Soon after the identification of FAS it became clear that not all individuals with heavy prenatal alcohol exposure demonstrated all of the features required for a diagnosis. The range of physical and behavioral outcomes was variable, and animal experimentation identified a number of factors that could influence the outcome, including the dose, timing of exposure, genetic factors, and nutritional status of the mother. The term “suspected fetal alcohol effects” (FAE) was suggested to deal with the less complete or partial expression of the syndrome (Clarren and Smith 1978), but because of a lack of precision and its frequent misuse, it was subsequently recommended that the term be discontinued (Aase et al. 1995). Two years later the Institute of Medicine (IOM) (Stratton et al. 1996) suggested new terminology to encompass the range of consequences following prenatal alcohol exposure. First, there was FAS, with or without confirmed maternal alcohol exposure. It was felt that the criteria for a diagnosis of FAS were sufficiently distinct and specific that the diagnosis could be made in the absence of knowledge about the history of alcohol
