title: Prevalence of children with severe fetal alcohol spectrum disorders in communities near Rome, Italy: new estimated rates are higher than previous estimates.
abstract: To determine the population-based epidemiology of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) in towns representative of the general population of central Italy.
  
  
  
  Slightly revised U.S. Institute of Medicine diagnostic methods were used among children in randomly-selected schools near Rome. Consented first grade children (n=976) were screened in Tier I for height, weight, or head circumference and all children≤10th centile on one of these measurements were included in the study. Also, teachers referred children for learning or behavioral problems. Children meeting either of these two criteria, along with randomly-selected controls, advanced to Tier II which began with a dysmorphology examination. Children with a possible FASD, and controls, advanced to Tier III for neurobehavioral testing, and their mothers were interviewed for maternal risks. Final diagnoses using indicators of dysmorphology, neurobehavior, and maternal risk were made in formally-structured, interdisciplinary case conferences.
  
  
  
  Case control comparisons of physical, neurobehavioral, and maternal risk variables are presented for 46 children with an FASD and 116 randomly-selected controls without a diagnosis on the FASD continuum. Rates of diagnoses within the FASD continuum are then estimated from these in-school data via three different methods. The range of rates of FAS produced by these methods is between 4.0 to 12.0 per 1,000; Partial FAS ranges from 18.1 to 46.3 per 1,000; and an FASD was found in 2.3% to 6.3% of the children.
  
  
  
  These rates are substantially higher than previous estimates of FAS and overall FASD for the general populations of Western Europe and the U. S., and raise questions as to the total impact of FASD on mental deficit in mainstream populations of Western Europe and the United States where the majority are middle class and are not believed to be characterized by heavy episodic drinking.
authors.affiliation: Center on Alcoholism, Substance Abuse, and Addictions (CASAA), The University of New Mexico, 2650 Yale SE, Albuquerque, NM 87106, USA. pmay@unm.edu
authors.forename: Philip A
authors.initials: PA
authors.lastname: May
authors.forename: Daniela
authors.initials: D
authors.lastname: Fiorentino
authors.forename: Giovanna
authors.initials: G
authors.lastname: Coriale
authors.forename: Wendy O
authors.initials: WO
authors.lastname: Kalberg
authors.forename: H Eugene
authors.initials: HE
authors.lastname: Hoyme
authors.forename: Alfredo S
authors.initials: AS
authors.lastname: Aragón
authors.forename: David
authors.initials: D
authors.lastname: Buckley
authors.forename: Chandra
authors.initials: C
authors.lastname: Stellavato
authors.forename: J Phillip
authors.initials: JP
authors.lastname: Gossage
authors.forename: Luther K
authors.initials: LK
authors.lastname: Robinson
authors.forename: Kenneth Lyons
authors.initials: KL
authors.lastname: Jones
authors.forename: Melanie
authors.initials: M
authors.lastname: Manning
authors.forename: Mauro
authors.initials: M
authors.lastname: Ceccanti
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology*; D006801:Humans; D007407:Interviews as Topic; D007558:Italy / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D012720:Severity of Illness Index; D055815:Young Adult