optimal human development generally occurs in identifiable stages (e.g., jean piaget's theory of cognitive development, erik erikson's stages of psychosocial development, john bowlby's attachment framework, and other developmental stage theories). fas interferes with normal development, which may cause stages to be delayed, skipped, or immaturely developed. over time, an unaffected child can negotiate the increasing demands of life by progressing through stages of development normally, but not so for a child with fas. by knowing what developmental stages and tasks children follow, treatment and interventions for fas can be tailored to helping a person meet developmental tasks and demands successfully. if a person is delayed in the adaptive behavior domain, for instance, then interventions would be recommended to target specific delays through additional education and practice (e.g., practiced instruction on tying shoelaces), giving reminders, or making accommodations (e.g., using slip-on shoes) to support the desired functioning level. this approach is an advance over behavioral interventions, because it takes the person's developmental context into account while developing interventions. advocacy model the advocacy model takes the point of view that someone is needed to actively mediate between the environment and the person with fas. advocacy activities are conducted by an advocate (for example, a family member, friend, or case manager) and fall into three basic categories. an advocate for fas: (1) interprets fas and the disabilities that arise from it and explains it to the environment in which the person operates, (2) engenders change or accommodation on behalf of the person, and (3) assists the person in developing and reaching attainable goals. the advocacy model is often recommended, for example, when developing an individualized education program (iep) for the person's progress at school. an understanding of the developmental framework would presumably inform and enhance the advocacy model, but advocacy also implies interventions at a systems level as well, such as educating schools, social workers, and so forth on best practices for fas. however, several organizations devoted to fas also use the advocacy model at a community practice level as well. public health and policy treating fas at the public health and public policy level promotes fas prevention and diversion of public resources to assist those with fas. it is related to the advocacy model but promoted at a systems level (rather than with the individual or family), such as developing community education and supports, state or province level prevention efforts (e.g., screening for maternal alcohol use during ob/gyn or prenatal medical care visits), or national awareness programs. several organizations and state agencies in the u.s. are dedicated to this type of intervention. as of 2016, the us centers for disease control estimated 3 million women in the united states are at risk of having a baby with fasd, and recommended that women of child-bearing age should be on birth control or abstain from drinking alcohol as the safest way to avoid this. prognosis the prognosis of fasd is variable depending on the type, severity, and if treatment is issued. prognostic disabilities are divided into primary and secondary disabilities. primary disabilities the primary disabilities of fas are the functional difficulties with which the child is born as a result of cns damage due to prenatal alcohol exposure. often, primary disabilities are mistaken as behavior problems, but the underlying cns damage is the originating source of a functional difficulty, rather than a mental health condition, which is considered a secondary disability. the exact mechanisms for functional problems of primary disabilities are not always fully understood, but animal studies have begun to shed light on some correlates between functional problems and brain structures damaged by prenatal alcohol exposure. representative examples include: learning impairments are associated with impaired dendrites of the hippocampus impaired motor development and functioning are associated with reduced size of the cerebellum hyperactivity is associated with decreased size of the corpus callosum functional difficulties may result from cns damage in more than one domain, but common functional difficulties by domain include: note that this is not an exhaustive list of difficulties. achievement: learning disabilities adaptive behavior: poor impulse control, poor personal boundaries, poor anger management, stubbornness, intrusive behavior, too friendly with strangers, poor daily living skills, developmental delays attention: attention-deficit/hyperactivity disorder (adhd), poor attention or concentration, distractible cognition: intellectual disability, confusion under pressure, poor abstract skills, difficulty distinguishing between fantasy and reality, slower cognitive processing executive functioning: poor judgment, information-processing disorder, poor at perceiving patterns, poor cause and effect reasoning, inconsistent at linking words to actions, poor generalization ability language: expressive or receptive language disorders, grasp parts but not whole concepts, lack understanding of metaphor, idioms, or sarcasm memory: poor short-term memory, inconsistent memory and knowledge base motor skills: poor handwriting, poor fine motor skills, poor gross motor skills, delayed motor skill development (e.g., riding a bicycle at appropriate age) sensory processing and soft neurological problems: sensory processing disorder, sensory defensiveness, undersensitivity to stimulation social communication: intrude into conversations, inability to read nonverbal or social cues, "chatty" but without substance secondary disabilities the secondary disabilities of fas are those that arise later in life secondary to cns damage. these disabilities often emerge over time due to a mismatch between the primary disabilities and environmental expectations; secondary disabilities can be ameliorated with early interventions and appropriate supportive services. six main secondary disabilities were identified in a university of washington research study of 473 subjects diagnosed with fas, pfas (partial fetal alcohol syndrome), and arnd (alcohol-related neurodevelopmental disorder): mental health problems: diagnosed with adhd, clinical depression, or other mental illness, experienced by over 90% of the subjects disrupted school experience: suspended or expelled from school or dropped out of school, experienced by 60% of the subjects (age 12 and older) trouble with the law: charged with or convicted of a crime, experienced by 60% of the subjects (age 12 and older) confinement: for inpatient psychiatric care, inpatient chemical dependency care, or incarcerated for a crime, experienced by about 50% of the subjects (age 12 and older) inappropriate sexual behavior: sexual advances, sexual touching, or promiscuity, experienced by about 50% of the subjects (age 12 and older) alcohol and drug problems: abuse or dependency, experienced by 35% of the subjects (age 12 and older) two additional secondary disabilities exist for adults: dependent living: group home, living with family or friends, or some sort of assisted living, experienced by 80% of the subjects (age 21 and older) problems with employment: required ongoing job training or coaching, could not keep a job, unemployed, experienced by 80% of the subjects (age 21 and older) protective factors and strengths eight factors were identified in the same study as universal protective factors that reduced the incidence rate of the secondary disabilities: living in a stable and nurturing home for over 73% of life being diagnosed with fas before age six never having experienced violence remaining in each living situation for at least 2.8 years experiencing a "good quality home" (meeting 10 or more defined qualities) from age 8 to 12 years old having been found eligible for developmental disability (dd) services having basic needs met for at least 13% of life having a diagnosis of fas (rather than another fasd condition) malbin (2002) has identified the following areas of interests and talents as strengths that often stand out for those with fasd and should be utilized, like any strength, in treatment planning: music, playing instruments, composing, singing, art, spelling, reading, computers, mechanics, woodworking, skilled vocations (welding, electrician, etc.), writing, poetry participation in non-impact sport or physical fitness activities lifespan one study found that the people with fasd had a significantly shorter life expectancy. with the average life span of 34 years old, a study found that 44% of the deaths were of "external cause", with 15% of deaths being suicides. epidemiology fasd is estimated to affect between 2% and 5% of people in the united states and western europe. fas is believed to occur in between 0.2 and 9 per 1000 live births in the united states. the lifetime costs of an individual with fas were estimated to be two million usd in 2002. drinking any quantity during pregnancy, the risk of giving birth to a child with fasd is about 15%, and to a child with fas about 1.5%. drinking large quantities, defined as 2 standard drinks a day, or 6 standard drinks in a short time, carries a 4.3% risk of a fas birth (i.e. one of every 23 heavy-drinking pregnant women will deliver a child with fas). in a recent count the prevailence of having any fasd disorder was 1 person out of 20, but some people estimate it could be as high as 1 in 7. australia