Prenatal Alcohol Exposure, Attention‐Deficit/Hyperactivity Disorder, and Sluggish Cognitive Tempo

Abstract

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.

The Clinical Utility and Specificity of Parent Report of Executive Function among Children with Prenatal Alcohol Exposure

“…These findings are consistent with prior studies showing an exacerbated effect of multiple risk factors in the AE+ group, resulting in more severe deficits in parent-reported behavior (Glass, Graham, et al, 2013; Graham, Crocker, et al, 2013; Ware et al, 2013) but not in neuropsychological performance (Glass, Ware, et al, 2013; Rasmussen et al, 2010). Our results support and extend these previous findings, as this is the first study to compare this pattern within the same domain.…”

The Influence of Extrinsic Reinforcement on Children with Heavy Prenatal Alcohol Exposure

“…Importantly, although parents were the source for most of the information on ADHD symptoms, the DISC interview includes questions about whether symptoms are present in more than one setting, as required for a diagnosis (American Psychiatric Association, 2013). In the AE group, 29 (85.3%) of subjects met these criteria for ADHD, consistent with previous literature (e.g., Burd et al, 2003, Graham et al, 2013, Ware et al, 2013). Children in the CON group had no indicators of ADHD, as defined above, nor did they have subclinical symptoms of ADHD on the C-DISC-4.0 (presence of 3–5 symptoms within a domain).…”

Prenatal Alcohol Exposure, FASD, and Child Behavior: A Meta-analysis

“…The largest difference in problem scores between PAE and control groups was observed in 2 studies in which children in the PAE group were selected based on high levels of PAE (>4 alcoholic drinks at least once per week, or ≥13 drinks per week throughout pregnancy). 26,34 Levels of PAE were not defined or reported in Brown et al 24 Pooled effects for the 3 summary problem scales showed no statistically significant differences between groups (P > .05; Fig 4). Age group comparisons were not possible.…”

“…Four North American studies assessed predominantly African American (83%-94%) 24,30 or exclusively African American cohorts. 32,33 In addition to PAE/FASD groups, 3 studies included subgroups with attention-deficit/hyperactivity disorder (ADHD), 15,26,34 and 1 study included a subgroup with prenatal cocaine exposure (Supplemental Appendix 2). 33 Additional data (eg, individual group sample size data) were requested for 3 articles, 17,23,29 but authors were unable to access archives (n = 2) or did not respond (n = 1).…”

“…After screening and review, 23 articles were included in qualitative or quantitative analysis, with between 2 and 8 articles (total: 16) included in various meta-analyses. Tables 3 and 4 show the characteristics of included studies, according to presence of FASD (10 studies) [13][14][15][16][17][18][19][20][21] or PAE (14 studies), respectively [22][23][24][25][26][27][28][29][30][31][32][33][34] : one study reported data for both PAE and FASD. 35 Most were from North America (n = 15; 65.2%), followed by Australia (n = 4) and Canada (n = 2), with 1 study each from Finland and Taiwan.…”