Comparison of Adaptive Behavior in Children With Heavy Prenatal Alcohol Exposure or Attention‐Deficit/Hyperactivity Disorder

Abstract

Background Adaptive behavior, the ability to respond successfully to everyday demands, may be especially sensitive to the effects of heavy prenatal alcohol exposure. Similar adaptive dysfunction is common in other developmental disorders including attention-deficit/hyperactivity disorder (ADHD). ADHD is frequently present in alcohol-exposed children and this overlap in clinical presentation makes identification of alcohol-exposed children difficult. Direct comparison of children with prenatal alcohol exposure and ADHD may yield distinct patterns of cognitive and behavioral performance and add to growing knowledge of the neuropsychological and behavioral profile of prenatal alcohol exposure. Therefore, the aim of the current study was to compare adaptive behavior in children with histories of heavy prenatal alcohol exposure (ALC), nonexposed children with ADHD (ADHD), and typically developing controls (CON). Methods Sixty-five children (ALC = 22, ADHD = 23, CON = 20) were selected from a larger ongoing study of the behavioral teratogenicity of alcohol. Alcohol-exposed and control participants were selected to match the ADHD subjects on age, sex, socioeconomic status, and race/ethnicity. Caregivers were administered the Vineland Adaptive Behavior Scales, a semi-structured interview, and were asked to rate their child’s behavior on 3 domains of adaptive function. Data were analyzed using regression techniques. Results Relative to controls, children in both the ALC and ADHD groups showed adaptive behavior deficits on all 3 domains and children in the ALC group were significantly more impaired than the ADHD group on the daily living skills domain. Within the ALC group, socialization standard scores were lower at older ages. This negative relationship between age and standard scores in the ALC group was also observed on the communication domain, a finding not previously reported. Conclusions This study suggests that both children with prenatal alcohol exposure and children with ADHD show impairments in adaptive function relative to controls, but that the pattern of impairment differs between these clinical groups. Adaptive ability in children with prenatal alcohol exposure is characterized by an arrest in development, as evidenced by a lack of improvement with age in socialization and communication scores. In contrast, children with ADHD exhibit a developmental delay in adaptive ability as their scores continued to improve with age, albeit not to the level of control children. Continued research focused on elucidating the patterns of deficits that exist in alcohol-exposed children ultimately will lead to improved differential diagnosis and effective interventions.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Proposed DSM-5 Diagnosis

“…A literature review [100] comparing children with PAE and those with ADHD concluded that children with PAE had greater impairments in problem-solving, overall IQ, shifting attention, verbal fluency, verbal encoding, daily living skills, and face and emotion processing than do children with ADHD. Adaptive behavior deficits observed in children with PAE grow increasingly more severe with age, suggesting a progressive decline in functioning over time relative to children with ADHD [65]. Children with PAE were also found to have more difficulties with conditions associated with over-arousal, whereas children with ADHD and no history of PAE demonstrated deficits in conditions of underarousal [101].…”

“…Notably, adaptive behavior deficits cannot be fully explained by decrements in IQ or a history of environmental disruption [64]. Children with PAE have been found to show delayed adaptive function even compared to those with Attention Deficit, Hyperactivity Disorder (ADHD), with socialization and communication impairments increasing with age [65]. Compared to healthy controls, young children with PAE need more intensive levels of adaptive support from parents and teachers [66].…”

Psycho-Social Characteristics of Children with Prenatal Alcohol Exposure, Compared to Children with Down Syndrome and Typical Children

“…These include hyperactivity (e.g., Aronson et al 1997;Mick et al 2002;Crocker et al 2009), conduct problems and oppositional behavior (e.g., Fryer et al 2007; Ryan and Ferguson 2006;Steinhausen et al 2003;Weinberg 1997), depression (e.g., Fryer et al 2007), and anxiety (Steinhausen et al 2003). It is, therefore, not surprising that poor academic achievement is also common among children with PAE (Fryer et al 2007).…”

Radiological studies of fetal alcohol spectrum disorders in humans and animal models: An updated comprehensive review

“…Attention deficit hyperactivity disorder (ADHD) is present in many cases of FASD and was suggested as a core deficit in FASD [100;101]. However, the impairments in adaptive function or cognitive ability in individuals with ADHD and FASD appeared distinct in certain respects [102][103][104].…”