related facial dysmorphology and growth retardation, can be used as evidence of signifi-
cant levels of prenatal alcohol exposure. Although both animal and human studies have
documented adverse effects of lower levels of drinking, identifying how much prenatal
exposure is needed to sign ificantly impact neurodevelop mental outcome remains chal-
lenging. Data suggest that a history of more than minimal gestationa l exposure (e.g., more
than light drinking) prior to pregnancy reco gnition and/or following pregnancy recogni-
tion may be required. Light drinking is defined as 1–13 drinks per month during preg-
nancy with no more than 2 of these drinks co nsumed on any 1 drinking occasion. Identifying
a minimal threshold of drinking during preg nancy will require consideration of a variety
of factors known to affect exposure and/or interact to influence developmental outcomes,
including stage of prenatal development, gestational smoking, maternal and fetal genet-
ics, and maternal physical status (i.e., ag e, health, and certain obstetric problems). 
Symptoms of ND-PAE include marked impairment in global  intellectual performance
(IQ) or neurocognitive impair ments in any of the following areas: executive functioning,
learning, memory, and/or visual-spatial reasoning. Impairments in self-regulation are pres-
ent and may include impairment in mood or behavioral regulation, attention deficit, or
impairment in impulse control. Finally, impa irments in adaptive functioning include com-
munication deficits and impairment in soci al communication and interaction. Impairment
in daily living (self-help) skills and impairment in motor skills may be present.  As it may be
difficult to obtain an accurate assessment of the neurocogni tive abilities of very young chil-