At present, there are no medications specifically approved for the
treatment of FASDs. However, several classes of medications are
routinely prescribed to address common symptoms, negative behaviors, or
other concerns for individuals with an FASD (examples of medications).
Because children often see many professionals before receiving an FASD
diagnosis, they might present with multiple medications prescribed by
multiple providers (with or without communication among providers). As
the medical home, the pediatrician serves an important role to evaluate
the appropriateness, impact, and potential interactions of these
problems are the most common behavior disorder treated by medication in
children. Research has demonstrated mixed results for use of stimulant
medications for attention problems of individuals with FASDs. One study
found slight improvement for symptoms of hyperactivity and
opposition/defiance, but no improvement for inattention See Doig J,
McLennan JD, Gibbard B. Medication effects on symptoms of attention
deficit/hyperactivity disorder in children with fetal alcohol spectrum
disorder. J Child Adolesc Psychopharmacol. 2007;18:365-371.
researchers have found no difference in performance or improvement for
children with FASDs on stimulant medications compared to children with
FASDs who were not taking stimulant medications. See Frankel F, Paley B,
Marquardt R, O’Connor M. Stimulants, neuroleptics and children’s
friendship training for children with fetal alcohol spectrum disorders. J
Child Adolesc Psychopharmacol. 2006;16:777-789.
symptoms in children, including children with developmental
disabilities such as FASDs, have been reported to be similar to those of
adults with sad mood or affect, loss of interest, and sleep problems.
In addition, for children, depression often includes school disruption,
negativity, irritability, aggression, and antisocial behaviors.
Selective serotonin reuptake inhibitors (SSRIs) are often prescribed to
children with FASDs. However, specific research on the efficacy of SSRIs
for depressive symptoms in children or adults with FASDs is not
available. Such research would provide important clinical information
for this population.
symptoms are not associated with FASDs. However, neuroleptics are
prescribed to children with developmental disabilities, including FASDs,
to address aggression, anxiety, or behavior regulation. Approximately
one-fifth of school-aged children and adults with prenatal alcohol
exposure meet diagnostic criteria for an anxiety disorder See Fryer SL,
McGee CL, Matt GE, Riley EP, Mattson SN. Evaluation of
psychopathological conditions in children with heavy prenatal alcohol
exposure. Pediatrics. 2007;119:733-741.
Infants with prenatal
alcohol exposure are more likely to exhibit attachment anxiety than
children without prenatal alcohol exposure. See O’Connor MJ, Kogan N,
Findlay R. Prenatal alcohol exposure and attachment behavior in
children. Alcohol Clin Exp Res. 2002;26:1592-1602.
many children, adolescents, and adults with developmental disabilities,
including those with FASDs, are prescribed multiple medications,
anecdotally referred to as “cocktails.” Such multiple prescriptions can
result from patients’ failure to disclose current medications, lack of
communication across providers, or failing to discontinue medications
that are not effective or no longer appropriate. Patient, parent,
education, and medical communities are becoming increasingly concerned
about multiple medications and their possible negative effects. Further,
research into drug therapies do not assess the use of multiple drugs
simultaneously, thus their interactional effects have not been studied.
When new medications are considered, it is important to fully review the
need and effectiveness of current medications and possible drug
interactions before adding to the “cocktail.” See Feldman, R., Meyer,
J.S., & Quenzer, L.F. (1997). Principles of neuropsychopharmacology.
Sunderland, MA: Sinauer Associates, Inc.
Choline Supplements May Improve Learning and Memory in People With Prenatal Alcohol Exposure
studying therapies for FASDs have found that choline supplements may
help. Dr Jennifer Thomas, a National Institute on Alcohol Abuse and
Alcoholism grantee, and colleagues at San Diego State University are
studying the effects of choline on several alcohol-induced behavior
problems. In their study, choline decreased hyperactivity in
alcohol-exposed rats. It also improved spatial and working memory.
Postnatal Choline Supplementation and Developmental Alcohol Exposure
growing literature suggests that pre- and/or early postnatal
supplementation with choline, an essential nutrient, can attenuate the
damaging effects of developmental alcohol on learning and memory. Using a
rodent model, a study examined if choline supplementation is effective
in mitigating alcohol’s teratogenic effects when administered during
adolescence/young adulthood. The results of the study indicate that
dietary intervention may reduce some fetal alcohol effects, even when
administered later in life, findings with important implications for
adolescents and young adults with FASDs.
Animal-Assisted Therapy (AAT)
commonly documented strength among individuals with FASDs is that they
tend to work well with animals. AAT is delivered by a professional
service provider, such as a recreation therapist, and is designed to
promote improvements in physical, emotional, social, or cognitive
functioning. Animals used in AAT can include cats, rabbits, birds, fish,
and perhaps most commonly, horses and dogs. One family who has found a
service dog particularly helpful for their son who has FAS has shared