• Substance use, abuse, and addiction
  • Infants and Toddlers

Since alcohol use has increased since the pandemic, researchers have found this pattern to also be among pregnant women as well. Therefore, experts worry this could result with more babies being born with damage from prenatal alcohol exposure. “Experts estimate that 2% to 5% of U.S. schoolchildren—as many as 1 in 20—may be affected by prenatal alcohol exposure, which can cause complications with growth, behavior, and learning. The effects on individuals and families, as well as the economic costs, are substantial.”

Clinicians should be aware that FASD often overlaps with mental health symptoms. These problems begin in early childhood and exist through adulthood, as described by Mary O’Connor, PhD, ABPP, founder of the UCLA Fetal Alcohol Spectrum Disorders Clinic ( Current Developmental Disorders Reports, Vol. 1, No. 1, 2014). Her research has also found a higher incidence of suicidal ideation and behavior in adolescents with FASD (Birth Defects Research, Vol. 111, No. 12, 2019).

Understanding FASD

Prenatal alcohol exposure can result in several conditions that fall under the FASD umbrella. These include fetal alcohol syndrome (FAS) and partial FAS, both of which can cause growth problems, central nervous system problems, and characteristic facial features (including small eye openings, flattening of the ridge between the nose and lip, and a thin upper lip), in addition to problems with learning and behavior. People with alcohol-related neurodevelopmental disorder (ARND) don’t have the characteristic facial features or growth deficiency of FAS, but they may have wide-ranging neurocognitive disabilities and problems with behavior and learning.

Each of the disorders in the fetal alcohol spectrum can cause problems with self-regulation, executive functioning, social skills, and math skills. These deficits often interfere with children’s performance in school and their ability to make friends. Yet while FASD often causes learning difficulties, the symptoms can be unpredictable. “FASD is the most common preventable cause of intellectual disability in the world. But the majority of alcohol-exposed children have a normal IQ,” Chasnoff said. One notable feature of FASD is a gap between intelligence and adaptive functioning, he added.

Diagnosis and Treatment of FASD

The gold standard for FASD diagnosis is a multidisciplinary evaluation looking at physical features, neurobehavioral impairments, and any known history of prenatal alcohol exposure. The assessment typically involves a variety of specialists such as physicians, speech/language pathologists, psychologists, and geneticists. But those comprehensive evaluations are hard to come by. “There are very few FASD clinics that provide full-service diagnosis,” O’Connor said. “It’s estimated that about only 1% of people with prenatal alcohol exposure can get a diagnosis in that type of situation.”

Preventing FASD, Attacking Stigma

Efforts are also underway to prevent babies from being born with FASD. The Centers for Disease Control and Prevention promotes two strategies to reduce alcohol-exposed pregnancies. CHOICES is an evidence-based program that helps women make decisions around drinking and contraception (Floyd, R. L., et al., American Journal of Preventive Medicine, Vol. 32, No. 1, 2007). The other strategy, alcohol screening and brief intervention (SBI), is a preventive service that involves screening questions about drinking patterns, a short conversation with patients who drink more than recommended amounts, and referral to treatment when appropriate (Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use [PDF, 2.11MB], Centers for Disease Control and Prevention, 2014). “These interventions could easily be incorporated as part of a psychologist’s practice,” O’Connor said. (See more on brief screening interventions.)


Weir, K. (2022). A Hidden Epidemic of Fetal Alcohol Syndrome. Vol. 53. No. 5.

American Psychological Association.