Fetal Alcohol Syndrome -- Copyright -- Preface -- Acknowledgments -- Contents -- Executive Summary -- DIAGNOSIS AND CLINICAL EVALUATION OF FETAL ALCOHOL SYNDROME -- Key Recommendations -- EPIDEMIOLOGY AND SURVEILLANCE OF FAS, ARBD, AND ARND -- Key Conclusions and Recommendations -- EPIDEMIOLOGY AND SURVEILLANCE OF DRINKING DURING PREGNANCY -- Key Recommendations -- PREVENTION -- Key Recommendations -- Indicated Prevention Interventions -- Selective Prevention Interventions -- Universal Prevention Interventions -- TREATMENT OF THE AFFECTED INDIVIDUAL -- Key Recommendations -- INTEGRATION AND COORDINATION -- RECOMMENDATION -- 1 Introduction -- HISTORY -- THE FEDERAL RESPONSIBILITY FOR FAS RESEARCH -- CONGRESSIONAL INTEREST -- THE COMMITTEE'S FOCUS AND PROCESS -- SOME IMPORTANT DEFINITIONS -- REFERENCES -- 2 Issues in Research on Fetal Drug Effects -- PRINCIPLES OF TERATOLOGY AND DEVELOPMENTAL TOXICOLOGY -- SUSCEPTIBLE STAGES OF DEVELOPMENT -- SUSCEPTIBLE SPECIES AND GENOTYPE -- DOSE-RESPONSE EFFECTS -- INTERVENTION AND PREVENTION -- A MULTIFACTORIAL MODEL -- REFERENCES -- 3 Vignettes -- SALLY -- ANN -- LYDIA -- MARK AND JAMES -- PETER -- MARY -- BABY HERBERT'S MOTHER -- REFERENCES -- 4 Diagnosis and Clinical Evaluation of Fetal Alcohol Syndrome -- PURPOSE OF MEDICAL DIAGNOSES -- USE OF DIAGNOSTIC CRITERIA -- STANDARDS FOR EVALUATING DIAGNOSTIC CRITERIA -- ISSUES IN DECIDING ON DIAGNOSTIC CRITERIA -- SPECIFIC ISSUES TO BE ADDRESSED IN IDENTIFYING CRITERIA FOR FETAL ALCOHOL SYNDROME -- Exposure to Alcohol -- Defining Physical Features -- Behavioral or Cognitive Features -- Role of Ancillary Measures -- Diagnosis Across the Life Span -- Relationship of Fetal Alcohol Effects to Fetal Alcohol Syndrome -- EVOLUTION OF THE DIAGNOSIS OF FETAL ALCOHOL SYNDROME -- LONGITUDINAL PERSPECTIVES ON THE FAS DIAGNOSIS -- DIAGNOSTIC CATEGORIES.

DIFFERENTIAL DIAGNOSIS -- CLINICAL UTILITY OF FAS, ARBD, AND ARND DIAGNOSES -- Prevention -- Prevention of Secondary Disabilities -- RECOMMENDATIONS: DIAGNOSTIC CRITERIA -- REFERENCES -- 5 Epidemiology and Surveillance of Fetal Alcohol Syndrome -- INCIDENCE AND PREVALENCE OF FAS, ARBD, AND ARND -- Registry-Based Studies -- Clinic-Based Studies -- Prospective Epidemiologic Studies of the Effects of Maternal Substance Abuse -- Population-Based Epidemiology Studies -- Issues and Considerations -- Role of Epidemiology in Prevention Programs -- Consistent Diagnosis -- Use of Multiple Data Sources -- SURVEILLANCE METHODS FOR FETAL ALCOHOL SYNDROME -- Passive Surveillance -- Advantages and Disadvantages -- Possible Solutions -- Active Surveillance for Fetal Alcohol Syndrome -- Advantages and Disadvantages -- Proxy Measures in an Active Surveillance Program -- Feasibility of Surveillance -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- 6 Epidemiology of Women's Drinking -- METHODOLOGIC CONSIDERATIONS -- Studies of Pregnant Women in Clinical Settings -- Studies of Pregnant Women in the General Population -- Other Issues -- DEFINITIONS AND PATTERNS OF DRINKING AMONG U.S. WOMEN -- Women in the General Population -- Pregnant Women -- Correlates of Drinking in Pregnancy -- NEEDED RESEARCH ON PREGNANT WOMEN'S DRINKING -- Increased Coordination of Research on FAS and Women's Drinking -- Increased Secondary Analysis of National Health and Alcohol Use Surveys -- Inclusion of Ethnic and Other Subgroup Populations in Studies of Drinking in Pregnancy -- Substance-Specific Versus Multiple-Substance Risk Factors -- CONCLUSIONS AND RECOMMENDATIONS -- REFERENCES -- 7 Prevention of Fetal Alcohol Syndrome -- A PUBLIC HEALTH MODEL OF PREVENTION -- Definitions -- UNIVERSAL PREVENTION INTERVENTIONS -- SELECTIVE PREVENTION INTERVENTIONS.

Population-Based Risk Factors for Giving Birth to an FAS Child -- Role of the Father -- Role of Health Care Professionals -- Screening Instruments -- Biomarkers -- Brief Interventions and Referral -- Professional Education -- Empirical Evaluation -- INDICATED PREVENTION INTERVENTIONS -- Women Who Have Given Birth to a Child with FAS, ARBD, or ARND -- Treatment of Alcohol Abuse and Dependence in Pregnant Women -- Treatment Outcome Research on Alcohol Abuse in Women -- Addressing Barriers to Research -- MAINTENANCE AND AFTERCARE -- PROGRAM EVALUATION -- PUBLIC HEALTH SERVICE-FUNDED RESEARCH -- SUMMARY -- RECOMMENDATIONS -- REFERENCES -- 8 The Affected Individual: Clinical Presentation, Intervention, and Treatment -- CLINICAL ISSUES IN INDIVIDUALS WITH FAS, ARBD, OR ARND -- Medical Overview: FAS Health Issues -- Behavioral and Social Issues -- Research Methodology -- Developmental Differences in Clinical Presentation -- Key Questions for Planning Interventions -- Patterns of Development -- Etiology -- Specificity -- INTERVENTION AND PREVENTION OF SECONDARY DISABILITIES -- Medical and Therapeutic Intervention -- Educational Interventions for Alcohol-Affected Children -- Other Interventions to Improve Outcomes for Affected Individuals -- Professional Training and Education of Policymakers -- Support for Families -- LIMITATIONS AND BARRIERS TO THE PROVISION OF SERVICES -- Accurate Identification -- Eligibility and Measurement of Development -- Inconsistency in Follow-Up -- SUMMARY: INTERVENTION AND TREATMENT -- RECOMMENDATIONS -- REFERENCES -- 9 Integration and Coordination: A Concluding Comment and Recommendation -- Appendix Biographies -- INSTITUTE OF MEDICINE STAFF -- Index.