FASD can affect various developmental areas, including general intelligence, motor function, attention and activity levels, language development, visual perception, learning and memory, adaptive functioning, and executive functioning (8, 9). Individuals with FASD can display maladaptive behaviors in childhood, which in turn can result in adverse life outcomes, including disrupted school experiences, trouble with the law, confinement, and substance use problems (10). Studies comparing individuals with FASD to IQ-matched individuals with another specific learning disorder showed that the FASD group consistently displayed lower adaptive functioning, which can manifest as difficulty with communication, socialization, and acquiring skills throughout life. These difficulties can become more severe with age if not recognized and addressed promptly (11, 12).

Although the inciting event for these impairments is exposure to alcohol in utero, several environmental and social factors have been identified that can perpetuate increased challenges throughout life for individuals with FASD. Many children with FASD have also been shown to experience adverse childhood events (ACEs), such as early maternal death, physical or emotional abuse, substance use in the home, being removed from their home, and having transient living environments, all of which may contribute to increased challenges for these children (10). Individuals with FASD may already be in a position of adversity, as many mothers of children with FASD live below the poverty line, have experienced physical or sexual abuse, or have mental health diagnoses (13). The combination of these factors means that children with FASD are often additionally exposed to ACEs, which may have compounding negative social and behavioral effects on a child, especially in the context of the neurodevelopmental effects of prenatal alcohol exposure.

Underdiagnosis and delays in diagnosis of FASD interfere with accessing proper healthcare and the social support that may help to overcome many difficulties experienced by individuals with FASD. Research suggests that the longer a child goes without an official FASD diagnosis, the higher the chance of deleterious consequences (10). Moreover, children with FASD frequently have other comorbid conditions that affect cognitive and social functioning, such as attention deficit-hyperactivity disorder and other mental health conditions, further convoluting the approach to diagnosis and treatment (13). Conversely, living in a stable and nurturing home and receiving a diagnosis before six years of age have been shown to protect against the adverse outcomes discussed above (2, 10). Eliminating some environmental factors that could hinder healthy development allows children with FASD to achieve their full potential through understanding their diagnosis and obtaining proper assistance.

Individuals with FASD face numerous challenges that can significantly impact their ability to function independently and thrive. Developmental delays, including difficulties with speech, motor skills, and cognition, are common, as are learning disorders and attention deficits (3). Addressing these issues often requires specialized education, therapy, and tailored support. Behavioral and emotional difficulties, such as poor impulse control and frustration management, further highlight the need for mental health services like FASD-informed counseling and behavioral therapy. Additionally, physical health concerns, including coordination problems and congenital abnormalities, may necessitate medical and therapeutic interventions (14).

Social and adaptive skills deficits also pose barriers for individuals with FASD, often making it difficult to navigate relationships or meet societal expectations. Programs focused on social skills training and community integration are essential for building confidence and fostering independence. Without targeted support, individuals with FASD are at a higher risk for secondary challenges, such as unemployment, homelessness, substance abuse, or legal issues. Preventative services, including job coaching, life skills training, and vocational programs, are critical in mitigating these risks and promoting long-term success (15).

FASD is a lifelong condition, meaning many individuals may benefit from ongoing support throughout adulthood (16). Services like case management, financial assistance, and housing support are vital for stability for some individuals. Families and caregivers may also benefit from education, respite care, and advocacy resources to better manage the unique needs of individuals with FASD. Furthermore, legal protections under the American Disabilities Act and Section 504 ensure access to necessary accommodations. Early and sustained access to tailored services enhances quality of life and raises community awareness, fostering greater inclusion and understanding (10).

Individuals with FASD face many adversities when it comes to accessing care, from difficulty with receiving a diagnosis, exclusion of the diagnosis from disability eligibility, lack of education relating to FASD in healthcare and school settings, and lack of social work services equipped to support these individuals (Figure 1).

Specialized FASD clinics play a critical role in addressing the diagnostic and treatment challenges faced by individuals with prenatal alcohol exposure. NM and several other states (e.g., Alaska, California, Florida, Georgia, Minnesota, Michigan, Nebraska, New York, South Dakota, and Washington) have established clinics dedicated to evaluating and supporting individuals exposed to substances during pregnancy, including alcohol. In NM, the FASD clinic at the Center for Development and Disability at the University of New Mexico School of Medicine employs an interdisciplinary team, including a pediatric neuropsychologist, a pediatrician, social workers, occupational therapists, and speech therapists. This clinic provides comprehensive diagnostic evaluations using Institute of Medicine criteria (18) and offers limited services to support patients and their families.

Despite these efforts, significant gaps remain. Most interventions for children with FASD are managed through the educational system, leaving care fragmented and dependent on individual school resources. Individuals in NM often face delays in obtaining diagnoses, with appointment wait times extending to six months or longer, compounded by challenges in retrieving records from outside facilities. Once individuals with FASD transition into adulthood, either by graduating from high school or aging out of foster care, their access to support diminishes drastically. With no clinics or organizations specifically focused on adults with FASD in New Mexico—and only a few available nationwide—services often cease at the very time individuals need assistance navigating the workforce and achieving independence.

Addressing these challenges requires expanding specialized FASD clinics to serve individuals across the lifespan and integrating alternative approaches, such as community-based programs and telehealth services, to bridge gaps in care and improve long-term outcomes for individuals with FASD. Despite various setbacks, additional support measures are available to help mitigate adverse effects. Professional organizations, such as FASD United at a national level and Families ASAP in NM, and local community workers provide essential reinforcements for families, offering assistance in managing a diagnosis of FASD. This may include attending meetings for Individualized Education Programs, advocating for tailored educational services, and providing critical education about FASD to caregivers and educators. The UNM FASD clinic also collaborates closely with the foster care system, receiving referrals from across the state, ensuring that children in state care have an opportunity for diagnosis and support.

State-level interventions, particularly in education and awareness, have the potential to make the most significant difference for patients with FASD in NM and across the country. Expanding knowledge about FASD among teachers, caregivers, counselors, coaches, and other adults who interact with children is critical to providing timely and effective care and support. Greater awareness of FASD signs and symptoms could lead to earlier diagnoses, improved access to specialized services, and better long-term outcomes for affected individuals. While NM has numerous community programs to support underserved populations, these initiatives must be adapted to meet the unique needs of individuals with FASD and their families. By refining existing resources and fostering a more informed network of caregivers and service providers, NM and other states can reduce diagnostic delays, enhance support systems, and help individuals with FASD achieve their full potential.