What is this?

• Children who are exposed to alcohol in the womb can experience a number of different difficulties, such as; problems with the structure of function of the central nervous system, birth defects, neurodevelopmental problems, growth problems and/or cognitive impairment. The neurodevelopmental problems can continue into adulthood, including issues with language development, learning, memory, non-verbal problem solving and social skills.
• Children who have foetal alcohol spectrum disorders (of which Foetal Alcohol Syndrome is the most severe) are likely to experience adverse life experiences. These include, issues with drugs and alcohol, disrupted education, inappropriate sexual behaviours and mental health problems.
• Parents and carers of children with FASD report that often conventional behavioural and learning approaches and interventions don’t help these children.
• The 7 studies in this review comprised 6 different interventions, these were; cognitive control therapy; language and literacy intervention; virtual reality game; maths intervention; rehearsal training; and videotape intervention.

How is it meant to work?

• The six interventions evaluated in this review differed in their methods and delivery; they are designed to improve the academic skills and learning strategies of children with FASD.
• In particular they focussed on practical language, literature and maths skills as well as fire and road safety.

What are the evaluated outcomes?

• Academic Skills
• Learning Strategies

How effective is it?

Academic Skills
Overall, the five studies that used interventions designed for academic skills had a mixed effect on academic skills. This is based on low strength evidence.

A study using language and literacy interventions found the intervention group showed greater improvements for reading, spelling and some pre-literacy domains, compared with those who did not receive the intervention. However no differences were found between the intervention and control group for general academic tests. There was limited information given about methodology for this Randomised Control Trial (RCT), 40 children with FASD were assigned to the intervention group and 25 children without FASD to the control group.

An RCT using a maths intervention adapted for children with FASD found a greater improvement in maths knowledge in the intervention group compared with the control group who received a standard psychoeducational intervention. There were 61 children in this study.

Another RCT using cognitive control therapy with ten children had mixed findings, with reports of improvements in behaviour in the intervention group, but no differences found between the intervention and control group for cognitive skills.

Two studies which used virtual reality games had a mixed effect on fire / street safety in children with FASD. One RCT with 32 children found fire and street safety did improve but only fire safety this was not maintained at follow-up. Another non-RCT study found an improvement in home fire safety for four children.

Learning Strategies
Overall, rehearsal training and modelling perceptual tasks had a mixed effect on learning strategies. This is based on very low strength evidence.

A study of 33 children assigned to rehearsal training to improve number memory or a control group, found no significant difference between intervention and control post intervention, but that the intervention group performed better  at follow-up. In another study, the four boys in the study could not imitate the building tasks they had been shown. There was no control group in this study.

Where has it been studied?

• Four of the studies were carried out in USA; 2 studies were carried out in South Africa; 1 study was carried out in Canada.
• It is not possible to make any suggestions about relevance to the UK context.

Who does it work for?

• There was limited detail given about the participants that have been involved in these studies.
• The studies included children aged 3-12.
• One study (Learning Strategy Intervention) specifically targeted boys.
• Recruitment of participants was from a range of places including clinics, schools and the community.
• Diagnosis of FASD varied across the studies, a broad range was used, all included children with problems that could not be explained by anything other than alcohol related problems from exposure to alcohol in the womb.

When, where and how does it work?

Very little detail about the mechanisms of these studies was reported; the review did not state whether any of the interventions were more effective in one context or another.

What are the costs and benefits?

No economic analysis was given in this review.

Case study

• A Language and Literacy intervention for children with FASD was carried out in Western Cape, South Africa.
• 40 children identified as having FASD and 25 children who had no alcohol exposure were included in the study. Children were randomly assigned either to the Language and Literacy intervention group or to a control group.
• The study was designed to test the efficacy of language and literacy intervention on children with FASD. Typically, children with FASD have weaker language and literacy skills than their peers.
• The intervention comprised a 30 minute session twice a week, in groups of five children, facilitated by an experienced speech and language therapist.
• A total of 38 hours of therapy was undertaken over the 9 month period (19 hours of language therapy alternating with 19 hours of phonological awareness and literacy training).
• Intervention sessions took place in a designated classroom in participating schools.
• The intervention focussed on pre/early literacy competencies necessary for spelling and reading.
• The findings suggest that interventions like this one can have significant benefits for children with FASD, particularly with more complex phonological skills.
• Adnams, C. M., Sorour, P., Kalberg, W. O., Kodituwakku, P., Perold, M. D., Kotze, A., September, S., Castle, B., Gossage, J., & May, P. A. (2007). Language and literacy outcomes from a pilot intervention study for children with fetal alcohol spectrum disorders in South Africa. Alcohol 41(6), 403–414.

In summary...

• This systematic review reported on six interventions in seven studies.
• The differences in quality of study design and reporting limits the extent to which effectiveness can be judged. More robust research is needed in this area.
• There were mixed findings for academic skills. There is some evidence to suggest that language, literacy and maths may be improved by these interventions, along with learning skills. However, more research is needed to draw firm conclusions.
• More research is needed to see if findings are applicable to a UK context.