The Overlooked Epidemic: Why Prenatal Alcohol Exposure Belongs in America’s National Health Strategy
America has a name, a budget, and a coordinated federal strategy for the opioid crisis. It does not have any of the three for prenatal alcohol exposure (PAE) — even though PAE and the fetal alcohol spectrum disorders (FASD) it causes are more common than autism, more costly than most chronic diseases addressed in the MAHA Report, and, unlike almost every other driver of childhood mental illness, entirely preventable. This is our response to the Make Our Children Healthy Again strategy, submitted to Secretary Robert F. Kennedy Jr. and built on the case laid out in our full report, An Overlooked Epidemic: A Brief Concerning Prenatal Alcohol Exposure.
What the MAHA Report Says About Alcohol — and What It Leaves Out
The MAHA Report and the Make Our Children Healthy Again strategy deserve credit at least for naming alcohol. The strategy directs the Surgeon General to “launch an education and awareness initiative on the impact of alcohol, controlled substances, vaping, and THC on children’s health,” and calls for expanded behavioral health access, reduced stigma, and integration of mental health care into the broader healthcare system.
“The Surgeon General will launch an education and awareness initiative on the impact of alcohol, controlled substances, vaping, and THC on children’s health.”
Make Our Children Healthy Again Strategy, 2025Those are worthwhile commitments. But read closely, and a specific, foreseeable, and preventable harm is missing entirely: not one sentence in the report names prenatal alcohol exposure, fetal alcohol spectrum disorders, or the fact that alcohol’s most severe and lifelong harm to children happens before birth, not after.
Mentions of PAE or FASD in the MAHA Report Despite alcohol being named four times as a children’s health priority.
That is not a minor gap. PAE is the leading known cause of preventable developmental disability in the United States, and it has been documented in the medical literature since 1973 — more than fifty years. A national strategy that addresses youth alcohol use but never mentions alcohol-exposed pregnancy is treating the symptom while missing the root cause it claims to target.
The Scale No One Is Naming
The numbers are not marginal. They are hiding in plain sight inside data the federal government already collects.
funding streams No national surveillance system
No DSM-5-TR diagnostic code
No coordinated response
~ despite prevalence exceeding many conditions that have all three.
as a national crisis 1.8% of Americans affected DSM-5-TR diagnosis assigned
~$1.5B/year in dedicated SOR/TOR grants
~$9B authorized under the 2018 SUPPORT Act
up to 7.1% of children Never formally recognized in national policy.
No DSM-5 diagnosis
$0 dedicated federal funding stream
$0 comparable national investment, ever
Prenatal alcohol exposure is more than 8 times as prevalent as opioid use disorder, and FASD in school-age children runs up to roughly 4 times greater — yet PAE/FASD has never received a comparable federal response, in dollars or in name.
The Hidden Tax of FASD
The Most Expensive Policy Is Pretending There Isn't One
When PAE/FASD goes unrecognized, taxpayers finance the consequences for a lifetime.
Without a coordinated federal strategy, the costs of prenatal alcohol exposure don't disappear—they accumulate. Special education, behavioral healthcare, foster care, disability services, corrections, housing assistance, and Medicaid all absorb costs that could be reduced through prevention and earlier intervention. We're already paying. We're just paying at the most expensive point possible.
The prevention math is not close. Screening a pregnancy for alcohol exposure and connecting a mother to support costs a fraction of one year of special education services for a misdiagnosed child, let alone a lifetime of care, corrections, and lost productivity. Every dollar spent naming, screening for, and preventing PAE is a dollar that does not have to be spent for the next fifty years managing its consequences.
A national mental health and chronic disease strategy that fails to name its single largest preventable driver of costs is not fiscally responsible. It is a deferred bill — and taxpayers are already paying the interest.
Sources for this section: CDC/Thomas et al., “Alcohol Consumption During Pregnancy Among Women Aged 18–49 Years — United States, 2021–2024,” MMWR 75(22), June 11, 2026; CDC ADDM Network, MMWR, 2025; May PA et al., Drug Alcohol Depend, 2021; Greenmyer et al., J Addict Med, 2018; Lupton, Burd & Harwood, Am J Med Genet C Semin Med Genet, 2004; Popova et al., Can J Public Health, 2011; SAMHSA/HHS SOR/TOR appropriations FY2024–FY2025.
One Root Cause, Five National Crises
PAE/FASD is not a niche issue. It is a hidden thread running through five priorities MAHA already claims to care about, but the strategy just hasn’t connected the dots.
Mental Health & Chronic Disease
Individuals with FASD face dramatically elevated rates of anxiety (nearly 40%), mood disorders (46%), and suicidality (over 25%). Standard treatments like CBT routinely fail because they assume memory and executive-functioning capacities that FASD impairs, driving a cycle of misdiagnosis and treatment failure that MAHA’s behavioral health investments cannot fix without naming the underlying cause.
Criminal Justice
Youth with FASD are up to 19 times more likely to be incarcerated, not because of criminality, but because of brain-based differences in cause-and-effect reasoning that courts and corrections systems aren’t trained to recognize. Diversion and reentry investments will continue to fail this population until screening is built in.
Education
FASD is likely the most common neurodevelopmental condition in American classrooms and the most overlooked. Without recognition, affected students are mislabeled, suspended, and excluded, and school systems spend heavily on interventions that were never designed for how their brains work.
Society & Community Stability
FASD drives outsized involvement in foster care, homelessness, and exploitation and strains the very equity and community-resilience initiatives MAHA champions because none of those initiatives account for undiagnosed brain-based disability.
Careers & Workforce
Up to 80% of adults with FASD experience chronic unemployment despite wanting to work, turning what could be workforce contribution into long-term dependence on public assistance.
Naming PAE/FASD does not require five new programs. It requires one: recognition, woven into the programs MAHA has already proposed.
What We’re Asking For
The fix is not expensive, and it is not new infrastructure. It is recognition, redirected toward existing systems.
Formally name PAE and FASD in the MAHA Report and the Make Our Children Healthy Again strategy as recognized drivers of mental health and chronic disease outcomes.
Expand the Surgeon General’s alcohol-awareness initiative, already announced in MAHA, to explicitly include prenatal alcohol exposure prevention messaging, not just general youth alcohol harms.
Establish a dedicated federal funding stream for PAE prevention, FASD diagnosis, and family support that is proportionate to prevalence, the way SOR/TOR grants exist for opioid use disorder.
Require validated alcohol-screening tools in routine prenatal and pediatric care, consistent with existing ACOG recommendations, tied to provider training and reimbursement.
Fund FASD-informed training for educators, pediatric providers, criminal justice professionals, and workforce development programs so that brain-based differences are no longer mistaken for defiance.
Support standardized diagnostic and billing infrastructure for FASD so the true cost and the savings from prevention can finally be tracked and measured.
This is a solvable problem. The evidence exists. The systems already exist. What’s missing is the name.
Read the Full Brief
This page summarizes the case made in full in our report, An Overlooked Epidemic: A Brief Concerning Prenatal Alcohol Exposure, prepared by Joel Sheagren and Carl Young of Embracing Neurodiversity, LLC, and mailed to Secretary Robert F. Kennedy Jr. The brief includes detailed sourcing across mental health, criminal justice, education, community stability, and workforce outcomes, plus a documented list of 428 medical, neurological, and behavioral conditions associated with PAE/FASD.
Behind every statistic in this brief is a child misdiagnosed, a parent blamed, a teenager in a courtroom that doesn’t understand him, or a young adult who wants to work but can’t hold a job — not from unwillingness, but from a brain shaped before birth by something entirely preventable. A credible national mental health and chronic disease strategy cannot leave this out. Join us in asking that it doesn’t.
About Embracing Neurodiversity
This report is prepared by Joel Sheagren and Carl Young of Embracing Neurodiversity, LLC — two fathers turning lived experience raising children with FASD, autism, ADHD, and trauma into a movement for systemic change. Their work includes the caregiver book Embracing Hope, the novel Embracing Zak, and the broader Embraced Movement spanning film, technology, and advocacy training.
Sources Used Across This Page
- CDC/Thomas SA, Gosdin LK, Terplan M, Kim SY, Deputy NP. “Alcohol Consumption During Pregnancy Among Women Aged 18–49 Years — United States, 2021–2024.” MMWR 2026;75(22):280–284.
- CDC ADDM Network. “Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years.” MMWR, 2025.
- May PA, et al. “Estimating the community prevalence, child traits, and maternal risk factors of fetal alcohol spectrum disorders (FASD) from a random sample of school children.” Drug Alcohol Depend, 2021.
- Greenmyer JR, Klug MG, Kambeitz C, Popova S, Burd L. “A Multicountry Updated Assessment of the Economic Impact of Fetal Alcohol Spectrum Disorder.” J Addict Med, 2018.
- Lupton C, Burd L, Harwood R. “Cost of fetal alcohol spectrum disorders.” Am J Med Genet C Semin Med Genet, 2004.
- Popova S, Lange S, Bekmuradov D, Mihic A, Rehm J. “Fetal alcohol spectrum disorder prevalence estimates in correctional systems: a systematic literature review.” Can J Public Health, 2011.
- SAMHSA / HHS, State Opioid Response (SOR) and Tribal Opioid Response (TOR) grant appropriations, FY2024–FY2025.
- Embracing Neurodiversity, LLC. An Overlooked Epidemic: A Brief Concerning Prenatal Alcohol Exposure. June 2026.
- The White House. MAHA Report / Make Our Children Healthy Again Strategy, 2025.
Note: The $400B national burden figure is a modeled extrapolation (per-person average cost × estimated prevalence), not a single government-published total — this is disclosed transparently in the page copy itself so the number is defensible under scrutiny. The $2M+ lifetime cost and multi-billion-dollar annual figure for FAS alone are the more conservative, CDC-cited numbers and are presented alongside it for credibility.
Practical Ways You Can Advocate
National policy changes when enough individual voices ask for the same thing at the same time. The MAHA strategy itself was shaped by public comment and advocacy — the same channels are open now to get PAE/FASD named in it.
Contact HHS Secretary Kennedy’s Office
Ask that PAE/FASD be formally recognized in the MAHA strategy and future national mental health and chronic disease reporting.
Contact HHS →Urge Your Members of Congress
Contact your U.S. Representative and Senators and ask them to support formal recognition and dedicated funding for PAE/FASD prevention, comparable to the opioid response.
Find Your Representatives →Share the Brief
Forward “An Overlooked Epidemic” to your pediatrician, your child’s school, your state legislator, or your local health department — the people positioned to act on it.
Get the Brief →Ask Your Provider
At your next prenatal or pediatric visit, ask whether a validated alcohol-screening tool is used, and request FASD-informed care if you or your child may be affected.
Amplify Online
Share this page and the brief with your network. Sample post copy is provided below so it’s a 30-second action, not a research project.
Join the Movement
Follow the Embraced Movement and Embracing Hope for ongoing advocacy opportunities, campaign updates, and ways to get involved beyond a single message.
EmbracedMovement.org →Sample Message You Can Copy and Send
To HHS or your member of Congress — edit freely before sending.
Subject: Include Prenatal Alcohol Exposure (PAE) and FASD in the MAHA Strategy
I’m writing to ask that the Make Our Children Healthy Again (MAHA) strategy formally recognize Prenatal Alcohol Exposure (PAE) and Fetal Alcohol Spectrum Disorders (FASD) as drivers of the mental health and chronic disease crisis it aims to solve.
PAE affects more than 1 in 7 U.S. pregnancies, and FASD is estimated to affect up to 1 in 20 U.S. children — a prevalence higher than autism — yet it has no dedicated federal funding stream, no DSM-5 diagnosis, and is not named anywhere in the MAHA Report.
I urge HHS to: name PAE/FASD in national mental health and chronic disease policy, direct the Surgeon General’s alcohol-awareness initiative to explicitly include prenatal alcohol exposure prevention, and establish funding for screening, diagnosis, and family support proportionate to its prevalence.
Thank you for considering this request.
[Your name]
[Your city, state]