Children in the U.S. Military Health System who carry a diagnosis of fetal alcohol syndrome or prenatal alcohol exposure overwhelmingly live with other neurodevelopmental disorders, according to findings presented at the fourth annual Workshop on Fetal Alcohol Spectrum Disorders Prevention and Clinical Guidelines Research, held on 17 September 2025 in Washington, DC. A meeting report published in BMC Proceedings summarizes the day-long event, which drew nearly 100 attendees from academia, health care, federal agencies, and patient advocacy organizations. Among 1,476 military-connected children identified through diagnostic codes for fetal alcohol syndrome, prenatal alcohol exposure, or both between fiscal years 2016 and 2023, 84.6 percent had at least one additional neurodevelopmental disorder, and nearly half had three or more.
The workshop is part of the FASD Prevention and Clinical Guidelines Research Initiative, a four-year, federally funded program begun in 2022 that focuses on fetal alcohol spectrum disorders within the Military Health System. The Uniformed Services University of the Health Sciences, working with the advocacy organization FASD United, Boston University School of Public Health, and other partners, leads the effort. Its primary aim is to increase awareness of and response to fetal alcohol spectrum disorders and their risk factors within the military health system, while building a model of care delivery that could be replicated in the civilian sector. The MHS delivers direct and private-sector care to approximately 9.6 million beneficiaries, including active-duty service members, retirees, and their families.
Fetal alcohol spectrum disorders are a group of neurodevelopmental disorders resulting from prenatal exposure to alcohol, producing developmental, behavioral, intellectual, and physical challenges that can persist across the lifespan. The condition ranks among the leading preventable causes of developmental disabilities in the United States. Because fetal alcohol spectrum disorders lack a dedicated diagnostic code, researchers in the population health assessment used diagnoses of fetal alcohol syndrome and prenatal alcohol exposure as proxies, a limitation the presenters acknowledged, noting the condition is often underdiagnosed or absent from formal diagnostic datasets.
The estimated prevalence of fetal alcohol syndrome or prenatal alcohol exposure among military-connected children was 0.42 cases per 1,000 over the 2016–2023 period. Children received their first diagnosis at an average age of 8, though the average age for a prenatal alcohol exposure diagnosis was 4, compared with 10 for fetal alcohol syndrome. The most common co-occurring conditions were attention-deficit/hyperactivity disorder, intellectual disability, and autism spectrum disorder, consistent with prior research. Co-occurring neurodevelopmental disorders were more common among boys than girls, and a higher proportion of White children had at least one co-occurring diagnosis compared with Black children. Among children living in guardianship or in a pre-adoptive ward or foster home, 93.9 percent had at least one co-occurring neurodevelopmental disorder.
Separate analyses of the 2018–2023 MHS data repository examined links between neurodevelopmental disorders, mental health conditions, and alcohol and substance use disorders in a population of roughly 4.8 million eligible individuals aged 0 to 25, including children of active-duty or retired service members and young adults serving in the military. About 1.7 percent had an alcohol use disorder and 2.7 percent had an alcohol or substance use disorder. Neurodevelopmental disorders were present in 12 percent of the eligible population. Among children with a neurodevelopmental disorder, approximately 40 percent had an alcohol use disorder or a combined alcohol and substance use disorder diagnosis, compared with 20 percent of those without such a diagnosis, a difference the researchers reported as statistically significant.
Stratified by age, alcohol use disorder and combined alcohol or substance use disorder were present in 0.2 percent and 1 percent of children aged 0 to 17, rising to 3.2 percent and 4.5 percent among young adults aged 18 to 25. Among children with mental health diagnoses, more than 80 percent had an alcohol use disorder or combined disorder diagnosis, compared with 25 percent of children without a mental health diagnosis; among young adults the comparable figures exceeded 60 percent versus 23 percent. Based on these findings, Elizabeth Hisle-Gorman of USUHS Pediatrics suggested that early identification and intervention for mental health and developmental diagnoses should be an important component of any strategy to prevent alcohol and substance use disorders among young people.
The keynote address, delivered by Nicole Marlow of the University of Florida, framed the day around suicide risk among people with disabilities. Drawing on data from more than 200,000 respondents to the National Survey on Drug Use and Health between 2015 and 2019, her studies found that people with disabilities had more than double the risk of suicidal behaviors compared with those without disabilities: a 2.13-fold higher risk of suicidal ideation, 2.66-fold higher risk of suicide planning, and 2.47-fold higher risk of suicide attempt. People with cognitive limitations or complex activity limitations showed the highest risk, and risk rose with the number of limitations. In an interaction study, veterans with a disability had a lower risk of suicidal behaviors than non-veterans with a disability, which Marlow suggested may reflect suicide prevention efforts and the Veterans Administration’s centralized mental health care model.
Qualitative interviews conducted for the initiative’s community needs assessment revealed persistent barriers on the provider side. Of a planned 25 to 30 interviews, 13 have been completed with MHS providers caring for children. Participants reported relying on screening tools such as the Survey of Well-Being of Young Children and the Ages and Stages Questionnaire, and some said they depended on the facial features of fetal alcohol syndrome when deciding whether to consider the diagnosis. Providers described hesitancy rooted in the absence of standard diagnostic criteria and fear of exposing families to stigma, which in the military context could extend to effects on a parent’s service career. Most reported little to no FASD education beyond medical school and residency, and many families face wait times of several months up to a year for services such as behavioral pediatrics or speech therapy.
On the intervention side, Eric Flake of the CHSR at USUHS presented a review of reviews of child-centered, non-pharmacological behavioral interventions delivered outside school settings, targeting executive function, self-management, social skills, and behavioral regulation. Contrary to historical notions that brain-based neurodevelopmental conditions cannot improve, these studies provide robust evidence that direct, child-centered interventions can lead to positive impacts on executive function and social skills. Flake’s team is now in the early stages of piloting a hub-and-spoke provider-to-provider consultation model in the Pacific Northwest, where many military families live but physical connectivity among providers and patients is limited. The team plans to evaluate how the model performs in expanding access to care, improving providers’ experiences with FASD diagnosis, and enhancing pathways of care.
A panel of individuals with lived experience reinforced the clinical picture. A survey by the Adult Leadership Collaborative of the FASD Changemakers, with responses from more than 500 individuals, found respondents faced increased risk for 258 of 260 health issues surveyed, developing them at younger ages than the general population. Panelists described clinicians dismissing their reports of FASD-related health concerns, and emphasized coordinated multidisciplinary care, belief in patient testimony, and avoidance of shaming families. Rachel Sayko Adams of Boston University presented findings from the INROADS studies showing that while people with disabilities are less likely to drink alcohol overall, those who do drink are more likely to engage in binge drinking, and one study found people with disabilities were almost twice as likely to report an unmet need for substance use disorder treatment. A systematic review found a lack of interventions for people with FASD directly targeting mental health and substance use challenges. Organizers closed the workshop by calling for improved screening, diagnosis, interventions, and care coordination, with work under the initiative slated to continue through 2028.
Subject of Research: Co-occurring neurodevelopmental, mental health, and substance use conditions among people with fetal alcohol spectrum disorders in the U.S. Military Health System
Article Title: Fourth annual workshop on fetal alcohol spectrum disorders prevention and clinical guidelines research: co-occurring conditions
Article References: Koehlmoos, T. P., Lee, E. H., Rivera, I., Wisdahl, J., & Donaldson, T. (2026). Fourth annual workshop on fetal alcohol spectrum disorders prevention and clinical guidelines research: co-occurring conditions. BMC Proceedings, 20(S27), Article 29. https://doi.org/10.1186/s12919-026-00386-0
Image Credits: AI Generated
DOI: 10.1186/s12919-026-00386-0
Keywords: fetal alcohol spectrum disorders, prenatal alcohol exposure, co-occurring conditions, Military Health System, neurodevelopmental disorders, suicide risk, ADHD, autism spectrum disorder, substance use disorders, provider consultation, FASD prevention, workshop report
News Source: Ophelia Keating. (October 30, 2026). Workshop report flags heavy burden of co-occurring conditions in fetal alcohol spectrum disorders. Scienmag.
