Development and Psychopathology: Fetal Alcohol Syndrome and Related Conditions

Prenatal exposure to alcohol, which is a neurobehavioral teratogen, can cause defects in the structure and function of the developing central nervous system and can also impact growth and morphology. These wide-ranging effects occur along a continuum, with the most severe impact known as fetal alcohol syndrome (FAS). As the identified population of alcohol-affected patients grows, because of enhanced societal awareness and increased diagnostic capability, it has become clear that the continuum of fetal alcohol effects can mean lifelong disabilities with serious implications for function in adolescence and adulthood. Both "primary" cognitive, communication, and behavioral difficulties, and adverse life outcomes or "secondary" disabilities occur. Caregivers report that alcohol-affected patients present an array of mental health concerns, suggesting that these patients will be seen in clinical practice. This review presents current information on diagnosis and incidence and overviews evidence that shows central nervous system dysfunction in this patient population. The basis for alcohol effects, and developmental influences on the expression of these effects, are discussed. Recent data on secondary disabilities and psychiatric conditions are provided, and clinical practice issues are discussed in detail, including conceptualizations of how secondary disabilities emerge, the diagnostic process, assessment, and intervention strategies.