The term fetal alcohol syndrome (FAS) was coined in 1973 to describe children with characteristic facial features, growth disorder and developmental delay associated with prenatal alcohol exposure. Yet, it was not until almost 20 years later that Australian researchers published on the public health significance of the range of conditions by then collectively termed fetal alcohol spectrum disorders (FASD). Similarly, the response to FASD within the government and various sectors of Australian society has been variable. Barriers in addressing FASD in the Australian context include a heavy drinking culture and large populations living in regional or remote communities and addressing FASD in high-risk populations such as juveniles in detention, some Aboriginal communities and “fly in-fly out” mining communities. Early Australian research was epidemiological, documenting notifications of FAS to birth defect registries and pediatric surveillance systems. The past decade has seen a rapid growth in Australian research into the full spectrum of FASD. Australian FASD diagnostic guidelines have recently been developed, a national FASD Action Plan has been endorsed, national and population-based data on FASD prevalence has been reported and large FASD intervention and prevention studies are underway within a National Centers of Research Excellence framework. In recent years, there has been a greater focus on neuropsychological aspects of FASD in diagnosis and intervention, with pediatric neuropsychologists playing a key role. A multidisciplinary model in the implementation of FASD prevention, diagnosis and therapy approaches is considered best practice. A key challenge for Australian clinicians, policy makers and researchers is to collaborate on a coordinated, national response to FASD that is data-driven and aligned with international guidelines and study protocols.