Among individuals with prenatal alcohol exposure, evidence of CNS dysfunction varies according to developmental stage. Although about one-half of young children prenatally exposed to alcohol show marked developmental delay in the first 3 years of life, other chil- dren affected by prenatal alcohol exposure may not exhibit signs of CNS dysfunction until they are preschool- or school-age. Additionally, impairments in higher order cognitive processes (i.e., executive functioning), which are often associated with prenatal alcohol ex- posure, may be more easily assessed in older children. When children reach school age, learning difficulties, impairment in executive function, and problems with integrative lan- guage functions usually emerge more clearly, and both social skills deficits and challeng- ing behavior may become more evident. In particular, as school and other requirements become more complex, greater deficits are noted. Because of this, the school years repre- sent the ages at which a diagnosis of ND-PAE would be most likely.
Suicide is a high-risk outcome, with rates increasing significantly in late adolescence and early adulthood.
Functional Consequences of Neurobehavioral Disorder
The CNS dysfunction seen in individuals with ND—PAE often leads to decrements in adap- tive behavior and to maladaptive behavior with lifelong consequences. Individuals affected by prenatal alcohol exposure have a higher prevalence of disrupted school expe- riences, poor employment records, trouble with the law, confinement (legal or psychiat- ric), and dependent living conditions.
Disorders that are attributable to the physiological effects associated with postnatal use of a substance, another medical condition, or environmental neglect. Other consid- erations include the physiological effects of postnatal substance use, such as a medication, alcohol, or other substances; disorders due to another medical condition, such as traumatic brain injury or other neurocognitive disorders (e.g., delirium, major neurocognitive dis- order [dementia]); or environmental neglect.
Genetic and teratogenic conditions. Genetic conditions such as Williams syndrome,
Down syndrome, or Cornelia de Lange syndrome and other teratogenic conditions such as behavioral characteristics. A careful review of prenatal exposure history is needed to clar- ify the teratogenic agent, and an evaluation by a clinical geneticist may be needed to dis- tinguish physical characteristics associated with these and other genetic conditions.
Mental health problems have been identified in more than 90% of individuals with histo- ries of significant prenatal alcohol exposure. The most common co-occurring diagnosis is attention-deficit/hyperactivity disorder, but research has shown that individuals with
ND-PAE differ in neuropsychological characteristics and in their responsiveness to phar- macological interventions. Other high- probability co-occurring disorders include oppo- sitional defiant disorder and conduct disorder, but the appropriateness of these diagnoses should be weighed in the context of the significant impairments in general intellectual and executive functioning that are often associated with prenatal alcohol exposure. Mood symptoms, including symptoms of bipolar disorder and depressive disorders, have been described. History of prenatal alcohol exposure is associated with an increased risk for later tobacco, alcohol, and other substance use disorders.
A. Within the last 24 months, the individual has made a suicide attempt.
Note: A suicide attempt is a seIf-initiated sequence of behaviors by an individual who, at the time of initiation, expected that the set of actions would lead to his or her own death. The “time of initiation" is the time when a behavior took place that involved ap- plying the method.)
B. The act does not meet criteria for nonsuicidal seIf-injury—that is, it does not involve self-injury directed to the surface of the body undertaken to induce relief from a nega- tive feeling/cognitive state or to achieve a positive mood state.
C. The diagnosis is not applied to suicidal ideation or to preparatory acts.
D. The act was not initiated during a state of delirium or confusion.
E. The act was not undertaken solely for a political or religious objective.