The quest for a neurobehavioral profile of heavy prenatal alcohol exposure

The devastating consequences of fetal alcohol syndrome (FAS) are well established, and, as a leading cause of intellectual disabilities (Pulsifer 1996), FAS has significant societal and public health implications. Importantly, FAS is associated with a broad range of neurobehavioral deficits (for more information, see the article by Coles, pp. 42-50 in this issue). However, FAS is only the most serious possible consequence of heavy prenatal alcohol exposure, and many individuals who do not meet diagnostic criteria for FAS also are severely impacted by gestational alcohol exposure. The term fetal alcohol spectrum disorders (FASD) is used to encompass a spectrum of effects that includes FAS towards the extreme end as well as conditions such as alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). The term ARND (Hoyme et al. 2005) refers to individuals who, after heavy prenatal alcohol exposure, exhibit neurobehavioral effects without meeting the physical criteria for FAS (for a review, see Vaurio et al. 2010). Clinical identification of this group of individuals is hampered precisely because they do not exhibit the external physical features of FAS, and the existing physiological biomarkers for gestational alcohol exposure have several limitations. Determination of a profile based on the neurobehavioral effects of heavy prenatal alcohol exposure would allow more accurate identification of affected individuals. To be clear, development of such a profile is aimed at identifying and characterizing those who are affected by prenatal alcohol exposure, not simply those who have been exposed to alcohol prenatally.