Medication Algorithm for FASD

Dr. Mela and a team of 12 multidisciplinary international experts spent over 2 years developing a decision-tree style medication algorithm to guide prescribers as they see patients with Fetal Alcohol Spectrum Disorder/Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (FASD/ND-PAE).

This algorithm is the first-ever treatment recommendation for psychotropic medications for FASD/ND-PAE. It is based on all available evidence (albeit very limited), which was consolidated in a systematic review. From there, the algorithm was developed.

The research team is working on evaluating the algorithm to understand the effectiveness and allow for improvements for future iterations. They are looking for clinicians to participate in this research.

The Medication Algorithm is now available in a mobile app: SimpliFASD. 

SimpliFASD on the App Store
SimpliFASD on Google Play

Research Publications:

Utilization of psychotropic medications in children with FASD: a retrospective review (open access)
BMC Pediatrics, November 2021

Treatment algorithm for the use of psychopharmacological agents in individuals prenatally exposed to alcohol and/or with diagnosis of fetal alcohol spectrum disorder (FASD)
Journal of Population Therapeutics and Clinical Pharmacology, July 2020

The utility of psychotropic drugs on patients with Fetal Alcohol Spectrum Disorder (FASD): a systematic review (open access)
Psychiatry and Clinical Psychopharmacology, April 2018

How to Use the Algorithm

This medication algorithm is intended for individuals with a primary diagnosis of:

  • Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure
  • Fetal Alcohol Spectrum Disorder (with or without sentinel facial features)
  • Alcohol-related Neurodevelopmental Disorder

Non-pharmaceutical approaches should be used before any medication options are tried for each patient. These include ensuring that the patient has sufficient dietary, exercise, and sleep support, and establishing family, psychosocial, and community supports. Other nonpharmacological interventions include functional behaviour analysis, behavioural management, and environmental modifications.

As a clinician, it is important to identify the primary “clusters” (domains) to target treatment. The first line of treatment is reserved for the cluster with the most impairing effect on functioning. After an adequate trial of the medications from the first line, medications from the second line can be tried, followed by other traditional guidance. Finally, if the first or second line medications are not effective, the adjunct treatment may be considered from the list in the algorithm. Read the quick guide for using the medication algorithm.

The clusters include:

  • Hyper-arousal (with hypervigilance, aggression, insomnia, irritability, agitation, anger, anxiety, tension, reduced pain threshold)
  • Emotional dysregulation (with mood swings, excitability, anxiety, depression)
  • Hyperactivity/Neurocognitive (with restless movements, impulsiveness, inattention, distractibility and executive dysfunction)
  • Cognitive inflexibility with impaired perspective taking, poor abstraction, low frustration tolerance, poor social skills and impaired reasoning and reality testing

The Medication Algorithm is now available in a mobile app. SimpliFASD is available for download through the android and Apple app stores on your phone or tablet.

Resources:           

Join the Project

We are looking for clinicians to help us evaluate the Medication Algorithm. This survey is to be completed by prescribers who are using the medication algorithm with their patients. If you choose to participate, you will be asked to complete questions requesting brief information about you as a clinician, the patient (deidentified) with whom you used the algorithm, and the outcomes of the algorithm use. Take the survey.

Partners: University of Saskatchewan and Canada FASD Research Network

TAKE THE SURVEY
FREQUENTLY ASKED QUESTIONS
ALGORITHM SUMMARY