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Hilly C, Wilson PH, Lucas B, McGuckian TB, Swanton R, Froude EH. Effectiveness of interventions for school-aged-children and adolescents with fetal alcohol spectrum disorder: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:1708-1733. [PMID: 37158227 DOI: 10.1080/09638288.2023.2207043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To describe allied health and educational interventions and their effectiveness for children and adolescents with fetal alcohol spectrum disorder (FASD). To appraise the quality and strength of studies. METHODS Electronic databases were searched between 2005 and March 2022, identifying non-pharmacological studies supporting function, activity, or participation for FASD participants aged 5-18 years using any quantitative research design. Outcomes were coded using International Classification of Functioning, Disability and Health, family of Participation Related Constructs and behaviour categories. Multi-level random-effects meta-analysis examined intervention effects. Study methodological quality was evaluated using Cochrane risk of bias tools, RoBiNT, AMSTAR 2 and NHMRC Hierarchy levels of evidence. Certainty of findings were synthesised using GRADE approach. RESULTS The systematic review included 25 studies with 735 participants, 10 of which were analysed by meta-analysis. Body function and structure, activity, behaviour, and sense of self outcomes were pooled. A small, positive effect favouring interventions was found (g = 0.29, 95% CI = 0.15-0.43), however the GRADE certainty was rated as low. No participation outcomes were identified. CONCLUSIONS Some interventions targeting body function and structure, activity and behaviour outcomes were effective. Evidence of interventions that support children's and adolescent's participation as an outcome is lacking.
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Affiliation(s)
- Catherine Hilly
- School of Allied Health, Australian Catholic University, Canberra, Australia
| | - Peter H Wilson
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Barbara Lucas
- The John Walsh Centre for Rehabilitation Research, The University of Sydney
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Ruth Swanton
- Occupational Therapy Department, Mercy University Hospital, Cork, Ireland
- Occupational Therapy Department, South Infirmary University Hospital, Cork, Ireland
| | - Elspeth H Froude
- School of Allied Health, Australian Catholic University, Sydney, Australia
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Kuschick D, Kuck J, Pachanov A, Geene R. Health promotion for families with parental alcohol addiction: a systematic review. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Abstract
Aim
Alcohol-related illnesses represent a major burden and challenge to families and pose health risks for all involved. Therefore, health promotion attempts need to focus on these vulnerable families and identify effective interventions. A systematic review was conducted of approaches to health promotion and prevention and their effectiveness for families with addiction concerns. The review focused on parental alcohol dependency.
Subject and methods
A systematic search of relevant databases was conducted, followed by a multistep screening process and a narrative synthesis of results.
Results
A total of 20 studies were included that evaluated 14 intervention programmes. The main target group was children with any form of fetal alcohol spectrum disorders and their caregivers. The study sample was dominated by behavioural approaches. The evidence base was heterogeneous. There was limited evidence of the effectiveness of combined counselling and coaching interventions that aimed to strengthen psychosocial resources.
Conclusion
The robustness of the results is limited by the moderate methodological quality of the studies. Because of the search strategy, which focused on studies with outcomes for parents with alcohol dependence, and the systematic review methodology, almost all studies reviewed featured behavioural prevention interventions. Very few studies provided specific information on the effectiveness of interventions for alcohol-dependent parents with a focus on environmental changes. The selected approach provided a limited mapping of the field of interest. However, these review findings provide the foundation for an evidence-based approach to health promotion for families with parental alcohol dependence.
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Kautz-Turnbull C, Rockhold M, Handley ED, Olson HC, Petrenko C. Adverse childhood experiences in children with fetal alcohol spectrum disorders and their effects on behavior. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:577-588. [PMID: 36811189 PMCID: PMC10050124 DOI: 10.1111/acer.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorders (FASD) have high rates of adverse childhood experiences (ACEs). ACEs are associated with a wide range of health outcomes including difficulty with behavior regulation, an important intervention target. However, the effect of ACEs on different areas of behavior has not been well characterized in children with disabilities. This study describes ACEs in children with FASD and how they impact behavior problems. METHODS A convenience sample of 87 caregivers of children (aged 3 to 12) with FASD participating in an intervention study reported on their children's ACEs using the ACEs Questionnaire and behavior problems on the Eyberg Child Behavior Inventory (ECBI). A theorized three-factor structure of the ECBI (Oppositional Behavior, Attention Problems, and Conduct Problems) was investigated. Data were analyzed using Pearson correlations and linear regression. RESULTS On average, caregivers endorsed 3.10 (SD = 2.99) ACEs experienced by their children. The two most frequently endorsed ACE risk factors were having lived with a household member with a mental health disorder, followed by having lived with a household member with a substance use disorder. Higher total ACEs score significantly predicted a greater overall frequency of child behavior (intensity scale), but not whether the caregiver perceived the behavior to be a problem (problem scale) on the ECBI. No other variable significantly predicted the frequency of children's disruptive behavior. Exploratory regressions indicated that a higher ACEs score significantly predicted greater Conduct Problems. Total ACEs score was not associated with Attention Problems or Oppositional Behavior. DISCUSSION Children with FASD are at risk for ACEs, and those with higher ACEs had a greater frequency of problem behavior on the ECBI, especially conduct problems. Findings emphasize the need for trauma-informed clinical care for children with FASD and increased accessibility of care. Future research should examine potential mechanisms that underlie the relationship between ACEs and behavior problems to optimally inform interventions.
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Affiliation(s)
- Carson Kautz-Turnbull
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Madeline Rockhold
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Elizabeth D Handley
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Heather Carmichael Olson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christie Petrenko
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
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Popova S, Charness ME, Burd L, Crawford A, Hoyme HE, Mukherjee RAS, Riley EP, Elliott EJ. Fetal alcohol spectrum disorders. Nat Rev Dis Primers 2023; 9:11. [PMID: 36823161 DOI: 10.1038/s41572-023-00420-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Alcohol readily crosses the placenta and may disrupt fetal development. Harm from prenatal alcohol exposure (PAE) is determined by the dose, pattern, timing and duration of exposure, fetal and maternal genetics, maternal nutrition, concurrent substance use, and epigenetic responses. A safe dose of alcohol use during pregnancy has not been established. PAE can cause fetal alcohol spectrum disorders (FASD), which are characterized by neurodevelopmental impairment with or without facial dysmorphology, congenital anomalies and poor growth. FASD are a leading preventable cause of birth defects and developmental disability. The prevalence of FASD in 76 countries is >1% and is high in individuals living in out-of-home care or engaged in justice and mental health systems. The social and economic effects of FASD are profound, but the diagnosis is often missed or delayed and receives little public recognition. Future research should be informed by people living with FASD and be guided by cultural context, seek consensus on diagnostic criteria and evidence-based treatments, and describe the pathophysiology and lifelong effects of FASD. Imperatives include reducing stigma, equitable access to services, improved quality of life for people with FASD and FASD prevention in future generations.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
| | - Michael E Charness
- VA Boston Healthcare System, West Roxbury, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Larry Burd
- North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Pediatric Therapy Services, Altru Health System, Grand Forks, ND, USA
| | - Andi Crawford
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, and University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Raja A S Mukherjee
- National UK FASD Clinic, Surrey and Borders Partnership NHS Foundation Trust, Redhill, Surrey, UK
| | - Edward P Riley
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,New South Wales FASD Assessment Service, CICADA Centre for Care and Intervention for Children and Adolescents affected by Drugs and Alcohol, Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
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5
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Betts JL, Eggins E, Chandler‐Mather N, Shelton D, Till H, Harnett P, Dawe S. Interventions for improving executive functions in children with foetal alcohol spectrum disorder (FASD): A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1258. [PMID: 36908848 PMCID: PMC9634003 DOI: 10.1002/cl2.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The consequences for children born with birth defects and developmental disabilities encompassed by foetal alcohol spectrum disorder (FASD) are profound, affecting all areas of social, behavioural and cognitive functioning. Given the strong evidence for a core deficit in executive functioning, underpinned by impaired self-regulation skills, there has been a growing focus on the development of interventions that enhance or support the development of executive functions (EFs). Objectives The primary objective of this review is to synthesise the evidence for structured psychological interventions that explicitly aim to improve EF in children. The review also sought to ascertain if the effectiveness of interventions were influenced by characteristics of the intervention, participants or type of EF targeted by the intervention. Search Methods Sixteen databases, 18 grey literature search locations and 9 trial registries were systematically searched to locate eligible studies (up to December 2020). These searches were supplemented with reference harvesting, forward citation searching, hand searches of topic-relevant journals and contact with experts. Selection Criteria Studies were included in the review if they reported on an impact evaluation of a psychological intervention aiming to improve EF in children 3-16 years who either had confirmed prenatal alcohol exposure or a formal diagnosis falling under the umbrella term of FASDs. Eligible study designs included randomised controlled trials (RCTs) and quasi-experimental designs with either no treatment, wait list control or an alternative treatment as a comparison condition. Single-group pre-post designs were also included. Data Collection and Analysis Standard methodological procedures expected by the Campbell Collaboration were used at all stages of this review. Standardised mean differences (SMDs) were used to estimate intervention effects, which were combined with random effects meta-analysis (data permitting). Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2) and Cochrane Risk of Bias in Non-Randomised Studies-Interventions tool (ROBINS-I). Main Results The systematic search identified 3820 unique records. After title/abstract and full-text screening, 11 eligible studies (reported in 21 eligible documents) were deemed eligible, with a combined 253 participants. Of the 11 studies, 6 were RCTs, 1 was a quasi-experiment and 4 were single-group pre-post intervention designs. All studies were rated as having an overall high or serious risk of bias, with some variation across domains for RCTs. For RCT and quasi-experimental studies, the overall effect of EF interventions on direct and indirect measures of EF generally favoured the experimental condition, but was not statistically significant. There was no difference between intervention and comparison groups on direct measures of auditory attention (k = 3; SMD = 0.06, 95% confidence interval [CI] = -1.06, 1.18), visual attention (k = 2; SMD = 0.90, 95% CI = -1.41, 3.21), cognitive flexibility (k = 2; SMD = 0.23, 95% CI = -0.40, 0.86), attentional inhibition (k = 2; SMD = 0.04, 95% CI = -0.58, 0.65), response inhibition (k = 3; SMD = 0.47, 95% CI = -0.04, 0.99), or verbal working memory (k = 1; d = 0.6827; 95% CI = -0.0196, 1.385). Significant heterogeneity was found across studies on measures of auditory attention and visual attention, but not for measures of cognitive flexibility, attentional inhibition or response inhibition. Available data prohibited further exploration of heterogeneity. There was no statistical difference between intervention and comparison groups on indirect measures of global executive functioning (k = 2; SMD = 0.21, 95% CI = -0.40, 0.82), behavioural regulation (k = 2; SMD = 0.18, 95% CI = -0.43, 0.79), or emotional control (k = 3; SMD = 0.01, 95% CI = -0.33, 0.36). Effect sizes were positive and not significant for meta-cognition (k = 1; SMD = 0.23, 95% CI = -0.72, 1.19), shifting (k = 2; SMD = 0.04, 95% CI = -0.35, 0.43), initiation (k = 1; SMD = 0.04, 95% CI = -0.40, 0.49), monitoring (k = 1; SMD = 0.25, 95% CI = -0.20, 0.70) and organisation of materials (k = 1; SMD = 0.25, 95% CI = -0.19, 0.70). Effect sizes were negative and not statistically different for effortful control (k = 1; SMD = -0.53, 95% CI = -1.50, 0.45), inhibition (k = 2; SMD = -0.08, 95% CI = -0.47, 0.31), working memory (k = 1; SMD = 0.00, 95% CI = -0.45, 0.44), and planning and organisation (k = 1; SMD = -0.10, 95% CI = -0.55, 0.34). No statistically significant heterogeneity was found for any of the syntheses of indirect measures of EF. Based on pre-post single-group designs, there was evidence for small to medium sized improvements in EF based on direct measures (cognitive flexibility, verbal working memory and visual working memory) and indirect measures (behavioural regulation, shifting, inhibition and meta-cognition). However, these results must be interpreted with caution due to high risk of bias. Authors' Conclusions This review found limited and uncertain evidence for the effectiveness of interventions for improving executive functioning in children with FASD across 8 direct and 13 indirect measures of EF. The findings are limited by the small number of high-quality studies that could be synthesised by meta-analysis and the very small sample sizes for the included studies.
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Affiliation(s)
- Joseph Lee Betts
- School of Applied PsychologyGriffith UniversityBrisbaneAustralia
| | - Elizabeth Eggins
- School of Applied PsychologyGriffith UniversityBrisbaneAustralia
| | | | - Doug Shelton
- Child Development ServiceGold Coast Hospital and Health ServiceSouthportAustralia
| | - Haydn Till
- Child Development Service, Gold Coast Hospital and Health ServiceSouthportAustralia
| | - Paul Harnett
- School of Criminology and Criminal JusticeGriffith UniversityMount GravattAustralia
| | - Sharon Dawe
- School of Applied PsychologyGriffith UniversityBrisbaneAustralia
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Mattson JT, Thorne JC, Kover ST. [Formula: see text]Parental interaction style, child engagement, and emerging executive function in fetal alcohol spectrum disorders (FASD). Child Neuropsychol 2022; 28:853-877. [PMID: 34978272 PMCID: PMC10686097 DOI: 10.1080/09297049.2021.2023122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
Children with fetal alcohol spectrum disorders (FASD) are known to experience cognitive and neurobehavioral difficulties, including in areas of executive function and social skills development. Interventions for these challenges have focused on a number of areas, including parent-based training. Despite the general consensus that specific parenting styles consistent with an "authoritative" - warm but firm - parenting approach may influence behavioral self-regulation, it is not known what specific parental interaction styles are associated with child engagement and emerging executive function in this population. The current study used an observation-based behavioral coding scheme during parent-child play interactions and associated parent report-based executive function measures in children with FASD. Here, we demonstrate that parental interaction styles with increased responsive/child-oriented behavior and parental affect are associated with higher levels of child play engagement, while parental interaction that has increased achievement-orientation is associated with higher levels of emerging executive function in children with FASD. These findings help inform future studies on behavioral targets in parent-based training programs and highlight the importance of considering certain parental interaction styles during parent-child play.
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Affiliation(s)
- Julia T. Mattson
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - John C. Thorne
- Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington
| | - Sara T. Kover
- Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington
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Brown J, Jonason A, Asp E, McGinn V, Carter MN, Spiller V, Jozan A. Fetal alcohol spectrum disorder and confabulation in psycholegal settings: A beginner's guide for criminal justice, forensic mental health, and legal interviewers. BEHAVIORAL SCIENCES & THE LAW 2022; 40:46-86. [PMID: 34689366 DOI: 10.1002/bsl.2540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over-representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety-provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre-existing impairment. This article serves as a beginner's guide for professionals working in criminal justice settings by (a) providing research-based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.
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Affiliation(s)
- Jerrod Brown
- Pathways Counseling Center, Inc., St. Paul, Minnesota, USA
- Concordia University, St. Paul, Minnesota, USA
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
| | - Alec Jonason
- Department of Psychology, Hamline University, St. Paul, Minnesota, USA
- Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, Minnesota, USA
| | - Erik Asp
- Department of Psychology, Hamline University, St. Paul, Minnesota, USA
- Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, Minnesota, USA
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Valerie McGinn
- The FASD Centre, Auckland, New Zealand
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Megan N Carter
- University of Washington, Seattle, Washington, USA
- Department of Social and Health Services, Special Commitment Center, Steilacoom, Washington, USA
| | | | - Amy Jozan
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
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8
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Reid N, Crawford A, Petrenko C, Kable J, Olson HC. A Family-Directed Approach for Supporting Individuals with Fetal Alcohol Spectrum Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-021-00241-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Kautz-Turnbull C, Petrenko CLM. A meta-analytic review of adaptive functioning in fetal alcohol spectrum disorders, and the effect of IQ, executive functioning, and age. Alcohol Clin Exp Res 2021; 45:2430-2447. [PMID: 34694016 DOI: 10.1111/acer.14728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Fetal alcohol spectrum disorders (FASD) are highly prevalent developmental disabilities associated with prenatal alcohol exposure. In addition to varied strengths and unique talents, people with FASD experience significant challenges, including in adaptive functioning. Adaptive functioning refers to skills related to everyday life such as communication, practical skills, and social skills. For the current review, we aimed to understand how adaptive functioning in FASD compares to that of alcohol nonexposed individuals and those with attention deficit-hyperactivity disorder (ADHD). Additionally, we investigated how this relationship may change based on IQ, executive functioning, and age. METHOD The current review was registered in the International Prospective Register of Systematic Reviews. Studies were eligible for inclusion if they measured adaptive functioning and included an FASD group and at least one eligible comparison group. Articles available in May 2021 in PubMed, PsycInfo, Scopus, and ProQuest Dissertations were searched. Publication bias was assessed using Egger's regression and three-level random effects models were computed for all domains of adaptive functioning. Possible moderation by IQ, executive functioning, and age were investigated when heterogeneity analyses were significant. A post hoc moderation analysis of recruitment method was also completed. RESULTS Thirty studies were included. Individuals with FASD had significantly lower adaptive functioning than other groups, with effect sizes ranging from 1.04 to 1.35 compared to alcohol nonexposed groups and from 0.30 to 0.43 compared to ADHD groups. No significant moderating effects were found for IQ or age; executive functioning significantly moderated communication skills in FASD compared to the alcohol nonexposed group. Recruitment method significantly affected this relationship, with larger effect sizes on average found for clinically identified samples than at-risk or population samples. CONCLUSIONS Individuals with FASD have impairments in adaptive functioning relative to alcohol nonexposed and ADHD groups, regardless of IQ, executive functioning, or age. Limitations of the review include small sample sizes in some comparisons and a limited age range.
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Ordenewitz LK, Weinmann T, Schlüter JA, Moder JE, Jung J, Kerber K, Greif-Kohistani N, Heinen F, Landgraf MN. Evidence-based interventions for children and adolescents with fetal alcohol spectrum disorders - A systematic review. Eur J Paediatr Neurol 2021; 33:50-60. [PMID: 34058625 DOI: 10.1016/j.ejpn.2021.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Brain function deficits cause strong negative impacts for the everyday lives of children and adolescents with fetal alcohol spectrum disorders (FASD). Therefore, evidence-based intervention programs that are specifically designed for patients with FASD are needed but still scarce. The aim of the presented article is a systematic literature review of evidence-based intervention strategies for children and adolescents with FASD. MATERIALS AND METHODS A comprehensive systematic literature search was conducted in several relevant databases to identify randomized-controlled intervention studies for children and adolescents with FASD. RESULTS We identified 25 randomized-controlled studies regarding interventions in FASD. Overall, evidence indicating that some therapeutic interventions are effective in children and adolescents with FASD was found. Even though evidence-based interventions rarely lead to improvements of performance into a "normal range", those measures can alleviate negative consequences of prenatal alcohol exposure and relieve daily burdens. CONCLUSION There are only a few randomized-controlled trials regarding therapy research for children and adolescents with FASD. Their results indicate that especially the combination of parent and child sessions present a promising approach for the treatment of FASD. Positive treatment effects of interventions seem to be domain specific, except for interventions regarding self-regulation or social interaction.
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Affiliation(s)
- Lisa K Ordenewitz
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Julia A Schlüter
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Judith E Moder
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Jessica Jung
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Katharina Kerber
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Naschla Greif-Kohistani
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.
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11
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Flannigan K, Coons-Harding KD, Anderson T, Wolfson L, Campbell A, Mela M, Pei J. A Systematic Review of Interventions to Improve Mental Health and Substance Use Outcomes for Individuals with Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder. Alcohol Clin Exp Res 2020; 44:2401-2430. [PMID: 33119894 PMCID: PMC7839542 DOI: 10.1111/acer.14490] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/18/2020] [Indexed: 12/25/2022]
Abstract
Individuals with fetal alcohol spectrum disorder (FASD) experience remarkably high rates of mental health and substance use challenges, beginning early in life and extending throughout adulthood. Proactive intervention can help to mitigate some of these negative experiences. Although the literature on FASD intervention is growing, there is currently a lack of consolidated evidence on interventions that may improve mental health and substance use outcomes in this population. Informed by a life course perspective, we undertook a systematic review of the literature to identify interventions that improve mental wellness through all developmental stages for people with prenatal alcohol exposure (PAE) and FASD. A total of 33 articles were identified, most of which were focused on building skills or strategies that underlie the well‐being of children with PAE and FASD and their families. Other interventions were geared toward supporting child and family wellness and responding to risk or reducing harm. There was a notable lack of interventions that directly targeted mental health and substance use challenges, and a major gap was also noted in terms of interventions for adolescents and adults. Combined, these studies provide preliminary and emerging evidence for a range of intervention approaches that may support positive outcomes for individuals with FASD across the life course.
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Affiliation(s)
- Katherine Flannigan
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Kelly D Coons-Harding
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Psychology Department, (KDC-H), Laurentian University, Sudbury, Ontario, Canada
| | - Tara Anderson
- (TA), Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Lindsay Wolfson
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,(LW), Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada
| | - Alanna Campbell
- (AC), Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Mansfield Mela
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Psychiatry, College of Medicine, (MM), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jacqueline Pei
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Educational Psychology, (JP), University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, (JP), University of Alberta, Edmonton, Alberta, Canada
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12
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Skorka K, McBryde C, Copley J, Meredith PJ, Reid N. Experiences of Children with Fetal Alcohol Spectrum Disorder and Their Families: A Critical Review. Alcohol Clin Exp Res 2020; 44:1175-1188. [PMID: 32282931 DOI: 10.1111/acer.14335] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/31/2020] [Indexed: 12/27/2022]
Abstract
Evidence suggests that children with fetal alcohol spectrum disorder (FASD) experience challenges across many areas of their daily lives and often require interprofessional supports. Recent studies have emphasized the need for an integrated system of care for children with FASD, incorporating medical, allied health, and education services, to facilitate open communication and support for the complex needs that many children experience. To develop such a system of care, it is important to first understand the impact of FASD on children's functioning during daily activities in different environmental contexts. A critical review of existing research was conducted using a critical interpretive synthesis approach. Results revealed that while many studies discussed impacts at the body functions and structures level of children with FASD, they often did not consider the activity, participation, and environmental factors also contributing to the daily functioning of this population. Several studies discussed caregiver experiences and challenges raising a child with FASD; however, no studies investigated the lived experiences relating to impacts across activities and environments from children's perspectives. In addition, the focus on deficits overshadowed investigation into the strengths of children with FASD, leaving a gap in the picture of their daily lives. Further research is required to determine the strengths that children with FASD demonstrate and the challenges impacting their daily functioning within different environmental contexts. Insights gleaned from such research would support intervention practices to become more holistic and interprofessional.
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Affiliation(s)
- Kelly Skorka
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Catherine McBryde
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jodie Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Pamela J Meredith
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
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Abstract
PURPOSE OF REVIEW Understanding the pathophysiologic, diagnostic, and treatment implications of the interface between mental disorder and the consequences of Prenatal Alcohol Exposure (PAE) is important for mental health professionals (MHP) seeking to provide the most effective care. This review was written to highlight the importance of identifying and intervening with regards to the unique mental health and medical needs of individual with PAE. RECENT FINDINGS Over the last year, research has identified differences in the diagnostic criteria for Neurodevelopmental Disorder Associated with PAE (ND-PAE)/Fetal Alcohol Spectrum Disorder (FASD) and called for standardization, given that diagnosis is the main route to appropriate support. Care will improve with advances in epigenetic, neuroimaging, and electrophysiological discoveries regarding the consequences of PAE. For example, recent progressions allow for improved detection of alterations in DNA methylation and functional connectivity between cortical and deep grey matter. Therapeutic innovations targeting specific neurocognitive impairment and ligand-specific symptom clusters, as well as lifelong multidisciplinary interventions to support patients, were reported as producing effective outcomes. SUMMARY Developments in genetics, epigenetics, imaging, and interventions are relevant to the current knowledge of FASD. MHP are encouraged to recognize the importance of understanding unique considerations for this population, including forensic implications and the whole-body impacts of FASD, which could assist in reducing stigma and improving quality of care.
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14
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Adebiyi BO, Mukumbang FC, Erasmus C. The Distribution of Available Prevention and Management Interventions for Fetal Alcohol Spectrum Disorder (2007 to 2017): Implications for Collaborative Actions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122244. [PMID: 31242673 PMCID: PMC6617245 DOI: 10.3390/ijerph16122244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 11/16/2022]
Abstract
The global prevalence of Fetal Alcohol Spectrum Disorder (FASD) remains high despite the various preventive and management interventions that have been designed and implemented to tackle the issue in various settings. The aim of the scoping review is to identify and classify prevention and management interventions of FASD reported globally across the life span and to map the concentration of these interventions across the globe. We searched some selected databases with predefined terms. Framework and narrative approaches were used to synthesize and report on the findings. Thirty-two prevention intervention studies and 41 management interventions studies were identified. All the interventions were reported to be effective or showed promising outcomes for the prevention and management of FASD, except four. Although Europe and Africa have a relatively higher prevalence of FASD, the lowest number of interventions to address FASD were identified in these regions. Most of the interventions for FASD were reported in North America with comparatively lower FASD prevalence. The uneven distribution of interventions designed for FASD vis-à-vis the burden of FASD in the different regions calls for a concerted effort for knowledge and intervention sharing to enhance the design of contextually sensitive preventive and management policy in the different regions.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Charlene Erasmus
- Child and Family Studies, University of the Western Cape, Cape Town 8001, South Africa.
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Coles CD, Kable JA, Taddeo E, Strickland D. GoFAR: improving attention, behavior and adaptive functioning in children with fetal alcohol spectrum disorders: Brief report. Dev Neurorehabil 2018; 21:345-349. [PMID: 29313400 PMCID: PMC6314185 DOI: 10.1080/17518423.2018.1424263] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This brief report describes the GoFAR intervention designed to improve attention, behavior, and adaptive functioning in children with FASD, ages 5 to 10 years. METHODS Thirty children were randomized to one of three conditions: GoFAR; FACELAND, and CONTROL; 25 completed the interventions. Over 10 sessions children and caregivers learned a metacognitive strategy (FAR) designed to improve cognitive control of behavior and adaptive functioning and practiced it during behavior analog therapy. Attention, behavior problems, and adaptive skills were measured pre- and post-intervention. RESULTS From pre- to post-testing the GoFAR intervention group improved on the Test of Variables of Attention (TOVA). Both intervention groups improved in Daily Living Skills. CONCLUSION This pilot study demonstrated that children with FASD and their caregivers benefit from a focused intervention designed to improve effortful control of behavior. The study suggests the need for a larger clinical trial to evaluate the intervention's effectiveness.
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Affiliation(s)
- Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics at Emory University School of Medicine, Atlanta, GA
| | - Julie A. Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics at Emory University School of Medicine, Atlanta, GA
| | - Elles Taddeo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
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Reid N, Petrenko CLM. Applying a Developmental Framework to the Self-Regulatory Difficulties of Young Children with Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2018; 42:987-1005. [PMID: 29672859 DOI: 10.1111/acer.13756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/08/2018] [Indexed: 12/31/2022]
Abstract
Prenatal alcohol exposure (PAE) can be associated with significant difficulties in self-regulatory abilities. As such, interventions have been developed that focus on improving varying aspects of self-regulation for this population. The application of a multilevel theoretical framework that describes the development of self-regulation during early childhood could further advance the field. First, this framework could assist in elucidating mechanisms in the trajectories of early adjustment problems in this population and, second, informing the development of more precise assessment and interventions for those affected by PAE. The aims of the current review were to provide an overview of the self-regulatory framework proposed by Calkins and colleagues (e.g., Calkins, 2007; Calkins and Fox, 2002); examine the self-regulatory difficulties that are commonly experienced during infancy (i.e., 0 to 2 years) and early childhood (i.e., 3 to 8 years) in children with PAE in the context of the developmental framework; and describe how the framework can inform the development of future assessment and intervention provision for young children with PAE. The application of a developmental framework, such as proposed by Calkins and colleagues, allows for a systematic and theoretically driven approach to assessment and intervention programs for young children with PAE.
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Affiliation(s)
- Natasha Reid
- Centre for Child Health Research, University of Queensland, Brisbane, Queensland
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