Conditions for Further Study 799
F. The disturbance causes clinically significant distress or impairment in social, aca-
demic, occupational, or other im portant areas of functioning.
G. The disorder is not better explained by the direct physiological effects associated with
postnatal use of a substance (e.g., a medication, alcohol or other drugs), a general
medical condition (e.g., traumatic brain injury, delirium, dementia), another known te-
ratogen (e.g., fetal hydantoin syndrome), a genetic condition (e.g., Williams syndrome,
Down syndrome, Cornelia de Lange syndrome), or environmental neglect.
Alcohol is a neurobehavioral te ratogen, and prenatal alcoho l exposure has teratogenic
effects on central nervous system (CNS ) development and subsequent function. Neurobe-
havioral disorder associated with prenatal alcohol exposure  (ND-PAE) is a new clarifying term,
intended to encompass the full range of de velopmental disabilities associated with expo-
sure to alcohol in utero. The current diagnost ic guidelines allow ND-PAE to be diagnosed
both in the absence and in the presence of th e physical effects of prenatal alcohol exposure
(e.g., facial dysmorphology required for a diagnosis of fetal alcohol syndrome).
Diagnostic Features
The essential features of ND-PAE are the mani festation of impairment in neurocognitive,
behavioral, and adaptive functioning associated with prenatal alcohol exposure. Impair-
ment can be documented based on past diagnostic evaluation s (e.g., psychological or ed-
ucational assessments) or medical records, reports by the in dividual or informants, and/
or observation by a clinician.
A clinical diagnosis of fetal alcohol synd rome, including specific prenatal alcohol-
related facial dysmorphology and growth retardation, can be used as evidence of signifi-