A Diagnosis of Exclusion: Demystifying Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure

Abstract

Neurodevelopmental disorder associated with prenatal alcohol exposure (ND-PAE) is the DSM-5 diagnostic term to describe the effects of alcohol exposure on the central nervous system and brain during the embryonic and fetal period. These effects, known as functional birth defects, are related to changes in the structure of brain architecture due to migration errors, cell death, and neuronal wiring. ND-PAE can occur at any point during pregnancy and has a prevalence rate of approximately 5–10% of American children. The full fetal alcohol syndrome results from a binge dose of 4–5 servings as early as the third week postconception, well before pregnancy recognition, and accounts for 10–15% of affected children. These children have mood dysregulation, social communication, perceptual defects, neurocognitive deficits, and fine as well as gross motor and coordination problems, all of which can impact the child’s adaptive functions and self-esteem. Early diagnosis and services through the life course can help these children live meaningful, productive lives in the community. However, families may need high levels of care to provide a structured lifestyle to reduce stressors and improve adaptive functions.