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Two expert FASD dysmorphologists, blind regarding prenatal alcohol exposure, independently evaluated each child\u2019s growth and dysmorphology at 4 clinics conducted over an 11\u2010year period. Case conferences were held to reach consensus regarding which children had FAS or PFAS growth and physical features using the Revised Institute of Medicine (2005) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of the physical phenotype was stable across the 4 ages for about half of the children with FAS and about one\u2010third of those with PFAS but more variable for the others. Test\u2013retest reliability was substantial for the FAS phenotype, but poorer for PFAS. Two distinct patterns were seen: a \u201cstrong phenotype\u201d that was consistently identified and a less consistent one in which dysmorphic features and\/or anthropometric deficits fluctuated or diminished with age. The physical phenotype was most apparent during early childhood and least apparent during puberty, due to differences in timing of the growth spurt and the evolving adult face. Short palpebral features and small head circumference diminished with age, flat philtrum fluctuated, while thin vermilion and weight and height restriction were stable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Key facial features that characterize FASD in early childhood diminish or evolve in some individuals, making diagnostic examinations that rely on these characteristics most sensitive during early childhood and school age. Moreover, puberty poses classification problems due to variability in timing of the growth spurt. Given that several features and small head circumference diminished with age, many individuals would be misdiagnosed if only examined at a later age.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.14534","type":"journal-article","created":{"date-parts":[[2020,12,19]],"date-time":"2020-12-19T20:33:54Z","timestamp":1608410034000},"page":"395-408","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Evolution of the Physical Phenotype of Fetal Alcohol Spectrum Disorders from Childhood through Adolescence"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9768-2671","authenticated-orcid":false,"given":"Sandra W.","family":"Jacobson","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurosciences Wayne State University School of Medicine Detroit MI USA"},{"name":"Department of Human Biology Faculty of Health Sciences University of Cape Town Cape Town South Africa"},{"name":"Department of Psychiatry and Mental Health Faculty of Health Sciences University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Eugene","family":"Hoyme","sequence":"additional","affiliation":[{"name":"Sanford Children\u2019s Genomic Medicine Consortium, Sanford Health Sioux Falls SD USA"},{"name":"Department of Pediatrics University of Arizona College of Medicine Tucson AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1554-6914","authenticated-orcid":false,"given":"R. Colin","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Pediatrics Institute of Human Nutrition Columbia University Irving Medical Center New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5666-3060","authenticated-orcid":false,"given":"Neil C.","family":"Dodge","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurosciences Wayne State University School of Medicine Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher D.","family":"Molteno","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health Faculty of Health Sciences University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesta M.","family":"Meintjes","sequence":"additional","affiliation":[{"name":"Department of Human Biology Faculty of Health 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