Early treatment and interventions for individuals with FASD
The assessment of symptoms of prenatal alcohol exposure and diagnosis is not the endpoint for the individuals with FASD and their family. These are rather a part of a continuum of care that aims to better understand the individual’s strengths and areas of challenges and needs of support. The diagnosis can help to find appropriate services and support options for the individual with FASD and for the family. Given the spectrum of disorders associated with prenatal alcohol exposure, as well as the age and maturity of those affected, services to affected individuals and their families have to be individually adapted as each case involves individual needs.
Individuals with FASD may need support and services throughout life. There is no one intervention or treatment model that fits all individuals exposed to alcohol during pregnancy. The treatment for individuals with FASD can include medical treatment, therapies targeting the areas in which the individual with FASD is challenged, and parenting training following individual needs. Interventions that maximise the protective factors such as early identification and diagnosis and early individualised support and follow-up and reduce the number of risk factors such as an unsafe and unstable childhood caregiving environment are likely to bring positive outcomes and prevent long-term consequences.
Children exposed to alcohol during pregnancy may require support and follow-up after birth already. They may need intensive care due to premature birth, withdrawal symptoms, irritability or feeding problems. Frequent follow-ups with different healthcare professionals may also be needed during the early years or later in life to treat other comorbid conditions. Later in childhood and adolescence, individuals with FASD can benefit from therapies including speech-language therapy, occupational therapy, physical therapy, and neuropsychological rehabilitation. These therapies can target domains where the exposed individuals have impairments, including verbal and social communication, motor skills, attention, self-regulation, as well as adaptive functioning. In addition, individuals with FASD may also benefit from services and therapies provided by psychologists and psychotherapists, targeting, for example, co-occurring mental health issues and challenges with social skills (Petrenko & Alto, 2017). Specific medical treatments for FASD do not exist, but some medications can be used to treat symptoms such as hyperactivity, poor impulse control, anxiety, sleep problems, or mood disorders (Petrenko & Alto, 2017).
It is likely that individuals with FASD are in contact with multiple services and systems throughout life. Good communication between healthcare, educational, social workers, and other professionals who are in contact with the child and the family can be a key to understanding the child’s strengths and challenges holistically, and tailoring individualised support and services for the child.
A healthy caregiving environment is important for a child’s health and development
A safe, responsive, and nurturing caregiving environment has a significant influence on children’s health and development. Children born to mothers with alcohol misuse during pregnancy can be exposed to double jeopardy. Not only do they have an increased risk of adverse birth outcomes and subsequent cognitive and behavioural impairments, but they can also be vulnerable to multiple risk factors in the caregiving environment that can negatively influence their development. These risk factors can include parental alcohol and other substance misuse, mental health problems, low socioeconomic status, interparental conflicts, child abuse, and neglect of care. For the child welfare services these risk factors can also be indications of an unhealthy caregiving environment. In the most severe cases, the children can be placed in out-of-home care during their early years (Flannigan et al., 2021; Staton-Tindall et al., 2013).
Consequently, these children and their families need intensive support across a range of services targeting child health and development, safety, and stability of the caregiving environment as well as parental psychosocial conditions. The interventions can also target parenting areas and caregiver–child interaction, which is especially important among families with alcohol misuse (THL, 2021).