***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES : To determine the prevalence and characteristics of fetal alcohol spectrum disorders ( FASD ) among first grade students ( 6- to 7-year-olds ) in a representative Midwestern US community . METHODS : From a consented sample of 70.5 % of all first grade rs enrolled in public and private schools , an over sample of small children ( ≤25th percentile on height , weight , and head circumference ) and r and omly selected control c and i date s were examined for physical growth , development , dysmorphology , cognition , and behavior . The children ’s mothers were interviewed for maternal risk . RESULTS : Total dysmorphology scores differentiate significantly fetal alcohol syndrome ( FAS ) and partial FAS ( PFAS ) from one another and from unexposed controls . Alcohol-related neurodevelopmental disorder ( ARND ) is not as clearly differentiated from controls . Children who had FASD performed , on average , significantly worse on 7 cognitive and behavioral tests and measures . The most predictive maternal risk variables in this community are late recognition of pregnancy , quantity of alcoholic drinks consumed 3 months before pregnancy , and quantity of drinking reported for the index child ’s father . From the final multidisciplinary case findings , 3 techniques were used to estimate prevalence . FAS in this community likely ranges from 6 to 9 per 1000 children ( midpoint , 7.5 ) , PFAS from 11 to 17 per 1000 children ( midpoint , 14 ) , and the total rate of FASD is estimated at 24 to 48 per 1000 children , or 2.4 % to 4.8 % ( midpoint , 3.6 % ) . CONCLUSIONS : Children who have FASD  are more prevalent among first grade rs in this Midwestern city than predicted by previous , popular estimates Data coming from a prospect i ve multidisciplinary study with repeated examinations of children with fetal alcohol syndrome ( FAS ) are reported . These patients underwent pediatric , neurological and psychiatric assessment , EEG-recordings and psychological testing . After a period of 3 - 4 years various subgroups of these children were re-examined . Follow-up examinations revealed that with increasing age dysmorphic signs became less apparent in children with FAS . Furthermore , neurologic performance improved and EEG-recordings revealed less pathological patterns . These positive findings were confirmed by the observation that these patients also experienced an improvement with regard to psychiatric status and cognitive functions . But it must be stated that the affected children did not become normal in all psychiatric areas . Hyperactivity and distractibility seem to be the major h and icap for a normal school career of these children . In general biological maturation seems to be the main factor responsible for the outcome of FAS OBJECTIVE Moderate to heavy levels of prenatal alcohol exposure have been associated with alterations in child behavior , but limited data are available on adverse effects after low levels of exposure . The objective of this study was to evaluate the dose-response effect of prenatal alcohol exposure for adverse child behavior outcomes at 6 to 7 years of age . METHODS Beginning in 1986 , women attending the urban university-based maternity clinic were routinely screened at their first prenatal visit for alcohol and drug use by trained research assistants from the Fetal Alcohol Research Center . All women reporting alcohol consumption at conception of at least 0.5 oz absolute alcohol/day and a 5 % r and om sample of lower level drinkers and abstainers were invited to participate to be able to identify the associations between alcohol intake and child development . Maternal alcohol , cigarette , and illicit drug use were prospect ively assessed during pregnancy and postnatally . The independent variable in this study , prenatal alcohol exposure , was computed as the average absolute alcohol intake ( oz ) per day across pregnancy . At each prenatal visit , mothers were interviewed about alcohol use during the previous 2 weeks . Quantities and types of alcohol consumed were converted to fluid ounces of absolute alcohol and averaged across visits to generate a summary measure of alcohol exposure throughout pregnancy . Alcohol was initially used as a dichotomous variable comparing children with no prenatal alcohol exposure to children with any exposure . To evaluate the effects of different levels of exposure , the average absolute alcohol intake was relatively arbitrarily categorized into no , low ( > 0 but < 0.3 fl oz of absolute alcohol/day ) , and moderate/heavy ( > /=0.3 fl oz of absolute alcohol/day ) for the purpose of this study . Six years later , 665 families were contacted . Ninety-four percent agreed to testing . Exclusions included children who missed multiple test appointments , had major congenital malformations ( other than fetal alcohol syndrome ) , possessed an IQ > 2 st and ard deviations from the sample mean , or had incomplete data . The Achenbach Child Behavior Checklist ( CBCL ) was used to assess child behavior . The CBCL is a parent question naire applicable to children ages 4 to 16 years . It is widely used in the clinical assessment of children 's behavior problems and has been extensively used in research . Eight syndrome scales are further grouped into Externalizing or undercontrolled ( Aggressive and Delinquent ) behavior and Internalizing or overcontrolled ( Anxious/Depressed , Somatic Complaints , and Withdrawn ) behaviors . Three syndromes ( Social , Thought , and Attention Problems ) fit neither group . Higher scores are associated with more problem behaviors . Research assistants who were trained and blinded to exposure status independently interviewed the child and caretaker . Data were collected on a broad range of control variables known to influence childhood behavior and /or to be associated with prenatal alcohol exposure . These included perinatal factors of maternal age , education , cigarette , cocaine , and other substances of abuse and the gestational age of the baby . Postnatal factors studied included maternal psychopathology , continuing alcohol and drug use , family structure , socioeconomic status , children 's whole blood lead level , and exposure to violence . Data were collected only from black women as there was inadequate representation of other racial groups . STATISTICAL ANALYSES Statistical analyses were performed using the SPSS statistical package . Frequency distribution , cross-tabulation , odds ratio , and chi(2 ) tests were used for analyzing categorical data . Continuous data were analyzed using t tests , analyses of variance ( ANOVAs ) with posthoc tests , and regression analysis . RESULTS Testing was available for 501 parent-children dyads . Almost one fourth of the women denied alcohol use during pregnancy . Low levels of alcohol use were reported in 63.8 % and moderate/heavy use in 13 % of pregnancies . Increasing prenatal alcohol exposure was associated with lower birth weight and gestational age , higher lead levels , higher maternal age , and lower education level , prenatal exposure to cocaine and smoking , custody changes , lower socioeconomic status , and paternal drinking and drug use at the time of pregnancy . Children with any prenatal alcohol exposure were more likely to have higher CBCL scores on Externalizing ( Aggressive and Delinquent ) and Internalizing ( Anxious/Depressed and Withdrawn ) syndrome scales and the Total Problem Score . The odds ratio of scoring in the clinical range for Delinquent behavior was 3.2 ( 1.3 - 7.6 ) in children with any prenatal exposure to alcohol compared with nonexposed controls . The threshold dose was evaluated with the 3 prenatal alcohol exposure groups . One-way ANOVA revealed a significant between group difference for Externalizing ( Aggressive and Delinquent ) and the Total Problem Score . ( ABSTRACT TRUNCATED OBJECTIVES : The purpose s of this investigation were to determine the frequencies of and associations between different neurodevelopmental disorders and to study the potential lasting effects of alcohol on children adopted from eastern Europe . METHODS : In a population -based , prospect i ve , observational , multidisciplinary , cross-sectional , cohort study of 71 children adopted from eastern Europe , children were assessed 5 years after adoption , from pediatric , neuropsychological , and ophthalmologic perspectives . RESULTS : Fetal alcohol spectrum disorders , that is , fetal alcohol syndrome ( FAS ) , partial FAS , and alcohol-related neurodevelopmental disorders , were identified for 52 % of children ; FAS was found for 30 % , partial FAS for 14 % , and alcohol-related neurodevelopmental disorders for 9 % . Alcohol-related birth defects were found for 11 % of children , all of whom also were diagnosed as having FAS . Mental retardation or significant cognitive impairment was found for 23 % of children , autism for 9 % , attention-deficit/hyperactivity disorder for 51 % , and developmental coordination disorder for 34 % . CONCLUSIONS : Fetal alcohol spectrum disorders and neurodevelopmental disorders were common in this long-term follow-up study of children adopted from orphanages in eastern Europe . Maternal alcohol consumption during pregnancy has long-lasting adverse effects , causing structural , behavioral , and cognitive damage despite a radically improved environment BACKGROUND Clinical and research advancements in the field of fetal alcohol spectrum disorders ( FASD ) require accurate and valid identification of FASD clinical subgroups . OBJECTIVES A comprehensive neuropsychological battery , coupled with magnetic resonance imaging , ( MRI ) , MR spectroscopy ( MRS ) , and functional MRI ( fMRI ) were administered to children with fetal alcohol spectrum disorders ( FASD ) to determine if global and /or focal abnormalities could be identified across the spectrum , and distinguish diagnostic subclassifications within the spectrum . The neuropsychological outcomes of the comprehensive neuroimaging study are presented here . METHODS The study groups included : 1 ) FAS/Partial FAS ; 2 ) Static Encephalopathy/Alcohol Exposed ( SE/AE ) ; 3 ) Neurobehavioral Disorder/Alcohol Exposed ( ND/AE ) as diagnosed by an interdisciplinary team using the FASD 4-Digit Code ; and 4 ) healthy peers with no prenatal alcohol .  A st and ardized neuropsychological battery was administered to each child and their primary caregiver by a psychologist . RESULTS Use of the 4-Digit Code produced three clinical ly and statistically distinct FASD clinical subgroups . The three subgroups ( ND/AE , SE/AE and FAS/PFAS ) reflected a linear continuum of increasing neuropsychological impairment and physical abnormality , representing the full continuum of FASD . Behavioral and psychiatric disorders were comparably prevalent across the three FASD groups , and significantly more prevalent than among the Controls . All three FASD subgroups had comparably high levels of prenatal alcohol exposure . CONCLUSIONS Although ND/AE , SE/AE , and FAS/PFAS are distinct FASD subgroups , these groups are not distinguishable solely by their neuropsychological profiles . While all children within a group shared the same magnitude of neuropsychological impairment , the patterns of impairment showed considerable individual variability . MRI , MRS and fMRI further distinguished these FASD subgroups OBJECTIVES . Prenatal exposure to alcohol interferes with fetal development and is the leading preventable cause of birth defects and developmental disabilities . The purpose of this study was to identify current knowledge , diagnosis , prevention , and intervention practice s related to fetal alcohol syndrome and related conditions by members of the American Academy of Pediatrics . METHODS . This study was developed collaboratively by the American Academy of Pediatrics and the Centers for Disease Control and Prevention . Question naires were mailed to a 3 % r and om sample ( n = 1600 ) of American Academy of Pediatrics members in the United States . General pediatricians , pediatric subspecialists , and pediatric residents were included . RESULTS . Participation rate was 55 % ( n = 879 ) . Respondents almost universally knew the teratology and clinical presentation of fetal alcohol spectrum disorders . However , they were less likely to report comfort with routine pediatric care of these children . Whereas 62 % felt prepared to identify and 50 % felt prepared to diagnose , only 34 % felt prepared to manage and coordinate the treatment of children with fetal alcohol spectrum disorders . Even fewer ( n = 114 [ 13 % ] ) reported that they routinely counsel adolescent patients about the risks of drinking and pregnancy . CONCLUSIONS . The survey confirms that pediatricians are knowledgeable about fetal alcohol syndrome but do not feel adequately trained to integrate the management of this diagnosis or prevention efforts into everyday practice . Furthermore , the respondents were not active in routine anticipatory guidance with adolescents for prevention of alcohol-affected pregnancies . The development , dissemination , and implementation of best practice tools for prevention , diagnosis , and referral of fetal alcohol syndrome that are specific for general and subspecialist pediatricians are recommended BACKGROUND The objective was to investigate the frequency of fetal alcohol spectrum disorders ( FASD ) and ophthalmologic anomalies in orphanage children in Brazil . METHODS A prospect i ve study was performed on 94 children living in an orphanage in Brazil . The children were examined by a multidisciplinary team consisting of specialists in pediatrics , neurology , psychology , neuropsychiatry , and ophthalmology . RESULTS The main reasons for living in the orphanage , in 61 % of the children , were negligence , child abuse , and ab and onment . Of all the children studied , 50 % had mothers with known alcohol abuse and 47 % had one or more diagnoses of neurodevelopmental/behavioral and /or cognitive deficits . General developmental delay was found in 18 % , intellectual disability in 3 % , cognitive impairment in 27 % , attention-deficit/hyperactivity disorder in  
    Output:
    
Conclusion : Increased rates of mental disorders in people with FASD are commonly reported .
Until these studies are available , this review provides the best available estimates of comorbid mental disorders in people with FASD