Behavioral interventions for individuals with fetal alcohol spectrum disorder: A review of systematic reviews

Background: Individuals diagnosed under the spectrum of fetal alcohol spectrum disorders (FASD) experience numerous cognitive and behavioral impairments, including learning disabilities, executive functioning dysfunction, and difficulties in emotional regulation. Studies of direct child-centered nonpharmacological behavioral interventions to improve outcomes have steadily developed over the past few decades. Systematic reviews of this literature have documented the wide collection of studies, and an overall review of these reviews permits a single, comprehensive analysis encompassing behavioral intervention research. Methods: Electronic databases were searched for systematic reviews from 2005 to 2024. Included reviews reported the effectiveness of child-centered behavioral, nonpharmacological interventions in noneducational settings for individuals with FASD from birth until the age of 18. Abstract screening, full-text screening, and data extraction were conducted using Covidence. AMSTAR-2 was utilized to assess the methodological quality of systematic reviews. Results: A total of seven systematic reviews were included for comprehensive analysis. Two reviews were of high quality, two were of low quality, and three were of critically low quality, as per AMSTAR-2 grading criteria. Categories of behavioral interventions within systematic reviews included executive functioning interventions, self-management interventions, social skill interventions, family-based interventions, cognitive behavioral interventions, and applied behavior analysis-based treatment. While numerous positive outcomes were identified across several behavioral interventions, the systematic reviews identified multiple limitations, such as high risk of bias and small sample sizes. Conclusion: Numerous positive outcomes were identified from among systematic reviews regarding FASD interventions; however, the current evidence base is limited by methodological weaknesses and potential risks of bias. Further research and implementation are necessary to strengthen the delivery of interventions and continue improving outcomes for individuals with FASD.