Of the 1,334 special education students in Great Falls schools, only eight have been diagnosed with fetal alcohol syndrome.

Gail Cleveland, who's in charge of the school district special education program, suspects that fetal alcohol syndrome too frequently goes undiagnosed.

"It requires mothers to admit that they've been drinking during pregnancy," she said. "So they deny it, and the physicians don't press the issue."

"Many physicians don't want to stigmatize these children by labeling them," agreed Carole Kenner, professor of nursing at the University of Cincinnati, "and others do not want to anger affluent clients whose alcohol consumption is considered legal and socially acceptable."

While there are many causes of attention deficit disorder, some doctors believe that fetal alcohol children are among those diagnosed with ADD.

"If you look at FAS behavior — hyperactivity, impulsivity, poor judgment and inability to learn from past experience — it's the same criteria for diagnosing ADD," said Dr. Robin LaDue, a clinical psychologist in Seattle who works with the fetal alcohol syndrome unit at the University of Washington.

"A lot of us feel that ADD is greatly over-diagnosed," added LaDue.

One major difference, she noted, is that fetal alcohol syndrome requires a doctor to prove, or a mother to admit, alcohol use during pregnancy, whereas ADD focuses solely on the symptoms.

Doctor say ADD can stem from causes other than prenatal exposure to alcohol.

Cathy McCann, genetics counselor with Shodair Hospital in Helena, said ADD can be connected to a number of factors.

"ADD can run in the family, but it also can have an environmental component," McCann said. "It can occur independently or it can occur in conjunction with alcohol."

Dr. Robert Hackford, a behavioral pediatrician at the Great Falls Clinic who deals frequently with ADD children, said it's tough to diagnose the effects of fetal alcohol exposure.

"On a rare occasion, I might make that diagnosis," he said, "but my main approach is to try to identify the problems relating to treatment.

"If a child has signs of attention deficit disorder, the child should be treated," he added, "and I would do that whether there was a diagnosis of FAS or not."

In Great Falls schools, there is no specific category for ADD children. Instead there are three categories — emotionally disturbed, learning disabled, and other health impaired — into which ADD students may be categorized.

In the past nine years, the number of children in those categories has increased by 42 percent — from 513 in 1989-90 to 727 in 1997-98. Classroom teachers currently provide medication, generally Ritalin, to 577 students, said Cleveland.