Background Children with heavy prenatal alcohol exposure often meet criteria for attention-deficit/hyperactivity disorder (ADHD). ADHD research has examined subtype differences in symptomology, including sluggish cognitive tempo (SCT). This construct is defined by behavioral symptoms including, hypoactivity and daydreaming, and has been linked to increased internalizing behaviors. The current study examined if similar findings are displayed in children with prenatal alcohol exposure. Methods As part of a multisite study, caregivers of 272 children (8–16y) completed the SCT scale and Child Behavior Checklist (CBCL). Four groups were included: alcohol-exposed children with ADHD (ALC+; n=75), alcohol-exposed children without ADHD (ALC−; n=35), non-exposed children with ADHD (ADHD; n=60), and non-exposed children without ADHD (CON; n=102). SCT and CBCL scores were analyzed using 2 (exposure) × 2 (ADHD) ANOVAs. Pearson correlations measured the relations between SCT, CBCL, and FSIQ. Discriminant function analysis (DFA) examined if SCT items could accurately classify groups. Results Analyses revealed significant main effects of Exposure and ADHD on SCT, internalizing, and externalizing scores, and significant interaction effects on SCT and internalizing scores. SCT significantly correlated with internalizing, externalizing, and attention ratings in all groups and with FSIQ in ALC+. DFA indicated that specific SCT items could distinguish ALC− from CON. Conclusions Alcohol-exposed children exhibited elevated SCT scores. Elevations were related to increased parent ratings of internalizing and externalizing behaviors and attention. These findings occurred in alcohol-exposed children regardless of ADHD symptoms and specific SCT items proved useful in distinguishing exposed children suggesting clinical utility for this measure in further defining the neurobehavioral profile related to prenatal alcohol exposure.

Clinical research and practice support a multi-method approach to validating behavioral problems in children. We examined whether parent-reported symptoms of hyperactivity and inattention (using the Disruptive Behavior Disorder Rating Scale) were substantiated by objective laboratory measures [hyperactivity measured by wrist-worn actigraphy (ACT) and inattention assessed using a 20-minute continuous performance task (CPT)] in three age- and demographically-matched groups of school-age children: children with prenatal alcohol exposure (AE), non-exposed children with idiopathic ADHD (ADHD), and controls (CON). Results indicated that the clinical groups (AE, ADHD) had significantly higher parent-reported levels for both domains compared to the CON group, and did not differ from each other. On the laboratory measures, the clinical groups were more inattentive than controls on the CPT, but did not differ from each other. In contrast, the ADHD group had higher objective activity on the ACT than AE and CON, which did not differ from each other. Thus, laboratory measures differentially validated parent reports in a group-dependent manner. Actigraphy substantiated parent-reported hyperactivity for children in the ADHD group but not for children in the AE group, while the CPT validated parent-reported inattention for both clinical groups. Although the majority of children in the AE group met criteria for ADHD, objective activity levels were not different from controls, indicating that hyperactivity may be a less prominent feature in the AE group. Thus, while there is considerable overlap between the effects of prenatal alcohol exposure and ADHD, differences in behavioral profiles may be clinically useful in differential diagnosis. Further, these data indicate that objective measures should be used to validate parent reports.

Objective Heavy prenatal alcohol exposure is associated with impaired school functioning. Spelling performance has not been comprehensively evaluated. We examined whether children with heavy prenatal alcohol exposure demonstrate deficits in spelling and related abilities, including reading, and tested whether there are unique underlying mechanisms for observed deficits in this population. Method Ninety-six school-age children comprised two groups: children with heavy prenatal alcohol exposure (AE, n=49) and control children (CON, n=47). Children completed select subtests from the WIAT-II and NEPSY-II. Group differences and relations between spelling and theoretically-related cognitive variables were evaluated using MANOVA and Pearson correlations. Hierarchical regression analyses were utilized to assess contributions of group membership and cognitive variables to spelling performance. The specificity of these deficits and underlying mechanisms was tested by examining the relations between reading ability, group membership, and cognitive variables. Results Groups differed significantly on all variables. Group membership and phonological processing significantly contributed to spelling performance. In addition, a significant group*working memory interaction revealed that working memory independently contributed significantly to spelling only for the AE group. All cognitive variables contributed to reading across groups and a group*working memory interaction revealed that working memory contributed independently to reading only for alcohol-exposed children. Conclusion Alcohol-exposed children demonstrated a unique pattern of spelling deficits. The relation of working memory to spelling and reading was specific to the AE group, suggesting that if prenatal alcohol exposure is known or suspected, working memory ability should be considered in the development and implementation of explicit instruction.

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Background Prenatal alcohol exposure affects inhibitory control and other aspects of attention and executive function. However, the efficacy of extrinsic reinforcement on these behaviors has not been tested. Methods Alcohol-exposed children (AE; n=34), children with ADHD (ADHD; n=23), and controls (CON; n=31) completed a flanker task with four reward conditions (no reward, reward, reward+occasional response cost, equal probability of reward+response cost). Inhibitory control was tested in the no reward conditions using a 3(group) x 2(flanker type) ANCOVA. Response to reinforcement was tested using 3(group) x 4(reward condition) x 4(flanker type) ANCOVA. Response time (RT) and accuracy were tested independently. Results Groups did not differ on demographic variables. The flanker task was successful in taxing interference control, an aspect of executive attention (i.e., responses to incongruent stimuli were slower than to congruent stimuli) and the AE group demonstrated impaired executive control over the other groups. Overall, the AE group had significantly slower response times compared to the CON and ADHD groups, which did not differ. However, reinforcement improved RT in all groups. While occasional response cost had the greatest benefit in the CON group, the type of reinforcement did not differentially affect the AE and ADHD groups. Accuracy across reward conditions did not differ by group, but was dependent on flanker type and reward condition. Conclusions Alcohol-exposed children, but not children with ADHD, had impaired interference control in comparison to controls, supporting a differential neurobehavioral profile in these two groups. Both clinical groups were equally affected by introduction of reinforcement, although the type of reinforcement did not differentially affect performance as it did in the control group, suggesting that reward or response cost could be used interchangeably to result in the same benefit.