Natural history

Fetal alcohol syndrome is not only a childhood disorder; the cognitive and behavioural effects and psychosocial problems may persist throughout adolescence into adulthood/22,,2, and ^i27,2 ) Although the facial features are not as distinctive after puberty and the growth deficiency is not as apparent as in the younger child, the central nervous system effects do persist throughout life. Approximately 50 per cent of those affected function as mentally retarded persons. Moreover, adaptive behavioural problems in communication skills and in socialization are apparent in those with both fetal alcohol effects and alcohol-related developmental disorder whose intelligence test scores are in the normal range.

Poor judgement, attention problems, distractibility, difficulty in recognizing common social cues, and problems in modulating mood continue as characteristic features. Family environmental problems often continue as risk factors for behavioural problems if there is a lack of stability in family life. In one follow-up study (27) that used structured interviews with non-retarded affected subjects, the most common diagnoses were alcohol or drug dependence, depression, psychotic disorders, and personality disorders (avoidant or antisocial). Further follow-up is needed to investigate the mechanisms involved in these psychiatric presentations, and particularly in determining the pathways leading to alcoholism.

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