Fetal alcohol spectrum disorder (FASD) is lifelong condition. There is no curative treatment. Prognosis depends on the severity of congenital anomalies, the need for surgical and medical treatments, the age at which therapy is introduced, and the efficacy of treatment. Affected children are susceptible to a range of disabilities that are secondary to neurodevelopmental problems.[40]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004 Aug;25(4):228-38.
http://www.ncbi.nlm.nih.gov/pubmed/15308923?tool=bestpractice.com
Children can be helped to fulfil their potential by use of targeted educational and behavioural interventions.
When examining the risk of adverse outcomes, there is evidence that prognosis can be improved by early diagnosis.[40]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004 Aug;25(4):228-38.
http://www.ncbi.nlm.nih.gov/pubmed/15308923?tool=bestpractice.com
Diagnosis before the age of 12 years decreases the risk of a range of adverse adult outcomes between 2- and 4-fold.[40]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004 Aug;25(4):228-38.
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Other protective factors include living in a stable, nurturing home and not being exposed to physical or sexual abuse or domestic violence.[40]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004 Aug;25(4):228-38.
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Social functioning
Only 14% of young adults live independently, whereas 27% live in institutions and 35% in assisted-living settings.[87]Spohr HL, Willms J, Steinhausen HC. Fetal alcohol spectrum disorders in young adulthood. J Pediatr. 2007;150:175-179.
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Adults with FASD are more likely to be unemployed,[88]Rangmar J, Hjern A, Vinnerljung B, et al. Psychosocial outcomes of fetal alcohol syndrome in adulthood. Pediatrics. 2015;135:e52-e58.
http://pediatrics.aappublications.org/content/135/1/e52.long
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and only 13% of adults have held an ordinary job by the age of 21 years.[87]Spohr HL, Willms J, Steinhausen HC. Fetal alcohol spectrum disorders in young adulthood. J Pediatr. 2007;150:175-179.
http://www.ncbi.nlm.nih.gov/pubmed/17236896?tool=bestpractice.com
Education outcomes are poor and influence a range of other outcomes, including employment. Of adolescents, 53% have been suspended from school, 29% have been expelled, and 25% have dropped out of school.[40]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004 Aug;25(4):228-38.
http://www.ncbi.nlm.nih.gov/pubmed/15308923?tool=bestpractice.com
Only 13% of young adults have had a high school education;[87]Spohr HL, Willms J, Steinhausen HC. Fetal alcohol spectrum disorders in young adulthood. J Pediatr. 2007;150:175-179.
http://www.ncbi.nlm.nih.gov/pubmed/17236896?tool=bestpractice.com
96% of children and adolescents have received special education.[89]Autti-Rämö I, Fagerlund A, Ervalahti N, et al. Fetal alcohol spectrum disorders in Finland: clinical delineation of 77 older children and adolescents. Am J Med Genet A. 2006;140:137-143.
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Inappropriate sexual behaviour increases with age to 52% in adults.[40]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004 Aug;25(4):228-38.
http://www.ncbi.nlm.nih.gov/pubmed/15308923?tool=bestpractice.com
Common problems in adolescents and adults are promiscuity (26%) and inappropriate sexual advances (18%).[40]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004 Aug;25(4):228-38.
http://www.ncbi.nlm.nih.gov/pubmed/15308923?tool=bestpractice.com
Around 60% of adolescents and adults have had contact with the law, and 35% have been incarcerated for a crime.[40]Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004 Aug;25(4):228-38.
http://www.ncbi.nlm.nih.gov/pubmed/15308923?tool=bestpractice.com
However, one study noted that the levels of criminal offenses were similar to the control population.[88]Rangmar J, Hjern A, Vinnerljung B, et al. Psychosocial outcomes of fetal alcohol syndrome in adulthood. Pediatrics. 2015;135:e52-e58.
http://pediatrics.aappublications.org/content/135/1/e52.long
http://www.ncbi.nlm.nih.gov/pubmed/25535260?tool=bestpractice.com
Hospital admission rates for alcohol use and psychiatric disorders are higher in adults with FASD.[88]Rangmar J, Hjern A, Vinnerljung B, et al. Psychosocial outcomes of fetal alcohol syndrome in adulthood. Pediatrics. 2015;135:e52-e58.
http://pediatrics.aappublications.org/content/135/1/e52.long
http://www.ncbi.nlm.nih.gov/pubmed/25535260?tool=bestpractice.com