Fetal alcohol spectrum disorder (FASD) is considered to be the most common cause of developmental disability, affecting more than 1% of the general population in North America. Inattention, hyperactivity, and impulsivity afflict 50-90% of children with FASD and are 3-9 times more common than in the general population. Of importance, a large proportion of children with FASD are affected by oppositional defiant/conduct disorder (ODD/CD), including lack of social judgment and failure to learn from experience. These devastating numbers are contrasted by almost no pharmacological research into treatment of these pervasive conditions in FASD. This review focuses on analyzing the published evidence on the effectiveness and safety of therapy for disruptive behaviors in FASD. Often, the child afflicted by FASD will not be allowed to participate in class activities without such therapies, which makes such analysis critical.