Specialized mental health services are essential. These can include: neuropsychological evaluation, medication management— and, especially, clinic-based (or home-based) specialized behavioral consultation.
Research shows that many children with FASD have behavioral problems (e.g., Mattson & Riley, 2000), psychiatric difficulties (e.g., O’Connor et al., 2002) and difficulties with adaptive function that are greater than expected, especially in middle childhood and beyond (e.g., Whaley et al., 2001). A natural history study of secondary disabilities shows very high rates of mental health problems and a clear need for treatment (Streissguth et al., 2004). A logical conclusion is that specialized, tailored mental health services are essential for families raising children with FASD— and for the individuals with FASD themselves. Such services can include neuropsychological evaluation, medication management, and clinic-based (or home-based) behavioral consultation.
Assessment of learning profiles has been highlighted as essential in intervention for children with FASD (Kalberg & Buckley, 2006). For adolescents and adults with FASD, neuropsychological evaluation (and follow-up case management) is especially important. Neuropsychological evaluation can document learning deficits and provide guidance for job training and vocational rehabilitation, the need for supplemental supportive income, and ways to adjust or adapt other adult services (even correctional efforts). Clinical neuropsychological services specialized for individuals with FASD are opening, such as one at the University of Washington’s FADU department. Beyond clinical efforts, neuropsychologists have published a growing stream of research that teases apart the diverse cognitive deficits seen among individuals with FASD. This is a vivid area of research, and much will be learned in the next few years.
Research data so far suggests that psychoactive medications are often used with children diagnosed with FASD who show externalizing and other behavioral problems (e.g., Carmichael Olson et al., 2005). Anecdotal reports suggest that medications are also frequently used with adolescents and adults. Psychoactive medications are used for a variety of reasons, including management of mood, activity, impulsivity and attention, sleep problems and so on. Experts (and families) have been calling for research on medication management for children with this set of neurodevelopmental disabilities, and while some studies have begun, this is a very challenging endeavor.
Clinical wisdom in the field of FASD has highlighted a combination of parent education and support with behavioral consultation that provides practical strategies for families raising children with FASD, as a very promising approach to FASD intervention. This type of help is especially important for families who are in crisis, or whose needs go beyond those that can be helped by participation in parent support groups or listservs alone. In the past few years, this type of intervention has been piloted by pioneering researchers such as Diane Malbin.
One recent research effort has focused on systematically creating, carefully describing, and testing an intervention model called the Families Moving Forward Program, that captures this clinical wisdom (Carmichael Olson et al., 2005). This research tests the impact of an individualized, home-based behavioral consultation (paired with caregiver support and education) that is aimed to help families raising school-aged children with FASD and clinically concerning behavioral problems. This program does try to help the children at highest risk for later secondary disabilities and difficulties in day-to-day function— so their learning and behavior problems are very significant and change may be slow. Once an evidence base is established, programs such as the Families Moving Forward Program can be streamlined and improved, and transitioned to the community (in a variety of locations) to make them more accessible. Research on these programs can help define the important treatment process to be used in mental health services for children with FASD and their families.
• Do careful research to describe FASD, including studies using psychological testing, MRI and other neuroimaging methods. It is important to understand the more common learning and behavioral deficits in FASD—and the underlying problems in brain structure and function. It is also important to understand the course of these problems over the lifespan.
• Educate mental health providers about FASD.
• Work toward recognizing FASD in mental health diagnostic codes.
• Continue research on promising intervention models for specialized mental health services!