Common Fetal Alcohol Spectrum Disorder Definitions

Fetal Alcohol Spectrum Disorder (FASD) is the umbrella term that encompasses the range of adverse effects associated with prenatal alcohol exposure. Common terms associated with an FASD are defined below. Additional information about the diagnosis of individual conditions is available in the Screening, Assessment and Diagnosis section on the FASD main page.

Prenatal Alcohol Exposure (PAE)

Prenatal alcohol exposure (PAE) is when a developing fetus is exposed to alcohol. All drinks containing alcohol (beer, wine, or liquor) have the potential to cause brain damage and harm a developing fetus. Alcohol is a known teratogen. Prenatal alcohol exposure is a leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities. Neurocognitive problems caused by prenatal alcohol exposure are lifelong. Currently, there is no known safe amount nor type of alcohol use during pregnancy.

Fetal Alcohol Spectrum Disorders (FASD)

Fetal alcohol spectrum disorders (FASD) is an umbrella term used to describe the range of preventable intellectual/neurodevelopmental disabilities and birth defects that result from prenatal alcohol exposure. Evaluation for an FASD includes a history of prenatal alcohol exposure, neurocognitive/behavioral functioning, dysmorphic features (particularly, facial dysmorphia), and growth parameters (prenatal and postnatal). The term FASD is not a clinical diagnosis in the United States.

Diagnoses under the FASD umbrella are: Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE), Alcohol-Related Neurodevelopmental Disorder (ARND), Fetal Alcohol Syndrome (FAS) and Partial Fetal Alcohol Syndrome (PFAS), and Alcohol-Related Birth Defects (ARBD).

The signs and symptoms of an FASD appear in various combinations within a spectrum of presentations. The number of FASD-related features vary among individuals and the severity of features can be from mild to severe. One or more diagnostic schema can be used to identify an FASD, dependent upon the presentations.

Individuals with an FASD need to be assessed within a patient- and family-centered medical home by clinicians with awareness about the effects of prenatal alcohol exposure for diagnosis, management, screening for co-occurring conditions, and referral/consultation when appropriate.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)

The diagnosis of Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) was introduced in the 5^th edition of the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association in 2013. Children with ND-PAE have neurodevelopmental, neurobehavioral, or mental health effects of prenatal alcohol exposure with or without cardinal facial dysmorphia and/or significant growth problems (height, weight, smaller head circumference of less than 10^th percentile) associated with Fetal Alcohol Syndrome (FAS) physical features. ND-PAE criteria include functional impairments of neurocognition, self-regulation, and adaptive functioning as well as a history of prenatal alcohol exposure. When a neurodevelopmental disorder is under consideration, prenatal alcohol exposure raises concern for ND-PAE.

ND-PAE and ARND are overlapping and similar but with a major difference. ND-PAE can be present with or without dysmorphic features whereas ARND is without the presence of full cardinal dysmorphic facial features found in individuals with FAS.

Alcohol-Related Neurodevelopmental Disorder (ARND)

Another FASD diagnosis that focuses on neurodevelopment is Alcohol-Related Neurodevelopment Disorder (ARND).  ARND is included in several available diagnostic schemes and typically has very specific criteria. Children with ARND have neurodevelopmental and neurobehavioral effects of prenatal alcohol exposure but specifically lack cardinal facial dysmorphia or growth deficits.   

Fetal Alcohol Syndrome (FAS) and Partial Fetal Alcohol Syndrome (PFAS)

Fetal Alcohol Syndrome has both physical and neurodevelopmental features.  Individuals are diagnosed with Fetal Alcohol Syndrome only if they meet the following 3 diagnostic criteria:

• prenatal and/or postnatal growth deficiency (lower-than-average height, weight or both, and/or smaller head circumference of less than 10^th percentile)
• three specific dysmorphic facial features
• smooth philtrum (the area between nose and upper lip)
• thin upper vermillion lip border
• reduced palpebral fissure length (the distance from the inner corner to the outer corner of the eye)
• any of a range of recognized neurodevelopmental or neurobehavioral features.

Individuals can be diagnosed with partial FAS (PFAS) if they have some of the diagnostic criteria of FAS without all of the features (growth impairment, decreased head circumference). PFAS is uncommon.

A diagnosis of FAS, with its distinctive dysmorphic features, is not an indicator of the severity of the impact of prenatal alcohol exposure. Individuals with different manifestations of ND-PAE or with ARND may be equally or more affected by prenatal alcohol exposure than those with FAS.    

Alcohol-Related Birth Defects (ARBD)

Individuals with Alcohol-Related Birth Defects (ARBD) only have problems with congenital anomalies caused by prenatal exposure to alcohol, and do not show evidence of neurocognitive or neurodevelopmental deficits (ND-PAE or ARND). Alcohol-Related Birth Defects are caused by the impact of prenatal exposure to alcohol on how an individual’s organs were formed and/or how they function, including the heart, kidney, bones, as well as hearing and/or vision. ARBD is uncommon.