Academic journal article Alcohol Research

Behavioral Interventions for Children and Adolescents with Fetal Alcohol Spectrum Disorders

Academic journal article Alcohol Research

Behavioral Interventions for Children and Adolescents with Fetal Alcohol Spectrum Disorders

Article excerpt

Exposure to alcohol in utero is considered to be a leading cause of developmental disabilities of known causation. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of facial anomalies, growth retardation, and central nervous system dysfunction. Both animal and human studies, however, suggest that there may be considerable variability in the manifestations of in utero alcohol exposure across individuals, and, consequently, the term fetal alcohol spectrum disorders (FASD) has come into usage to reflect the entire continuum of effects associated with such exposure. In addition to FAS, this term encompasses the conditions of partial FAS, alcohol-related neurodevelopmental disorder, and alcoholrelated birth defects. Despite extensive evidence of significant cognitive, behavioral, and social deficits in people with FASD, research on behavioral interventions for FASD has lagged behind. However, in recent years there has been a marked increase in efforts to design and test interventions for this population. This article will review current empirically tested interventions, methodological challenges, and suggestions for future directions in research on the treatment of FASD. KEY WORDS: Prenatal alcohol exposure; fetal alcohol spectrum disorders; fetal development; developmental disability; developmental disorder; teratogenesis; child; adolescent; intervention; behavioral intervention

More than 35 years ago, fetal alcohol syndrome (FAS) was first identified in the United States as a major birth defect resulting from prenatal alcohol exposure (Jones and Smith 1973; Jones et al. 1973). FAS is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system dysfunction. Evidence from both animal and human studies, however, suggests that there is considerable variability in the manifestations of in utero alcohol exposure across individuals. Such variability depends on numerous factors, including dosage, timing of exposure, pattern of exposure, maternal age and body mass index and genetics, as well as postnatal variables such as nutrition, socioeconomic conditions, and environmental enrichment (Bonthius andWest 1990; Day and Richardson 2004; Downing et al. 2009; Hannigan et al. 2007; Jacobson et al. 2006; Jones 2006;May et al. 2008, see also May and Gossage, pp. 15-26, in this issue). In light of this variability, the umbrella term, fetal alcohol spectrum disorders (FASD) (Warren et al. 2004) has come into usage to reflect the entire continuum of effects associated with in utero alcohol exposure. In addition to FAS, this term encompasses the conditions of partial FAS, alcoholrelated neurodevelopmental disorder (ARND), and alcoholrelated birth defects (ARBDs, as described by the Institute of Medicine [Stratton et al. 1996]).

Over the past three decades, extensive research has documented the teratogenic effects of alcohol in both animal and human studies, and such research has highlighted a range of cognitive, behavioral, and physical impairments associated with prenatal alcohol exposure. Intellectual and learning disabilities, executive dysfunction, speech and language delays, behavioral and emotional difficulties, poor social skills, and motor deficits have all been reported among people with FASD (Burd et al. 2003; Green et al. 2009; Guerri et al. 2009; Kalberg et al. 2006; Kodituwakku 2007, 2009; O'Connor and Paley 2009; Paley and O'Connor 2007; Rasmussen 2005; Rasmussen and Bisanz 2009; Riley and McGee 2005; Roebuck et al. 1998; Streissguth 2007; Streissguth et al. 2004;Walthall et al. 2008;Willoughby et al. 2008).

Notably, much of the FASD research has focused on people receiving treatment, often at clinics specializing in FASDdiagnosis and treatment. Therefore, less is known about how people exposed to alcohol prenatally might present in more generalized mental health or medical settings, where their impairments may be less readily identified as resulting (at least partly) from in utero exposure to alcohol. …

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