Caregivers’ Experiences of Family-Based Trauma-Informed Interventions for Children with Prenatal Alcohol Exposure

Abstract Children prenatally exposed to alcohol often face a multitude of difficulties such as mental health difficulties and behavioural and cognitive challenges. A high percentage of children with prenatal alcohol exposure (PAE) have also experienced traumatic life events. Research suggests that interventions can help reduce the difficulties faced after trauma, particularly when involving the caregiver and child. Due to the cognitive difficulties often experienced by children with PAE, it is unclear whether typical trauma-informed interventions can be effectively used with this population. This study aimed to explore the experiences of caregivers whose children with PAE participated in a family-based, trauma-informed intervention. Eleven caregivers (10 adoptive, one foster) were recruited via therapeutic services in the UK and an established FASD mailing list. Caregivers were caring for a total of 12 children with PAE aged 8 to 18. A variety of interventions were received, including Theraplay, Dyadic Developmental Psychotherapy, Cognitive Behavioural Therapy, Sandplay Therapy, therapeutic parenting sessions and sensory therapies. These were accessed for varying lengths of times and in different combinations. Reflexive thematic analysis was employed to explore semi-structured interview data, with particular focus on perceived benefits and challenges, children’s ability to engage in therapy, potential outcomes and factors influencing change. This generated five interrelated themes: (1) Enduring the therapeutic journey to survive, (2) Engagement as fluid and negotiable, (3) The therapeutic relationship is the active ingredient, (4) “There’s no magic button”: supported caregivers are the agents of change, (5) Redefining success. Family-based therapy was positioned as a relational, effortful, and ongoing process that supports families to live with enduring complexity. Therapeutic change was primarily located within caregivers’ development of understanding, responsiveness and ability to adapt the caregiving environment, as opposed to within the child. Engagement emerged as negotiated and developmentally contingent, with the therapeutic relationship as a central component. Therapy was shaped by the perceived permanence of PAE and trauma and by wider systemic constraints. The findings support family-based, flexible therapeutic approaches for children with PAE and trauma that prioritise relational safety and caregiver understanding. Early sensory and play-based interventions, integration of therapeutic models, and caregiver-only sessions may enhance effectiveness.