Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) is a mental health condition that results from exposure to alcohol before birth. It is a type of fetal alcohol spectrum disorder (FASD).

Symptoms of ND-PAE can vary, depending on factors such as the amount of alcohol exposure. The condition can affect behaviors, mood, and communication skills.

Read on to learn more about the causes and symptoms of ND-PAE. This article also looks at how doctors diagnose the condition, what the treatment options are, and more.

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ND-PAE can affect thinking, behavior, and social skills. People with the disorder might have difficulty with relationships, emotions, and stress management.

The symptoms of ND-PAE can vary depending on several factors, including:

  • the amount and timing of alcohol exposure
  • genetic factors
  • environmental influences

Physical symptoms

ND-PAE may cause certain facial features to form in some children during development. Healthcare professionals refer to these as cardinal dysmorphic facial features:

  • a smooth ridge above the lip and under the nose
  • a thin upper lip
  • narrow eye width

The disorder can also cause the following physical symptoms:

  • low weight at birth
  • slower-than-average growth
  • a small head

Behavioral symptoms

Behavioral symptoms of ND-PAE include:

  • short attention span
  • impulsivity
  • language and communication difficulties
  • limited social skills and difficulty understanding the emotions of others
  • difficulty understanding social cues and norms
  • inappropriate or aggressive behavior
  • rapid and extreme mood changes
  • anxiety
  • depression
  • sleep difficulties

These symptoms might interfere with important aspects of daily life. ND-PAE may also affect academic performance, job satisfaction, and interpersonal relationships.

Learn more about behavioral issues and FASD.

ND-PAE results from exposure to alcohol during pregnancy. Alcohol can cross the placenta, travel through the umbilical cord, and affect a developing fetus’s brain and other organs.

A 2019 research review noted the factors that can contribute to FASD, including:

  • the amount of alcohol a person consumes during pregnancy
  • how often a person drinks during pregnancy
  • the stage of pregnancy in which a person drinks
  • the mother’s health, nutrition, and metabolism, such as how long it takes for the mother’s body to clear alcohol
  • the father’s alcohol use and genetics
  • the child’s genetics and environment

There is no safe amount or time frame for alcohol consumption during pregnancy. Any amount of alcohol can cause ND-PAE, another FASD, or other harmful effects.

Learn more about the effects of drinking alcohol during pregnancy.

Health experts first labeled ND-PAE as a diagnosis in the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Doctors have been able to diagnose ND-PAE since 2013.

There is no specific test for ND-PAE. Doctors diagnose it based on a combination of criteria, including:

  • confirmed or suspected prenatal alcohol exposure, which the APA defines as a minimum of 13 alcoholic drinks per month during pregnancy or more than 2 drinks in a single sitting
  • problems with thinking and memory, such as during planning or when trying to remember recently learned information
  • behavioral issues, including extreme bursts of anger, mood issues, or difficulties with switching between tasks
  • problems with day-to-day activities such as bathing, dressing appropriately for the weather, and playing with others

To diagnose ND-PAE, doctors may use various methods, such as:

  • taking a full medical history
  • performing a physical examination
  • conducting interviews with the child or adult and their caregivers or family members
  • using standardized questionnaires or rating scales
  • performing neuropsychological testing or assessment
  • ordering brain imaging or genetic testing, which may help distinguish between ND-PAE and attention deficit hyperactivity disorder (ADHD)

Diagnosing ND-PAE can be challenging because the symptoms can overlap with those of other conditions, such as ADHD, autism spectrum disorder, learning disabilities, and mental health conditions. Therefore, it is important to consult a qualified professional who has experience in evaluating FASDs.

There is no cure for ND-PAE. However, there are various treatments and interventions that can help people with ND-PAE improve their daily functioning and enhance their quality of life.

Treatment options will vary depending on each person’s needs and symptoms. Regular follow-ups, close monitoring, and treatment plan changes may be necessary.

A doctor may recommend medications such as:

  • stimulants to regulate attention and impulsivity
  • antidepressants to treat mood and sleep issues
  • neuroleptics to help manage aggression and anxiety
  • anti-anxiety medications to manage anxiety

Other treatments that may help include:

  • behavior and education therapy, which can help improve learning, social skills, and educational skills
  • training for parents and caregivers on how to communicate with, nurture, and support a child who has ND-PAE
  • support from a family counselor or therapist

Protective factors

Some factors around treatment, known as protective factors, may help reduce complications and help children with ND-PAE flourish.

These include:

  • diagnosis before 6 years of age
  • a loving, empathetic, and stable home environment during a child’s school years
  • an environment without domestic violence
  • enrollment in special education programs and social services

Alternative therapies for ND-PAE

Some parents may try untested therapies that are sometimes effective in helping children with ND-PAE. These might include:

  • animal therapy
  • relaxation therapy, including visual imagery and meditation
  • auditory training
  • creative art therapy
  • massage
  • acupuncture
  • yoga and exercise
  • biofeedback
  • vitamins, herbal supplements, and homeopathy

However, it is important to consult a doctor before trying these methods for a child, as little evidence supports their use.

ND-PAE affects brain development and behavior. It may also cause cardinal dysmorphic facial features. ND-PAE overlaps with alcohol-related neurodevelopmental disorder (ARND), but ARND does not cause cardinal dysmorphic facial features to develop.

Fetal alcohol syndrome (FAS) and alcohol-related birth defects (ARBD) are other types of FASD. Children with FAS may have reduced growth, cardinal dysmorphic facial features, nervous system issues, and problems with vision, hearing, or communication. FAS causes more physical impairments alongside the behavioral challenges than ND-PAE does.

Those with ARBD do not display behavioral or cognitive difficulties but could have issues with one or more organs, their bones, and their hearing.

The complications of ND-PAE are mostly social, cognitive, and occupational. They can include:

  • difficulty with planning, organizing, and following instructions
  • trouble with reasoning, problem-solving, and abstract thinking
  • issues when processing emotions, social cues, and norms
  • reduced memory and recall

These symptoms can affect a person’s experiences with school, work, family, and friends.

The best way to prevent ND-PAE is to avoid alcohol completely during a confirmed pregnancy or when trying to get pregnant. Drinking any amount of alcohol at any time during pregnancy introduces the risk of ND-PAE and other FASDs.

Stopping alcohol use at any point during pregnancy can reduce the risk of ND-PAE and preserve healthy brain development. All types of alcohol, including wine and beer, are harmful during pregnancy.

Resources are available for people who might benefit from support to stop drinking alcohol, including:

Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) is a type of fetal alcohol spectrum disorder. It can happen when a person drinks during pregnancy. Alcohol can pass to the fetus through a person’s placenta, interfering with the nervous system during growth.

ND-PAE can cause psychological, cognitive, behavioral, and physical symptoms, although the symptoms vary.

Parents or caregivers of a child with ND-PAE should work with the doctor to create an individualized care plan that supports the child’s learning, social development, and emotional well-being. The best way to prevent the condition is to completely avoid alcohol consumption during pregnancy.