The article examines the widespread use of psychotropic medications in adolescents with Fetal Alcohol Spectrum Disorder (FASD), highlighting a significant gap between current prescribing practices and the limited evidence supporting their effectiveness.
It emphasizes that individuals with FASD are uniquely vulnerable to adverse and unpredictable medication responses due to underlying neurodevelopmental differences. High rates of polypharmacy, inconsistent outcomes, and iatrogenic effects (harm caused by treatment) are common, often leading to cycles of increased medication use rather than improved functioning.
In response, the authors propose a structured, ethically grounded tapering protocol that reframes medication reduction as a therapeutic and developmental process. This model prioritizes:
- Neurodevelopmental understanding
- Relational stability (caregivers, educators, supports)
- Environmental predictability
- Cultural context and identity
The protocol includes three phases:
- Multidimensional assessment
- Gradual tapering with integrated supports
- Long-term monitoring and relational consolidation
Overall, the article calls for a shift away from symptom-driven pharmacological approaches toward holistic, relational, and context-driven care for individuals with FASD.
Reflection for the WRaP Project: Relevance to Educators
This article reinforces a key message at the core of WRaP: behaviour in students with FASD must be understood through a neurodevelopmental and relational lens, not simply managed as a problem to fix.
It highlights how easily behaviours like inattention, emotional reactivity, or impulsivity can be misinterpreted, especially when medication is involved or changing. What may appear as worsening behaviour can actually reflect brain-based differences, environmental stress, or even medication side effects.
For educators, this underscores the importance of predictability, consistency, and relationship. Stable routines, clear expectations, and strong communication with caregivers are not just good practice; they are essential supports that directly influence student regulation and success.
The article also reminds us that educators play a critical role in preventing cycles of misunderstanding. With the right lens, teachers can shift from reacting to behaviour to responding with intention, adjusting expectations and supporting regulation rather than escalating interventions.