Evaluating what works for children with prenatal alcohol exposure: Assessing the potential role of early childhood adversity

Abstract

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term describing a range of impairments following prenatal alcohol exposure (PAE). Difficulties with executive functioning (EF) are among the most common impairments in the condition. While research has traditionally focused on describing FASD, recently attention has turned to evaluating interventions. Two existing reviews suggest that there is promise with a range of approaches, although there is considerable variability noted in outcome measures and populations. The emerging problems associated with exposure to extensive adversity in early life has also been identified in this vulnerable population of children and young people. In the light of these concurrent foci, this thesis begins with a comprehensive systematic review and meta-analysis of interventions published across academic and grey literature that aimed to improve executive functioning in children aged 3-16 years (Study 1). A comprehensive search yielding 8,638 records resulted in identification of 11 eligible studies with results synthesised across 253 participants. Results showed no significant impact of intervention across all but one outcome measure: response inhibition. These findings need to be interpreted with caution as there were significant limitations with the published work. Nonetheless, the corpus of work to date suggests that interventions may need to move beyond a focus on supporting the development of EFs. Further consideration needs to be given to other co-occurring factors in children with FASD that may either limit or negate current approaches for supporting the development of EFs.