Do we need the term "FAE"?

ABBREVIATIONS. FAS, fetal alcohol syndrome; FAE, fetal alcohol effect. Fetal alcohol syndrome (FAS) was first recognized as a distinct clinical entity by Jones and Smith in 1973.' In their first reports, 2,3 all affected children had been born to severely alcoholic women, and had in common problems in three major categories: 1. prenatal and/or postnatal growth deficiency; 2. abnormal brain function reflected in mental deficit; and 3. a distinctive pattern of mild facial dysmorphology. Later psychological studies revealed a pattern of behavioral aberration, which is quite common in affected children, but has not been shown to be unique to FAS. As is usually the case with newly described clinical syndromes, diagnosticians soon began to realize that they were encountering children with some, but not all the classical signs of FAS. Typically , the maternal history indicated moderate to severe gestational alcohol abuse and the child showed developmental delay and behavioral abnormalities , but the characteristic facial anomalies were absent and growth and development were variably affected. Because a diagnosis of FAS demanded the presence of all three primary diagnostic criteria, (growth deficiency, CNS dysfunction, and physical characteristics) 6 a term was needed to refer to children with what seemed to be form fruste FAS, and references to " suspected fetal alcohol effects " began to appear in the literature. 7-9 This was not intended to be a diagnosis, but only a " bookmark, " suggesting that the abnormalities seen in the child were compatible with those caused by prenatal alcohol exposure, but that the pattern was not sufficiently complete to permit definition of FAS. Unfortunately, within a few years after its introduction , the designation fetal alcohol effect (FAE) began to be applied more or less indiscriminately to children with a variety of problems, even those with simple growth deficiency or isolated behavioral aberration , based almost entirely on the knowledge (or suspicion) that their mothers drank alcohol during pregnancy. Not only clinicians, but concerned teachers , social workers, and foster parents, seeking expla