Interventions for improving executive functions in children with fetal alcohol spectrum disorder: systematic review and meta-analysis

Abstract

Introduction: There is a growing focus on the development of interventions that enhance or support the development of executive functions (EF). This systematic review and meta-analysis synthesises evidence in children (aged 3-16 years). Method: Studies were included in the review if they reported a psychological intervention aiming to improve EF in children 3-16 years who had either confirmed prenatal alcohol exposure or a diagnosis relating to fetal alcohol spectrum disorder (FASD). Eligible study designs included randomised controlled trials (RCT), quasi-experimental and single-group pre-post designs with either no treatment, wait list control or an alternative treatment as a comparison condition. Results: The systematic search identified 3747 records, 11 unique studies met inclusion criteria: six RCTs, one quasi-experimental and four pre-post intervention designs. For RCT and quasi-experimental studies, the overall effect of EF interventions generally favoured the experimental condition, but was not statistically significant for all but one EF domain. For pre-post single group designs, there was evidence for small to medium sized improvements in EF. However, these results must be interpreted with caution due to high risk of bias. Discussion and Conclusions: This review found limited and uncertain evidence for the effectiveness of interventions for improving EF in children with FASD. Implications for Further Research: Only a small number of eligible comparison group studies are included in the present analyses, and it is likely that relatively small sample sizes hinder detection of effects across outcomes. These findings underscore the need for a greater number of high-quality comparison studies with larger sample sizes. This will allow for more definitive conclusions to be drawn regarding the overall effectiveness of interventions for EF in children with FASD.