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. 2025 Jun;49(6):1248-1262.
doi: 10.1111/acer.70068. Epub 2025 Apr 27.

Psychosocial, neurocognitive, and physical development in Eastern European adopted adolescents with and without fetal alcohol spectrum disorder

Pablo Carrera  1   2 , Laurie C Miller  3   4 , Jesús Palacios  1 , Maite Román  1
Affiliations

Psychosocial, neurocognitive, and physical development in Eastern European adopted adolescents with and without fetal alcohol spectrum disorder

Pablo Carrera et al. Alcohol Clin Exp Res (Hoboken). 2025 Jun.

Abstract

Background: Most internationally adopted individuals have been exposed to an array of developmental risk factors, including early institutionalization and other adverse experiences. Adopted children from Eastern Europe tend to show worse neurodevelopmental outcomes than adopted individuals from other areas of origin. Previous studies have shown a high incidence of prenatal alcohol exposure and fetal alcohol spectrum disorders (FASD) among this population, a factor that may explain some of their complex needs. However, direct comparisons of adoptees (from Eastern Europe or elsewhere) with and without FASD have not been previously reported.

Method: In this study, we compared 69 internationally adopted adolescents with and without FASD and 30 community adolescents in their degree of physical growth, neurobehavioral impairment, psychosocial, and neurocognitive function using standardized assessments including both parent-reported questionnaires and performance tests. The presence of FASD or prenatal alcohol exposure was collected via parent reports.

Results: Fourteen adopted adolescents (20.3% of the adopted sample) had FASD, whereas 55 adopted adolescents did not. Adopted adolescents in the FASD group showed more difficulties in several domains of psychosocial adjustment and cognitive development and lower head circumferences, compared with adopted adolescents without FASD and community adolescents, whereas in a few other areas, the pattern was less clear-cut. Adopted adolescents without FASD also presented difficulties, although to a lesser degree.

Conclusions: Adopted adolescents with FASD showed a complex profile of deficits in social communication, certain neurocognitive areas (particularly in working memory and language), and self-regulation. However, given that internationally adopted individuals have been exposed to an array of developmental risk factors for neurodevelopment, caution is needed before assuming that the difficulties observed in adoptees from Eastern Europe derive exclusively from prenatal alcohol exposure.

Keywords: fetal alcohol spectrum disorder; international adoption; neurobehavioral impairment; neurocognitive development; psychosocial adjustment.

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Conflict of interest statement

The authors have no relevant financial or nonfinancial interests to disclose.

Figures

FIGURE 1
FIGURE 1
Standardized‐to‐norm means and distribution of psychosocial adjustment variables in adopted adolescents with and without FASD. Scores were standardized using the community group mean and SD. AF, adopted adolescents with FASD; ANF, adopted adolescents without FASD.
FIGURE 2
FIGURE 2
Standardized‐to‐norm means and distribution of neurocognitive variables in adopted adolescents with and without FASD. Scores were standardized using the community group mean and SD. AF, adopted adolescents with FASD; ANF, adopted adolescents without FASD.
FIGURE 3
FIGURE 3
Standardized means and distribution of physical development variables in adopted adolescents with and without FASD. Standardized scores based on Spanish multicentric norms are presented (Sánchez González et al., 2011). AF, adopted adolescents with FASD; ANF, adopted adolescents without FASD.
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