The field seems to be evolving toward a kind of continuum of disability characteristics resulting from alcohol exposure during pregnancy....
The CDC reported that 10.2% of pregnant women consumed alcohol within the last 30 days and 3.1% reported binge drinking. Recent studies estimated that between 2% and 5% of school-aged children in the U.S. have FASD and that most of these children are not diagnosed. In addition, only 25% of children affected by alcohol exposure alcohol in utero show physical features of FASD. As a result, in 2011, the National Institute on Alcohol Abuse and Alcoholism and the CDC organized a group of researchers to evaluate the FASDs that lack physical features. They found that the three main features that affected this population were neuro-cognition, self-regulation and adaptive functioning. These features then formed the basis of the ND-PAE diagnostic criteria.
Neurocognitive impairment includes either global impairment, executive dysfunction, deficits in learning, memory problems or trouble with visual-spatial reasoning. These criteria can be assessed by standardized testing, clinical observation or clinical history. Approximately 86% of individuals with FASDs have an IQ in the low average or borderline ranges.
Self-regulation impairment includes difficulty regulating mood or behavior, attention deficits or poor impulse control. Early signs of mood and behavior regulation problems include sleep issues or severe reactions to discomfort for infants, extended tantrums for toddlers and increased incidence of externalizing behaviors as well as severe reactions to stress for older children.
Adaptive functioning impairment can occur either in communication, social communication and interaction, daily living skills or motor skills for very young children. Children might show difficulty in understanding figurative language — idioms, jokes or sarcasm — and social communication conventions, such as how to effectively enter a conversation. Socially, they can be overly friendly with strangers and have difficult learning social rules through experience — eg, how to join a group on the playground — placing them at high risk for bullying and being manipulated by others. While a child with ND-PAE might learn hygiene or house rules, maintaining those skills is a challenge. In addition, their motor skills are impaired at the fine motor level, such as writing, or gross motor level such as coordination and balance.