This tool is not intended as a diagnostic evaluation, but as a way to see if FASD is something to consider when talking to your/your child’s health care provider.
Review the checklistFASD Checklist
Below are the results of your FASD Checklist. As a reminder, this tool is not intended as a diagnostic evaluation, but is intended as a way to see if FASD is something to consider when talking to your/your child’s health care provider. For more information, visit proofalliance.org.
Did the mother drink any alcohol when she was pregnant?
Alcohol includes all types and any amount of wine, beer, and mixed drinks.
Yes, I know this as a fact and could provide documentation/personal accounts Yes, I strongly suspect this, but cannot provide documentation/personal accounts Maybe/I'm Unsure No, I know that there was no alcohol consumed during pregnancy Next
Click all that apply
Difficulty in school Poor social skills Poor understanding of personal boundaries Easily manipulated and led by others Lack of fear of strangers Immaturity for age compared to peers Back NextClick all that apply
Developmental delay Impulsivity and/or hyperactive behavior Difficulty paying attention Trouble remembering important details Difficulty following directions Back NextClick all that apply
Needs more time to process information Difficulty problem solving Poor reasoning and judgment skills Difficulty regulating emotions(emotional outbursts) Concrete, literal thinker Back Next
Click all that apply
Difficulty applying knowledge to a new situation Lack of inhibitions (disinhibited about sharingpersonal information with others/no filter) Difficulty learning from experience
(repeats mistakes) Difficulty connecting their actions
with consequences (understanding the effects
of their actions on others) Back Next
Click all that apply
Difficulty with managing money Chronically misses appointments or deadlines Back NextClick all that apply
Having one or more mental health disorders(depression, anxiety, bipolar disorder, etc.) Hearing or vision problems Poor coordination Sensitivity to light, touch, or sound Ongoing sleeping difficulties Growth deficiency (smaller in height and
weight at birth, height and weight
below the 10th percentile) Back Next
An FASD assessment is a good idea.
It looks like getting an FASD assessment might be a good idea. You can print your answers and use it to have a discussion with your primary care doctor, or you can contact an FASD Diagnostic Clinic in Minnesota by clicking here.
This tool is not intended as a diagnostic evaluation, but rather as a way for you to see if FASD is something for you to consider when talking with your health care provider.
An FASD assessment might be needed.
It looks like there might be an eventual need for an FASD assessment once you have spoken with your primary healthcare provider. Because of the complicated nature of an FASD assessment, proof of alcohol exposure during pregnancy is usually needed by an FASD Diagnostic Clinic.
This tool is not intended as a diagnostic evaluation, but rather as a way for you to see if FASD is something for you to consider when talking with your health care provider.
There was no alcohol exposure.
It looks like there was no alcohol exposure during pregnancy. Without alcohol, there is no FASD in the pregnancy. There still might be other concerns or disorders that should be discussed with your primary care doctor.
This tool is not intended as a diagnostic evaluation, but rather as a way for you to see if FASD is something for you to consider when talking with your health care provider.
