BackgroundFetal alcohol spectrum disorder (FASD) is a highly prevalent lifelong disorder with high rates of comorbid neurodevelopmental disorders. Individuals with FASD are often exposed to abuse, neglect and foster home placements which have uncertain effects on the lifelong course of FASD. In this study we compare the prevalence of adverse childhood events (ACEs) and neurodevelopmental disorders in subjects with fetal alcohol spectrum disorders (FASD) and non-FASD controls.MethodsA cross-sectional chart review of patients referred to a regional developmental center was used to identify people with FASD and non-FASD controls. We recorded the number of ACEs and neurodevelopmental disorders in each patient’s chart. The most common diagnoses were attention deficit hyperactivity disorder, comprehension deficits, sleep disorders, and cognitive impairments. T-tests and a regression equation were utilized to determine significant differences between the groups.ResultsThe review identified 203 subjects, 98 with FASD and 105 non-FASD controls. Group mean age was 8.6 years and 64.5% were male. People with FASD were more likely to have any ACEs (mean 5.3) with ACE scores 3.7 points higher than non-FASD controls (mean 1.69) (t = 11.29; p < .001). Increased ACEs were associated with increased rates of neurodevelopmental disorders for people with FASD (R = .179, p = .026) but not for non-FASD controls (R = .130, p = .094).Conclusions: Both FASD and subsequent exposure to ACEs are associated with increased risk for development of comorbid neurodevelopmental disorders. Prevention of ACEs during childhood may decrease risk for development of comorbid neurodevelopmental disorders.

Aim: To conduct a systematic review and quantitative analysis of the world literature on the economic impact of fetal alcohol spectrum disorder (FASD). Methods: A comprehensive literature review was conducted using multiple electronic databases and reference materials. Results: Thirty-two studies from 4 countries met the inclusion criteria (United States [n = 20], Canada [n = 9], Sweden [n = 2], and New Zealand [n = 1]). The studies reported the economic impact of FASD on health care, special education, residential care, criminal justice system, productivity losses due to morbidity and premature mortality, productivity losses of caregivers of children with FASD, and intangible costs. The economic estimates vary considerably due to the different methodologies used by different studies. The mean annual cost for children with FASD was estimated to be $22,810 and for adults $24,308. Residential costs for children with FASD were 4-fold greater than for adults with FASD. The costs of lost productivity for adults were 6.3-fold greater than for children. Conclusions: The data on the economic burden of FASD are scarce, and the existing estimates likely underestimate the full economic impact of this disorder on the affected individuals, their caregivers, and society. However, the current research is sufficient to demonstrate that FASD is a serious public health problem associated with tremendous economic burden.

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