Fetal alcohol spectrum disorder: Management and prognosis
- Carol Weitzman, MD
Carol Weitzman, MD
- Professor of Pediatrics
- Yale School of Medicine
- Pat Rojmahamongkol, MD
Pat Rojmahamongkol, MD
- Yale School of Medicine
- Siriraj Hospital, Mahidol University, Thailand
Prenatal exposure to alcohol is a leading preventable cause of birth defects and developmental disabilities. Fetal alcohol spectrum disorder (FASD) is a term that is used to describe the range of effects that can occur in an individual who was prenatally exposed to alcohol and may have lifelong implications and high societal costs .
This topic will provide an overview of the management of FASD. The clinical features and diagnosis of FASD and alcohol use in pregnancy are discussed separately. (See "Fetal alcohol spectrum disorder: Clinical features and diagnosis" and "Alcohol intake and pregnancy".)
FASD is an umbrella term that encompasses the range of physical, mental, behavioral, and cognitive effects that can occur in individuals with prenatal alcohol exposure [2,3]. In most diagnostic schema, FASD is not a diagnostic term but describes a group of specific conditions, including (table 1) [4,5]:
●Fetal alcohol syndrome
●Partial fetal alcohol syndrome
- Popova S, Lange S, Burd L, Rehm J. The Economic Burden of Fetal Alcohol Spectrum Disorder in Canada in 2013. Alcohol Alcohol 2016; 51:367.
- Bertrand J, Floyd RL, Weber MK, et al. National Task Force on Fetal alcohol syndrome and fetal alcohol effect. Fetal alcohol syndrome: Guidelines for referral and diagnosis. Center for Disease Control and Prevention; Atlanta, GA, 2004. Available at: www.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf (Accessed on February 24, 2014).
- Bertrand J, Floyd LL, Weber MK, Fetal Alcohol Syndrome Prevention Team, Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC). Guidelines for identifying and referring persons with fetal alcohol syndrome. MMWR Recomm Rep 2005; 54:1.
- American Academy of Pediatrics Fetal Alcohol Spectrum Disorders Toolkit. Common definition. Available at: http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Common-Definitions.aspx (Accessed on August 22, 2016).
- National Organization on Fetal Alcohol Syndrome. www.nofas.org/about-fasd/ (Accessed on April 19, 2014).
- Hoyme HE, Kalberg WO, Elliott AJ, et al. Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. Pediatrics 2016; 138.
- Hagan JF Jr, Balachova T, Bertrand J, et al. Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure. Pediatrics 2016; 138.
- Evensen D, Lutke J. Eight magic keys: Developing successful interventions for students with FAS. 1997.
- Streissguth AP, Bookstein FL, Barr HM, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr 2004; 25:228.
- Paintner A, Williams AD, Burd L. Fetal alcohol spectrum disorders--implications for child neurology, part 2: diagnosis and management. J Child Neurol 2012; 27:355.
- Hanlon-Dearman A, Green CR, Andrew G, et al. Anticipatory guidance for children and adolescents with Fetal Alcohol Spectrum Disorder (FASD): practice points for primary health care providers. J Popul Ther Clin Pharmacol 2015; 22:e27.
- American Academy of Pediatrics Fetal Alcohol Spectrum Disorders Toolkit. Addressing families of children with an FASD. Available at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Addressing.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token (Accessed on May 08, 2016).
- FASD Regional Training Centers Curriculum Development Team. Fetal Alcohol Spectrum Disorders Competency-Based Curriculum Development Guide for Medical and Allied Health Education and Practice. Atlanta, GA: Centers for Disease Control and Prevention 2009. Available at: www.cdc.gov/ncbddd/fasd/curriculum/FASDguide_web.pdf (Accessed on April 15, 2016).
- American Academy of Pediatrics Fetal Alcohol Spectrum Disorders Toolkit. Addressing Families of Children with an FASD http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/The-Toolkit.aspx (Accessed on April 10, 2014).
- Hartrey L, Wells JS. The meaning of respite care to mothers of children with learning disabilities: two Irish case studies. J Psychiatr Ment Health Nurs 2003; 10:335.
- Holmes AM, Deb P. The effect of chronic illness on the psychological health of family members. J Ment Health Policy Econ 2003; 6:13.
- American Academy of Pediatrics Fetal Alcohol Spectrum Disorders Toolkit. Algorithm for Evaluation of Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Spectrum Disorders (FASDs) Within the Medical Home. Available at: www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Algorithm-for-Evaluation.aspx (Accessed on February 24, 2014).
- McPherson M, Arango P, Fox H, et al. A new definition of children with special health care needs. Pediatrics 1998; 102:137.
- American Academy of Pediatrics Fetal Alcohol Spectrum Disorders Toolkit. Case management/ Care coordination. Available at: www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Case-Management.aspx (Accessed on February 24, 2014).
- The Interagency Coordinating Committee on FASDs. Consensus statement on recognizing Alcohol-Related Neurodevelopmental Disorder (ARND) in primary health care of children. 2011. Available at: www.niaaa.nih.gov/sites/default/files/ARNDConferenceConsensusStatementBooklet_Complete.pdf (Accessed on February 24, 2014).
- British Medical Association. Alcohol and pregnancy: Preventing and managing fetal alcohol spectrum disorders. February 2016. http://www.bma.org.uk/working-for-change/improving-and-protecting-health/alcohol/alcohol-and-pregnancy (Accessed on February 11, 2016).
- Bertrand J, Interventions for Children with Fetal Alcohol Spectrum Disorders Research Consortium. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil 2009; 30:986.
- Peadon E, Rhys-Jones B, Bower C, Elliott EJ. Systematic review of interventions for children with Fetal Alcohol Spectrum Disorders. BMC Pediatr 2009; 9:35.
- Kodituwakku PW, Kodituwakku EL. From research to practice: an integrative framework for the development of interventions for children with fetal alcohol spectrum disorders. Neuropsychol Rev 2011; 21:204.
- Masotti P, Longstaffe S, Gammon H, et al. Integrating care for individuals with FASD: results from a multi-stakeholder symposium. BMC Health Serv Res 2015; 15:457.
- Olson HC, Oti R, Gelo J, Beck S. "Family matters:" fetal alcohol spectrum disorders and the family. Dev Disabil Res Rev 2009; 15:235.
- Kalberg WO, Buckley D. FASD: what types of intervention and rehabilitation are useful? Neurosci Biobehav Rev 2007; 31:278.
- Technical Assistance and Training System. TATS eUpdate Curriculum and Learning Environment. Developmentally-appropriate practice-Adaptive/self-help skills. Available at: www.tats.ucf.edu/docs/eUpdates/Curriculum-14.pdf (Accessed on April 18, 2014).
- Streissguth AP, Aase JM, Clarren SK, et al. Fetal alcohol syndrome in adolescents and adults. JAMA 1991; 265:1961.
- Streissguth AP, Barr HM, Olson HC, et al. Drinking during pregnancy decreases word attack and arithmetic scores on standardized tests: adolescent data from a population-based prospective study. Alcohol Clin Exp Res 1994; 18:248.
- Howell KK, Lynch ME, Platzman KA, et al. Prenatal alcohol exposure and ability, academic achievement, and school functioning in adolescence: a longitudinal follow-up. J Pediatr Psychol 2006; 31:116.
- Senturias Y, Weitzman CC. Fetal alchohol spectrum disorders. In: The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed, Augustyn M, Zuckerman B, Caronna EB (Eds), Wolters Kluwer Health Lippincott Williams & Wilkins, Philadelphia 2011. p.213.
- Coles CD. Going the extra MILE: A math tutoring program for alcohol affected kids http://www.psychiatry.emory.edu/PROGRAMS/GADrug/coles_mile_article.html (Accessed on March 31, 2014).
- Kable JA, Taddeo E, Strickland D, Coles CD. Community translation of the Math Interactive Learning Experience Program for children with FASD. Res Dev Disabil 2015; 39:1.
- Wells AM, Chasnoff IJ, Schmidt CA, et al. Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: an adaptation of the Alert Program®. Am J Occup Ther 2012; 66:24.
- Therapy Works Inc. The ALERT Program. Available at: www.alertprogram.com (Accessed on May 07, 2016).
- Nash K, Stevens S, Greenbaum R, et al. Improving executive functioning in children with fetal alcohol spectrum disorders. Child Neuropsychol 2015; 21:191.
- Soh DW, Skocic J, Nash K, et al. Self-regulation therapy increases frontal gray matter in children with fetal alcohol spectrum disorder: evaluation by voxel-based morphometry. Front Hum Neurosci 2015; 9:108.
- Rao PA, Beidel DC, Murray MJ. Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations. J Autism Dev Disord 2008; 38:353.
- Sexuality education of children and adolescents with developmental disabilities. American Academy of Pediatrics. Committee on Children with Disabilities. Pediatrics 1996; 97:275.
- O'Connor MJ, Frankel F, Paley B, et al. A controlled social skills training for children with fetal alcohol spectrum disorders. J Consult Clin Psychol 2006; 74:639.
- O'Connor MJ, Laugeson EA, Mogil C, et al. Translation of an evidence-based social skills intervention for children with prenatal alcohol exposure in a community mental health setting. Alcohol Clin Exp Res 2012; 36:141.
- Turner K, Reynolds JN, McGrath P, et al. Guided Internet-Based Parent Training for Challenging Behavior in Children With Fetal Alcohol Spectrum Disorder (Strongest Families FASD): Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2015; 4:e112.
- Burd L, Christensen T. Treatment of fetal alcohol spectrum disorders: are we ready yet? J Clin Psychopharmacol 2009; 29:1.
- Williams JF, Smith VC, COMMITTEE ON SUBSTANCE ABUSE. Fetal Alcohol Spectrum Disorders. Pediatrics 2015; 136:e1395.
- Rangmar J, Hjern A, Vinnerljung B, et al. Psychosocial outcomes of fetal alcohol syndrome in adulthood. Pediatrics 2015; 135:e52.
- Bailey BA, Sokol RJ. Pregnancy and alcohol use: evidence and recommendations for prenatal care. Clin Obstet Gynecol 2008; 51:436.
- Prevention of fetal alcohol syndrome (fas). Can Child Adolesc Psychiatr Rev 2003; 12:87.
- Centers for Disease Control and Prevention. Fetal Alcohol Spectrum Disorders (FASDs). Data and Statistics. Available ata; www.cdc.gov/ncbddd/fasd/data.html (Accessed on February 24, 2014).
- Green PP, McKnight-Eily LR, Tan CH, et al. Vital Signs: Alcohol-Exposed Pregnancies--United States, 2011-2013. MMWR Morb Mortal Wkly Rep 2016; 65:91.
- ROLE OF THE PRIMARY CARE PROVIDER
- Early identification
- Education and anticipatory guidance
- Family support
- Medical home
- OVERVIEW OF MANAGEMENT
- General recommendations
- Targeted interventions
- - Academic skills
- - Executive function/self-regulation
- - Social skills
- - Adaptive skills
- - Parent training
- Asymptomatic children with prenatal alcohol exposure
- INDICATIONS FOR REFERRAL
- Mental health
- INFORMATION FOR PATIENTS