Guidelines for identification and treatment of individuals with attention deficit/hyperactivity disorder and associated fetal alcohol spectrum disorders based upon expert consensus

Abstract

BackgroundThe association of attention deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorders (FASD) results in a complex constellation of symptoms that complicates the successful diagnosis and treatment of the affected individual. Current literature lacks formal guidelines, randomized control trials, and evidence-based treatment plans for individuals with ADHD and associated FASD. Therefore, a meeting of professional experts was organized with the aim of producing a consensus on identification and treatment guidelines that will aid clinicians in caring for this unique patient population.MethodsExperts from multiple disciplines in the fields of ADHD and FASD convened in London, United Kingdom, for a meeting hosted by the United Kingdom ADHD Partnership (UKAP; www.UKADHD.com) in June 2015. The meeting provided the opportunity to address the complexities of ADHD and FASD from different perspectives and included presentations, discussions, and group work. The attendees worked towards producing a consensus for a unified approach to ADHD and associated FASD.ResultsThe authors successfully came to consensus and produced recommended guidelines with specific regards to identification and assessment, interventions and treatments, and multiagency liaisons and care management, highlighting that a lifespan approach to treatment needs to be adopted by all involved. Included in the guidelines are: 1) unique ‘red flags’, which when identified in the ADHD population can lead to an accurate associated FASD diagnosis, 2) a treatment decision tree, and 3) recommendations for multiagency care management.ConclusionsWhile clinically useful guidelines were achieved, more research is still needed to contribute to the knowledge base about the diagnosis, treatment, and management of those with ADHD and associated FASD.

Fetal alcohol spectrum disorders: an overview of current evidence and activities in the UK

“…Instead a consensus of practice-based evidence currently guides the treatment of comorbid FASD and ADHD. [29] These areas highlight that while globally much work has been done to improve the quality of life and understanding of FASD, there is a need to systematically and robustly evaluate interventions. This needs to be appropriately funded to develop gold standard evidence that can inform guidance development groups, such as the UK National Institute for Health and Care Excellence (NICE).…”

Exploring the experiences of social workers in working with children suspected to have fetal alcohol spectrum disorders

“…However, the present study found that the only parenting support offered was generic, which is inadequate for children with FASD as they require different parenting strategies to typically developing children (Paley and O'Connor, 2009;Rutman and van Bibber, 2010). As family support networks and non-pharmacological treatments are recommended for families of children with neurodevelopmental disorders (Hall and Graff, 2011;Young, et al, 2016), it would be beneficial if individuals within these networks were FASD aware as it would improve the efficacy of the support the children receive.…”

Treatment algorithm for the use of psychopharmacological agents in individuals prenatally exposed to alcohol and/or with diagnosis of fetal alcohol spectrum disorder (FASD)

“…28 Nonresponse to stimulants has been suggested as a "red flag" for clinicians to consider ND-PAE/ FASD diagnosis and to explore other treatment considerations. 33 Clinicians should closely monitor and manage possible side effects of stimulants in children.…”