Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ONGOING

all patients

1st line – assessment of strengths and needs

Plus – education and learning strategies

Plus – neurocognitive habilitation therapy

Plus – social skills training

Plus – parent programmes

Plus – stimulant medications

Plus – behavioural interventions

Consider – surgery

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ONGOING
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all patients
1st line – 

assessment of strengths and needs

The first step in management requires recognition of exposed children, diagnosis, and full clinical and psychological assessment to determine the child's specific strengths and needs.

Interventions should then be recommended to address the child's specific profile of strengths and vulnerabilities.

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ONGOING
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all patients
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with academic or learning difficulties
Plus – 

education and learning strategies

Treatment recommended for ALL patients in selected patient group

Cognitive control therapy (which addresses body position, movement, and awareness; attention; and information processing, controlling, and categorising) was shown to improve behaviour in children with fetal alcohol syndrome (FAS).[71]

A language and literacy intervention (a combination of language therapy, phonological awareness, and literacy training administered by a speech therapist) has been shown to significantly improve literacy, reading, and spelling skills.[72][73]

A mathematics intervention (Math Interactive Learning Experience [MILE]) was shown to improve mathematics knowledge, which was maintained at 6-month follow-up, in children with FAS or partial FAS and an IQ over 50.[74][75] MILE is based on the theory that there are basic cognitive functions that support mathematical cognitions and that impact academic achievement and adaptive functioning skills.

Virtual-reality games have been assessed for teaching children with FAS or partial FAS.[76] Computer-based virtual-reality games can be designed to teach children a new skill (e.g., fire safety). Children receiving the virtual-reality intervention had significantly increased knowledge, which was maintained at 1-week follow-up.[76]

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ONGOING
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all patients
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with executive function problems
Plus – 

neurocognitive habilitation therapy

Treatment recommended for ALL patients in selected patient group

Neurocognitive habilitation intervention has been shown to improve executive function and problem-solving skills in children with fetal alcohol spectrum disorder (FASD) and alcohol-related neurodevelopmental disorder (ARND).[77]

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ONGOING
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all patients
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with social skill deficits
Plus – 

social skills training

Treatment recommended for ALL patients in selected patient group

Child friendship training, a social skills training programme based on social learning theory, has been shown to significantly improve knowledge of social skills in children with FAS, partial FAS, or alcohol-related neurodevelopmental disorder (ARND) who have social skill deficits and a verbal IQ 70 and over. This was maintained at 3-month follow-up.[78]

Parents reported improved social skills and decreased problem behaviours. However, teachers did not report any significant differences.[78]

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ONGOING
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all patients
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with externalising or attention problems
Plus – 

parent programmes

Treatment recommended for ALL patients in selected patient group

The Families Moving Forward Program has been assessed in children with FASDs who have externalising or attention problems and a verbal IQ 70 and over.[79] This programme uses a low-intensity model of supportive behavioural consultation lasting 9 to 11 months and has shown significant improvement in parenting self-efficacy and engagement in self-care behaviours and a decrease in challenging and disruptive behaviours.[79]

Neurocognitive habilitation was developed as a systematic intervention for children with a diagnosis of FAS or ARND in the foster-care system.[79] The programme provides support and education for families and focuses on improving children's executive functioning, which leads to improvement in measures of executive functioning.[79]

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ONGOING
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all patients
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with attention-deficit hyperactivity disorder (ADHD)
Plus – 

stimulant medications

Treatment recommended for ALL patients in selected patient group

A trial of central nervous system stimulants should be considered in children with FASDs who have symptoms of ADHD.[81]

Hyperactivity-impulsivity scores significantly improved with treatment, but attention did not, in children with a diagnosis of ADHD in addition to FAS or partial FAS.[82][83] Children with both ADHD and FASD may have a better response to dexamphetamine than methylphenidate.[84]

Doses and medications are the same as used for ADHD alone. See Attention deficit hyperactivity disorder in children.

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ONGOING
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all patients
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with attention-deficit hyperactivity disorder (ADHD)
Plus – 

behavioural interventions

Treatment recommended for ALL patients in selected patient group

Attention process training, a programme designed to address attention and concentration in individuals with brain injury through addressing attention processing, has been shown to significantly improve measures of sustained attention and non-verbal reasoning, but not measures of executive function, in children with both fetal alcohol spectrum disorders (FASDs) and ADHD.[80]

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ONGOING
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all patients
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with birth defects
Consider – 

surgery

Additional treatment recommended for SOME patients in selected patient group

Surgery may be required, the type depending on the specific birth defect.

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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