A Systematic Review of Interventions to Improve Mental Health and Substance Use Outcomes for Individuals with Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder

Abstract

Individuals with fetal alcohol spectrum disorder (FASD) experience remarkably high rates of mental health and substance use challenges, beginning early in life and extending throughout adulthood. Proactive intervention can help to mitigate some of these negative experiences. Although the literature on FASD intervention is growing, there is currently a lack of consolidated evidence on interventions that may improve mental health and substance use outcomes in this population. Informed by a life course perspective, we undertook a systematic review of the literature to identify interventions that improve mental wellness through all developmental stages for people with prenatal alcohol exposure (PAE) and FASD. A total of 33 articles were identified, most of which were focused on building skills or strategies that underlie the well-being of children with PAE and FASD and their families. Other interventions were geared toward supporting child and family wellness and responding to risk or reducing harm. There was a notable lack of interventions that directly targeted mental health and substance use challenges, and a major gap was also noted in terms of interventions for adolescents and adults. Combined, these studies provide preliminary and emerging evidence for a range of intervention approaches that may support positive outcomes for individuals with FASD across the life course.

Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder

“…Moreover, most individuals with FASD show no obvious physical signs of impairment ( Andrew, 2011 ), and the “hidden” nature of the disability can further compound the challenges of accurate identification. There is a critical lack of mental health and substance use interventions for individuals with FASD ( Flannigan et al, 2020 ). Furthermore, a lack of recognition of the potential for wellness and resilience among individuals with FASD may create barriers to service access where mental health and substance use treatments are denied because of service providers’ misperceptions about the disability ( Anderson et al, 2019 ).…”

A shift in perspective on secondary disabilities in fetal alcohol spectrum disorders

“…A recent systematic review of interventions found that the needs of individuals with FASD (and PAE) become more complex in later adolescence, emerging adulthood, and adulthood. This review noted that existing interventions for older individuals were designed with a more responsive approach to mitigate risk and reduce harm (Flannigan et al, 2020). Yet in the larger field of intellectual and developmental disabilities (IDD), over the past four decades, there has been a movement away from this type of “deficits approach,” to a focus on self‐advocacy and the application of strengths‐based approaches to supporting individuals with IDD over the lifespan (Wehmeyer, 2020).…”

“…A discussion of measurable indicators of QOL, aligned with the rights of persons with disabilities, is available and could be used to guide multiple intervention ideas, especially for older individuals with FASD, and their families and service systems (Gómez et al, 2020). This could be a useful resource, as strengths‐based interventions have increasingly been called for in the field of FASD (e.g., Flannigan et al, 2020).…”

Prenatal and Postnatal Choline Supplementation in Fetal Alcohol Spectrum Disorder

“…Importantly, these deficits persist into adulthood, and individuals with FASD can experience lifelong cognitive and physical impairment, psychiatric comorbidity, incarceration, homelessness, and other psychosocial challenges [ 9 , 21 ]. Although the literature on effective treatments for FASD has been growing, at present, very few interventions exist specifically for this population [ 22 , 23 ].…”