I do not know how to make it more clear than the subject of this article.

The bottom line is that this may well be another area where insignificant features common to 70+% of those diagnosed are seen as essential by all-too-many practicing physicians. Several recent articles in the neuropsychology and neurology literature make it VERY plain that the physical features associated with FAS are meaningless when assessing the cognitive and behavioral impact of in utero exposure to alcohol. That is to say that all those people that physicians have so focused on with all those physical features who "qualify" for full-blown FAS as opposed to the somehow less significant FAE are not necessarily any more impaired cognitively than than the "normal" looking people that only have FAE. And, all-too-many physicians apparently dismiss the idea of serious cognitive and behavioral problems in the absence of such physical features.

The most recent studies all appear to be headed the same way - no level of alcohol consumption appears "safe" and the absence of physical features traditionally associated with FAS is a meaningless factor that has become inappropriately focused upon diagnostically when one is assessing cognitive and behavioral disability.

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From Mattson, Riley, Gramling, Delis, and Jones (1998). Neuropsychological comparison of Alcohol-exposed children with or without physical features of Fetal Alcohol Syndrome. _Neuropsychology_, 12, 146-153.

ABSTRACT

FAS is associated with behavioral and cognitive deficits. However, the majority of children born to alcohol-abusing woman do not meet the formal criteria for FAS and it is not known if the cognitive abilities of these children differ from those children with FAS. Using a set of neuropsychological tests, 3 groups were compared: (a) children with FAS, (b) children without FAS who were born to alcohol-abusing women (PEA group), and (c) normal controls. The results indicate that, relative to controls, both the FAS and the PEA groups were impaired on tests of language, verbal learning and memory, academic skills, fine-motor speed, and visual-motor integration. These data suggest that heavy prenatal alcohol exposure is related to a consistent pattern of neuropsychological deficits and the degree of these deficits may be independent of the presence of physical features associated with FAS.

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From a psychologist’s perspective - if a person has all the cognitive and behavioral symptoms/signs of FAS, I'm not certain what the issue is between the use of the terms FAS and FAE? The information offered by geneticists and physicians, while interesting, really doesn't address the cognitive and behavioral issues as those professions are typically ill-equipped to assess those areas and often have glossed over them and even been adversely impacted by what they see physically (meaning that they have been negatively biased toward physically different and positively biased to more typical looking children when assessing cognitive abilities).

-Robert W. Montgomery, Ph.D.