Project Summary Accurate diagnosis and early identification of infants or children with Fetal Alcohol Spectrum Disorders (FASD) is essential to initiating early intervention leading to improved outcomes for affected children. However, children with FASD are most often not diagnosed until many years after birth. As a result, many years of appropriate and beneficial intervention or treatment are missed. Given the high prevalence of FASD in areas of the world where the disorder has been studied, earlier and more accurate recognition of children with FASD is of high public health importance. Building on the existing Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) longitudinal cohort study in Ukraine, we aim to fill this critical gap in knowledge in two ways. First, we will develop a panel of three prenatal/early infancy biomarkers that can predict FASD. These biomarkers include maternal and infant microRNA expression profile, maternal and infant cytokine expression profile, and an early infancy measure of neurobehavioral performance. Second, we will develop risk/resilience prediction models based on the developmental trajectories of children enrolled in the cohort. These models will identify the characteristics of a prenatally exposed infant/child at a given age that are predictive of the child's later growth and performance. This work will support earlier identification of affected children and can help to determine appropriate early allocation of resources for intervention and treatment to those children most likely to benefit. Furthermore, our findings may suggest novel approaches to biological and environmental targets for treatment and intervention. We will also work collaboratively with other investigators in the CIFASD Consortium to interactively address the overall goals of the Consortium in improving diagnosis and treatment of FASD.