Prevalence and Traits of FASD in the US Population: Evidence from Schools

This multidisciplinary team of researchers has examined the prevalence, specific characteristics, and targeted etiology of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) among children in multiple settings: medical clinics, referral clinics, and school populations. In-school studies have proven to be the most innovative and promising for establishing an accurate and complete epidemiology of all forms of FASD in a population. The methods, logistics, and techniques of in-School studies represent an effective innovation, and these methods have developed nicely since 1997. In-school studies, as proposed here, have been conducted by this research team with success in two foreign countries, South Africa and Italy, in three pilot studies with very limited budgets and short time frames in the United States (U.S.). As proposed here they will yield accurate and meaningful results to move research forward to gain an understanding of the population-based prevalence and specific characteristics of FASD within the U.S. population and the information will be invaluable to a variety of areas relevant to public health, clinical, and even insights relevant to basic science. Assessments will be made of the prevalence and population-based characteristics of not only severe FASD (FAS and partial FAS (PFAS)), but also of those less severe diagnoses with less obvious dysmorphology; alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). Such studies are overdue for the U.S., for the extent, characteristics, context, and impact of FASD in one or more mainstream U.S. populations are basically unknown.

We are in a unique position, and the timing of this RFA is optimal. Our populations-based clinical and epidemiologic research methods are now refined, and directions for further improvements in FASD research in the U.S. are clear from both international work, and from three brief pilot studies in the U.S. Our cohesive and primed research group has worked together in virtually all sites where NIAAA has funded active case ascertainment FASD research. Furthermore, we are uniquely positioned by having received formal permission from two middle-American school districts to initiate this research and will gain permission at a third site soon.

Through screening, clinical examination, psychological and behavioral testing, sophisticated maternal interviews, and a targeted application of genetic testing, we will use slightly revised Institute of Medicine (IOM) - recommended interdisciplinary, diagnostic, and epidemiology methods in 1st grade classes.

Specific Aims:
  1. Assess, for the first time in a U.S. population, the minimal prevalence and estimate the true prevalence of FASD in three U.S. school populations via combinations of case control and random sampling methods.
  2. Define the specific 1) physical growth and morphological traits and b) intellectual, and developmental characteristics among mainstream U.S. children with FASD and controls from the same communities.
  3. A nested study is included to explore possible genetic contributions, as opposed to teratogenic influences, on the facial phenotype and disabilities of cases of severe FASD.
  4. Define key maternal risk factors for FASD in the three study populations: alcohol consumption and other drug use (by quantity, frequency, and timing of use), demographic, social, socioeconomic, body mass, nutrition, spiritual/religious, and mental health status.
  5. Coordinate all data content, collection, formatting, and procedures with the Data Analysis Coordination Component (DACC) of the Collaboration of FASD Prevalence (CoFASP), and provide all data collected to the DACC.