Episode seven: Rethinking FASD: Diagnosis, Support and Systemic Change

Dr. Gurpreet (Preety) Salh is a pediatrician and researcher affiliated with the BC Children's Hospital Research Institute. Her work focuses on understanding and improving how developmental disabilities, including Fetal Alcohol Spectrum Disorder (FASD), are diagnosed and treated. Dr. Salh's takes an intersectional approach in her research. She is particularly interested in how prenatal alcohol and substance exposure overlap with the effects of complex trauma experienced in early childhood. Her work recognizes that "many children diagnosed with FASD have faced significant adversity."

In this episode, Dr. Gurpreet Salh unpacks Fetal Alcohol Spectrum Disorder (FASD) as a neurodevelopmental spectrum condition shaped by prenatal alcohol exposure and strongly influenced by social and systemic factors. She explains that a diagnosis requires impairment across at least three of twelve possible neurodevelopmental domains, sentinel facial features are present in only a minority of cases and that every child presents with a different constellation of difficulties. She also introduces provocative questions she and colleagues raised in a recent Lancet article: whether the current diagnostic framework is specific enough, if confounding factors like trauma, poverty and genetic conditions are being adequately considered, and whether the diagnostic process itself reflects systemic bias as much as clinical need.

Dr. Salh emphasizes that questioning the diagnosis is not about eliminating it, but about making it more precise and just. She walks through the practical realities of treatment — behavioral intervention, ADHD management, speech-language therapy and FASD key workers through BC’s Ministry of Children and Family Development (MCFD) — while acknowledging that post-diagnosis supports remain inadequate for many. For primary care providers, she offers clear, actionable guidance: ask about alcohol exposure as part of every developmental history using non-blaming language, focus on a child's functional profile rather than the diagnostic label alone, read the recommendations section of the psychology report, and understand the pathway to supports like Community Living BC and PWD designation. 

Credits

Season one of CPD In Practice is accredited by the College of Family Physicians of Canada (CFPC). To claim your credits, you must enroll in the CPD In Practice+ learning activity.