A systematic review of challenging behaviors in children exposed prenatally to substances of abuse.
Only three of 37 studies tested interventions for challenging behaviors in substance-exposed kids—target postnatal environmental variables when you do treat.
01Research in Context
What this study did
Dixon et al. (2008) read every paper they could find on challenging behaviors in children exposed to alcohol, cocaine, or other drugs before birth. They kept only the 37 studies that actually measured behavior. Then they looked for clear links between the drug and later problems.
What they found
Alcohol showed the clearest link to later hitting, yelling, or defiance. Cocaine looked less guilty once home life was counted. Only three of the 37 studies tried an intervention. The big message: change the child’s world today; the past cannot be undone.
How this fits with other research
O'Reilly et al. (2008) is one of the three intervention studies R et al. counted. A quick functional assessment cut problem behavior for two cocaine-exposed children. No fancy changes were needed; standard FBA worked.
Bertrand (2009) came next and added five new FASD programs that actually worked. Benallal et al. (2026) later pooled parent-training studies and also saw gains. Together these papers flip the 2008 “no evidence” verdict into a clear action list: assess, teach parents, and track results.
Jirikowic et al. (2010) and Pei et al. (2017) show what clinics now recommend after diagnosis: speech, OT, and school supports. These service lists match the 2008 call to target postnatal variables.
Why it matters
You will meet these kids. Prenatal exposure is common yet often hidden. Start with a fast functional assessment, just like O'Reilly et al. (2008) did. Add parent training from the Larbi list and sensory screens from Bellon-Harn et al. (2020). You do not need special tools; you need to act.
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02At a glance
03Original abstract
A review of the existing literature on the occurrence of challenging behavior among children with prenatal drug exposure was conducted. While a large number of studies were identified that evaluated various outcomes of prenatal drug exposure, only 37 were found that directly evaluated challenging behaviors. Of the 37 studies, 23 focused on prenatal cocaine exposure, and 14 focused on prenatal alcohol exposure; most studies relied on broadband measures such as the CBCL for the assessment of challenging behavior. Among the 37 studies, a clear role for the postnatal environment on developing challenging behaviors was evident; however, prenatal alcohol exposure showed a much clearer independent effect upon challenging behaviors than was noted in the prenatal cocaine studies. Additionally, only 3 of the 37 studies addressed interventions for challenging behaviors, each of which showed an improvement in child behavior or parent-child interactions. As researchers have continued to show the importance of the postnatal environment, it is likely that interventions addressing specific environmental risk factors will be helpful to reduce or prevent challenging behaviors among this population.
Research in developmental disabilities, 2008 · doi:10.1016/j.ridd.2007.05.006