Abstract
BackgroundChildren with Fetal Alcohol Spectrum Disorders (FASD) may have significant neurobehavioural problems persisting into adulthood. Early diagnosis may decrease the risk of adverse life outcomes. However, little is known about effective interventions for children with FASD. Our aim is to conduct a systematic review of the literature to identify and evaluate the evidence for pharmacological and non-pharmacological interventions for children with FASD.MethodsWe did an electronic search of the Cochrane Library, MEDLINE, EMBASE, PsychINFO, CINAHL and ERIC for clinical studies (Randomized controlled trials (RCT), quasi RCT, controlled trials and pre- and post-intervention studies) which evaluated pharmacological, behavioural, speech therapy, occupational therapy, physiotherapy, psychosocial and educational interventions and early intervention programs. Participants were aged under 18 years with a diagnosis of a FASD. Selection of studies for inclusion and assessment of study quality was undertaken independently by two reviewers. Meta-analysis was not possible due to diversity in the interventions and outcome measures.ResultsTwelve studies met the inclusion criteria. Methodological weaknesses were common, including small sample sizes; inadequate study design and short term follow up. Pharmacological interventions, evaluated in two studies (both RCT) showed some benefit from stimulant medications. Educational and learning strategies (three RCT) were evaluated in seven studies. There was some evidence to suggest that virtual reality training, cognitive control therapy, language and literacy therapy, mathematics intervention and rehearsal training for memory may be beneficial strategies. Three studies evaluating social communication and behavioural strategies (two RCT) suggested that social skills training may improve social skills and behaviour at home and Attention Process Training may improve attention.ConclusionThere is limited good quality evidence for specific interventions for managing FASD, however seven randomized controlled trials that address specific functional deficits of children with FASD are underway or recently completed.
Highlights
Children with Fetal Alcohol Spectrum Disorders (FASD) may have significant neurobehavioural problems persisting into adulthood
Children exposed to alcohol in utero may have significant neurobehavioural problems persisting into adulthood [1] and/or develop one of the Fetal Alcohol Spectrum Disorders [2,3]
After exclusion of ineligible studies, only twelve studies fulfilled our inclusion criteria
Summary
Children with Fetal Alcohol Spectrum Disorders (FASD) may have significant neurobehavioural problems persisting into adulthood. Children exposed to alcohol in utero may have significant neurobehavioural problems persisting into adulthood [1] and/or develop one of the Fetal Alcohol Spectrum Disorders [2,3] This spectrum includes: FAS, the most severe outcome of alcohol exposure in utero; Partial FAS; and Alcohol Related Neurodevelopmental Disorder (ARND), the diagnosis of which requires confirmation of maternal alcohol exposure and neurodevelopmental problems not otherwise explained. Included are Alcohol Related Birth Defects (ARBD), the diagnosis of which require confirmation of maternal alcohol exposure and specific birth defects attributable to alcohol.[3] The term Fetal Alcohol Effects (FAE) was previously used to describe children with some, but not all of the features of FAS.[4] Adverse life outcomes for individuals with FAS or FAE include inappropriate sexual behaviours, disrupted school education, trouble with the law, confinement, and mental health, alcohol and drug problems.[5]
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