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Pharmacological Treatment of Disruptive Behavior in Children with Fetal Alcohol Spectrum Disorder

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Abstract

Fetal alcohol spectrum disorder (FASD) is considered to be the most common cause of developmental disability, affecting more than 1 % of the general population in North America. Inattention, hyperactivity, and impulsivity afflict 50–90 % of children with FASD and are 3–9 times more common than in the general population. Of importance, a large proportion of children with FASD are affected by oppositional defiant/conduct disorder (ODD/CD), including lack of social judgment and failure to learn from experience. These devastating numbers are contrasted by almost no pharmacological research into treatment of these pervasive conditions in FASD. This review focuses on analyzing the published evidence on the effectiveness and safety of therapy for disruptive behaviors in FASD. Often, the child afflicted by FASD will not be allowed to participate in class activities without such therapies, which makes such analysis critical.

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References

  1. May PA, Baete A, Russo J, Elliott AJ, Blankenship J, Kalberg WO, Buckley D, Brooks M, Hasken J, Abdul-Rahman O, Adam MP, Robinson LK, Manning M, Hoyme HE. Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics. 2014;134(5):855–66.

    Article  PubMed  Google Scholar 

  2. Patten AR, Brocardo PS, Christie BR. Omega-3 supplementation can restore glutathione levels and prevent oxidative damage caused by prenatal ethanol exposure. J Nutr Biochem. 2013;24(5):760–9.

    Article  CAS  PubMed  Google Scholar 

  3. Da Lee R, Rhee GS, An SM, Kim SS, Kwack SJ, Seok JH, Chae SY, Park CH, Yoon HJ, Cho DH, Kim HS, Park KL. Differential gene profiles in developing embryo and fetus after in utero exposure to ethanol. J Toxicol Environ Health A. 2004;67(23–24):2073–84.

    Article  CAS  PubMed  Google Scholar 

  4. Smith SM, Garic A, Flentke GR, Berres ME. Neural crest development in fetal alcohol syndrome. Birth Defects Res C Embryo Today. 2014;102(3):210–20.

    Article  CAS  PubMed  Google Scholar 

  5. Drew PD, Kane CJ. Fetal alcohol spectrum disorders and neuroimmune changes. Int Rev Neurobiol. 2014;118:41–80.

    PubMed Central  PubMed  Google Scholar 

  6. Wozniak JR, Fuglestad AJ, Eckerle JK, Kroupina MG, Miller NC, Boys CJ, Brearley AM, Fink BA, Hoecker HL, Zeisel SH, Georgieff MK. Choline supplementation in children with fetal alcohol spectrum disorders has high feasibility and tolerability. Nutr Res. 2013;33(11):897–904.

    Article  CAS  PubMed  Google Scholar 

  7. Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O’Malley K, Young JK. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004;25:228–38.

    Article  PubMed  Google Scholar 

  8. Jacobson SW, Jacobson JL, Sokol RJ, Chiodo LM, Corobana R. Maternal age, alcohol abuse history, and quality of parenting as moderators of the effects of prenatal alcohol exposure on 7.5-year intellectual function. Alcohol Clin Exp Res. 2004;28(11):1732–45.

    Article  PubMed  Google Scholar 

  9. Rasmussen C. Executive functioning and working memory in fetal alcohol spectrum disorder. Alcohol Clin Exp Res. 2005;29(8):1359–67.

    Article  PubMed  Google Scholar 

  10. Mattson SN, Riley EP. Parent ratings of behavior in children with heavy prenatal alcohol exposure and IQ-matched controls. Alcohol Clin Exp Res. 2000;24(2):226–31.

    Article  CAS  PubMed  Google Scholar 

  11. Niccols A. Fetal alcohol syndrome and the developing socio-emotional brain. Brain Cogn. 2007;65(1):135–42.

    Article  PubMed  Google Scholar 

  12. O’Malley KD, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Can J Psychiatry Rev Can Psychiatr. 2002;47(4):349–54.

    Google Scholar 

  13. Oesterheld JR, Kofoed L, Tervo R, Fogas B, Wilson A, Fiechtner H. Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: a controlled pilot study. J Child Adolesc Psychopharmacol. 1998;8(1):39–48.

    Article  CAS  PubMed  Google Scholar 

  14. Steinhausen HC, Willms J, Spohr HL. Long-term psychopathological and cognitive outcome of children with fetal alcohol syndrome. J Am Acad Child Adolesc Psychiatry. 1993;32:990–4.

    Article  CAS  PubMed  Google Scholar 

  15. O’Connor MJ, Shah B, Whaley S, Cronin P, Gunderson B, Graham J. Psychiatric illness in a clinical sample of children with prenatal alcohol exposure. Am J Drug Alcohol Abuse. 2002;28:743–54.

    Article  PubMed  Google Scholar 

  16. Famy C, Streissguth AP, Unis AS. Mental illness in adults with fetal alcohol syndrome or fetal alcohol effects. Am J Psychiatry. 1998;155:552–4.

    Article  CAS  PubMed  Google Scholar 

  17. Snyder J, Nanson J, Snyder RE, Block GW. Stimulant efficacy in children with FAS. In: Streissguth AP, Kanter J, editors. The challenge of fetal alcohol syndrome: overcoming secondary disabilities. Seattle: University of Washington Press; 1997. p. 64–77.

    Google Scholar 

  18. Nugent K, Smart W. Attention-deficit/hyperactivity disorder in postsecondary students. Neuropsychiatr Dis Treat. 2014;26(10):1781–91.

    Google Scholar 

  19. Panevska LS, Zafirova-Ivanovska B, Vasileva K, Isjanovska R, Kadri H. Prevalence, gender distribution and presence of attention deficit hyperactivity disorder by certain sociodemographic characteristics among university students. Mater Sociomed. 2014;26(4):253–5.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Silva D, Houghton S, Hagemann E, Bower C. Comorbidities of attention deficit hyperactivity disorder: pregnancy risk factors and parent mental health. Community Ment Health J; 2014 (Epub).

  21. Sinopoli KJ, Schachar R, Dennis M. Traumatic brain injury and secondary attention-deficit/hyperactivity disorder in children and adolescents: the effect of reward on inhibitory control. J Clin Exp Neuropsychol. 2011;33(7):805–19.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Oades RD, Sadile AG, Sagvolden T, Viggiano D, Zuddas A, Devoto P, Aase H, Johansen EB, Ruocco LA, Russell VA. The control of responsiveness in ADHD by catecholamines: evidence for dopaminergic, noradrenergic and interactive roles. Dev Sci. 2005;8(2):122–31.

    Article  PubMed  Google Scholar 

  23. Rubia K, Alegria AA, Cubillo AI, Smith AB, Brammer MJ, Radua J. Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biol Psychiatry. 2014;76(8):616–28.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Snyder J, Nanson J, Snyder R, Block G. A study of stimulant medication in children with FAS. In: Streissguth A, Kanter J, editors. Overcoming and preventing secondary disabilities in fetal alcohol syndrome and fetal alcohol effects. Seattle: University of Washington Press; 1997.

    Google Scholar 

  25. Oesterheld JR, Kofoed L, Tervo R, Fogas B, Wilson A, Fiechtner H. Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: a controlled pilot study. J Child Adolesc Psychopharmacol. 1998;8(1):39–48.

    Article  CAS  PubMed  Google Scholar 

  26. Doig J, McLennan JD, Gibbard WB. Medication effects on symptoms of attention-deficit/hyperactivity disorder in children with fetal alcohol spectrum disorder. J Child Adolesc Psychopharmacol. 2008;18(4):365–71.

    Article  PubMed  Google Scholar 

  27. Ter-Stepanian M, Grizenko N, Zappitelli M, Joober R. Clinical response to methylphenidate in children diagnosed with attention-deficit hyperactivity disorder and comorbid psychiatric disorders. Can J Psychiatry. 2010;55(5):305–12.

    PubMed  Google Scholar 

  28. O’Malley KD, Koplin B, Dohner VA. Psychostimulant clinical response in fetal alcohol syndrome. Can J Psychiatry. 2000;45(1):90–1.

    PubMed  Google Scholar 

  29. Jin C, Schachar R. Methylphenidate treatment of attention-deficit/hyperactivity disorder secondary to traumatic brain injury: a critical appraisal of treatment studies. CNS Spectr. 2004;9(3):217–26.

    PubMed  Google Scholar 

  30. Patten SB, Waheed W, Bresee L. A review of pharmacoepidemiologic studies of antipsychotic use in children and adolescents. Can J Psychiatry. 2012;57(12):717–21.

    PubMed  Google Scholar 

  31. Bachmann CJ, Lempp T, Glaeske G, Hoffmann F. Antipsychotic prescription in children and adolescents: an analysis of data from a German statutory health insurance company from 2005 to 2012. Dtsch Arztebl Int. 2014;111(3):25–34.

    PubMed Central  PubMed  Google Scholar 

  32. Ronsley R, Scott D, Warburton WP, Hamdi RD, Louie DC, Davidson J, Panagiotopoulos C. A population-based study of antipsychotic prescription trends in children and adolescents in British Columbia, from 1996 to 2011. Can J Psychiatry. 2013;58(6):361–9.

    PubMed  Google Scholar 

  33. Baeza I, de la Serna E, Calvo-Escalona R, Morer A, Merchán-Naranjo J, Tapia C, Martínez-Cantarero MC, Andrés P, Alda JA, Sánchez B, Arango C, Castro-Fornieles J. Antipsychotic use in children and adolescents: a 1-year follow-up study. J Clin Psychopharmacol. 2014;34(5):613–9.

    Article  CAS  PubMed  Google Scholar 

  34. Pringsheim T, Gorman D. Second-generation antipsychotics for the treatment of disruptive behaviour disorders in children: a systematic review. Can J Psychiatry. 2012;57(12):722–7.

    PubMed  Google Scholar 

  35. Ipser J, Stein DJ. Systematic review of pharmacotherapy of disruptive behavior disorders in children and adolescents. Psychopharmacology (Berl). 2007;191(1):127–40.

    Article  CAS  Google Scholar 

  36. Frankel F, Paley B, Marquardt R, O’Connor M. Stimulants, neuroleptics, and children’s friendship training for children with fetal alcohol spectrum disorders. J Child Adolesc Psychopharmacol. 2006;16(6):777–89.

    Article  PubMed  Google Scholar 

  37. Ozarfati J, Koren G. Treatment of disruptive behavior in FASD. J Pop Ther Clin Pharmacol (in press).

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Acknowledgments

No sources of funding were used in the preparation of this review. The author has no conflicts of interest that are relevant to the review.

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Authors and Affiliations

  1. Motherisk Program, Division of Clinical Pharmacology/Toxicology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Gideon Koren

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Correspondence to Gideon Koren.

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Koren, G. Pharmacological Treatment of Disruptive Behavior in Children with Fetal Alcohol Spectrum Disorder. Pediatr Drugs 17, 179–184 (2015). https://doi.org/10.1007/s40272-015-0118-4

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