胎儿酒精谱系障碍

管理的第一步需要对暴露过酒精的儿童的识别、诊断以及完整的临床和心理评估以确定孩子具体的优势与弱势；

然后推荐干预法来处理孩子具体的优势与劣势情况。

认知控制疗法（对体位、运动以及意识、注意力和信息加工、控制和分类）被发现可以改善患胎儿酒精综合征的孩子的行为。[68]Riley EP, Mattson SN, Li TK, et al. Neurobehavioral consequences of prenatal alcohol exposure: an international perspective. Alcohol Clin Exp Res. 2003;27:362-373.http://www.ncbi.nlm.nih.gov/pubmed/12605086?tool=bestpractice.com

语言与识字干预（即由语言治疗师管理的语言疗法、音韵学意识以及读写能力训练的结合）被证明可以大大提高识字、阅读以及拼写能力。[69]Adnams CM, Sorour P, Kalberg WO, et al. Language and literacy outcomes from a pilot intervention study for children with fetal alcohol spectrum disorders in South Africa. Alcohol. 2007;41:403-414.http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17936509http://www.ncbi.nlm.nih.gov/pubmed/17936509?tool=bestpractice.com[70]Stromland K, Mattson SN, Adnams CM, et al. Fetal alcohol spectrum disorders: an international perspective. Alcohol Clin Exp Res. 2005;29:1121-1126.

数学干预被证明可以提高数学知识，这在患有胎儿酒精综合征或部分胎儿酒精综合征以及智商过50的孩子中，这些知识6个月的随访时也可维持。[71]Coles CD, Kable JA, Taddeo E. Math performance and behavior problems in children affected by prenatal alcohol exposure: intervention and follow-up. J Dev Behav Pediatr. 2009;30:7-15.http://www.ncbi.nlm.nih.gov/pubmed/19194327?tool=bestpractice.com[72]Kable JA, Coles CD, Taddeo E. Socio-cognitive habilitation using the math interactive learning experience program for alcohol-affected children. Alcohol Clin Exp Res. 2007;31:1425-1434.http://www.ncbi.nlm.nih.gov/pubmed/17550365?tool=bestpractice.com数学互动学习经验（MILE）的理论基础是基本认知功能支持数学认知且影响学习成绩及适应性功能技巧。

针对胎儿酒精综合征和部分胎儿酒精综合征的孩子也评估了虚拟现实的游戏。[73]Coles CD, Strickland DC, Padgett L, et al. Games that "work": using computer games to teach alcohol-affected children about fire and street safety. Res Dev Disabil. 2007;28:518-530.http://www.ncbi.nlm.nih.gov/pubmed/16965894?tool=bestpractice.com]以计算机为基础的虚拟-现实游戏可被设计用来教孩子们一个新的技巧（如防火安全）。接受虚拟-现实干预的孩子知识储备大大增加，并且能维持到1周以后的随访中。[73]Coles CD, Strickland DC, Padgett L, et al. Games that "work": using computer games to teach alcohol-affected children about fire and street safety. Res Dev Disabil. 2007;28:518-530.http://www.ncbi.nlm.nih.gov/pubmed/16965894?tool=bestpractice.com

神经认知小儿康复疗法的干预被证明可以提高胎儿酒精谱系障碍以及酒精相关的神经系统发育障碍患儿的执行功能和解决问题的技巧。[74]Wells AM, Chasnoff IJ, Schmidt CA, et al. Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: an adaptation of the Alert Program®. Am J Occup Ther. 2012;66:24-34.http://ajot.aota.org/article.aspx?articleid=1851537http://www.ncbi.nlm.nih.gov/pubmed/22251828?tool=bestpractice.com

孩子的友谊训练，一个基于社会学系理论的社交能力培训计划，被证明能大大提高患有胎儿酒精综合征、部分胎儿酒精综合征或酒精相关的神经发育障碍（社交能力欠缺而且智商70或以上）的孩子的社交知识。这将维持到3个月的访问期。[75]O'Connor MJ, Frankel F, Paley B, et al. A controlled social skills training for children with fetal alcohol spectrum disorders. J Consult Clin Psychol. 2006;74:639-648 (erratum in: J Consult Clin Psychol. 2007;75:71).http://www.ncbi.nlm.nih.gov/pubmed/16881771?tool=bestpractice.com

父母称，孩子们的社交能力在此期间提高而且问题行为也相应减少。不过，老师们却认为没有明显的差别[75]O'Connor MJ, Frankel F, Paley B, et al. A controlled social skills training for children with fetal alcohol spectrum disorders. J Consult Clin Psychol. 2006;74:639-648 (erratum in: J Consult Clin Psychol. 2007;75:71).http://www.ncbi.nlm.nih.gov/pubmed/16881771?tool=bestpractice.com

家长教育课程，如家庭勇往直前课程在患有胎儿酒精谱系障碍的孩子（有外部或注意力问题而且智商在70以上）中被评估。[76]Bertrand J. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil. 2009;30:986-1006.http://www.ncbi.nlm.nih.gov/pubmed/19327965?tool=bestpractice.com这个课程使用了持续9-11个月的低强度行为会诊支持模式，家长的自我效能及参与自我护理行为有较大的进步，并且减少了挑战行为和破坏行为。[76]Bertrand J. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil. 2009;30:986-1006.http://www.ncbi.nlm.nih.gov/pubmed/19327965?tool=bestpractice.com

收养护理系统的患胎儿酒精综合征或酒精相关的神经系统发育障碍儿童，开发了神经认知小儿康复，作为一个系统干预。[76]Bertrand J. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil. 2009;30:986-1006.http://www.ncbi.nlm.nih.gov/pubmed/19327965?tool=bestpractice.com这个课程为家庭提供了支持和教育而且集中改善孩子的执行功能，进而促成了执行功能指标的改善。[76]Bertrand J. Interventions for children with fetal alcohol spectrum disorders (FASDs): overview of findings for five innovative research projects. Res Dev Disabil. 2009;30:986-1006.http://www.ncbi.nlm.nih.gov/pubmed/19327965?tool=bestpractice.com

有ADHD症状的胎儿酒精谱系障碍的儿童可考虑中枢神经系统兴奋剂治疗，这些孩子同时有酒精相关的神经系统发育障碍症状。[78]Peadon E, Elliott EJ. Distinguishing between attention-deficit hyperactivity disorder and fetal alcohol spectrum disorders in children: clinical guidelines. Neuropsychiatr Dis Treat. 2010;6:509-515.http://www.ncbi.nlm.nih.gov/pubmed/20856914?tool=bestpractice.com

活跃冲动分数随着治疗大大改善，但除了胎儿酒精综合征和部分胎儿酒精综合征的孩子外，患有酒精相关的神经系统发育障碍的孩子中注意力没有改善。[79]Snyder J, Nanson J, Snyder R, et al. A study of stimulant medication in children with FAS. In: Streissguth A, Kanter J, eds. Overcoming and preventing secondary disabilities in fetal alcohol syndrome and fetal alcohol effects. Seattle, WA: University of Washington Press; 1997:64-77.[80]Oesterheld JR, Kofoed L, Tervo R, et al. 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;8:39-48.http://www.ncbi.nlm.nih.gov/pubmed/9639078?tool=bestpractice.com同时患有酒精相关的神经系统发育障碍和胎儿酒精综合征的孩子可能对右旋安非他明比哌醋甲酯反应更好。[81]O'Malley KD, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Can J Psychiatry. 2002;47:349-354.http://www.ncbi.nlm.nih.gov/pubmed/12025433?tool=bestpractice.com

剂量和药物与酒精相关的神经系统发育障碍的患者的使用一样。

系统的注意力训练，一门旨在解决（脑部有损伤）个体注意力和集中程度的课程，在患有胎儿酒精谱系障碍和注意力缺陷/多动症孩子中，被证明会大大改善持续注意和非言语推理的指标，而不是测试执行功能的指标。[77]Vernescu R. Attention process training in young children with fetal alcohol spectrum disorders. 2nd International Conference on Fetal Alcohol Spectrum Disorders; Victoria, BC: 2007.

可能需要外科手术，手术方式取决于具体的先天畸形类型。