Interventions for children with fetal alcohol spectrum disorders (FASDs): Overview of findings for five innovative research projects☆
Section snippets
Intervention framework
All of the interventions were designed to improve the developmental outcomes of individuals with FASDs, reduce secondary conditions, and improve the lives of families affected by FASDs. Although our understanding of the deficits and disturbances associated with FASDs is far from complete, individuals exposed to alcohol during fetal development can show evidence of central nervous system (CNS) dysfunction resulting from structural brain damage (Ma et al., 2005; Spadoni, McGee, Fryer, & Riley,
Human subjects approval
All studies were approved by the CDC Institutional Review Board (IRB) and by the individual IRBs from each research site. For children under state guardianship, the IRB of the applicable state Department of Children and Family Services reviewed and approved the research. Informed consent was obtained from the parent(s) or legal guardian(s), and assent was obtained from children at appropriate ages for each intervention.
Diagnosis of participants across intervention sites
Participants for all interventions were recruited from established FASDs and genetics clinics. Every child received a multidisciplinary evaluation by trained clinicians to assess for the presence of the diagnostic features of an FASD. Children with any of the diagnoses within the spectrum were eligible. Two of the study sites (University of California at Los Angeles and University of Washington) used the Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code (Astley,
Study 1. Project bruin buddies: a social skills training program to improve peer friendships for children with fetal alcohol spectrum disorders (University of California at Los Angeles)
This study was designed to examine the effect of parent-assisted children's friendship training (CFT) (Frankel & Myatt, 2003) compared with the effect of delayed treatment control (DTC) on the social skills of children with a history of prenatal alcohol exposure, and to examine the maintenance of social skills gained over a 3-month period.
Research suggests that children with FASDs exhibit considerable social impairment. Problems understanding social cues, indiscriminant social behavior, and
Study 2. Georgia-sociocognitive habilitation using the math interactive learning experience (MILE) program (Marcus Institute)
This project was developed to evaluate the effect of a sociocognitive habilitation program designed to improve the behavioral and mathematical functioning of alcohol-affected children. Deficits in mathematical functioning have been reported consistently among alcohol-affected individuals (Coles et al., 1991; Goldschmidt, Richardson, Stoffer, Geva, & Day, 1996; Howell, Lynch, Platzman, Smith, & Coles, 2006; Jacobson et al., 2003; Mattson, Riley, Gramling, Delis, & Jones, 1998; Streissguth et
Study 3. Neurocognitive habilitation for children with fetal alcohol spectrum disorders (Children's Research Triangle)
The specific aim of this study was to develop and evaluate a program of neurocognitive habilitation for children who had been in foster care or who had been adopted, and who had a diagnosis of FAS or ARND. In 1998, the U.S. General Accounting Office (1998) reported that 74% of children in foster care in Illinois had at least one parent who was required to undergo drug or alcohol treatment as part of the case plan for family reunification. In about half the cases, alcohol was used alone or in
Study 4. Parent–child interaction therapy: application of an evidence-based treatment to reduce behavior problems among children with fetal alcohol spectrum disorders (University of Oklahoma Health Sciences Center)
The aim of the study was to evaluate two group-based interventions for children with FASDs) that would reduce (a) behavior problems among children with FASDs and (b) decrease parenting stress among caregivers. One treatment used a group adaptation of an evidenced-based behavioral parent training treatment, Parent-Child Interaction Therapy (PCIT) (Eyberg & Boggs, 1998) that provided both parents and children with a live, coached practice of behavioral parenting skills. The other was a
Study 5. Families moving forward: a behavioral consultation intervention to improve outcomes for families raising children with fetal alcohol spectrum disorders (University of Washington)
The overall goal of this study was to evaluate an intervention designed to improve caregiver self-efficacy, meet family needs, and reduce child problem behaviors. The specific aims of the study were: (a) to create a feasible, specialized behavioral consultation intervention – the Families Moving Forward (FMF) Program – for caregivers raising children with FASDs, based in part on positive behavior support techniques, and (b) to assess the efficacy of the FMF intervention, when compared with the
General discussion
Until now, information and strategies for interventions specific to individuals with FASDs have been gleaned from work with children having other disabilities (without appropriate adaptation) and the practical wisdom gained by parents and clinicians through trial and error. Although informative to a limited degree, such evolving treatments have been implemented without systematic or scientific evaluation. The five interventions presented here are the first specifically designed and adapted for
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The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors would like to thank the participating children and families for their tremendous contribution to each of these studies.
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Interventions for Children with Fetal Alcohol Spectrum Disorders Research Consortium members listed by institution: Jacquelyn Bertrand and R. Louise Floyd, Centers for Disease Control and Prevention, Atlanta, GA, USA; Mary J. O’Connor, Fred Frankel, and Blair Paley, University of California, Los Angeles, CA, USA; Claire D. Coles, Julie Kable, Elles Taddeo, and Donna Dent, Marcus Institute, Atlanta, GA, USA; Ira Chasnoff, Anne Wells, and Greg Bailey, Children's Research Triangle, Chicago, IL, USA; Robin Gurwitch, John Mulvhill, Mark Chaffin, and Matthew Grim, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Heather Carmichael Olson, and Susan Astley, University of Washington, Seattle, WA, USA.