ND-PAE Fast Facts

Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (ND-PAE) is a neurological disorder that causes problems with behavior, intellectual abilities, and learning.

ND-PAE is a fetal alcohol spectrum disorder (FASD). FASDs are a group of disorders caused by a baby’s exposure to alcohol during pregnancy.

No one knows how common FASDs are, but some researchers estimate that as many as 5% of people in the United States and Western Europe may be affected by one of the disorders.

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FASDs are a group of disorders caused by a baby’s exposure to alcohol during pregnancy.

What is ND-PAE?

Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) is a neurological disorder caused by prenatal alcohol exposure. It can cause a wide range of symptoms related to physical development, intellectual abilities, behavior, and other brain-related deficits.

Fetal alcohol spectrum disorders (FASDs) are a group of disorders resulting from a baby’s exposure to alcohol before birth due to the mother’s consumption. The group is comprised of several different disorders that vary in severity and types of symptoms.

Symptoms of ND-PAE

ND-PAE symptoms vary widely from case to case, both in which symptoms are present and their severity. Common symptoms include:

  • Low birth weight
  • Slow growth
  • Small head size
  • Atypical facial features (small eyes; thin upper lip; short, upturned nose; smooth skin between the nose and upper lip)
  • Hyperactivity
  • Problems with attention
  • Learning disabilities
  • Speech impairments
  • Intellectual disabilities
  • Feeding problems in babies

Difference from Other FASDs

The different types of FASDs are categorized according to their symptoms. Other FASDs include:

  • Fetal alcohol syndrome (FAS) is the most severe FASD. Children with FAS typically suffer from physical, cognitive, psychological, and behavioral symptoms.
  • Alcohol-Related Birth Defects (ARBD) are physical symptoms of pre-birth alcohol exposure. The symptoms can affect the heart, kidneys, bones, and other parts of the body.
  • Alcohol-Related Neurodevelopmental Disorder (ARND) is characterized by brain-related symptoms that affect intellectual, cognitive, and behavioral abilities.

ND-PAE is similar to ARND, but the two disorders have crucial differences. In particular, ND-PAE can be diagnosed if a child has the distinctive atypical facial features associated with FAS. In ARND, the facial symptoms are not present.

Other physical symptoms that may be present in ND-PAE but that aren’t present in ARND include:

  • Low birth weight
  • Slow growth
  • Small head size

What Causes ND-PAE?

ND-PAE is caused by a baby’s exposure to alcohol during pregnancy. The exposure is generally caused by the mother’s drinking. Alcohol in the mother’s blood passes through the umbilical cord to the developing fetus, where it interferes with normal development in different parts of the body. The developing brain and central nervous system seem to be especially vulnerable to the toxic effects of alcohol.

Is ND-PAE Hereditary?

The risk of FASDs themselves does not seem to be increased by genetic factors. Still, the drinking behaviors that can make it more likely that a fetus will be exposed to alcohol may have an inherited component. Misuse of alcohol can have many causes, many of which are situational. However, studies have indicated that some people are more likely to abuse or become addicted to certain drugs. The increased risk seems to be determined by genetics and is likely inherited within families. Studies have identified genetic factors that increase an individual’s risk of developing an alcohol use disorder.

How Is ND-PAE Detected?

Some FASD symptoms, such as the atypical facial features associated with FAS, may be apparent at birth, but some of the symptoms of ND-PAE may not be noticeable until later. Some potential early signs of ND-PAE include:

  • Low birth weight
  • Small head size
  • Slow growth
  • Poor feeding behavior in infants
  • Delayed development of speech
  • Coordination problems
  • Sleep disruptions
  • Hearing or vision problems

How Is ND-PAE Diagnosed?

Diagnosis of FASD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out other problems that may be causing the symptoms. After these exams, if the doctor suspects that a FASD is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis.

Diagnostic steps may include:

  • A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
  • Medical history. The doctor will ask questions assessing the child’s medical history and the mother’s behavior (including her drinking habits) during pregnancy.
  • Psychological assessments. If no physical or neurological causes can be found, the doctors may use these evaluations to determine if the symptoms fit the diagnostic criteria for FASDs. The assessments may also be used to rule out other disorders with similar symptoms, such as attention-deficit/hyperactivity disorder or autism. The assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, behavior, and mental health history. Family members or caregivers may also be asked to participate in these evaluations.

Diagnosis of ND-PAE requires that a child shows problems in three different areas of neurological functioning. These areas include:

  • Neurocognitive functioning. Problems in this area include difficulty with intellectual abilities, planning, organization, flexibility, learning, memory, and visual-spatial reasoning.
  • Self-regulation. These problems include difficulty with impulse control, control of emotions or mood, and attention.
  • Adaptive functioning. Problems in this area include impairments in communication, social interaction, managing routine daily tasks, and motor skills (including coordination and balance).

For diagnosis, the baby must have been exposed to more than a minimal amount of alcohol during pregnancy. The American Psychiatric Association defines the threshold as more than 13 alcoholic drinks by the mother during any 30-day period during pregnancy or more than two drinks in a sitting.


How Is ND-PAE Treated?

ND-PAE has no cure, and no treatment will reverse its symptoms. However, early intervention and ongoing treatment can help lessen the effects of the symptoms and teach a child how to manage the difficulties caused by the disorders. Common treatment approaches include:

  • Medications to manage psychological or behavioral symptoms such as difficulties with attention or hyperactivity
  • Psychotherapy to manage emotional or psychological symptoms
  • Therapies for learning disabilities
  • Parental training to teach parents how to manage their child’s symptoms

How Does ND-PAE Progress?

ND-PAE is a life-long condition; its symptoms do not go away, even with treatment. If the disorder is left untreated, it can lead to significant complications, including:

  • Mental health-related issues, including anxiety and depression
  • Problems at school or work
  • Relationship difficulties
  • Substance abuse
  • Risky or inappropriate sexual behavior
  • Legal problems
  • Financial problems
  • Difficulty living independently

How Is ND-PAE Prevented?

FASDs can be prevented if mothers entirely avoid alcohol during pregnancy. Steps that can prevent FASDs include:

  • Avoid all alcohol throughout your pregnancy. There is no known safe amount of alcohol or any period during pregnancy when it is safe to drink.
  • Avoid alcohol if you are sexually active and not using birth control. You can be unaware you are pregnant for weeks after the pregnancy begins, and early alcohol exposure may be especially harmful to the fetus.
  • Stop drinking even if you’ve already been drinking during pregnancy. The fetus continues to develop throughout the pregnancy, and the less exposure to alcohol, the better.
  • Ask your doctor about the safety of drinking while you’re breastfeeding.

ND-PAE Caregiver Tips

Many people with FASDs also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with FASDs:

ND-PAE Brain Science

Scientists don’t know precisely how alcohol harms the brain and the central nervous system during fetal development, but several factors might be at play.

  • Alcohol may interfere directly with the development of brain cells and may also interfere with the migration of cells from their place of origin to their final, normal location in the brain.
  • Alcohol may limit blood flow through the placenta to the fetus, and lack of blood supply may deprive developing brain cells of vital oxygen.
  • The breakdown of alcohol may produce toxic substances that damage or kill developing brain cells.

ND-PAE Research

Title: Dissecting the Genetics of Fetal Alcohol Spectrum Disorders (DiGFASD)

Stage: Recruiting

Principal Investigator: Tatiana Foroud

Indiana University

Indianapolis, IN  

Fetal Alcohol Syndrome (FAS) typically involves poor growth for age, particular facial characteristics, and cognitive deficiencies. Although FAS was first described in literature over 40 years ago, significant challenges remain in developing rapid and efficient approaches to identify individuals who were prenatally exposed to alcohol. Further, no widely available effective interventions or treatments to improve the long-term outcomes of individuals with FAS and related disorders (collectively known as Fetal Alcohol Spectrum Disorders or FASD) exist, despite the high prevalence (as high as 33.5 per 1,000 in some communities) of FASD across the United States.

The Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) seeks to address critical issues related to earlier and improved recognition of FASD, identify biomarkers of exposure, and elucidate the genetic risk factors contributing to FASD risk and resilience by conducting multidisciplinary projects and maintaining cooperative resources. This project is part of CIFASD’s ongoing efforts and will specifically address the elucidation of genetic factors contributing to risk and resilience in FASD.

Prior work with animal models of FASD has identified genetic variants that contribute to alterations in facial morphology after exposure to alcohol during embryonic development (McCarthy et al., 2013). Prenatal alcohol exposure also activates immune pathway genes in animal models. The identification of these genetic factors suggests that genetic variation may similarly contribute to differences in response to prenatal alcohol exposure in humans. This project aims to identify genetic variants that protect against or increase the effects of prenatal alcohol exposure in humans.


Title: CIFASD 5 tDCS and Cognitive Training

Stage: Not Yet Recruiting

Principal Investigator: Jeffrey R. Wozniak, PhD

University of Minnesota

Minneapolis, MN  

This is a randomized placebo-controlled trial of cognitive training with transcranial direct current stimulation (tDCS) for children and adolescents (ages 8-17 years) with prenatal alcohol exposure (PAE).

Prenatal alcohol exposure (PAE) has profound detrimental effects on brain development and, consequently, has permanent consequences for cognition, learning, and behavior. Individuals with Fetal Alcohol Spectrum Disorders (FASD) commonly have a range of neurocognitive impairments that directly lead to practical problems with learning, attention, working memory, task planning/execution, and decision-making, among other areas of functioning. Despite the profound public health burden posed by FASD, there have been very few treatment studies in this population. This study will examine the effects of cognitive remediation training augmented with transcranial direct current stimulation (tDCS) in children and adolescents with PAE. The study involves a baseline visit with cognitive testing, 5 sessions of tDCS (including the baseline visit) with active and sham arms, and a 6th visit for cognitive testing.


Title: Scaling Up: A Multi-Site Trial of e-SBI for Alcohol Use in Pregnancy (e-Health)

Stage: Not Yet Recruiting

Principal Investigator: Steven J. Ondersma, PhD

Michigan State University

Flint, MI  

This research study aims to determine if pregnant women screening positive for alcohol risk, like the brief alcohol intervention application that the investigators have developed (called the MommyCheckup, a technology-delivered SBIRT, or e-SBIRT), and if it helps them to reduce alcohol use. The investigators also wish to test whether e-SBIRT effects can be enhanced by booster sessions and/or tailored text messages.

This factorial trial will include 384 participants. Participants will be pregnant women aged 18-35 who score positive on a frequently used and well-validated screening tool for alcohol use risk in pregnancy (the T-ACE). We will also add a requirement of either drinking weekly or more in the past month, or having 4 or more drinks at a time at least monthly in the 12 months before becoming pregnant. To be eligible for the study, participants must also report smartphone ownership, willingness to receive study-related text messages, use their smartphone for study-related assessments and/or booster sessions, and being at 20 weeks gestation or less. Participants will be excluded if they are not planning to carry the pregnancy to term or cannot communicate in English. All participants must reside in Connecticut, Massachusetts, or Michigan. Completion of the baseline assessment is also necessary for inclusion.

Participants will be recruited via community flyers and online posts, flyers, and other advertising via multiple digital platforms that may appear as banners, text, images, video, and/or URL links to the study website, which further links to the screening survey. The flyers and ads will contain basic information indicating that they are for a health-related study for women 18-35 years of age who can communicate in English. Interested women meeting these criteria will be provided a website address, QR code, or link to a study website, where they will be presented with an electronic information sheet, which they may access via their smartphone or tablet. Those who click “I agree” at the end of this information sheet will be invited to complete the initial computer-directed screening survey via a link from the study website to a Qualtrics survey. This survey will ask a range of questions so that the study’s inclusion and exclusion criteria are not readily apparent (to limit fraud).

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