Digit Diagnostic Code for fetal alcohol spectrum disorders and the Hoyme fetal alcohol spectrum disorders diagnostic guidelines differ markedly. The performances of the 2 diagnostic systems were compared.<\/jats:p><jats:p>METHODS. The fetal alcohol syndrome diagnostic criteria from the 4-Digit Code and Hoyme guidelines were applied to 952 patients who had received an interdisciplinary, fetal alcohol spectrum disorders, diagnostic evaluation at the University of Washington with the 4-Digit Diagnostic Code and 16 children with confirmed absence of prenatal alcohol exposure.<\/jats:p><jats:p>RESULTS. The prevalence of fetal alcohol syndrome was 3.7% with the 4-Digit Code and 4.1% with the Hoyme guidelines. Although the prevalences were similar, the patients identified were not. Only 17 individuals met the fetal alcohol syndrome criteria for both systems. An extraordinary number of patients (35%) met the Hoyme criteria for the fetal alcohol syndrome facial phenotype, but only 39 of those 330 patients met the Hoyme criteria for fetal alcohol syndrome. Even some children with no alcohol exposure (25%) had the Hoyme fetal alcohol syndrome face. The specificities of the Hoyme fetal alcohol syndrome face for the Hoyme fetal alcohol syndrome diagnosis and prenatal alcohol exposure were low in these populations.<\/jats:p><jats:p>CONCLUSIONS. Without a specific facial phenotype, a valid diagnosis of fetal alcohol syndrome cannot be rendered for patients with prenatal alcohol exposure, because a causal link between their outcomes and exposure cannot be established, and a valid diagnosis of fetal alcohol syndrome cannot be rendered for patients with unknown alcohol exposure, because the face cannot serve as a valid proxy measure for alcohol exposure. Diagnostic guidelines must confirm the specificity of their fetal alcohol syndrome facial criteria to validate their diagnostic criteria.<\/jats:p>","DOI":"10.1542\/peds.2006-0577","type":"journal-article","created":{"date-parts":[[2006,10,2]],"date-time":"2006-10-02T17:04:22Z","timestamp":1159808662000},"page":"1532-1545","source":"Crossref","is-referenced-by-count":70,"title":["Comparison of the 4-Digit Diagnostic Code and the Hoyme Diagnostic Guidelines for Fetal Alcohol Spectrum Disorders"],"prefix":"10.1542","volume":"118","author":[{"given":"Susan J.","family":"Astley","sequence":"first","affiliation":[{"name":"Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2006,10,1]]},"reference":[{"key":"2021120822390123900_R1","unstructured":"Stratton K, Howe C, Battaglia F, eds. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press; 1996"},{"key":"2021120822390123900_R2","unstructured":"Astley SJ, Clarren SK. Diagnostic Guide for Fetal Alcohol Syndrome and Related Conditions: The 4-Digit Diagnostic Code. Seattle, WA: University Publication Services; 1997:93"},{"key":"2021120822390123900_R3","unstructured":"Astley SJ, Clarren SK. Diagnostic Guide for Fetal Alcohol Syndrome and Related Conditions: The 4-Digit Diagnostic Code. 2nd ed. Seattle, WA: University Publication Services; 1999:111"},{"key":"2021120822390123900_R4","doi-asserted-by":"crossref","unstructured":"Astley SJ, Clarren SK. Diagnosing the full spectrum of fetal alcohol exposed individuals: introducing the 4-Digit Diagnostic Code. Alcohol Alcohol.\u20082000;35:400\u2013410","DOI":"10.1093\/alcalc\/35.4.400"},{"key":"2021120822390123900_R5","unstructured":"Astley SJ. Diagnostic Guidelines for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code. 3rd ed. Seattle, WA: University Publication Services; 2004:114"},{"key":"2021120822390123900_R6","unstructured":"Centers for Disease Control and Prevention. Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Atlanta, GA: Centers for Disease Control and Prevention; 2004"},{"key":"2021120822390123900_R7","doi-asserted-by":"crossref","unstructured":"Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Can Med Assoc J.\u20082005;172(suppl 5):s1\u2013s21","DOI":"10.1503\/cmaj.1040302"},{"key":"2021120822390123900_R8","doi-asserted-by":"crossref","unstructured":"Hoyme HE, May PA, Kalberg WO, et al. A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: clarification of the 1996 Institute of Medicine criteria. Pediatrics.\u20082005;115:39\u201347","DOI":"10.1542\/peds.2004-0259"},{"key":"2021120822390123900_R9","doi-asserted-by":"crossref","unstructured":"Clarren SK, Astley SJ. The development of the Fetal Alcohol Syndrome Diagnostic and Prevention Network in Washington State. In: Streissguth A, Kanter J, eds. The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities. Seattle, WA: University of Washington Press; 1997:40\u201351","DOI":"10.1515\/9780295803326-008"},{"key":"2021120822390123900_R10","unstructured":"Clarren SK, Carmichael-Olson H, Clarren SGB, Astley SJ. A child with fetal alcohol syndrome. In: Guralnick MJ, ed. Handbook of Clinical Assessment for Young Children With Developmental Disabilities. Baltimore, MD: Paul H. Brookes; 2000:307\u2013326"},{"key":"2021120822390123900_R11","doi-asserted-by":"crossref","unstructured":"Astley SJ, Stachowiak J, Clarren SK, Clausen C. Application of the fetal alcohol syndrome facial photographic screening tool in a foster care population. J Pediatr.\u20082002;141:712\u2013717","DOI":"10.1067\/mpd.2002.129030"},{"key":"2021120822390123900_R12","doi-asserted-by":"crossref","unstructured":"Astley SJ, Clarren SK. A case definition and photographic screening tool for the facial phenotype of fetal alcohol syndrome. J Pediatr.\u20081996;129:33\u201341","DOI":"10.1016\/S0022-3476(96)70187-7"},{"key":"2021120822390123900_R13","doi-asserted-by":"crossref","unstructured":"Astley, SJ, Clarren SK. Measuring the facial phenotype of individuals with prenatal alcohol exposure: correlations with brain dysfunction. Alcohol Alcohol.\u20082001;36:147\u2013159","DOI":"10.1093\/alcalc\/36.2.147"},{"key":"2021120822390123900_R14","doi-asserted-by":"crossref","unstructured":"Astley SJ. Fetal alcohol syndrome prevention in Washington State: evidence of success. 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Do we need the term \u201cFAE\u201d?Pediatrics.\u20081995;95:428\u2013430"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/118\/4\/1532\/1116376\/zpe01006001532.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/118\/4\/1532\/1116376\/zpe01006001532.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T02:47:56Z","timestamp":1736563676000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/118\/4\/1532\/68964\/Comparison-of-the-4-Digit-Diagnostic-Code-and-the"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,10,1]]},"references-count":23,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2006,10,1]]},"published-print":{"date-parts":[[2006,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2006-0577","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,10,1]]}}}