Fetal Alcohol Spectrum Disorders (FASD): Prevention and Intervention

Bill Dunty, PhD; Elizabeth Powell, PhD; Tatiana Balachova, PhD; and Deidra Roach, MD

NIAAA FASD Working Group Concept Clearance

Purpose

The purpose of this concept is to support research that advances interventions for Fetal Alcohol Spectrum Disorders (FASD) and prevention approaches to reduce prenatal alcohol exposure and the incidence of FASD.

Background

Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental deficits in the United States. It can cause a range of intellectual and behavioral problems, which appear at any time during childhood and last a lifetime. Fetal Alcohol Spectrum Disorders is an umbrella term for a range of physical, cognitive, and behavioral disorders caused by prenatal alcohol exposure. Recent prevalence studies estimate that approximately 1 to 5 percent of U.S. first-grade children have FASD.

Individuals with FASD experience a unique combination of day-to-day challenges, which may include medical, behavioral, educational, and social problems. People with FASD may have difficulty in areas of 1) neurocognition (i.e. global intellectual impairment, executive function deficits, poor working memory, learning problems); 2) self-regulation (i.e. impulse control problems, impaired mood or behavioral regulation, attention deficits, organization difficulties); and 3) adaptive functioning (i.e. communication issues, problems with daily living, poor social skills, gross or fine motor delay).

FASD are 100% preventable if a developing fetus is not exposed to alcohol. Given that approximately half of all pregnancies in the United States are not planned, the U.S. Surgeon General recommends that women who are pregnant, might be pregnant, or consider becoming pregnant should abstain from alcohol. Despite these guidelines, approximately 1 in 9 pregnant women report drinking alcohol in the past 30 days and about one third who report consuming alcohol engage in binge drinking, a pattern of consumption most harmful to the developing fetus.

Research Objectives

NIAAA is interested in novel intervention and prevention research for FASD across the lifespan (i.e. prior to birth, newborn, early childhood, adolescent or adult periods).

Intervention research may seek to:

• Develop and evaluate novel prenatal therapeutic approaches, medications, and dietary supplements
• Pursue various interventions to mitigate the neurocognitive and behavioral deficits associated with FASD across the lifespan
• Develop and evaluate innovative approaches to improve health and quality of life for individuals with FASD and their families
• Implement and expand interventions previously shown to be effective for FASD and/or other developmental disabilities populations
• Evaluate approaches to improve implementation of evidence-based interventions and access to care for individuals with FASD

Prevention research may seek to:

• Improve established methods that help women reduce or abstain from drinking during pregnancy
• Design and evaluate novel prevention approaches to promote alcohol (and other substance) abstinence in women to prevent prenatal alcohol exposure
• Develop and examine translation into practice of effective biopsychosocial, community-based, and policy approaches for preventing prenatal alcohol exposure
• Design and evaluate cost-effective interventions aimed at preventing FASD in high risk and vulnerable populations 
• Advance strategies to reduce stigma associated with alcohol use during pregnancy and FASD

Outcome/Justification

Over the past decade, NIAAA supported the development of various treatment approaches using dietary supplements, metacognitive strategies and sensorimotor training among others to improve cognitive and behavioral outcomes in individuals with FASD. Similarly, NIAAA has funded research into screening, brief interventions, and treatment approaches for high-risk and vulnerable populations, including pregnant women. Despite these investments, challenges remain with a critical need to build the evidence base for interventions to improve outcomes in individuals with FASD and for prevention, including primary, secondary, and tertiary approaches, to decrease alcohol use during pregnancy and incidence of FASD.

Furthermore, an examination of NIAAA’s FASD portfolio from FY2015-2020 has revealed disproportional funding among the IC’s four areas of FASD research – Etiology, Diagnosis, Intervention and Prevention – with funded awards in the latter two areas consisting of only 20% of the total number of new awards. Given this imbalance and the need to translate promising preclinical findings to clinical science and practice, NIAAA seeks to encourage FASD-related intervention and prevention research.