Alcohol is a neurobehavioral teratogen, and prenatal alcohol exposure has teratogenic effects on central nervous system (CNS) development and subsequent function. Neurobe- havioral disorder associated with prenatal alcohol exposure (ND—PAE) is a new clarifying term, intended to encompass the full range of developmental disabilities associated with expo- sure to alcohol in utero. The current diagnostic guidelines allow ND—PAE to be diagnosed both in the absence and in the presence of the physical effects of prenatal alcohol exposure (e.g., facial dysmorphology required for a diagnosis of fetal alcohol syndrome).
The essential features of ND-PAE are the manifestation of impairment in neurocognitive, behavioral, and adaptive functioning associated with prenatal alcohol exposure. Impair- ment can be documented based on past diagnostic evaluations (e.g., psychological or ed- ucational assessments) or medical records, reports by the individual or informants, and/ or observation by a clinician.
A clinical diagnosis of fetal alcohol syndrome, including specific prenatal alcohol- related facial dysmorphology and growth retardation, can be used as evidence of signifi- cant levels of prenatal alcohol exposure. Although both animal and human studies have documented adverse effects of lower levels of drinking, identifying how much prenatal exposure is needed to significantly impact neurodevelopmental outcome remains chal- lenging. Data suggest that a history of more than minimal gestational exposure (e.g., more than light drinking) prior to pregnancy recognition and / or following pregnancy recogni- tion may be required. Light drinking is defined as 1—13 drinks per month during preg- nancy with no more than 2 of these drinks consumed on any 1 drinking occasion. Identifying a minimal threshold of drinking during pregnancy will require consideration of a variety of factors known to affect exposure and / or interact to influence developmental outcomes, including stage of prenatal development, gestational smoking, maternal and fetal genet- ics, and maternal physical status (i.e., age, health, and certain obstetric problems).
Symptoms of ND-PAE include marked impairment in global intellectual performance (IQ) 0r neurocognitive impairments in any of the following areas: executive functioning, learning, memory, and / or visual-spatial reasoning. Impairments in self-regulation are pres- ent and may include impairment in mood or behavioral regulation, attention deficit, or impairment in impulse control. Finally, impairments in adaptive functioning include com- munication deficits and impairment in social communication and interaction. Impairment in daily living (self-help) skills and impairment in motor skills may be present. As it may be difficult to obtain an accurate assessment of the neurocognitive abilities of very young chil- dren, it is appropriate to defer a diagnosis for children 3 years of age and younger.
Associated features vary depending on age, degree of alcohol exposure, and the individ- ual’s environment. An individual can be diagnosed with this disorder regardless of socio- economic or cultural background. However, ongoing parental alcohol/substance misuse, parental mental illness, exposure to domestic or community violence, neglect or abuse, disrupted caregiving relationships, multiple out-of-home placements, and lack of conti- nuity in medical or mental health care are often present.
The prevalence rates of ND-PAE are unknown. However, estimated prevalence rates of clini- cal conditions associated with prenatal alcohol exposure are 2%—5% in the United States.