Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul 16;27(3):e1-e13.
doi: 10.15586/jptcp.v27i3.681.

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

Mansfield Mela  1 , Ana Hanlon-Dearman  2 , A G Ahmed  3 , Susan D Rich  4 , Rod Densmore  5 , Dorothy Reid  6 , Alasdair M Barr  7 , David Osser  8 , Tara Anderson  9 , Bola Suberu  10 , Osman Ipsiroglu  11 , Hasu Rajani  12 , Christine Loock  11
Affiliations

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

Mansfield Mela et al. J Popul Ther Clin Pharmacol. .

Abstract

Psychotropic medication treatment of individuals who have experienced prenatal alcohol exposure (PAE) has lagged behind psychosocial interventions. Multiple psychotropic medications are often prescribed for those diagnosed with a range of neurodevelopmental disabilities and impairments of PAE (neurodevelopmental disorder associated with prenatal alcohol exposure and/or fetal alcohol spectrum disorder [ND-PAE/FASD]). Despite the diverse comorbid mental disorders, there are no specific guidelines for psychotropic medications for individuals with ND-PAE/FASD. When prescribed, concerned family members and caregivers of individuals with ND-PAE/FASD reported that polypharmacy, which was typical and adverse effects render the psychotropic medications ineffective. The objective of this work was to generate a treatment algorithm for the use of psychopharmacological agents specifically for individuals with ND-PAE/FASD. The development of decision tree for use to prescribe psychotropic medications incorporated findings from previous research and the collective clinical experience of a multidisciplinary and international panel of experts who work with individuals with ND-PAE/FASD, including an algorithm specialist. After multiple meetings and discussions, the experts reached consensus on how best to streamline prescribing along neurodevelopmental clusters. These were subdivided into four ligand-specific, receptor-acting medication targets (hyperarousal, emotional dysregulation, hyperactive/neurocognitive, and cognitive inflexibility). Each cluster is represented by a list of common symptoms. The experts recommended that prescribers first ensure adequate psychosocial and environmental, including sufficient dietary, exercise, and sleep support before prescribing psychotropic medications. Treatment then progresses through three steps of psychotropic medications for each cluster. To support established treatment goals, the most function impairing clusters are targeted first.

Keywords: fetal alcohol spectrum disorder; medication algorithm; prenatal alcohol exposure; psychiatric medication; psychopharmacological agents.

PubMed Disclaimer

Conflict of interest statement

The authors declare no potential conflicts of interest with respect to research, authorship and/or publication of this article.

References

    1. 1. Cook JL, Green CR, Lilley CM, et al. Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. Can Med Assoc J. 2016;188(3):191–7 - DOI
    1. 2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Pub; 2013.
    1. 3. Peadon E, Rhys-Jones B, Bower C, et al. Systematic review of interventions for children with fetal alcohol spectrum disorders. BMC Pediatr. 2009;9(1):35 - DOI
    1. 4. Mela M, Okpalauwaekwe U, Anderson T, et al. The utility of psychotropic drugs on patients with Fetal Alcohol Spectrum Disorder (FASD): A systematic review. Psychiatry Clin Psychopharmacol. 2018:1–10 - DOI
    1. 5. Ipsiroglu O, Berger M, Lin T, et al. Pathways to overmedication and polypharmacy: Case examples from adolescents with fetal alcohol spectrum disorders. In: The science and ethics of antipsychotic use in children. Amsterdam: Elsevier; 2015. pp. 125–48.

Publication types

Substances

LinkOut - more resources