Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders.
BACKGROUND
Children 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.


METHODS
We 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.


RESULTS
Twelve 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.


CONCLUSIONS
There 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.
Peadon
Elizabeth
E
Discipline of Paediatrics and Child Health, University of Sydney, Australia. elizabp5@chw.edu.au
Rhys-Jones
Biarta
B
Bower
Carol
C
Elliott
Elizabeth J
EJ
D020268:Alcohol-Induced Disorders, Nervous System / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D001521:Behavior Therapy / Q000706:statistics & numerical data; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003147:Communication Disorders / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy; D018479:Early Intervention, Educational / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000706:statistics & numerical data; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000188:drug therapy / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D007223:Infant; D007859:Learning Disabilities / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D009788:Occupational Therapy / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012944:Social Support; D013070:Speech Therapy / Q000706:statistics & numerical data
D014150:Antipsychotic Agents; D000697:Central Nervous System Stimulants; D008774:Methylphenidate