Medication

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Medication and Emerging Therapies

 

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 medications. 

Stimulant Medication
Attention 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. 

Other 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.

Mood Regulators
Depressive 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.

Neuroleptics
Psychotic 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.  

“Cocktails” 
Finally, 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.

Emerging Therapies
Choline Supplements May Improve Learning and Memory in People With Prenatal Alcohol Exposure
Researchers 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
A 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)
One 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 their story.

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