CanFASD recently released a new issue paper Broad Approaches to Psychotherapy for Individuals with FASD. Below is a short summary. You can read the full issue paper here.

Issue:

Many people with fetal alcohol spectrum disorder (FASD) experience mental health challenges at some point in their lives. Despite the mental health needs of people with FASD being well-documented, there is relatively little evidence around how best to respond. When mental health needs aren’t met, individuals with FASD may experience additional adversity which has significant personal, social, and economic costs for the individual, their family, and the wider community.

Background:

General Factors Impacting Therapy Outcomes

• Psychotherapy is known to be effective at addressing a wide range of mental health concerns
• The specific approach to psychotherapy has less of an impact on outcomes than “common factors” that can be applied across different types of therapy
  • One of the most widely studied common factors is therapeutic alliance, which is a “purposeful and collaborative” relationship between therapist and client
• Although the literature on common factors isn’t specific to people with FASD, the relational strengths of individuals with FASD align well with the therapeutic alliance

Psychotherapy Research in FASD

• Right now, there is not enough evidence to strongly endorse any specific therapeutic approach for working with clients with FASD
• However, studies show that people with FASD and other developmental disabilities can and do benefit from psychological interventions

Barriers for Individuals with Developmental Disabilities

• Individuals with developmental disabilities (including those with FASD) experience significant obstacles in accessing adequate supports for mental health challenges
• These obstacles can relate to both the disability itself (e.g., cognitive or communication difficulties) or systemic barriers (e.g., limited availability of disability-informed services)
• People with FASD experience additional challenges to accessing supports outside of those common to the developmental disability population, such as highly complex needs, resulting in multi-layered barriers

Emerging FASD-Informed Approaches

• Therapists and service providers must account for the unique needs of those with FASD in psychotherapy using flexible, creative, and adapted approaches
  • Adapted responses: An integrated model for FASD-informed clinical practice recommends that clinicians engage in reflection, communicate through open discussion, and take action to find strategies that work best for individuals with FASD and meet the client where they are at.
  • Practical strategies: emerging evidence in the field of FASD parallels some adapted approaches recommended for clients with developmental disabilities, such as offering simplified treatments, repetition and consistency, using multi-modal techniques, identifying functional needs, role-playing and skill-building, and engaging a support person, among others.
  • Consideration of complex needs: Therapeutic approaches need to recognize the unique biopsychosocial complexities of FASD and consider the broader factors that influence individual health and wellbeing.

Take Home Message:

FASD can have significant impacts on the mental health and wellbeing of individuals with FASD and their families. Although there is limited research on psychotherapy for people with FASD, insight from clinical and anecdotal evidence in the FASD field as well as information from the broader literature provides promising avenues for future FASD-informed approaches. Targeted research, practice, and policy efforts are needed to implement effective treatment and supports for individuals with FASD, their families, and communities.

Authors: Katherine Flannigan, Jacqueline Pei, Kaitlyn McLachlan, & Mansfield Mela

Date: July 2022

For more information, including recommendations, please read the full issue paper here.