Advancing Recognition of Fetal Alcohol Spectrum Disorders: the Proposed DSM-5 Diagnosis of “Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)”

Abstract

Fetal alcohol spectrum disorders (FASD) are a surprisingly common, yet under-identified set of lifelong neurodevelopmental disabilities with substantial economic and social costs—and high rates of debilitating secondary conditions. An advance in the field of FASD is a proposed diagnostic category included in the 2013 Diagnostic and Statistical Manual for Mental Health Disorders (DSM-5): “Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure” (ND-PAE). With clinical guidelines to inform its use, appropriate recognition of ND-PAE can allow wider identification of individuals impacted by alcohol’s teratogenic effects. Accurately recognizing that a diagnosis of ND-PAE might apply can inform health and mental health providers about when to refer for specialty assessment, and suggest when and how to adapt usual treatments or access tailored interventions. This paper explains the evolution in diagnostic terms, discusses clinical use of ND-PAE, explores dilemmas, and presents ideas for “FASD-informed care” for individuals who meet proposed ND-PAE criteria.