Since the first publication on fetal alcohol syndrome appeared in the scientific literature over 30 years ago, there has been a great deal of research interest in the topic. This paper reviews findings within the past 10 years related to causes, frequency, and diagnosis of alcohol-related disabilities, before turning to the impact these disabilities have on affected children, their families and communities. The needs of parents who have children with alcohol-related disabilities are described, including a broad support network, helpful professionals, good relationship with the school, income support, and a strengths-based parenting approach. Finally, barriers that families face in service availability, accessibility, appropriateness, adequacy, and acceptability are reviewed.