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Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders

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Children with Fetal Alcohol Spectrum Disorders (FASD) may have significant neurobehavioural problems persisting into adulthood. Early diagnosis may decrease the risk of adverse life outcomes. However, little is known about effective interventions for children with FASD. Our aim is to conduct a systematic review of the literature to identify and evaluate the evidence for pharmacological and non-pharmacological interventions for children with FASD. We did an electronic search of the Cochrane Library, MEDLINE, EMBASE, PsychINFO, CINAHL and ERIC for clinical studies (Randomized controlled trials (RCT), quasi RCT, controlled trials and pre- and post-intervention studies) which evaluated pharmacological, behavioural, speech therapy, occupational therapy, physiotherapy, psychosocial and educational interventions and early intervention programs. Participants were aged under 18 years with a diagnosis of a FASD. Selection of studies for inclusion and assessment of study quality was undertaken independently by two reviewers. Meta-analysis was not possible due to diversity in the interventions and outcome measures. Twelve studies met the inclusion criteria. Methodological weaknesses were common, including small sample sizes; inadequate study design and short term follow up. Pharmacological interventions, evaluated in two studies (both RCT) showed some benefit from stimulant medications. Educational and learning strategies (three RCT) were evaluated in seven studies. There was some evidence to suggest that virtual reality training, cognitive control therapy, language and literacy therapy, mathematics intervention and rehearsal training for memory may be beneficial strategies. Three studies evaluating social communication and behavioural strategies (two RCT) suggested that social skills training may improve social skills and behaviour at home and Attention Process Training may improve attention. There is limited good quality evidence for specific interventions for managing FASD, however seven randomized controlled trials that address specific functional deficits of children with FASD are underway or recently completed.
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... Pei et al. [17] and Jirikowic et al. [18] suggested that because the needs of individuals with FASD are diverse, their assessment and management should be personalized. Most importantly, early diagnosis and intervention could minimize the impact of some of the problems that arise from prenatal alcohol exposure [19][20][21][22][23][24]. Reid et al. [22] showed that there is growing evidence supporting The World Health Organization (WHO) recognizes FASD as a public health issue and has developed a guideline for the identification and management of substance use and substance use disorders in pregnancy [7]. ...
... Pei et al. [17] and Jirikowic et al. [18] suggested that because the needs of individuals with FASD are diverse, their assessment and management should be personalized. Most importantly, early diagnosis and intervention could minimize the impact of some of the problems that arise from prenatal alcohol exposure [19][20][21][22][23][24]. Reid et al. [22] showed that there is growing evidence supporting the effectiveness of FASD management interventions in improving outcomes for early to middle childhood. ...
... However, there is a dearth of management interventions for individuals with FASD beyond early and middle childhood [22] suggesting inadequate management plans for these individuals. Peadon et al. [23] reported that pharmacological and non-pharmacological management interventions have shown some benefit among children with FASD. While Paley and O'Connor [25] confirmed that behavioral interventions showed immediate post-intervention effects, they did not ascertain the long-term follow-up outcomes. ...
Article
Background The global prevalence of Fetal Alcohol Spectrum Disorder (FASD) remains high despite the various preventive and management interventions that have been designed and implemented to tackle the issue in various settings. The scoping review aims to identify and classify prevention and management interventions of FASD reported globally across the life span and to map the concentration of these interventions across the globe. Methods We conducted a scoping review searching databases such as Ebsco Host (Academic Search Complete, ERIC, SoINDEX, Health Source: Nursing/Academic Edition, CINAHL, Medline and Psych-ARTICLES), SAGE Journals, Sabinet and PubMed. Two reviewers independently screened studies for eligibility and used the Effective Public Health Project assessment tool to assess the methodological rigour of the included studies. A framework approach to data analysis was done and a narrative approach was used to synthesise and report on the findings. Results Thirty-two prevention intervention studies and 41 management intervention studies were identified. All the interventions were reported to be effective or showed promising outcomes for the prevention and management of FASD, except four. Although Europe and Africa have a relatively higher prevalence of FASD, the lowest number of interventions to address FASD were identified in these regions. Most of the interventions for FASD were reported in North America with comparatively lower FASD prevalence. Conclusions The uneven distribution of interventions designed for FASD vis-à-vis the burden of FASD in the different regions calls for a concerted effort for knowledge and intervention sharing to enhance the design of contextually sensitive preventive and management policy in the different regions. Key messages There are effective interventions for the prevention and management of FASD, however, the interventions were not distributed according to the burden of FASD in different regions. There is a great need to share and implement context/culturally appropriate interventions for the prevention and management of FASD among regions.
... Research recommends intervention should target specific areas of difficulty for children with PAE and FASD. 30 Involvement of physiotherapists and occupational therapists in the diagnostic process allows identification of functional motor deficits. This knowledge will inform recommendations for the family and school staff and leads to appropriate referral for motor interventions, providing more holistic care for the child. ...
Article
Aim: To determine the relationship between motor abilities and intelligence in children and young people with prenatal alcohol exposure (PAE) being assessed for fetal alcohol spectrum disorder (FASD). Method: This was a cross-sectional correlational study of children and young people with PAE being assessed for FASD. The relationship between motor abilities (Movement Assessment Battery for Children, Second Edition) and intelligence (Wechsler Intelligence Scale for Children, Fourth or Fifth Edition) was calculated using correlation and regression analyses. Attention and executive function were considered as potential confounding variables. Results: The relationship between motor abilities and intelligence in 73 children and young people (48 males, 25 females; aged 6-17y, mean age 10y 5mo [SD 2y 9mo]) assessed for FASD was small and statistically non-significant (r=0.05, p=0.67). Interpretation: The findings confirm that motor abilities and intelligence should be assessed separately when investigating an FASD diagnosis. Intelligence scores should not be used to estimate motor abilities, nor should they dictate when motor testing be completed. Assessing intelligence and motor domains separately will enhance diagnostic accuracy, identify the need for strategies or interventions to address functional motor skills, and further define the role of physiotherapy and occupational therapy in FASD assessment and intervention.
... Given the varied causes and influences regarding firesetting behaviors in individuals with FASD, emergency response professionals and fire prevention specialists are encouraged to learn about the various deficits and limitations individuals with FASD typically experience. Increasing knowledge about these issues will ultimately help in better supporting individuals with FASD and subsequently result in a reduced likelihood of such behaviors occurring (Chandrasena et al., 2009;Peadon et al., 2009;Riley et al., 2003). It will also help first responders and fire prevention professionals to better understand the behavioral and cognitive symptoms of FASD when they are confronted by these issues while performing their duties. ...
Article
Full-text available
Central nervous system damage resulting from prenatal exposure to alcohol, often referred to as fetal alcohol spectrum disorders (FASD), commonly manifests as lacking cognitive functioning, problem solving, impulsivity, memory, executive functioning, and social skill deficits. For individuals with FASD, these brain-based deficits translate into impulsive behaviors and poorly thought-out decision-making, coupled with an inability to anticipate and recognize the sometimes very severe consequences of their behaviors. Not unexpectedly, individuals with FASD frequently find themselves disproportionately involved in the criminal justice system and mental health services. For some individuals with FASD, these behaviors can also include firesetting. First responders, like other health and legal professionals, are often unable to recognize the behavioral indicators of FASD, primarily due to a lack of training. As a result, firesetting behaviors are often attributed to deliberate, willful acts of delinquency, a desire to damage property, thrill seeking, or as attempts for personal gain, rather than being viewed as maladaptive attempts to solve problems by individuals who lack the tools to do this in more appropriate ways. These same skill deficits also present when individuals with FASD are interviewed about their involvement in such behaviors, sometimes resulting in confabulation, suggestibility, and false confessions. Further education and training in FASD are vital for first responders if they are to better support individuals with FASD and minimize their chances of becoming involved in firesetting behaviors. Furthermore, this training and education will help ensure that first responders can intervene in more appropriately when crisis situations do occur. This article will outline key behavioral symptoms of FASD as well as provide first responders with suggestions as to how to best support individuals when FASD is suspected. The brief quote that follows highlights some of the key challenges facing individuals with FASD and how poor decision-making and impulsiveness can result in severe consequences for the individual and those around them.
... About 70% of individuals with FASD have attention deficits (Landgren et al., 2019) that may be improved with stimulant medication (Ozsarfati & Koren, 2015), or by environmental adaptation such as reducing distractions and gaining focus before talking to the individual. Memory deficits may be mitigated to a degree with repetition, providing written notes when literacy skills are adequate, or cues to aid recall (Peadon et al., 2009). ...
Article
Full-text available
Fetal alcohol spectrum disorder (FASD) is an increasingly important issue in the New Zealand (NZ) Criminal Justice System (CJS). FASD may impact an offender's ability to participate meaningfully in the trial process, giving rise to the issue of unfitness to stand trial. Capacity to apprehend, comprehend, participate in, make decisions about and communicate within legal process intersect with the complexity and severity of charges. Courts are required to make a nuanced analysis of multiple and complex factors, merging medical and legal expertise into decisions made. We explore the nature of FASD and its implications for criminal justice in NZ. The legal and clinical issues in relation to fitness and FASD will be discussed.
... Most recommended psychosocial interventions have been subjected to rigorous randomized double blind control studies providing the evidential basis [4]. With respect to psychotropic medication interventions, the research is limited, and the findings lack consensus [5,6]. The challenge herein is the result of the multiple comorbidities associated with ND-PAE/FASD: medical management risks overmedicating individuals and producing multiple adverse effects [7,8]. ...
Article
Full-text available
Background Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental condition resulting from pre-natal alcohol exposure. In Canada, an estimated 1.4-4% of newborns are affected by FASD. FASD is often associated with behavioural comorbidities and many individuals require psychotropic medication. However, to date there are no FASD specific guidelines for prescribing medication. Recently, Mela and colleagues described four behavioural symptom clusters commonly seen in FASD with suggested pharmacologic treatment for each cluster within an algorithm. The primary objective was to compare the proposed treatment algorithm retrospectively to actual treatment in a real-world FASD pediatric practice. The secondary objective was to refine the description of symptom clusters which will be targeted with treatment. Methods We collected the diagnostic and medication history from all patient visits of a Regina Developmental Pediatrician who specializes in FASD diagnosis and medication treatment. Three hundred fifty-four FASD patients were identified between 2005 to 2020. The medications that would be predicted from the algorithm were compared to the real-world historical data. A positive case was defined as all algorithm-predicted medications matching the historical data; a negative case had one or more medications failing to match. Results Of the 354 patients, 36 were removed for insufficient information. Of the remaining 318 cases, 172 (54.1%) were positive compared to 146 (45.9%) negatives. In single prescription cases ( n =147), the incidence of positives was 67.3%; in multi-prescriptions ( n =72) it was 27.8%; and in cases where no prescription was needed ( n =99), the positive incidence was 53.5%. Conclusions The prescription algorithm is promising but requires further refinement to accommodate the range of presentations in children with FASD. With respect to unclassified symptoms, we propose the following: sleep onset difficulty as hyperarousal ; gender dysphoria and obsessive compulsive disorder as cognitive inflexibility ; grief as emotional regulation ; and autism spectrum disorder as hyperactive/neurocognitive .
Article
White matter alterations have been reported in children with prenatal alcohol exposure (PAE) and in children with attention deficit hyperactivity disorder (ADHD); however, as children with PAE often present with ADHD, covert PAE may have contributed to previous ADHD findings. Additionally, data regarding intracortical myelination in ADHD are lacking. Therefore, we evaluated intracortical myelination (assessed as the T1w/T2w ratio at 4 cortical ribbon levels) and myelin-related deep white matter features in children (aged 8–13 years) with ADHD with PAE (ADHD + PAE), children with familial ADHD without PAE (ADHD-PAE), and typically developing (TD) children. In widespread tracts, ADHD + PAE children showed higher mean and radial diffusivity than TD and ADHD-PAE children and lower fractional anisotropy than ADHD-PAE children; ADHD-PAE and TD children did not differ significantly. Compared to TD children, ADHD + PAE children had lower intracortical myelination only at the deepest cortical level (mainly in right insula and cingulate cortices), while ADHD-PAE children had lower intracortical myelination at multiple cortical levels (mainly in right insula, sensorimotor, and cingulate cortices); ADHD + PAE and ADHD-PAE children did not differ significantly in intracortical myelination. Considering the two ADHD groups jointly (via non-parametric combination) revealed common reductions in intracortical myelination, but no common deep white matter abnormalities. These results suggest the importance of considering PAE in ADHD studies of white matter pathology. ADHD + PAE may be associated with deeper, white matter abnormalities, while familial ADHD without PAE may be associated with more superficial, cortical abnormalities. This may be relevant to the different treatment response observed in these two ADHD etiologies.
Article
Children with Fetal Alcohol Spectrum Disorder (FASD) can experience neurodevelopmental, physical, psychological and behavioural impairments that can result in a disrupted school experience. However, educators often have limited knowledge or experience in the identification and support of students with FASD, and there is a critical need for effective tools and resources to ensure students with FASD are supported in their ongoing learning and development. This scoping review aimed to identify and evaluate publicly available educator resources that aid in the identification, and support of students with FASD in primary/elementary school. In addition, educators and FASD experts were consulted to obtain feedback on currently available resources, and key issues and priorities for FASD resources. In total, 124 resources were identified by searching peer-reviewed and grey literature databases, app stores, podcast services and contacting FASD experts. Information was found on identification (23 resources) and support of students with FASD (119 resources). No resources provided information on referral. Most resources were average (40%) to good (33%) quality, as measured by a composite tool based on adaptions of the NHMRC FORM Framework and iCAHE Guideline Quality Checklist. A minority of resources had been formally evaluated (7%). Review findings and consultations with experts and educators indicate a critical need for referral guides, evidence-based short-format resources, and centralised access for school communities to high-quality resources. Taken together, this study has identified key areas for future resource development and research to better support primary school students with FASD.
Chapter
Comprehensive assessment and resulting treatment recommendations involving individuals diagnosed with fetal alcohol spectrum disorders (FASD) often include the use of psychotropic medications. Such medications, some with known approved indications, target mental disorders while others, with no approved indications, treat symptoms. Psychostimulants, antidepressants (e.g., selective serotonin reuptake inhibitors—SSRIs), antipsychotics, alpha-adrenergic agonists, and mood stabilizers are reported to have efficacious benefit in FASD. A psychotropic medication algorithm was developed and proposed for use in treating the complex presentation common in those with FASD. The algorithm aligns specific medications to different clusters representing abnormalities in hyperactivity, affect regulation, hyperarousal, and cognitive flexibility. Through a three-step decision tree, choice of medications is simplified, and incidence of polypharmacy is reduced. Another innovation in prescribing psychotropic medications relevant to the forensic setting is the use of dextroamphetamine in treating significant impulsivity in offenders. Potentially relevant to both guilt and sentencing phases, offenders with FASD may benefit from stimulants that mitigate poor impulse control. Consent, compulsory treatment, and formulary coverage are important themes also addressed in this chapter. Medications in the forensic setting raise issues of voluntariness, compulsion, and appropriate use. Therefore, the chapter includes guidance on effectively anticipating medication misuse and diversion. Such efforts should include the role of ancillary professionals, especially pharmacists. Poignant case examples are included. The content in this chapter is applicable to professionals with clinical as well as forensic roles.
Chapter
Fetal alcohol spectrum disorder (FASD) is a multifaceted disorder that has a significant impact on daily functioning and attainment of goals for those affected. Given the complexities of FASD, researchers and clinicians are tasked with identifying general principles of effective intervention and support, as well as understanding how therapies may be tailored to meet individual needs. Over the past 30 years, research has grown substantially in the field of FASD, but has lagged considerably behind for intervention studies. This chapter provides a glimpse of the psychological therapies that have been studied among FASD-affected populations, predominantly over the past 10 years and predominantly in early to middle childhood. The intervention studies that are discussed center around the following broad themes: attention, executive functioning, and self-regulation; specific cognitive or academic deficits; adaptive and social skills; and caregiver or family-based interventions. Findings suggest that the deficits in FASD are amenable to treatment, and that in some cases, treatment effects are generalizable to aspects of daily life and are maintained for periods up to 6 months. Best practice guidelines are discussed. Future research is needed to understand the effect of psychological interventions across broader age ranges (especially in adolescence and adulthood), with novel psychological therapies (e.g., mindfulness) that have not been previously studied, across systems, and over more extended follow-up periods.
Chapter
Children in Care (CIC) are a particularly vulnerable group of children and young people who have an increased risk of prenatal drug and alcohol exposure, and therefore, of foetal alcohol spectrum disorders, FASD [1]. Health assessments offer the ideal opportunity for identification and assessment of neurodevelopmental disorders, but unless the referring social worker and the health professionals, carrying out the assessments, have sufficient knowledge and recognition of the risk factors and presenting difficulties, this is a missed opportunity for the child. Because placements in care are not all long term, and disruption can occur, it is vital that appropriate assessment is offered as early as possible, and that interventions for the child can be implemented as early as possible. This may be complicated as not all children exposed to alcohol prenatally will develop FASD, and children may not present with symptoms suggestive of a disorder before they are of school age. Neurodevelopmental difficulties may not even become apparent until the child is around 8 or 9 years old. It is important that carers for children who have, or might have FASD, are informed as how best to support the child in the long term. Services for children and health professionals need to develop pathways for assessment and management of children in care with FASD, and to be able to complete these in a timely way. Once identified, there needs to be advanced planning in preparation for affected young people Leaving Care.
Chapter
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Article
Fetal alcohol spectrum disorders constitute a major public health problem. This article presents an overview of important issues that surround these disorders and emphasizes the structural and neurobehavioral consequences associated with prenatal exposure to alcohol. Diagnostic criteria are discussed, and possible moderating factors for the range of outcomes are mentioned. In addition, the prevalence of fetal alcohol spectrum disorders is described, and estimates of the financial impact of these disorders are given. Heavy prenatal alcohol exposure can severely affect the physical and neurobehavioral development of a child. Autopsy and brain imaging studies indicate reductions and abnormalities in overall brain size and shape, specifically in structures such as the cerebellum, basal ganglia, and corpus callosum. A wide range of neuropsychological deficits have been found in children prenatally exposed to alcohol, including deficits in visuospatial functioning, verbal and nonverbal learning, attention, and executive functioning. These children also exhibit a variety of behavioral problems that can further affect their daily functioning. Children exposed to alcohol prenatally, with and without the physical features of fetal alcohol syndrome, display qualitatively similar deficits. Determining the behavioral phenotypes that result from heavy prenatal alcohol exposure is critical, because the identification of these children is crucial for early interventions. In addition, knowing which brain areas are involved might enable the development of better intervention strategies. However, intervention needs to go beyond the affected individual to prevent future cases. As evidenced by the staggering financial impact these disorders have on society, prevention efforts need to be aimed at high-risk groups, and this issue needs to be made a high priority in terms of public health.
Conference Paper
Fetal alcohol spectrum disorders constitute a major public health problem. This article presents an overview of important issues that surround these disorders and emphasizes the structural and neurobehavioral consequences associated with prenatal exposure to alcohol. Diagnostic criteria are discussed, and possible moderating factors for the range of outcomes are mentioned. In addition, the prevalence of fetal alcohol spectrum disorders is described, and estimates of the financial impact of these disorders are given. Heavy prenatal alcohol exposure can severely affect the physical and neurobehavioral development of a child. Autopsy and brain imaging studies indicate reductions and abnormalities in overall brain size and shape, specifically in structures such as the cerebellum, basal ganglia, and corpus callosum. A wide range of neuropsychological deficits have been found in children prenatally exposed to alcohol, including deficits in visuospatial functioning, verbal and nonverbal learning, attention, and executive functioning. These children also exhibit a variety of behavioral problems that can further affect their daily functioning. Children exposed to alcohol prenatally, with and without the physical features of fetal alcohol syndrome, display qualitatively similar deficits. Determining the behavioral phenotypes that result from heavy prenatal alcohol exposure is critical, because the identification of these children is crucial for early interventions. In addition, knowing which brain areas are involved might enable the development of better intervention strategies. However, intervention needs to go beyond the affected individual to prevent future cases. As evidenced by the staggering financial impact these disorders have on society, prevention efforts need to be aimed at high-risk groups, and this issue needs to be made a high priority in terms of public health.
Article
This paper describes the psychopharmacological interventions in patients with Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (PFAS) or Alcohol-related Neurodevelopmental Disorder (ARND). The pharmacological histories of patients who had a confirmed inutero exposure to alcohol and were between the ages of 3.5 and 17 yrs were collected from a chart review of children seen in a child development unit over the previous seven years. Medications were grouped under 6 categories: stimulants, α2-presynaptic agonists, selective serotonin reuptake inhibitors, mood stabilizers, antipsychotics, and tricyclics. Twenty-two patients had 66 medications trials: 63% responded well to stimulants. 82% responded well to selective serotonin reuptake inhibitors, 88% responded well to a mood stabilizer and 83% responded well to an antipsychotic. Aggressive treatment, including medication, should beneficially influence the broad range of secondary disabilities seen in these patients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
: Children with heavy prenatal alcohol exposure have well documented deficits in overall cognitive ability. Recently, attention has turned to the executive function (EF) domain in this population. Until recently, comprehensive measures of EF have not been available within one test battery. This study used a battery of tests to assess four domains of EF in alcohol-exposed children. : The Delis-Kaplan Executive Function Scale was used to evaluate EF in 18 children with heavy prenatal alcohol exposure, with and without a diagnosis of fetal alcohol syndrome (FAS), and 10 nonexposed controls. Children ranged in age from 8 to 15 years. Measures from four domains of executive functioning were analyzed: planning ability, cognitive flexibility, selective inhibition, and concept formation and reasoning. Tasks consisted of primary EF measures as well as measures of secondary component skills. : Alcohol-exposed children were deficient on EF measures compared with nonexposed controls. Furthermore, in most cases, children with and without the FAS diagnosis did not differ from one another. These deficits were not entirely explainable by concomitant deficits on component skills. Specific impairments were identified within the domains of planning and response inhibition, with additional deficits in abstract thinking and flexibility. : Deficits in executive functioning were observed in alcohol-exposed children with or without the diagnosis of FAS and in the absence of mental retardation. Performance on these EF tasks provides insight into the cognitive processes driving overall performance and has implications for adaptive and daily functions. These results arc consistent with anecdotal and empirical reports of deficits in behavioral control and with neuroanatomical evidence of volumetric reductions in structures within the frontal-subcortical system in children with heavy prenatal alcohol exposure.
Article
This article presents the proceedings of a symposium presented at the 2004 annual meeting of the International Society for Biomedical Research on Alcoholism, held in Mannheim, Germany. The organizers and chairpersons were Kerstin Stromland and Kenneth R. Warren. The presentations were as follows: 1) "Comparison of FASD in Moscow, Russia, and San Diego, California," by Sarah N. Mattson; 2) "Neurobehavior and Interventions in FASD in South Africa," presented by Colleen M. Adnams; 3) "Ophthalmologic Involvement in the Fetal Alcohol Syndrome" presented by Kerstin Strömland; and 4) "Brain Imaging in Children With Fetal Alcohol Spectrum Disorders," by Ilona Autti-Rämö.
Article
To assess general intellectual functioning in children with histories of heavy prenatal alcohol exposure, with or without the facial features and growth deficiencies characteristic of fetal alcohol syndrome (FAS). Forty-seven alcohol-exposed children were recruited on evaluation at a dysmorphology clinic and evaluated as part of a university research project using standard tests of IQ. Thirty-four of the alcohol-exposed patients met the traditional diagnostic criteria for FAS. The other 13 alcohol-exposed children lacked both the pattern of facial features and prenatal or postnatal growth deficiency characteristic of the diagnosis. Compared with normal control subjects matched for age, sex, and ethnicity, both groups of alcohol-exposed children displayed significant deficits in overall IQ measures and deficits on most of the subtest scores. Although those in the nondysmorphic group usually obtained marginally higher IQ scores than those in the FAS group, few significant differences were found between the two alcohol-exposed groups. These results indicate that high levels of prenatal alcohol exposure are related to an increased risk for deficits in intellectual functioning and that these can occur in children without all of the physical features required for a diagnosis of FAS. They also emphasize the need for conducting a thorough history of prenatal alcohol exposure in children with intellectual deficits.
Article
Children diagnosed with fetal alcohol syndrome (FAS) were assessed with items from the social skills domain of the Vineland Adaptive Behavior Scales (VABS) via interviews with their caregivers. Their scores were compared with scores from children in two control groups. The control groups included children matched for IQ to the FAS group (specifically on verbal IQ, henceforth, the VIQ group) and children with IQ scores in the average to above-average range (normal control group). Forty-five children (age range, 5 years 7 months to 12 years 11 months) were assessed (n/group = 15). All groups differed with regard to social ability, as measured by the VABS (NC > VIQ > FAS), even when the effects of socioeconomic status were held constant. The three subdomains of the VABS social scale (interpersonal relationship skills, use of play and leisure time, and coping skills) were assessed, and results showed that the children with FAS were most impaired on the subdomain that assessed interpersonal relationship skills. An additional measure was constructed by obtaining an age-equivalent score for the VABS social scale and calculating a difference score by subtracting the child's chronological age from his/her age-equivalent score. There was a significant correlation between chronological age and difference scores for children in the FAS group but not for children in the two control groups. Specifically, in older children with FAS, there was an increased discrepancy between their ages and their age-equivalent scores, a discrepancy that was not present in children in the control groups. These results suggest that social deficits in children with FAS are beyond what can be explained by low IQ scores and indicate that there may be arrested, and not simply delayed, development of social abilities in children with FAS.