Adopted children from the former Soviet Union: are they at risk of fetal alcohol spectrum disorder?

QUESTION: One of the families in my practice is considering adoption of a 2-year-old child from the former Soviet Union. The family has been reassured by the agency that a doctor will examine the child to rule out developmental delays. However, my understanding from your previous articles is that one cannot rule out fetal alcohol spectrum disorder (FASD) at that age. Are these children at increased risk of developing FASD? ANSWER: You are correct: FASD cannot be ruled out at 2 years of age. The risk of FASD, neglect, and abuse among children in orphanages in the former Soviet Union is high. While adoption of children with known developmental delays should be encouraged and supported, most families seek to adopt with the assumption that these children will be healthy.