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         Teaching Children With Fetal Alcohol Syndrome:     more detail
  1. Fantastic Antone Succeeds: Experiences in Educating Children with Fetal Alcohol Syndrome by Judith Kleinfeld, 1993-06-01
  2. Reaching Out to Children with FAS/FAE: A Handbook for Teachers, Counselors, and Parents Who Live and Work with Children Affected by Fetal Alcohol Syndrome by Diane Davis, 1994-06
  3. The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities
  4. Prenatal Exposure to Drugs/Alcohol: Characteristics and Educational Implications of Fetal Alcohol Syndrome and Cocaine/Polydrug Effects by Jeanette M. Soby, 1996-10
  5. Beyond the gloom and doom: Tools for help and hope with Native people affected by fetal alcohol syndrome and related neuro-developmental disorders by Suzanne L. B Kuerschner, 2001

21. Fetal Alcohol Syndrome
entitled alcohol, Drugs, and the Fetus A teaching Package (84 morphology assessedby digital image analysis in children with fetal alcohol syndrome.
http://www.tsbvi.edu/Outreach/seehear/fall00/fas1.htm
Home Site TOC Site Search Outreach ... Fall 2000 Table of Contents
Fetal Alcohol Syndrome
By Blanche Stetler, Parent and Family Specialist, New Jersey Deafblind Project In September of 1989 we adopted a little boy who we named Timmy. Timmy was 2 weeks old at the time, and, unbeknownst to us, was born to a mother who both drank and took drugs while she was pregnant. We found this out during a regular office visit to our pediatrician after our doctor had received Timmy's birth records from the adoption agency. Since then, we have been on a roller coaster ride between doctors, therapists, and educational professionals trying to get him the help he needs. Tim has both a vision and hearing impairment caused by Fetal Alcohol Syndrome. He also has Attention Deficit Hyperactivity Disorder (ADHD) and a Seizure Disorder. Even though he is now 11, developmentally he is at 5-6 year-old level. We have tried many different medications over the years to control his hyperactivity and seizures. It is an ongoing battle. It seems whenever he has a growth spurt, the medications no longer work, and we go on to something else. Even though we knew Timmy's birth history when we started visiting neurologists, it still took many years for us to get a firm diagnosis of Fetal Alcohol Syndrome (FAS). We have compiled the following information over the years to help us. Some things were from doctors and others were from teachers, therapists, professionals, books, and support groups.

22. Federation Of Invisible Disabilities - Fetal Alcohol Syndrome
Characteristics Prevalence Prevention teaching Strategies Other conditionof fetal alcohol Effect (FAE Characteristics children with FAS have small
http://www.fids.bc.ca/fas.html
Federation of Invisible Disabilities Home What's New! Who We Are Become a Member ... FAQ Fetal Alcohol Syndrome Definition Causes Characteristics Prevalence ... Resources
Definition:
Fetal Alcohol Syndrome (FAS) is an organic disorder which can be caused by prenatal alcohol exposure.
Causes This diagnosis may result from chronic alcohol use during pregnancy. The associated condition of Fetal Alcohol Effect (FAE) may occur from moderate or binge drinking.
Characteristics: Children with FAS have small size or weight before birth, display two of the following signs: small head size, narrowed eye openings, thin upper lip, and developmental, intellectual or neurological impairment. Also associated with FAS are a wide nose, widely spaces eyes, flattened mid-face, congenital heart defects, poor coordination, social skills impairment and an IQ range of 60-70.
Prevalence: Two out of every 1,000 children born in the U.S. have FAS. Twice as many exhibit FAE. Experts believe that even more children and adults could be diagnosed with FAE.
Prevention: This is the most preventable birth defect. Mothers should abstain from drinking alcohol during pregnancy. Risk for fetus alcohol abuse is greatest in the first trimester of pregnancy.

23. Texas Fetal Alcohol Syndrome Newsletter: December 1998
Medical Consequences A Comprehensive Slide teaching Program for Strategies for Workingwith children with fetal alcohol syndrome, participants learned a
http://www.main.org/texasfasc/dec98journal.html
d
FAS Journal/Texas FAS Consortium
Vol. 1 Issue 3 - December 1998
Return to FAS Journal Main Index
TOP News
New Executive Director
As of October 1, 1998 the Texas Office for Prevention of Developmental Disabilities has a new Executive Director. Julian L. "Larry" Camp was hired by the Executive Committee of TOP to head their Administrative Office. Mr. Camp has 23 years of experience in Developmental Disabilities and Mental Health, most recently with the Bluebonnet Trails MHMR Center in Round Rock, Tx. Mr. Camp will be overseeing TOP's Task Forces and Subcommittees. He will be working closely with the FAS Consortium and its chair Lila Thompson.
Previous FAS Meeting News
Dr. Robert J. Clayton hosted the August 13, 1998, FAS Consortium meeting at the UTHSC in San Antonio. Cheryl Washington, a Special Education Teacher and Education Coordinator for the San Antonio Affiliate of the National Association of Children of Alcoholics, gave an outstanding presentation on "At Risk Populations." Ms. Washington discussed the communal approach to teaching children with special needs with a life-long learning approach encompassing every area of their lives. Such an approach would decrease the number of children with special needs that are lost through the cracks of the traditional education system in Texas every year. Bobbi Johnson of Phoenix House premiered some of the Professional Training programs that her organization has available to enhance community outreach for "At Risk Populations."

24. Fetal Alcohol Syndrome/Prenatal Substance Exposure-FAQ
Where would I find some information about teaching strategies for children withfetal alcohol syndrome (FAS) or children with problems due to prenatal
http://ericec.org/faq/fetalalc.html
Fetal Alcohol Syndrome/Prenatal Substance Exposure (reviewed July 1999)
    The ERIC Clearinghouse on Disabilities and Gifted Education (ERIC EC)
    The Council for Exceptional Children
    1110 N. Glebe Rd.
    Arlington, VA 22201-5704
    Toll Free: 1.800.328.0272
    E-mail: ericec@cec.sped.org
    Internet: http://ericec.org
Where would I find some information about teaching strategies for children with fetal alcohol syndrome (FAS) or children with problems due to prenatal substance exposure? Fetal Alcohol Syndrome is an organic brain disorder caused by prenatal alcohol exposure. The affected person may have:
  • height, weight, and growth deficiencies.
  • a specific pattern of facial features.
  • central nervous system damage i.e., a unique cluster of behavioral symptoms.
One of the most debilitating characteristics of FAS and FAE is the poor ability to adapt to demands of surroundings. Educational experiences should make students as independent as possible, both now and in the future, with the outcome being adults functioning as fully as they are able. For some children, "functional" may mean following traditional academic curricula. Many students are fairly accomplished in academic subjects. To be independent, they also may need to learn to ride buses, prepare meals, use money appropriately, and not only perform a job, but use the social skills necessary to keep it. Educational goals and objectives should go beyond classroom boundaries and target skills to be used not only at school, but in homes and communities as successful, productive citizens.

25. CBC.CA - The National
Hope teaching kids with fetal alcohol syndrome Reporter Jennifer Rattray AirdateJune 13, 2002 In Canada, about 65,000 children have fetal alcohol syndrome,
http://www.cbc.ca/national/news/fas/

Indepth

Viewpoint

Science

Live

School of Hope
Teaching kids with fetal alcohol syndrome

Reporter: Jennifer Rattray
Airdate: June 13, 2002
In Canada, about 65,000 children have fetal alcohol syndrome, a condition triggered when their mothers drink alcohol during pregnancy. It affects a child's mind and body. It makes learning incredibly difficult. Children who have it often struggle through the school system and fall through the cracks. But not at one school in Winnipeg. For these children it's a school of hope.
Eleven-year-old Jesse Laporte has fetal alcohol syndrome (FAS), but Jesse is thriving at school because he goes to Winnipeg's David Livingstone School. The public elementary school has two special classrooms for 16 children with fetal alcohol syndrome. Angeline Ramkissoon Eight years ago, the stereotype about kids and FAS was challenged by four women there. Leading the way was Angeline Ramkissoon, the school's principal. "We had a group of kids coming into our school system who are fetal alcohol syndrome and we knew absolutely nothing about fetal alcohol," she says. "We were overwhelmed because, like everything else, you're afraid of the unknown. And when you don't know much about it, well the best thing to do is to find out about it." "These kids are so sensitive to sight and sounds that they would be able to hear the flickering from the bulbs."

26. Fetal Alcohol Syndrome/Fetal Alcohol Effects
Parents Who Live and Work with children Affected by fetal alcohol syndrome by Diane informationand procedures for diagnosing, teaching, and parenting
http://www.our-kids.org/Books/fas.htm

27. FAS Community Resource Center
A collection of articles discussing this diagnosis.Category Health Reproductive Health fetal alcohol syndrome...... Number one FAS issue Behavior children with FAS teaching the Teachers about FAS/ARND;The from the National Organization on fetal alcohol syndrome The latest
http://www.come-over.to/FASCRC/
About FAS-CRC FAS C ommunity R esource C enter
Information about Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Spectrum Disorders (FASD)
teresa@come-over.to

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28. New Currents In Teaching And Learning, Volume 6, No.6: Post Secondary Education
teaching children with FAS,; and diagnostic criteria. Students were also expectedto A textbook on fetal alcohol syndrome published by the Special Needs Adoptive
http://www.ucalgary.ca/pubs/Newsletters/Currents/Vol6.6/FAS.html
Post Secondary Education in Fetal Alcohol Syndrome
Dorothy Badry, Rehabilitation Sessional Instruction
Community Rehabilitation and Disability Studies Program
The Community Rehabilitation and Disability Studies Program at the University of Calgary offers a post-diploma program (Bachelor of Community Rehabilitation [BCR]) to students working in the field of rehabilitation who want to complete a degree. The degree is available to students in the provinces of British Columbia, Alberta and Saskatchewan through small groups of students identified as Community of Learners (COL). These students can access the program through a variety of means, including distance education.
One area of required study is in the area of health as it relates to disability. The COL has identified a particular interest in the study of Fetal Alcohol Syndrome (FAS). Many students felt that they had encountered disabled adults in their practice who indeed had many of the characteristics of FAS, but had never been formally diagnosed. It was decided that it would be beneficial to offer a course in this area to provide professional training and promote awareness of FAS among community rehabilitation professionals. COL students identified a need to receive training in the many complex issues related to FAS, an entirely preventable disability.
Why should students in the field of disability studies do a course in Fetal Alcohol Syndrome? FAS is an emerging field of study. Professionals in the field of rehabilitation and social work are increasingly aware of the complexity of social, physical,behavioural and emotional issues for those affected by FAS.

29. MCF - Fetal Alcohol Syndrome - Where To Go For Information
teaching the Tough Ones. CH (1996 ).Working with SubstanceExposed children—Strategiesfor fetal alcohol syndrome/fetal alcohol Effects A Resource Manual,.
http://www.mcf.gov.bc.ca/child_protection/fas/fas2f.htm
Community Action Guide: Working Together for the Prevention of Fetal Alcohol Syndrome
Where to go for further information
In Pediatrics Volume 95. Albuquerque, NM: American Academy of Pediatrics. Give and Take: A booklet for pregnant women on alcohol and drugs . Kingston ON: AWARE. Alcohol Health and Research World: Fetal Alcohol Syndrome Volume 18, No. 1 . (1994). Washington DC: National Institute of Alcohol Abuse and Alcoholism. B.C. Ministry of Education Skills and Training (1996). . Victoria, B.C.: Special Programs Branch. Boudreau, J.L. and Trerice, S. (1993). Responding to the Needs of People with FAS/E . Whitehorse, Yukon: Yukon Association for Community Living. Callahan, M., Lumb, C. and Wharf, B. (1994). Strengthening Families by Empowering Women . Victoria, B.C.: Child, Family and Community Research Program, School of Social Work, University of Victoria. Alcohol, Tobacco, and Other Drugs May Harm the Unborn

30. MCF - Fetal Alcohol Syndrome -Early Intervention
Working Together for the Prevention of fetal alcohol syndrome teaching the child sociallyappropriate skills to self growth and development of children with FAS
http://www.mcf.gov.bc.ca/child_protection/fas/fas2d.htm
Community Action Guide: Working Together for the Prevention of Fetal Alcohol Syndrome
Early intervention with those affected by FAS
When we raise issues about FAS on the community level, often those living and working with those with FAS identify the need to have more information about how to intervene with those affected. The following information is offered to address this important need. Just as the characteristics of those affected have been presented by age level in the FAS section of this Guide, the interventions that work are presented here by age level. The information provided is general in content. It is important that all interventions be individualized and that all recognize the uniqueness of each child. No two children with FAS and other alcohol related effects are alike, even if they have the same diagnosis and the same family experiences.
Environment plays a significant role in the growth and development of all children. It can either enhance or hinder development. Early intervention can reduce the impact of a delay in development. In some situations, it can prevent secondary disabilities (such as mental health problems, school problems, trouble with the law, and alcohol and other drug problems) from occurring later in life.
It cannot be stressed enough that all care must be family-centred and culturally sensitive, with attention to the role that parents play in the development of their children.

31. Newsletter Archive | Teaching Young Children With FAS: What Teachers Should Know
When teaching young children with fetal alcohol syndrome (FAS), teachersshould remember that FAS manifests itself in different ways.
http://www.pbrookes.com/email/archive/november01/November01EC2.htm
Teaching Young Children with FAS: What Teachers Should Know
From the November 2001 Early Childhood newsletter.
When teaching young children with fetal alcohol syndrome (FAS), teachers should remember that FAS manifests itself in different ways. According to Claire Coles, a professor of psychiatry at the Emory University School of Medicine, some children struggle with visual-spatial skills, some with motor coordination, and some with self-regulation. They may be withdrawn, or they may be very friendly and talkative. This wide range of symptoms coupled with the fact that children are often not diagnosed until elementary school makes FAS a challenge for early childhood educators in the classroom.
As a result of often not being diagnosed early in life, children with FAS often don't receive necessary intervention in their early years. Occasionally, symptoms of FAS are misdiagnosed as ADHD or another developmental disability.
Teaching Strategies
Teachers should be sure to give children with FAS clear instructions and use multimodal approaches to instruction, says Dr. Coles. Using physical objects, such as manipulatives, is recommended in particular. Since children with FAS may have mild developmental delays or a borderline IQ (but don't usually meet the criteria for mental retardation), Dr. Coles recommends that teachers give children multiple cues to help them retrieve information and complete activities.
Children with FAS generally need a lot of structure. Because many children with FAS struggle with performance-related activities, such as those involving fine motor or visual-spatial skills like puzzles and playing with small objects, teachers may need to supply extra help to encourage the children to use and develop those skills. Children with FAS may also struggle with memory; however, their verbal skills are usually not affected.

32. Alcohol Research Center - LSUHSC - Fetal Alcohol Syndrome
fetal alcohol syndrome Home Educators Email support for parents copingwith the special challenges of teaching children afflicted with FAS.
http://alcoholresearch.lsumc.edu/fas.asp
Funding for this site is provided by The National Institute on Alcohol Abuse and Alcoholism (NIAAA) LSUHSC HOME
Fetal Alcohol Syndrome
Fetal Alcohol Syndrome lies at the extreme of a range of effects, known as FAE - Fetal Alcohol Effects, that alcohol has on an unborne child. FAS is characterized by low birth weight, retarded growth before and after birth, damange to the central nervous system, and deformities of the face and head. Alcohol can begin to affect a fetus even while it is in the embryonic stage, as early as 2 weeks after conception. The fetus becomes especially vulnerable between 4-8 weeks during a transition stage from embryo to fetus. It remains highly vulnerable throughout the pregnancy. [ REF A fetus shares a very close relationship with its mother. It gets all the nutruients that it needs to survive and grow from its mother. It also gets any polutants in the mother's bloodstream such as alcohol. A fetus is extremely fragile and can be irreversibly damaged from even small amounts of alcohol. It has been shown that occasional drinking in light amounts do not significantly increased the risk of FAS. However even light drinking over a prolonged or continuous amount of time can cause significant defects of the fetus. [ REF Here is a list of the symptoms of FAS.

33. Fetal Alcohol Syndrome And Effect
mother, who was adopting three children with fetal alcohol exposure themselves tofind resources to improve their children's lives We need to be teaching 12year
http://www.treefort.org/~tjk/fas/part1_8.htm
FAS WORKSHOPS
Teachers and professionals working with children and adults with FAS and FAE can receive information on alcohol effects and intervention strategies atworkshops scheduled for later this month.
Families seeking information and support may attend a support group meeting.
Theresa Kellerman, coordinator of the FAS Community Resource Center in Tucson, will lead the workshops.
A workshop designed for professionals will be held from 1 to 4 p.m. Dec. 11.
One for teachers will be held from 1 to 4 p.m. Dec. 26.
Registration is $20, to cover the cost of materials.
Workshops will also be held for parents. For dates and locations of all the workshops, call Kellerman at 296-9172.
Visit her Web page at
http://fas.home.ml.org
Depth of need fueled her devotion to cause
Theresa Kellerman stands nearby as John plays the drums. W hen Theresa Kellerman and her family moved to Tucson in 1979, there were few resources for people living with fetal alcohol syndrome.
She knew help was needed for herself and others like her. Three years ago, Kellerman helped organize an FAS prevention committee. Last year, she started the FAS Community Resource Center, offering education and support to parents and professionals dealing with prenatal alcohol damage.

34. Educational Assistant 2003 - Sessions For Friday From 1:00 PM - 4:00 PM
214, fetal alcohol syndrome / fetal alcohol Effects. 216, Fragile X syndromeCoping and Working with FXS. 252, teaching children with Down syndrome . . .
http://www.educationalassistant.macewan.ca/sessionlist.cfm?TimeID=11

35. AADD - Fetal Alcohol Syndrome
Intervention programs targeted to children with alcohol done by the Alaska Fetalalcohol syndrome Prevention Project making 2. Focus on teaching daily living
http://www.aadd.org/html/prevfas.html
Atlanta Alliance on Developmental Disabilities The mission of the Atlanta Alliance on Developmental
Disabilities is to build communities of support, acceptance, and opportunity for children, adults, and families living with developmental disabilities.
FAS FACTS Fetal Alcohol Syndrome What is FAS / FAE / ARBD ?

The Fetal Alcohol Syndrome Study Group of the National Council on Alcoholism outlines minimal criteria for the diagnosis of Fetal Alcohol Syndrome (FAS) as being "evidence of abnormalities in three specific areas: growth, central nervous system functions, and facial characteristics." Fetal Alcohol Effects (FAE) is the term commonly used to describe children with fewer or less severe birth defects in the same areas. In both FAS and FAE, the birth defects are caused when a woman drinks alcohol during pregnancy. FAS and FAE are 100% preventable. Alcohol Related Birth Defects (ARBD) is a term that is used to describe birth defects caused by prenatal exposure to alcohol that had previously been called FAS/FAE.

36. Internet Links
Facts About fetal alcohol syndrome. fetal alcohol syndrome Forum. PraderWilli syndromeAssociation. Strategies for teaching children with Behavior Disorders.
http://staffweb.peoriaud.k12.az.us/Richard_Flagle/links.htm
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37. .:: Mothercraft ::. A Canadian Leader In Healthy Child Development
Providers (1999) children with fetal alcohol syndrome grow up in without doubt, childrenwith FAS challenge us to The Affective Curriculum teaching AntiBias
http://www.mothercraft.ca/05_projects_publications_00.htm
Early Literacy Development and School Readiness Project
This project examines the ways in which early learning environments support the development of literacy and school readiness in young children. Completion date: Fall 2003
Early Intervention Project
This study examines the tools required to help children in at-risk groups to overcome obstacles to their healthy development. Completion date: Fall 2003
With the support of the Early Year Challenge Fund, Mothercraft and the Toronto East General Hospital have collaborated to produce fact sheets on the symptoms, causes, assessment and treatment of 6 disorders of early childhood, including:
  • Attachment Disorders Attention Deficit/Hyperactivity disorder (ADHD) Autism Fetal Alcohol Syndrome (FAS) Learning Disabilities Regulatory Disorders
To obtain a copy of The FACTS, contact

38. Link8
Critical Issues in Educating Autistic children and Youth teaching Mainstreamed, Diverse,and AtRisk Students Young Adults with fetal alcohol syndrome or fetal
http://www.educ.ucalgary.ca/swork/ipp/link8.html
References
HOME
GENERAL: Alberta Education. Behaviour Disorders in Schools: A Practical Guide to Identification, Assessment and Correction. Edmonton, 1986. Alberta Education. "School Act." Education Programs and Services Policy Requirements. http://ednet.edc.gov.ab.ca/educationguide/pol%2Dplan/polregs/162.htm Alberta Education. Funding Manual for School Authorities in the 1998/1999 School Year. Edmonton, 1998. Alberta Education. Programming for Students with Special Needs. Special Education Branch: Edmonton, 1995. Alberta Education. Teacher Alert System: A Guide for Teacher Managed Assessment of Students Who are "At Risk" of School Failure. Edmonton, 1991. The Inclusive Classroom: Educating Exceptional Children. Nelson Canada: Scarborough, 1993. Understanding Learning Disabilities. 2nd Ed. Marfield Publishing: California, 1982. Calgary Board of Education. Memorandum: re. 1998-99 Severe Disabilities Funding Process. Clark, B. Growing Up Gifted. Merrill Publishing Co.: Ohio, 1983. Deutsch Smith, Deborah. Teaching the Learning Disabled.

39. Fetal Alcohol Syndrome
Our children who lack performance abilities need access By teaching Liz things otherslearn independently I Can Be Living with fetal alcohol syndrome or Effects
http://www.kidscanlearn.net/FAS.htm
There is Hope for Children with
Fetal Alcohol Spectrum Disorder My name is Jodee Kulp, I am the mother of Liz Kulp, (FAE, 16) who was diagnosed at 12.5 with Fetal Alcohol Effects (FAE) . Our journey with Liz has taken our family through foster care and adoption, attachment issues, years of night terrors, rages, and diagnosis of failure-to-thrive, light sensitivities, food sensitivities, sound sensitivities, SI, ADHD, ADD, central auditory processing disorder, visual processing disorder and finally FAE. In essence brain, sensory and metabolic issues due to prenatal alcohol exposure. Liz makes the best of life. Her strong spirit, determination and perseverance offsets her compromised mind, senses and body. She and our family have worked hard to help her become the "best she can be." Three points I would like to address: 1. DIAGNOSIS IS ESSENTIAL
2. NUTRITION IS VITAL
3. NEURODEVELOPMENT IS POSSIBLE. There is hope for our children. 1. DIAGNOSIS IS ESSENTIAL
: In my naiveté, I didn't want a diagnosis of Fetal Alcohol for my child. FAS/FAE is a diagnosis with stigma. In reality it was the diagnosis that provided the keys to help Liz become a more productive and manageable person. We need to build public relations to destigmatize FASD. It is not a "bad" person or a "bad" label. With knowledge and acceptance we can move forward for families and persons with FASD. Age 12.5 was too late for the amount of work needed to help my daughter. We needed more time to revisit therapies and build stronger neural connections. I believe with an earlier awareness her adult life would hold more opportunities. We need to encourage struggling families to seek help. Diagnosis is the first step of getting the support families need.

40. Fetal Alcohol Syndrome
understanding of young children and in practical knowledge about teaching. are moreor less effective with children with fetal alcohol effects, evaluation
http://www.nap.edu/readingroom/books/fetal/summary.html
Fetal Alcohol Syndrome
Executive Summary In recognition of the seriousness of this problem, the U.S. Congress mandated in Section 705 of Public Law 102-321, the ADAMHA Reorganization Act, that the Institute of Medicine (IOM) of the National Academy of Sciences conduct a study of FAS and related birth defects. This report is in response to that mandate. The charge to the committee was to improve the understanding of available research knowledge and experience on:
  • tools and approaches for diagnosing FAS and related disorders,
  • the prevalence of FAS and related disorders in the general population of the United States,
  • the effectiveness of surveillance systems, and
  • the availability and effectiveness of prevention and treatment programs for these conditions.
As part of its work, the committee reviewed and assessed U.S. Department of Health and Human Services agency research on the topic and provided guidance for the future. DIAGNOSIS AND CLINICAL EVALUATION OF
FETAL ALCOHOL SYNDROME
A medical diagnosis serves several major purposes: to facilitate communication among clinicians; to facilitate communication between clinician and patient (including, in this instance, the parents of patients); to assist in the study of pathophysiology and etiology; and to guide treatment. In addition to the well-documented guidelines of good reliability and validity, a number of practical considerations also inform decisions about diagnostic criteria. Placing a patient in a diagnostic category confers both benefits and disabilities. For example, the diagnosis of FAS may validate a patient's disability and facilitate appropriate interventions and social benefits. On the other hand, the diagnosis may also be used to stigmatize and to create se lf-fulfilling prophecies about the future that could be detrimental to the patient and his or her family.

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