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Bernadette Safe
Annette Joosten
Roslyn Giglia


fetal alcohol spectrum disorder, motor skills, motor skill disorders, childhood development, adolescence


Motor impairments are one of the difficulties present in people prenatally exposed to alcohol, and are included in the diagnostic criteria for Fetal Alcohol Spectrum Disorder.
The aim of this review was to examine the extent and common types of motor impairment present in persons aged over 12 years prenatally exposed to alcohol as evidence for determining the skills that should be assessed and addressed in intervention.


A systematic review of current evidence using various electronic databases was conducted. Studies were appraised using a recognised clinical appraisal tool.


Seven studies published between 1998 and 2014 met the inclusion criteria. There is some evidence that difficulties with fine motor skills, visual motor integration, and balance skills persist in people who have been prenatally exposed to alcohol. Most studies did not focus on adolescent or adult participants in isolation, making it difficult to generalise results. Varied methodological designs made it difficult to compare studies as few used common standardised assessments


A review of functional difficulties in each individual would be required to determine if a motor assessment is warranted. Further research is required using assessments recommended in diagnostic guidelines to determine the common motor difficulties seen in adolescents and adults.

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1. Lange S, Probst C, Gmel G, et al. Global prevalence of fetal alcohol spectrum disorder among children and youth: a systematic review and meta-analysis. JAMA Pediatr 2017;171:10:948–56. doi: 10.1001/jamapediatrics.2017.1919.
2. Burns L, Breen C, Bower C, O’ Leary C, Elliott EJ.Counting fetal alcohol spectrum disorder in Australia: the evidence and the challenges. Drug Alcohol Rev2013;32:461–7. doi: 10.1111/dar.12047.
3. Fitzpatrick JP, Latimer J, Carter M, Oscar J, Ferreira ML, Carmichael Olson H, et al. Prevalence of fetal alcohol syndrome in a population-based sample of children living in remote Australia: The Lililwan Project. J Paediatr Child Health 2015;51:450–7. doi: 10.1111/jpc.12814.
4. Clark E, Lutke J, Minnes P, Ouellette-Kuntz H. Secondary disabilities among adults with fetal alcohol spectrum disorder in British Columbia. J FAS Int 2004;2:1–12.
5. Streissguth A, Bookstein F, Barr H, Sampson P, O’MalleyK, Young J. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr 2004;25:228–38.
6. Cook JL, Green CR, Lilley CM, Anderson SM, Baldwin ME, Chudley AE, et al. Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan. CMAJ2016;188:191. doi: 10.1503/cmaj.141593.
7. Bower C, Elliott EJ. On behalf of the Steering Group. Report to the Australian Government Department of health: Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD).” 2016. Available at:
8. American Psychiatric Association. DSM-5 Diagnostic Classification. Diagnostic and Statistical Manual of Mental Disorders. DSM Library. Arlington, VA.: American Psychiatric Association; 2013.
9. Roebuck TM, Simmons RW, Richardson C, Mattson SN, Riley EP. Neuromuscular responses to disturbance of balance in children with prenatal exposure to alcohol. Alcohol Clin Exp Res 1998;22:1992–7.
10. Jirikowic T, Hsu LY, McCoy SW, et al. Clinical balance responses to sensorimotor training to affect balance for children with fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2014;38:179A.
11. Adnams CM, Kodituwakku PW, Hay A, et al. Patterns of cognitive-motor development in children with fetal alcohol syndrome from a community in South Africa [corrected] [published erratum appears in Alcoholism 2001 Aug;25(8):1187]. Alcohol Clin Exp Res 2001;25:557–62 6p.
12. Roebuck-Spencer TM, Mattson SN, Marion SD, Brown WS, Riley EP. Bimanual coordination in alcohol-exposed children: Role of the corpus callosum. J Int Neuropsychol Soc 2004;10:536–48.
13. Abel EL. Cerebral palsy and alcohol consumption during pregnancy: Is there a connection? Alcohol Alcohol 2010;45:592–4. doi: 10.1093/alcalc/agq063.
14. Kalberg WO, Provost B, Tollison SJ, et al. Comparison of motor delays in young children with fetal alcohol syndrome to those with prenatal alcohol exposure and with no prenatal alcohol exposure. Alcohol Clin Exp Res 2006;30:2037.
15. Bookstein FL, Streissguth AP, Sampson PD, Connor PD, Barr HM. Corpus callosum shape and neuropsychological deficits in adult males with heavy fetal alcohol exposure. Neuroimage 2002;15:233–51.
16. Doney R, Lucas BR, Jones T, et al. Fine motor skills in children with prenatal alcohol exposure or fetal alcohol spectrum disorder. J Dev Behav Pediatr. 2014;35:598–609. doi: 10.1097/DBP.0000000000000107.
17. Lucas BR, Latimer J, Pinto RZ, et al. Gross motor deficits in children prenatally exposed to alcohol: a meta-analysis. Pediatrics 2014;134:192–209. doi: 10.1542/peds.2013-3733.
18. Golding J, Emmett P, Iles-Caven Y, Steer C, Lingam R. A review of environmental contributions to childhood motor skills. J Child Neurol 2014;29:1531–47. doi: 10.1177/0883073813507483.
19. Cousins M, Smyth MM. Developmental coordination impairments in adulthood. Hum Mov Sci 2003;22:433–59.
20. Kirby A, Edwards L, Sugden D. Emerging adulthood in developmental coordination disorder: Parent and young adult perspectives. Res Dev Disabil 2011;32:1351-60. doi: 10.1016/j.ridd.2011.01.041.
21. Hands B, Licari M, Piek J. A review of five tests to identify motor coordination difficulties in young adults. Res Dev Disabil 2015;41–42:40-51. doi: 10.1016/j.ridd.2015.05.009.
22. Skinner RA, Piek JP. Psychosocial implications of poor motor coordination in children and adolescents. Hum Mov Sci 2001;20:73–94.
23. Eggleston M, Hanger N, Frampton C, Watkins W. Coordination difficulties and self-esteem: A review and findings from a New Zealand survey. Aust Occup Ther J 2012;59:456-62. doi: 10.1111/1440-1630.12007.
24. Foundation for Alcohol Research and Education. National FASD Clinic and Clinical Network Plan. 2015. Available at:
25. Adam K, Peters S, Chipchase L. Knowledge, skills and professional behaviours required by occupational therapist and physiotherapist beginning practitioners in work-related practice: A systematic review. Aust Occup Ther J 2013;60:76–84. doi: 10.1111/1440-1630.12006.
26. National Health and Medical Research Council. NHMRC Levels of Evidence and Grades for Recommendations for Developers of Guidelines. 2009. Available at:
27. Law M, Stewart D, Pollock N, Letts L, Bosch J, Westmorland M. Critical Review Form – Quantitative Studies: McMaster University; 1998. Available at: review.pdf.
28. Eagers J, Franklin R, Broome K, Yau M. A review of occupational therapy’s contribution to and involvement in the work-to-retirement transition process: An Australian perspective. Aust Occup Ther J 2016;63:277–92. doi: 10.1111/1440-1630.1230.
29. Vaurio L, Riley E, Mattson S. Neuropsychological Comparison of Children with Heavy Prenatal Alcohol Exposure and an IQ-Matched Comparison Group. J Int Neuropsychol Soc 2011;17:463–73. doi: 10.1017/S1355617711000063.
30. Streissguth A. Offspring Effects of prenatal alcohol exposure from birth to 25 years: The Seattle Prospective
Longitudinal Study. J Clin Psychol Med Settings 2007;14:81–101. doi: 10.1007/s10880-007-9067-6.
31. Connor P, Sampson P, Streissguth A, Bookstein F, Barr H. Effects of prenatal alcohol exposure on fine motor coordination and balance: A study of two adult samples. Neuropsychologia 2006;44:744–51.
32. Tamana S, Pei J, Massey D, Massey V, Rasmussen C. Neuropsychological impairments and age-related differences in children and adolescents with fetal alcohol spectrum disorders. J Popul Ther Clin Pharmacol 2014;2:e167–e80.
33. Beery K, Beery N. The Beery-Buktenica Development Test of Visual-Motor Integration: administration, scoring and teaching manual. 6th ed. Minneapolis, MN: Pearson; 2010.
34. Matthews CG, Klove H. Instruction Manual for the Adult Neuropsychological Test Battery. Madison, WI.: University Wisconsin Medical School; 1964.
35. Parham L, Ecker C, Miller Kuhanek H, Glennon T. Sensory Processing Measure Manual. Los Angeles: Western Psychological Services; 2007.
36. Henderson A, Sugden D, Barnett A. Movement Assessment Battery for Children (Movement ABC-2). 2nd ed. London, UK.: The Psychological Corporation; 2007.
37. Shumway-Cook A, Woollacott M. Motor Control: Translating Research into Clinical Practice. 3 ed. Philadelphia: Lippincott, Williams, & Watkins; 2007.
38. Mattson SN, Riley EP, Gramling L, Delis DC, Jones KL. Neuropsychological comparison of alcohol-exposed children with or without physical features of fetal alcohol syndrome. Neuropsychology 1998;12:146–53.
39. Connor PD, Sampson PD, Streissguth AP, Bookstein FL, Barr HM. Effects of prenatal alcohol exposure on fine motor coordination and balance: A study of two adult samples. Neuropsychologia 2006;44:744–51.
40. Aragon AS, Kalberg WO, Buckley D, Barela-Scott LM, Tabachnick BG, May PA. Neuropsychological study of FASD in a sample of American Indian children: processing simple versus complex information. Alcohol Clin Exp Res 2008;32:2136–48. doi: 10.1111/j.1530-0277.2008.00802.x.
41. Jirikowic T, McCoy S, Lubetzky-Vilnai A, et al. Sensory control of balance: A comparison of children with fetal alcohol spectrum disorders to children with typical development. J Popul Ther Clin Pharmacol 2013;20:e212–e28.
42. Benz J, Rasmussen C, Andrew G. Diagnosing fetal alcohol spectrum disorder: History, challenges and future directions. Paediatr Child Health 2009;14:231–7.
43. Rasmussen C, Bisanz J. executive functioning in children with fetal alcohol spectrum disorders: profiles and age-related differences. Child Neuropsychol 2009;15:201–15. doi: 10.1080/09297040802385400.
44. Simmons RW, Thomas JD, Levy SS, Riley EP. Motor response programming and movement time in children with heavy prenatal alcohol exposure. Alcohol 2010;44:371–8. doi: 10.1016/j.alcohol.2010.02.013.
45. Klintsova AY, Matthews JT, Goodlett CR, Napper RM, Greenough WT. Therapeutic motor training increases parallel fiber synapse number per Purkinje neuron in cerebellar cortex of rats given postnatal binge alcohol exposure: preliminary report. Alcohol Clin Exp Res 1997;21:1257–63.
46. Klintsova AY, Goodlett CR, Greenough WT. Therapeutic motor training ameliorates cerebellar effects of postnatal binge alcohol. Neurotoxicol Teratol 2000;22:125–32.
47. Simmons RW, Levy SS, Riley EP, Madra NM, Mattson SN. Central and peripheral timing variability in children with heavy prenatal alcohol exposure. Alcohol Clin Exp Res 2009;33:400–7. doi: 10.1111/j.1530-0277.2008.00849.x.