Effectiveness of interventions for school-aged-children and adolescents with fetal alcohol spectrum disorder: a systematic review and meta-analysis

Abstract

Purpose

To describe allied health and educational interventions and their effectiveness for children and adolescents with fetal alcohol spectrum disorder (FASD). To appraise the quality and strength of studies.

Methods

Electronic databases were searched between 2005 and March 2022, identifying non-pharmacological studies supporting function, activity, or participation for FASD participants aged 5–18 years using any quantitative research design. Outcomes were coded using International Classification of Functioning, Disability and Health, family of Participation Related Constructs and behaviour categories. Multi-level random-effects meta-analysis examined intervention effects. Study methodological quality was evaluated using Cochrane risk of bias tools, RoBiNT, AMSTAR 2 and NHMRC Hierarchy levels of evidence. Certainty of findings were synthesised using GRADE approach.

Results

The systematic review included 25 studies with 735 participants, 10 of which were analysed by meta-analysis. Body function and structure, activity, behaviour, and sense of self outcomes were pooled. A small, positive effect favouring interventions was found (g = 0.29, 95% CI = 0.15–0.43), however the GRADE certainty was rated as low. No participation outcomes were identified.

Conclusions

Some interventions targeting body function and structure, activity and behaviour outcomes were effective. Evidence of interventions that support children’s and adolescent’s participation as an outcome is lacking.

IMPLICATIONS FOR REHABILITATION

• To address participation outcomes for children and adolescents with fetal alcohol spectrum disorder (FASD), it is important to understand their participation needs and directly measure these.

• Interventions identified targeted body function and structure, activity, and behaviour outcomes.

• Participation outcomes of children’s/adolescent’s attendance, involvement and preferences were not identified.

• A combination of individual- and context-focused interventions is recommended to maximise rehabilitation outcomes for children and adolescents with FASD.

Keywords:

• Fetal alcohol spectrum disorders
• intervention
• ICF
• children
• systematic review
• meta-analysis

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Correction

Disclosure statement

The authors have no conflicts of interest to declare.

Data availability statement

Data extracted from included studies and used for analyses can be obtained from the corresponding author.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The authors would like to acknowledge Semra Griffiths, Health Sciences Librarian at Australian Catholic University Canberra, for peer-reviewing the search strategy. No funding was received to undertake this review.