This longitudinal prospective study will evaluate adverse outcomes in a 25-year follow-upof a birth cohort of approximately 500. These young adults were prenatally exposed to known levels and patterns of alcohol, according to maternal report during pregnancy in 1974-75. Data from 10previous examinations (day one to 21 years) will be examined as potential covariates and mediators. The basic hypothesis for this long-term teratogenic study is that prenatal alcohol exposure exerts an enduring dose-dependent influence on offspring health and development across the life span. Specific Aims for this 5-year proposal: 1. To analyze prenatal alcohol effects using data collected from 450 21-year olds given a 5-hour laboratory examination to measure memory, executive function, information processing, physical size, facial features, and alcohol/drug use and abuse. 2. To conduct pilot studies and a 25-year examination of these same subjects, focusing on neuromotor function, attention, mental illness, and life problems including alcohol dependence. To analyze these data in terms of prenatal alcohol effects and relevant lifespan covariates and mediatingfactors. 3. To identify specific patterns of deficit that might serve as markers for individuals with Alcohol-Related Neurodevelopmental Disorder (ARND) as defined in the recent Institute of Medicine (IOM) report on FAS. In such individuals,long term outcomes and life events modifying such outcomes will beinvestigated. These proposed studies have far-reaching public health implications. Alcohol remains the teratogenic drug most frequently ingested during pregnancy. New studies indicate that the birth rate of FAS and ARND combined is nearly 1 per 100 births. As it stands now, alcohol-affected infants, children and adults are often denied services when they lack the characteristic FAS face. It is essential that the long term adult consequences of these birth defects be understood and that markers of clinically affected individuals be identified to support appropriate diagnosis and intervention.