Page 203

Index

A

Aarskog syndrome, 79

Abstinence during pregnancy, 27, 103, 105

counseling for, 11, 146

encouraged as means of FAS prevention, 9, 17, 27, 118

Academic performance, 69, 159, 163-164, 165; see also Adolescence and post-puberty development

Acetaldehyde adducts, 129-130

Active surveillance, 7, 91, 94-96, 97

linkages to treatment, 8, 97

proxy measures, 7, 95-96

Adaptive functioning, 73, 159, 163

Adolescence and post-puberty development, 6, 36, 80, 158

behavior patterns, 165-166, 168-169

catch-up growth, 73, 75

Adoption, 13, 15, 67, 74, 171, 172, 181, 186

Adulthood, 19, 75, 166

Affected individuals, see Behavioral patterns; Cognitive performance; Developmental stages and life span; Diagnostic criteria; Growth deficiency; Incidence and prevalence of FAS; Physical anomalies; Secondary disabilities; Treatment and intervention for FAS children

African Americans

FAS rates, 83

maternal drinking patterns, 103

Age

and drinking patterns, 106, 107, 108-109, 121

and subsequent pregnancies, 136

see also Developmental stages and life span

Aggression 163

Alanine aminotransferases (ALT), 128-129

Alcohol abuse, 117

among FAS adolescents, 158

biological markers, 9, 109, 126-131

diagnostic definition, 5n, 29-30, 68, 74, 77n

social-environmental factors, 88-89, 100-102, 108-109

stigma of, 92, 94, 96, 112, 146



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Page 203 Index A Aarskog syndrome, 79 Abstinence during pregnancy, 27, 103, 105 counseling for, 11, 146 encouraged as means of FAS prevention, 9, 17, 27, 118 Academic performance, 69, 159, 163-164, 165; see also Adolescence and post-puberty development Acetaldehyde adducts, 129-130 Active surveillance, 7, 91, 94-96, 97 linkages to treatment, 8, 97 proxy measures, 7, 95-96 Adaptive functioning, 73, 159, 163 Adolescence and post-puberty development, 6, 36, 80, 158 behavior patterns, 165-166, 168-169 catch-up growth, 73, 75 Adoption, 13, 15, 67, 74, 171, 172, 181, 186 Adulthood, 19, 75, 166 Affected individuals, see Behavioral patterns; Cognitive performance; Developmental stages and life span; Diagnostic criteria; Growth deficiency; Incidence and prevalence of FAS; Physical anomalies; Secondary disabilities; Treatment and intervention for FAS children African Americans FAS rates, 83 maternal drinking patterns, 103 Age and drinking patterns, 106, 107, 108-109, 121 and subsequent pregnancies, 136 see also Developmental stages and life span Aggression 163 Alanine aminotransferases (ALT), 128-129 Alcohol abuse, 117 among FAS adolescents, 158 biological markers, 9, 109, 126-131 diagnostic definition, 5n, 29-30, 68, 74, 77n social-environmental factors, 88-89, 100-102, 108-109 stigma of, 92, 94, 96, 112, 146

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Page 204 see also Drinking among women; Drinking during pregnancy; Heavy drinking; Treatment and prevention of alcohol abuse Alcoholics Anonymous (AA), 140 Alcohol-related birth defects (ARBD), 3, 5, 7, 77, 78-79, 80, 97 incidence and prevalence, 84, 97 Alcohol-related effects (diagnostic category), 4-5, 76-77, 78-79, 80. see also ''Fetal alcohol effects" diagnostic criteria, 4-5, 67, 70, 76-77, 78 Alcohol-related neurodevelopmental disorder (ARND), 3, 5, 7, 77, 78-79, 80, 81, 97 incidence and prevalence, 97 Alkaline phosphatase (AP), 129 Aminotransferases, 128-129 Anger, 80 Animal models and studies intervention and prevention strategies, 11-12, 15, 45-47, 144, 147, 155, 186 paternal alcohol exposure, 121 teratogenic effects, 6, 20, 22, 28, 37-41, 81 Antisocial behavior, 80 Anxiety, 80, 107, 108 Asian Americans, FAS rates, 83 Aspartate aminotransferases (AST), 128-129 Aspirin, 45-46 Attention, 15, 73, 159, 163, 164, 168, 186 Attention-deficit hyperactivity disorder (ADHD), 69, 161, 164, 177, 182 Autopsy studies, 72 B Babies, see Newborn period and infancy Bartenders, 122 Baseline data, 7, 89-90, 97 Behavioral patterns, 4, 5, 17, 43-44, 73, 75, 76, 77, 81, 158-166 across developmental stages, 69, 159-166, 168-169 as diagnostic criteria, 3, 67, 69 etiology, 166-167, 169-173 of FAS adolescents, 165-166, 168-169 of newborns and infants, 160-161 research needs, 15, 186 research studies, 158-159 specificity to FAS, 13, 79, 167, 173 vignettes, 56-58 see also Alcohol-related neurodevelopmental disorder (ARND) Behavioral Risk Factors Surveillance Surveys (BRFSS), 100, 104, 105, 106 Binge drinking, 44, 68, 106, 165, 166 Biological markers, 6, 72, 81, 115, 126-131, 135, 169 of alcohol abuse, 9, 109, 126-131 research needs, 6, 9, 81, 109 Birth, see Newborn period and infancy Birth control, 11, 136, 146-147 Birth Defects Monitoring Program (BDMP), 22, 83, 91 Birth registries, 83, 84, 90 Birth to Three Project, 142 Blood alcohol levels, 127 Bloom syndrome, 79 Brain damage, 4, 38, 39-40, 44, 68, 71, 72-73, 74, 75, 76, 81, 157, 169, 173 Brain stem auditory evoked response (BAER) test, 157 Breast-feeding, 142, 157 Breath analyzer, 127 Brief interventions, 10, 123-124, 131-135 C CAGE test, 124, 126 Carbohydrate-deficient transferrin (CDT), 130-131 Cardiac defects, 38, 156 Caregiving environment, 13, 53, 163, 165, 169-173 Case management, 11, 142, 147 Categories, see Alcohol-related birth defects (ARBD); Alcohol-related neurodevelopmental disorder

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Page 205 (ARND); Diagnostic categories; FAS with confirmed maternal alcohol exposure; FAS without confirmed maternal alcohol exposure; Partial FAS Caucasians/whites FAS rates, 83 maternal drinking, 106, 107 Center for Substance Abuse Prevention (CSAP), 23 Center for Substance Abuse Treatment (CSAT), 23 Centers for Disease Control and Prevention (CDC) risk factor surveys, 100, 104, 105 screening check lists, 72 surveillance and prevention programs, 22, 28, 83-84, 91, 97, 136, 144-145, 176, 195 Central nervous system (CNS) dysfunction, 4, 33, 38, 39, 71, 75, 76, 91 Cerebellar hypoplasia, 69, 73 Child abuse, 53, 102, 142, 170, 173 Cigarettes, see Smoking Clinical practice guidelines, 15, 186 Clinic-based studies, 8, 102, 103, 158 FAS incidence and prevalence estimates, 83, 84-87 Cocaine, 21, 23, 36, 105, 137; see also Crack cocaine Cognitive-behavioral interventions, 140 Cognitive performance, 4, 5, 17, 19, 73, 75, 76, 77, 81, 158, 159, 161, 163-164 see also Alcohol-related neurodevelopmental disorder (ARND); Mental retardation Community involvement, 114-115, 122, 185 Computed tomography (CT), 69, 72 Confidentiality, 92, 141, 176, 186 Congenital rubella syndrome (CRS), 20-21 Contraceptive services, 11, 136, 146-147 Coordination of services, 15-16, 176, 183-184, 194-196 Coordination problems, 73 Corpus callosum callosal dysgenesis, 69, 73 Counseling for abstinence during pregnancy, 11, 146 brief interventions, 10, 123-124, 131-135 contraceptive services, 11, 136, 146-147 Crack cocaine, 21, 105, 137 Cranial size, 4, 68, 70, 76 Creatine phosphokinase (CPK), 127 Cross-sectional research, syndrome characteristics over life span, 80 Culture, see Ethnic groups; Social-environmental factors Custody losses and retention, 11, 21, 142, 171-173; see also Foster care D Dental abnormalities, 156, 157 Depression, 80, 102, 107-108 Developmental delay, 6, 19, 73, 81, 135, 154, 161, 184 research needs, 6, 81 Developmental stages and life span behavioral patterns across, 69, 159-166, 168-169 diagnoses performed over, 6, 67, 70, 73-74, 80, 92 interventions over, 15, 166, 167-169, 174-175, 186 research needs, 6, 80, 167 variability in outcomes, 13, 167-168 worsening of effects over, 168-169 see also Adolescence and post-puberty development; Adulthood; Newborn period and infancy; Preschool period; School age Developmental toxicity, 33-37 Diagnoses and diagnostic labels consistency of, 64-65, 91-92 history of FAS definition, 17-19, 70-73 as marker for preventive interventions, 79-80 problems in surveillance, 64, 84, 90, 91-92

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Page 206 and secondary disability prevention, 80, 182 uses of, 2, 63-64, 79-80 at various developmental stages, 6, 67, 70, 73-74, 80, 92 see also Biological markers Diagnostic and Statistical Manual (DSM), 29-30, 64 Diagnostic categories, 3, 4-5, 74-79 Diagnostic criteria, 2-6, 64-70, 182, 185 for alcohol abuse and dependence, 5n, 29-30, 68, 74, 77n alcohol-related effects, 4-5, 67, 70, 76-77, 78 application across life span, 3, 6, 67, 70, 80 behavioral and cognitive features, 3, 67, 69 clinical applications, 64, 66, 67, 80 documented exposure to alcohol, 2, 3, 4, 6, 67-68, 74-75, 76, 80 physical features, 2, 67, 68 reliability and validity, 64-65, 71-72 research applications, 64, 66, 67, 80 research needs, 6, 80-81 role of imaging technology, 3, 67, 69, 69-70, 72-73 Dietary and nutrition factors, 9, 102, 109 fat intake, 46 Diethylbestrol (DES), 41 Differential diagnosis, 64, 79 Diphenylhydantoin (DPH, phenytoin), 34, 35, 41 Dose-response relationships, 41-45, 103, 112 Drinking among women, 9, 22, 100, 102, 105, 108, 109-110 heavy drinkers, 88, 105 low and moderate intake, 105 stigmatizing effects, 112, 146 Drinking contexts, 107 Drinking during pregnancy, 8-9, 103, 100-107 bingeing, 44, 68, 106, 165, 166 documentation of, 2, 3, 4, 6, 67-68, 74-75, 76, 80, 132 factors influencing, 9, 100-102, 106-107, 109, 121, 147 fetal protection mechanisms, 9, 12, 109, 147 first trimester, 106-107 heavy drinking, 27, 89, 100-101, 106, 120, 121 low and moderate intake, 2, 26-27, 116, 117-118, 120 and multiple-substance use, 21, 109 as proxy indicator of FAS, 95-96, 143 reduction of intake, 105-106, 119-120, 133-134 research needs, 9, 107-110 variation among ethnic groups, 103, 108-109 vignettes, 53-62 see also Abstinence during pregnancy Drugs, see Illicit drug use during pregnancy "Drunk" baby, 19 Dubowitz syndrome, 79 Dysmorphism, see Physical anomalies E Early intervention programs, 175, 176, 177 Eating disorders, 107 Education, see Academic performance; Parenting education; Professional training and education; Public education campaigns Educational interventions, 15, 186 for children with prenatal drug exposure, 15, 186 for secondary disabilities, 14, 155, 174-175, 177-179 Eligibility for services, 155, 156, 182-183 Embryonic period, 38-39 Emotional health, 15, 173, 186 Environment, see Caregiving environment; Social-environmental factors Epicanthal folds, 72 Epidemiology and surveillance, 6-7, 89-97 active surveillance, 7, 91, 94-96, 97

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Page 207 drinking among women, 9, 22, 100, 105, 108, 109-110 drinking during pregnancy, 8-9, 22, 100-109 FAS baseline data, 7, 89-90, 97 and FAS diagnostic problems, 64, 84, 90, 91-92 passive surveillance, 6-7, 83, 91-94 role in prevention programs assessment, 89-90, 97 use of multiple data sources, 84, 90-91 see also Clinic-based studies; Incidence and prevalence of FAS; Longitudinal studies; Population-based epidemiologic studies; Registry-based studies Erythrocyte delta-aminolevulinic acid (ALA) dehydrase, 127-128 Ethnic groups biomodal patterns of alcohol abuse, 88-89, 103 and maternal drinking, 103, 108-109, 121 variation in FAS prevalence estimates, 7, 90, 97 see also African Americans; Asian Americans, FAS rates; Caucasians/whites; Hispanics, FAS rates; Native Americans Etiology, of behavioral patterns, 166-167, 169-173 Eyebrows, 72 Eye defects, 38, 72, 73, 157 F Facial anomalies, 17, 38, 68, 70, 72, 73, 165 in diagnosis, 4, 73, 74, 75, 76 presence at birth, 71, 73, 160 Failure to thrive, 73, 157, 161 Families alcohol abuse history in, 53, 102, 107 interventions and support, 11, 14, 14-15, 117, 142, 180-181, 185 involvement in mothers' alcohol reduction and cessation, 10, 11, 115, 122, 146, 147 stability of, 53, 170 see also Caregiving environment FAS with confirmed maternal alcohol exposure (diagnostic category), 3, 4, 74, 76 FAS without confirmed maternal alcohol exposure (diagnostic category), 3, 4, 74-75, 76 Fathers, see Partners of women; Paternal alcohol exposure "Fetal alcohol effects" (FAE), 3, 63, 67, 70, 78. see also Alcohol-related effects Folic acid deficiency, 21 Follow-up in treatment, 15, 183, 186 Foster care, 11, 13, 74, 142, 171, 172, 181 Fragile-X syndrome, 69, 74, 79 G Gamma glutamyl transferase (GGT), 128, 131 Gatekeeping, 66, 79, 182 Gender differences alcohol treatment effectiveness, 139 biological markers for alcohol abuse, 128, 130-131 growth, 73 prenatal dose-response effects, 44 Genetic susceptibility, 40-41, 90 D-Glucaric acid, 127 Growth deficiency, 40, 71, 73-74, 157, 160 in diagnosis, 4, 70, 75, 76, 92, 160 low birthweight, 4, 40, 41, 68, 69-70, 76, 92-93 H Head Start, 175, 177 Health care interventions, 12, 147, 176-177 brief interventions, 10, 123-124, 131-135 referrals, 10, 11, 15, 131-132, 135, 147, 184 screening for maternal alcohol use, 124-131

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Page 208 secondary disabilities, 174, 176-177 selective, 10, 123-133 training, 11, 15, 123, 132-133, 147, 184 universal, 118-119 Health Resources and Services Administration (HRSA), 23, 143, 195 Healthy People 2000 goals, 20, 89-90 Hearing problems, 73, 157 Heavy drinking, 29, 30-31, 88, 105 definitions, 106 during pregnancy, 27, 89, 100-101, 106, 120, 121 identification, 11, 123, 124-126, 132-133, 147 Heroin, 35 Hispanics, FAS rates, 83 Hospital discharge data, 83, 84, 91 Hydronephrosis, 156 Hyperactivity, 159, 160, 161, 163, 164, 182 I Ibuprofen, 46 Illicit drug use during pregnancy, 21, 103, 105, 109 educational interventions for children, 15, 186 forced treatment and incarceration, 21, 137 Imaging techniques, 45, 69, 71 role in establishing diagnostic criteria, 3, 67, 69-70, 72-73 Impulse control, 164 Incarceration, of substance-abusing mothers, 21, 137 Incidence and prevalence of FAS alternative estimates, 1, 6, 19, 27, 82-91 among ethnic minorities, 7, 83, 97 Income and socioeconomic status, 89, 103, 106, 107, 108-109, 116-117, 121, 155 Indian Health Service, 23, 144, 195 Indicated prevention interventions, 10, 11-12, 115, 135-141, 145-147 alcohol abuse treatment as, 9, 10, 11, 107-108, 115, 135, 138-141, 141, 145, 154 for mothers of FAS children, 79, 135, 136-137 reproductive counseling and contraceptive services, 11, 136, 146-147 research needs, 11-12, 146-147 Indomethacin, 46 Infants, see Newborn period and infancy Integration and coordination of services, 15-16, 176, 183-184, 194-196 Intellect, see Cognitive performance Interagency cooperation, 15-16, 195-196 national survey, 7, 16, 97, 196 task force, 16, 196 Intervention, see Educational interventions; Health care interventions; Prevention interventions and measures; Treatment and intervention for FAS children; Treatment and prevention of alcohol abuse IQ scores, 159, 163 Iron deficiency anemia, 131 Isolation, 80 Isotreinoin, 42 J Judgment, 73, 158, 163 K Kidney anomalies, 156 L Labeling, see Diagnoses and diagnostic labels; Warning labels Language development and deficits, 15, 73, 159, 161-163, 186 Lead, 34, 35 Learning disabilities, 73

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Page 209 Liver damage, 127 Longitudinal studies, 19, 80, 86-87, 167 Low and moderate drinking, 105 during pregnancy, 2, 26-27, 116, 117-118, 120 Low birthweight, 4, 40, 41, 68, 69-70, 76, 92-93 M Magnetic resonance imaging (MRI), 45, 69, 71 Maintenance and aftercare, 114, 142 Males, see Gender differences; Partners of women Mandatory drug testing, 21 March of Dimes, 133 Marijuana, 34, 36, 42 Marital status, 107, 121, 122 Maternal and Child Health Bureau (MCHB), 23, 143 Maternal Health Practices and Child Development (MHPCD) Project, 93, 102 Maternal mortality, 171 Maternal PKU, 79 Math ability, 73, 159, 163-164, 166, 168 Mean corpuscular volume (MCV), 129 Media campaigns, 116, 147 Medical interventions, see Health care interventions Medical records, 84, 90, 92, 94 Memory, 163 Mental retardation, 19, 159, 169, 173 FAS as leading nongenetic cause, 7, 97 Methadone, 35 Methylmercury, 34, 35 Methylphenidate, 177 Metropolitan Atlanta Congenital Defects Program (MACDP), 83-84 Michigan Alcoholism Screening Test (MAST), 126 Microcephaly, 69, 72, 92 Middle class populations, 89, 103, 155 Minorities, see Ethnic groups Moderate drinking, see Low and moderate drinking Motivational interviewing, 140 Multidisciplinary approaches to service, 15, 16, 194-196 Muscle tone, 73 N National Fetal Mortality Survey, 104 National Health and Nutrition Examination Survey, 104 National Institute on Alcohol Abuse and Alcoholism (NIAAA), 16, 21-22, 28, 144, 195, 196 National Institute on Drug Abuse (NIDA), 21, 22 pregnancy survey, 104, 105 National Institutes of Health (NIH), 21-22 National Longitudinal Alcohol Epidemiologic Study, 104 National Longitudinal Survey of Youth (NLSY), 104, 105 National Maternal and Infant Health Interview Survey (NMIHS), 104, 105, 106 National Natality Survey, 104 National Organization on Fetal Alcohol Syndrome (NOFAS), 133 National Pregnancy and Health Survey, 22, 104, 105 National surveys, 7, 97, 108, 109 on drinking and pregnancy, 9, 102-103, 104, 108, 109 interagency cooperation in, 7, 16, 97, 196 Native Americans incarceration of pregnant women, 137 maternal drinking patterns, 88-89, 103 substance abuse treatment programs, 23 surveillance, 83, 87-89, 93 Neglect, 53, 142, 157, 170, 171, 173 Neonatal withdrawal syndrome, 135, 160 Neural tube defects, 21 Neurobehavioral deficits, see Behavioral patterns Neurobiological indicators, see Biological markers Neurotoxicity, 33-36, 38, 39-40, 157

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Page 210 Newborn period and infancy associated health conditions, 156 behavior patterns, 160-161 blood alcohol levels, 19 diagnosis during, 19, 70, 75, 91, 93-94, 168 environment enrichment, 46 low birthweight, 4, 40, 41, 68, 69-70, 76, 92-93 Non-steroidal anti-inflammatory (NSAI) agents, 46 Noonan's syndrome, 79 Normative standards, 68, 69 O Obstetrician gynecologists, 118-119, 124, 133, 194 Occupational therapy, 176, 177 Ocular problems, see Eye defects Opiates, 34, 35-36 Opitz syndrome, 79 Organogenesis, 38 Otitis media, 157, 161 Outcomes research, alcohol treatment for women, 138-141 P Palpebral fissures, 4, 72, 76 Parenting education, 15, 180-181, 185 Parity, 47, 136 Partial FAS (diagnostic category), 3, 4, 75, 76, 78 Partners of women drinking behavior, 102, 107, 108, 121 stability of relations with, 53, 107, 122 targeted for interventions, 10, 11, 117, 121-122, 142, 146 Passive surveillance, 6-7, 83, 91-94, see also Registry-based studies direct measures, 92 indirect measures, 92-94 Paternal alcohol exposure, 121-122 Pattern recognition, 72 Pediatric specialties, 176, 194 Peers and friendships, 163 of pregnant women, 10, 122 Perinatal 20 demonstration project, 22 Phenylketonuria, 79 Physical anomalies, 17-19, 156-157, 159 as diagnostic criteria, 2, 67, 68 prenatal development, 37-40 see also Alcohol-related birth defects (ARBD); Facial anomalies; Growth deficiency Physical therapy, 176, 177 Physician involvement, see Health care interventions Placental growth, 69, 70 Polychlorinated biphenyls (PCBs), 34, 35 Population-based epidemiologic studies, 7, 87-89, 96 drinking during pregnancy, 83, 95, 102-103 Poverty areas and inner cities, 89, 103, 155 Prader-Willi syndrome, 74 Predifferentiation period, 37-38 Pregnancy, see Abstinence during pregnancy; Drinking during pregnancy Pregnancy Risk Assessment Monitoring System (PRAMS), 106 Pregnant and Postpartum Women and Their Infants (PPWI) initiative, 23, 142-143 Prenatal care, 107, 124, 126-127, 133-135 Prenatal development, susceptibility over, 36, 37-40 Preschool period behavior patterns, 161-163, 168 services, 174, 177, 183 Prevalence, see Incidence and prevalence of FAS Prevention interventions and measures, 9-12, 112-113 birth defects, 20-21 case management approaches, 114, 142, 147 comparison among programs, 11, 146

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Page 211 evaluation of impacts, 11, 16, 113, 119-120, 142-144, 146, 147, 196 indicated, 10, 11-12, 115, 135-141, 145-147 models of, 113-114 research needs, 11-12, 113, 146-147 research programs, 22-23, 144-145 secondary disabilities, 13-15, 80, 154, 173-181, 182-183, 185-186, 196 selective, 9-10, 12, 115, 120-135, 145, 147 universal, 9, 12, 114-115, 116-120, 145, 147 Problem solving, 163 Professional training and education diagnosis of FAS, 66, 91, 92, 94, 133, 182 identification of heavy drinking, 11, 123, 132-133, 147 in prevention of FAS, 15, 132-133, 136, 179-180, 185 referral for treatment, 11, 15, 147, 184 Prospective studies, 83, 84, 86-87, 158-159 on effects of maternal substance use, 7, 26-27, 93, 94 Prostaglandin (PG), 45-46 Protective factors against fetal injury, 9, 12, 45-46, 109, 147 women's drinking reduction, 9, 109, 147 Proxy indicators of prevention activities impacts, 119, 143-144 surveillance criteria, 7, 92-94, 95-96 validation, 96 Psychological factors, 9, 102, 107, 109, 147 Psychotherapeutic drugs, 105, 177 Ptosis, 72 Puberty, see also Adolescence and post-puberty development Public education campaigns, 9, 20, 116 Public Health Service (USPHS), 19, 20, 21-23 R Racial groups, see Ethnic groups Radiation, 34, 35 Referrals, 10, 11, 15, 131-132, 135, 147, 184 professional training in, 11, 15, 147, 184 Registry-based studies, 7, 83-84 Research needs alcohol abuse, 9, 27-28, 102, 107-110, 138, 139, 141 behavioral patterns, 15, 186 biological markers, 6, 9, 81, 109 developmental stages, 6, 80, 167 diagnostic criteria, 6, 80-81 prevention interventions, 11-12, 113, 146-147 Research programs and studies, 21-23, 144-145 behavioral patterns, 158-159 coordination of, 15-16, 107, 194-196 prevention interventions, 22-23, 144-145 teratogenic effects, 19-20, 27, 37-45, 158 see also Animal models and studies; Clinic-based studies; Cross-sectional research; Epidemiology and surveillance; Longitudinal studies; National surveys; Population-based epidemiologic studies; Prospective studies; Research needs Residential Treatment for Women and Their children, 23 Retrospective studies, 83, 84, 86, 158 Risk factors, see Dietary and nutrition factors; Social-environmental factors Rubella, 20-21 S Salicylate, 42 School age, 163-165, 168, 183

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Page 212 School performance, see Academic performance Screening tools, 11, 146; see also Biological markers Secondary disabilities, 12, 13-14, 80, 154-155, 173-181 and caregiving environment, 155, 169-173 educational interventions, 14, 155, 174-175, 177-179 medical interventions, 174, 176-177 Seizures, 73, 157-158 Selective prevention interventions, 9-10, 12, 115, 120-135, 145, 147 biological markers, 126-131 brief interventions, 123-124, 131-135 health care professionals' roles, 10, 123-133 and prenatal care, 133-135 professional training, 132-133 referrals, 131-132 research needs, 12, 147 screening instruments, 124-126 targeting of demographic subgroups, 12, 147 targeting of family, 115, 122, 147 targeting of women's partners, 121-122 Self-esteem, 102, 107, 140 Self-help groups, 140 Sensory integration, 15, 161, 163, 186 Skeletal anomalies, 38, 156 Sleep disturbances, 160 Smoking, 34, 36, 101, 105, 121 Social-environmental factors, 9, 90, 109, 147 in alcohol abuse, 88-89, 100-102, 108-109 role in modifying fetal alcohol exposure, 15, 46-47, 186 Socioeconomic status, see Income and socioeconomic status Species susceptibility, 40 Speech delays, 73, 157 Stability of relationships, 53, 107, 121, 171-173 State-based surveys, 22, 97 State government agencies, 195 Stigma of alcohol abuse, 92, 94, 96, 112, 146 of FAS diagnosis, 2, 66 Substance Abuse and Mental Health Services Administration (SAMHSA), 23, 143, 195 Support groups, 140, 181 Surgeon General's warning, 2, 22, 27, 118 Surveillance, see Epidemiology and surveillance Sweden, FAS rate, 84 T T-ACE test, 125, 126 Targeting, see Indicated prevention interventions; Selective prevention interventions Teratogenic effects, 33-36, 73, 101, 121, 159-160 dose-response effects, 41-45 low-level alcohol use, 27 multifactorial model, 47-48 research studies, 19-20, 27, 37-45, 158 Thalidomide, 41, 42 Therapeutic intervention, 176-177 Tobacco, see Smoking Training, see Professional training and education Treatment and intervention for FAS children, 12-14, 27-28, 173-186 availability of services, 156, 175-176 barriers to services, 155-156, 175-176, 181-184 community outreach programs, 185 coordination of services, 15, 16, 195, 196 early identification, 14, 80, 155, 168, 182, 185 eligibility for services, 155, 156, 182-183 follow-up, 15, 183, 186 local and regional clusters, 14, 185 planning, 166-173

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Page 213 Treatment and prevention of alcohol abuse availability of services, 10-11, 137, 138, 141 in drug treatment programs, 21 evaluation of effectiveness, 138-141, 143-144 forced, 21, 137 intensive, 10-11, 140-141, 146 as a preventive intervention for FAS, 9, 10, 107-108, 115, 135, 138, 145, 154 referrals, 10, 135 research needs and barriers, 27-28, 102, 138, 139, 141 Tremors, 73 Turner's syndrome, 79 TWEAK test, 125, 126 Twin studies, 41, 121 U Universal prevention interventions, 9, 12, 114-115, 116-120, 145, 147 health care professionals' roles, 118-119 research needs, 12, 147 Urinary dolichol, 127-128 Urine testing, 21, 127-128 Urogenital problems, 38, 156 V Velocardiofacial syndrome, 79 Vigilance, 164 Violence against women, 102, 107, 108 Vision problems, 73, 156, 157 Vitamin A, 42 W Warning labels, 118, 119-120 Whites, see Caucasians/whites Wiedemann-Beckwith syndrome, 74 Williams syndrome, 79 Women's drinking, see Drinking among women; Drinking during pregnancy