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•  the availability and effectiveness of prevention and treatment programs for these conditions.

As part of its work, the committee reviewed and assessed U.S. Department of Health and Human Services agency research on the topic and provided guidance for the future.

FAS is caused by prenatal exposure to high levels of alcohol. FAS is not a ''drunk" baby or a baby physically dependent on or addicted to alcohol. Although the manifestations of FAS might change with age, FAS never completely disappears and, as with many developmental disabilities, there is no cure, although there might be some amelioration in some individuals. The committee studied data on the relation between low or moderate levels of prenatal alcohol exposure and more subtle abnormalities associated with such exposure, but it was unable to conclude that these subtle abnormalities, as detected by statistical calculations from epidemiologic studies of defined populations, do or do not represent a distinct clinical entity. The clinical significance of these effects for an individual is not clear. The committee is cognizant of the grave concern of many pregnant or preconceptional women and their partners about possible effects of less than heavy consumption of alcohol. The lack of diagnostic criteria for or more definitive statements regarding possible effects of low to moderate exposure to alcohol should not be interpreted as contradictory to the Surgeon General's warning against drinking alcohol during pregnancy.

DIAGNOSIS AND CLINICAL EVALUATION OF
FETAL ALCOHOL SYNDROME

A medical diagnosis serves several major purposes: to facilitate communication among clinicians; to facilitate communication between clinician and patient (including, in this instance, the parents of patients); to assist in the study of pathophysiology and etiology; and to guide treatment. In addition to the well-documented guidelines of good reliability and validity, a number of practical considerations also inform decisions about diagnostic criteria. Placing a patient in a diagnostic category confers both benefits and disabilities. For example, the diagnosis of FAS may validate a patient's disability and facilitate appropriate interventions and social benefits. On the other hand, the diagnosis may also be used to stigmatize and to create self-fulfilling prophecies about the future that could be detrimental to the patient and his or her family.

The key issues noted by the committee for identification of FAS include the following:

1.  Should a documented history of exposure to alcohol be required for the diagnosis of FAS?

2.  Which physical features should be used to define the disorder?



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