BACKGROUND AND OBJECTIVE: Primary disabilities in children prenatally exposed to alcohol have a major impact on their daily life. It is suggested that these issues persist into adulthood, but few studies have addressed the outcome in adults with prenatal exposure, especially those with fetal alcohol syndrome (FAS). The aim of this follow-up study was to investigate outcome variables, such as education, employment, health, and criminal acts, in 79 adults diagnosed with FAS. METHODS:We carried out a national register-based study of 79 adults with an FAS diagnosis, at a mean age of 32. Education, social adjustment, and mental health outcomes were analyzed and compared with 3160 comparison individuals matched on age, gender, and place of birth. RESULTS:The FAS group was much more likely to have received special education (25% vs 2%), be unemployed (51% vs 15%), and receive a disability pension (31% vs 3%) than the comparisons, but the levels of criminal offenses were similar. The FAS group had higher hospital admission rates for alcohol abuse (9% vs 2%) and psychiatric disorders (33% vs 5%) and was more likely to be prescribed psychotropic drugs (57% vs 27%).CONCLUSIONS: Swedish children with FAS have quite diverse psychosocial outcomes in adulthood, considerably worse than for majority population peers. Potential risk and protective factors within the FAS group deserve study to enable development of effective interventions. WHAT'S KNOWN ON THIS SUBJECT:Prenatal alcohol exposure can cause congenital neuropsychological and behavioral disabilities in later life. These usually lead to secondary disabilities (adverse outcome when the individual interacts with environmental settings), such as problems with school, the law, alcohol, or drugs. WHAT THIS STUDY ADDS:This was a 30-year psychosocial register-based follow-up on adults with fetal alcohol syndrome and state care comparison group. The FAS-group had lower education and higher rates of unemployment, social welfare, and mental health problems than peers. Rates of criminality did not differ.

Children born to mothers who had abused alcohol throughout pregnancy had severe behavioural and intellectual problems which remained at age 11 to 14 years. Of 24 children examined, 10 had attention deficit hyperactivity disorder (ADHD) with or without developmental coordination disorder, two had Asperger syndrome, and one had an autistic‐like condition not meeting the criteria for Asperger syndrome. Six of these 24 attended special schools for the mentally retarded and a further 11 were given special education, leaving only seven attending regular schools without any type of support. The children had difficulties in mathematics, logical conclusions, visual perception, spatial relations, short‐term memory, and attention. Sixteen children lived in foster homes. There was a clear correlation between the occurrence and severity of the neuropsychiatric disorder and the degree of alcohol exposure in utero.

From a retrospective material including all the 103 children of 30 alcoholic women, the 21 youngest born 1970-76, were paired to controls matched for sex, age, birth weight, gestational age and living area. IQ scores were measured with Griffiths and WISC scales. Controls tested within the normal range for Swedish children, while the study group scored 15-19 IQ points below controls (p less than 0.01), the means of the study group corresponding to -1.6 SD below means of the controls. Significant differences between the groups were found in all subscales. Visual perception was measured with Frostig's test. Perceptual age was generally equal to mental age except in the most severely affected cases where perceptional age was lower than mental age. A marked perceptual delay exceeding 1 year was found in 8/17 tested cases in the study group, while all controls were normal. Developmental levels evaluated from Human Figure Drawings according to Koppitz was in accordance with IQ test results. Indicators of emotional instability were found significantly more often in the study group than in controls. Hyperactivity, distractability and short attention span were found in 12/21 cases and perseveration in 6/21 cases but not among controls. Members of the study group with traits of the fetal alcohol syndrome (10/21) had significantly lower IQ and perceptual delay was more pronounced than in members without such signs. No significant IQ difference was found between subjects reared in foster homes and in biological homes.

This paper reports on a follow-up study of 24 children to alcoholic mothers at 12 to 14 years of age. The mothers were offered support to help them stop drinking during pregnancy and was grouped to time point of instituted sobriety. Six of the 24 children attended a school for the mentally retarded, and 11 children had some kind of special education. The children have difficulties in mathematics, logical conclusions, visual perception, spatial relations, and short-range memory/attention. Sixteen children were in fostercare. A clear correlation between the occurrence and severity of neuropsychological problems and the degree of alcohol exposure in utero was found.

Twenty-one children born 1970-76, selected from 103 children of 30 alcoholic women, were paired to controls matched for sex, age, birth weight and gestational age. The sample (10 girls, 11 boys) was representative of the whole group with regard to weight, length and head circumference at birth. At follow-up (mean age 70 months) the study group was significantly leaner, shorter and had smaller mean head circumference than the control group. The controls had significant catch-up growth from birth to follow-up of weight, height and head circumference to the mean for Swedish children. The study group had no catch-up growth. Compared to controls the study group had significantly lower fine and gross motor age test scores and inferior coordination. One child had cerebral palsy (spastic hemiplegia) and in 6 other children slight tremor and ataxia were observed. Malformations and/or other signs of the fetal alcohol syndrome (FAS) were found in 10 cases. Study group children with FAS had significantly slower growth of head circumference than others without FAS. Children placed in foster home care (n = 11) were found to have significantly (p less than 0.05) lower birth weight, birth length and head circumference than children raised at home (n = 10). There were no significant differences at follow up between study group children raised in foster homes or in homes of their biological mother.