Background Fetal alcohol spectrum disorder (FASD) is a prevalent neurodevelopmental disorder that is caused by prenatal alcohol exposure (PAE) and associated with a range of cognitive, affective, and health concerns. Although the identification of FASD can facilitate the provision of interventions and support, and plays a protective role against adverse outcomes, there are high rates of missed detection. The identification of FASD via screening may improve its recognition across settings. The current systematic review examined the available evidence on FASD screening tools and approaches across age groups and settings. Methods A systematic search was carried out for both peer‐reviewed studies and gray literature sources published between January 1990 and May 2020 and was preregistered with PROSPERO (#CRD42019122077). Studies included in the review focused on human applications of FASD screening in children, adolescents, and adults. The quality of the studies was assessed using the QUADAS‐2 and GRADE frameworks. Results The search yielded 20 screening tools and approaches across 45 studies, broadly characterized in 2 groups. The first group included approaches currently in use that aim to identify individuals at risk of FASD using a range of markers (n = 19) or associated sentinel dysmorphic facial features (n = 6). Another group of studies, characterized as emerging, focused on identifying promising biomarkers of PAE/FASD (n = 20). Overall, we identified limited research supporting the psychometric properties of most screening approaches. The quality review provided evidence of bias due to the common use of case–control designs and lack of adequate reference standards. Conclusions Although several FASD screening tools and approaches are available for use across a range of age groups and settings, the overall evidence base supporting their psychometric properties is weak, with most studies demonstrating significant risk of bias. Service providers should exercise caution in selecting and implementing FASD screening tools given these limitations. It is critically important to accurately identify individuals with FASD across ages and settings to support healthy outcomes. Thus, there is a pressing need for additional research in this area, particularly validation studies in large and representative samples using robust methodological approaches.

The need to improve identification and understanding of individuals who have fetal alcohol spectrum disorder (FASD), including their strengths and challenges, is being increasingly recognized. Identification of FASD via screening is an important system-level intervention that may serve to improve early and accurate recognition of individuals who may have FASD, facilitate the provision of appropriately tailored support and interventions, and in doing so, foster healthy and positive outcomes for individuals and families. Effective and ethical implementation of FASD screening practices requires consideration of several factors for success, ensuring that resulting benefits outweigh potential harms. Using an implementation science framework, this topical review aims to provide an overview of these key considerations in order to guide further research and support practice and decision-making for service providers, organizations, and policy makers in the implementation of FASD identification and screening practices. These include prioritizing partnerships with stakeholders; taking a person-centered and ethical approach to FASD identification and screening; applying rigorous methodological research approaches to screening tool development, validation, and evaluation; increasing broader FASD awareness and response capacity at the system level; and advocating for continued policy reform and resources to enhance effective community-based support andinterventions following identification.