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New FASD algorithm to deliver targeted prescribing guidelines

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People with fetal alcohol spectrum disorder (FASD) are often prescribed multiple psychotropic medications to treat co-occurring neurodevelopmental impairments – but this approach can potentially put them at risk of overmedication and unpredictable side effects.
 
Instead, healthcare providers should look at psychosocial and environmental factors before prescribing psychotropic medications.
 
These are the findings of new research from Canada, which found family members and carers of people with FASD report polypharmacy and its side effects can render the medications ineffective.
 
Due to the complexity of FASD, there has previously been no consistency in how medications are prescribed and such approaches ‘lag behind psychosocial interventions’, the researchers say.
 
This problem saw the researchers – led by Professor Mansfield Mela – to develop the first ever medication treatment algorithm for people with FASD, designed to assist healthcare providers in prescribing the most appropriate treatment for symptoms of FASD and other neurodevelopmental disorders.
 
These treatments can be either medication or non-drug based.
 
Rather than prescribing based on the overall FASD diagnosis, the algorithm targets specific symptoms individuals experience the most.
 
Common ‘cluster’ symptoms include hyper-arousal (hypervigilance, aggression, insomnia and anxiety), emotional dysregulation (mood swings, excitability, depression), hyperactivity (restlessness, impulsiveness, inattention), cognitive inflexibility, poor abstraction, low frustration tolerance, poor social skills and impaired reasoning and reality testing.
 
Once these symptoms are addressed, appropriate treatment can be streamlined and the risk of over-medicating reduced, which should improve the daily functioning of the person with FASD, the researchers believe.
 
Although some medication may be necessary, healthcare professionals should explore non-pharmaceutical interventions first, according to Professor Mela.
 
‘Environmental and behavioural stressors, such as not eating well or not getting enough sleep, can impact the number and severity of symptoms someone with FASD may experience,’ Professor Mela said.
 
‘Addressing these environmental and behavioural factors first can potentially eliminate the need for medication to address those symptoms.’
 
Exercise, a healthy diet, adequate sleep and supportive healthy relationships and environments are all non-pharmaceutical interventions included in the algorithm.

Australian FASD experts from Telethon Kids Institute have also identified that early assessment and intervention, as well as adapting environments and modifying lifestyle behaviours before prescribing medications, can be of significant benefit to individuals with FASD and their carers.
 
These include:

• developing structured and predictable routines
• creating safe and predictable environments that consider the impact of sensory input (such as auditory stimuli) on an individual
• creating a safe and non-punitive ‘chill-out’ zone where the individual can retreat if feeling overwhelmed or needing a calming space.

The medication algorithm was developed over a two-year period in consultation with medical experts and community carers of people with FASD who expressed concerns around overmedication. As a management rather than a prevention tool, it aims to support people diagnosed with FASD – often a permanent part of their life.
 
‘People affected by fetal alcohol exposure are at risk of life-long brain damage, which may result in learning difficulties, mental illness, contact with the criminal justice system and subsequent incarceration. Often they require lifelong support,’ Australian Drug Foundation CEO Dr Erin Lalor recently told newsGP.

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alcohol FASD overprescribing polypharmacy

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