data from long-term clinical studies of individuals with FAS gathered from a number of different populations (Lemoine and Lemoine, 1992 [France]; Steinhausen et al., 1993 [Germany]; Streissguth et al., 1991 [Native American]) arguing that outcome can be predicted most effectively by examining the interaction between severity of biological insult (operationally defined as dysmorphia) and environmental risk (operationally defined as caregiving instability and abuse or neglect). This relationship comes as no surprise, because it is well known that in other studies of high-risk children, poor social and caregiving environments exacerbate negative outcomes, whereas middle-class social status (Aylward, 1992) and well-designed early intervention (Bryant and Ramey, 1987) ameliorate these negative effects. However, few systematic attempts have been made to intervene with alcohol-affected children to test the possibility that such strategies would be effective in producing more positive outcomes.
It is possible to speculate on reasons for the lack of interest in intervention with this group of children (see Coles and Platzman, 1992). Many of those identified as alcohol-affected are of minority or low socioeconomic status (SES) (Abel, 1995). For these reasons, families often lack the resources that are required to access appropriate services (Anderson and Novick, 1992). It is also well known that most medical and other professionals are not comfortable dealing with substance abuse or with addicts (Chappel, 1973; Robinson and Podnos, 1966). In addition, however, there has been an attitude that ''the damage is done" and that, given the biological nature of the insult to the nervous system, there is little to be done to help affected children. Some clinical studies have appeared to suggest that an optimal rearing environment may not significantly alter the deficits observed in children with FAS (Streissguth et al., 1985). However, others have argued that postnatal environment and experience do, indeed, significantly influence outcome in terms of both behavioral and cognitive development (Brown et al., 1991; Smith and Coles, 1991). Although there are few clinical studies in affected children, animal research suggests that the postnatal rearing environment may have positive outcomes even in alcoholized animals (Hannigan et al., 1993; Weinberg et al., in press). Although one cannot extrapolate directly from findings in animals to the clinical setting, the present data certainly indicate one possible direction for future research on treatment of children exposed to alcohol prenatally.
When considered, the view that intervention may not be useful in children affected by alcohol seems odd, because it is inconsistent with the attitude taken toward other groups of high-risk and disabled children, who are the focus of many early intervention and special education efforts (Meisels and Shonkoff, 1990). Children with Down syndrome, for instance, usually are more seriously affected than those with FAS. Nevertheless, such children are regularly identified early and placed in intervention (Farran, 1990), although their developmental scores during the first year often do not qualify them for services.
There appear to be several kinds of barriers that have prevented alcohol-affected