The prevalence and characteristics of fetal alcohol spectrum disorders (FASD) among first grade children were determined in a representative Midwestern US city. No significant differences by race or ethnicity were found. The overall sample was white (76%), black (7.0%), Asian (4.3%), and Hispanic (8.2%). Most predictive maternal risk variables were late recognition of pregnancy, quantity of alcoholic drinks consumed 3 months before pregnancy, and quantity of drinking reported for the index child's father. The prevalence of FAS in this community ranged from 6 to 9 per 1000 children; and total rate of FASD was 24 to 48 per 1000 children, or 3.6%. Children with a FAS diagnosis were shorter, lighter, and had smaller heads than all others; their BMI centile was lowest when compared to partial FAS cases, and alcohol-related neurodevelopmental disorder (ARND). A significantly higher frequency of smooth philtrum occurs in FAS cases compared to PFAS, ARND, and controls. A narrow vermilion border of the upper lip was significantly different in all FASD children compared to controls. All groups differed significantly by mean total dysmorphology score, and the total score significantly discriminates the FAS and PFAS groups from other groups. Minor dysmorphic features not specifically included in the diagnostic criteria include short inner canthal distance, inter-pupillary distance, clinodactyly and camptodactyly; all differ significantly by diagnosis. Children with FASD are more likely to have a hypoplastic midface, more clinodactyly and camptodactyly, and more frequent epicanthal folds. Performance centiles on all cognitive and behavioral tests were significantly lower for children with FASD compared to controls. The FASD group performed more poorly than controls on verbal IQ, working memory, general and conceptual ability and teacher rating of adaptive behavior. 
COMMENTARY. The diagnostic criteria of FAS are growth deficiency, craniofacial abnormalities (smooth philtrum, thin upper lip), CNS developmental disorders (microcephaly, agenesis of the corpus callosum, cerebellar hypoplasia), small phalanges and nails, single palmar crease, epilepsy, cognitive and behavioral disorders .