Therapy Approaches That Make a Difference for Children with FASD

Caitlin Houghton
Sep 22
4 min read

Fetal Alcohol Spectrum Disorder (FASD) is one of the most common yet least understood neurodevelopmental conditions. Estimates suggest that at least 3–5% of the Australian population may be affected, although prevalence varies depending on community and context (Bower & Elliott, 2016). Children with FASD often face lifelong challenges with learning, memory, emotional regulation, attention, and adaptive skills. But with the right therapeutic supports, they can thrive. Families often ask: what actually makes a difference?

Drawing on the growing body of evidence, here are therapy approaches that research and practice show can create meaningful change for children with FASD.

1. A Foundation of Safety and Relationship

The starting point for any therapy with children who have FASD is not a technique—it’s the relationship. Children with FASD are more likely to have experienced early adversity, and research highlights that stress, unpredictability, and trauma compound neurological differences (Peadon et al., 2009; Price et al., 2017).

Therapists can:

Prioritise predictable routines and environments.
Build trust through consistency, warmth, and patience.
Recognise the child’s behaviour as communication, not “defiance.”

When the nervous system feels safe, children are more able to access the learning and therapeutic strategies we introduce.

2. Speech and Language Therapy Focused on Social Communication

Children with FASD often experience difficulties with receptive and expressive language, as well as social pragmatics (Carmichael Olson et al., 2009). Speech therapy is effective when it goes beyond vocabulary drills and supports:

Narrative skills – helping children organise and share stories.
Social understanding – using modelling, role-play, and video feedback.
Augmentative and Alternative Communication (AAC) when language is significantly impacted.

Approaches like Story Champs (Spencer & Petersen, 2012) or Hanen programs can scaffold language while also supporting social connection.

3. Occupational Therapy for Regulation and Daily Living

Occupational therapists play a critical role in supporting children with FASD. Research suggests OT is most effective when it helps with regulation, sensory integration, and functional independence (Kable et al., 2016). Useful approaches include:

Sensory supports tailored to the child’s profile (quiet spaces, movement breaks, weighted items).
Executive functioning scaffolds such as visual schedules, timers, and step-by-step routines (Mattson et al., 2011).
Skill-building for daily living, from dressing and eating to community participation.

The emphasis is not on “fixing deficits” but on adapting environments and building capacity.

4. Mental Health and Counselling Supports

Rates of anxiety, depression, and trauma exposure are higher in children and adolescents with FASD (O’Connor et al., 2015). Counselling can be effective when interventions are relational, structured, and concrete:

Cognitive-behavioural strategies adapted to the child’s developmental level.
Play-based therapy for emotional expression and problem-solving.
Family support and psychoeducation, reducing stress and increasing understanding (Premji et al., 2019).

A strong message from families is that therapy is most helpful when it supports both the child and the caregiving environment.

5. Collaborative, Transdisciplinary Models

Perhaps the strongest evidence is not about one discipline, but about how services are delivered. Reviews emphasise that children with FASD benefit most when professionals and families work together in consistent, coordinated ways (Peadon & Elliott, 2010; Reid et al., 2015).

This might look like:

Shared goal-setting across speech, OT, counselling, and school.
Cross-discipline observation and joint sessions.
Unified strategies for behaviour, communication, and learning.

6. Strength-Based Approaches

Research shows that children with FASD have remarkable creativity, humour, persistence, and capacity for joy (Denys et al., 2011). Therapy is most effective when it identifies and builds on these strengths. Using a strengths-based lens shifts the narrative from “managing problems” to “supporting potential.”

Final Thoughts

What makes the difference is a combination of evidence-based strategies, strong therapeutic relationships, and collaborative, family-centred care.

Supporting children with FASD means committing to patience, flexibility, and hope. When therapy honours dignity, adapts to individual needs, and works alongside families, it creates the conditions for children not just to cope but to flourish.

References

Bower, C., & Elliott, E. J. (2016). On behalf of the Steering Group. Report to the Australian Government Department of Health: Australian Guide to the diagnosis of FASD.
Carmichael Olson, H., et al. (2009). A call to action: Advancing essential services and research on FASD. Journal of Clinical Child & Adolescent Psychology, 38(5), 736–750.
Denys, K., Rasmussen, C., & Henneveld, D. (2011). The effectiveness of a community-based intervention for parents with FASD. Journal of Population Therapeutics and Clinical Pharmacology, 18(3), 421–437.
Kable, J. A., Taddeo, E., & Strickland, D. (2016). Neurodevelopmental interventions for children with FASD: A review. Neurotoxicology and Teratology, 54, 121–133.
Mattson, S. N., Crocker, N., & Nguyen, T. T. (2011). Fetal Alcohol Spectrum Disorders: Neuropsychological and behavioural features. Neuropsychology Review, 21, 81–101.
O’Connor, M. J., et al. (2015). Psychiatric illness in a clinical sample of children with FASD. Alcoholism: Clinical and Experimental Research, 39(12), 2310–2320.
Peadon, E., Rhys-Jones, B., Bower, C., & Elliott, E. J. (2009). Systematic review of interventions for children with FASD. BMC Pediatrics, 9, 35.
Peadon, E., & Elliott, E. J. (2010). Distinguishing between attention-deficit hyperactivity and FASD in children: Clinical guidelines. Neuropsychiatric Disease and Treatment, 6, 509–515.
Premji, S., et al. (2019). The effectiveness of interventions for FASD: A systematic review. Canadian Journal of Public Health, 110(5), 586–597.
Price, A., Cook, P. A., Norgate, S. H., & Mukherjee, R. A. S. (2017). Prenatal alcohol exposure and traumatic childhood experiences: A systematic review. Neuroscience & Biobehavioral Reviews, 80, 89–98.
Reid, N., et al. (2015). Systematic review of FASD interventions in adolescence. BMC Psychiatry, 15, 223.
Spencer, T. D., & Petersen, D. B. (2012). Narrative intervention for children with language disorders. Journal of Speech, Language, and Hearing Research, 55, 748–767.