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

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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.

Plus – education and learning strategies

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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 categorizing) was shown to improve behavior in children with fetal alcohol syndrome (FAS).[72]

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.[73][74]

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 >50.[75][76] 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 evaluated for teaching children with FAS or partial FAS.[77] 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.[77]

Plus – neurocognitive habilitation therapy

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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).[78]

Plus – social skills training

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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 program based on social learning theory, has been shown to significantly improve knowledge of social skills in children with fetal alcohol syndrome (FAS), partial FAS, or alcohol-related neurodevelopmental disorder who have social skill deficits and a verbal IQ ≥70. This was maintained at 3-month follow-up.[79]

Parents reported improved social skills and decreased problem behaviors. However, teachers did not report any significant differences.[79]

Plus – parent programs

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ONGOING
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all patients
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with externalizing or attention problems
Plus – 

parent programs

Treatment recommended for ALL patients in selected patient group

The Families Moving Forward Program has been evaluated in children with fetal alcohol spectrum disorders (FASD) who have externalizing or attention problems and a verbal IQ ≥70.[80] This program uses a low-intensity model of supportive behavioral consultation lasting 9 to 11 months, and has shown significant improvement in parenting self-efficacy and engagement in self-care behaviors, and a decrease in challenging and disruptive behaviors.[80]

Neurocognitive habilitation was developed as a systematic intervention for children with a diagnosis of fetal alcohol syndrome or alcohol-related neurodevelopmental disorder in the foster-care system.[80] The program provides support and education for families and focuses on improving children's executive functioning, which leads to improvement in measures of executive functioning.[80]

Plus – stimulant medications

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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 fetal alcohol spectrum disorders who have symptoms of ADHD.[82]

Hyperactivity-impulsivity scores significantly improved with treatment, but attention did not, in children with a diagnosis of ADHD in addition to fetal alcohol syndrome (FAS) or partial FAS.[83][84] Children with both ADHD and FASD may have a better response to dexamphetamine than methylphenidate.[85]

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

Plus – behavioral interventions

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

behavioral interventions

Treatment recommended for ALL patients in selected patient group

Attention process training, a program 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 nonverbal reasoning, but not measures of executive function, in children with both fetal alcohol spectrum disorders and ADHD.[81]

Consider – surgery

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ONGOING
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all patients
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with birth defects
Consider – 

surgery

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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