The Effects of Prenatal Alcohol Exposure and Attention‐Deficit/Hyperactivity Disorder on Psychopathology and Behavior

Abstract

Background The present study examined prevalence of psychiatric disorders and behavioral problems in children with and without prenatal alcohol exposure (AE) and attention-deficit/hyperactivity disorder (ADHD). Methods Primary caregivers of 344 children (8–16y, M=12.28) completed the Computerized Diagnostic Interview Schedule for Children-IV (C-DISC-4.0) and the Child Behavior Checklist (CBCL). Subjects comprised 4 groups: AE with ADHD (AE+, n=85) and without ADHD (AE−, n=52), and non-exposed with ADHD (ADHD, n=74) and without ADHD (CON, n=133). The frequency of specific psychiatric disorders, number of psychiatric disorders (comorbidity), and CBCL behavioral scores were examined using chi-square and ANCOVA techniques. Results Clinical groups had greater frequency of all psychiatric disorders, except for anxiety, where the AE− and CON groups did not differ. There was a synergistic effect of AE and ADHD on conduct disorder. For Comorbidity, children with ADHD had increased psychiatric disorders regardless of AE, which did not have an independent effect on comorbidity. For CBCL scores, there were significant main effects of AE and ADHD on all scores and significant AE X ADHD interactions for Withdrawn/Depressed, Somatic Complaints, Attention, and all Summary scores. There was a synergistic effect of AE and ADHD on Externalizing, Total Problems, and Attention Problems. Conclusion Findings indicate that ADHD diagnosis elevates children’s risk of psychiatric diagnoses, regardless of AE, but suggest a synergistic relation between AE and ADHD on conduct disorder and externalizing behavioral problems in children. Findings affirm a poorer behavioral prognosis for alcohol-exposed children with ADHD and suggest that more than one neurobehavioral profile may exist for individuals with AE.

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.…”

“…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.…”

“…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).…”

Educational Needs and Care of Children with FASD

“…Behaviors associated with the effects of PAE appear similar to behaviors observed in children with attention deficit hyperactivity disorder (ADHD) [53][54][55][56]. However, there are differences between the two disorders [55,56].…”

Mental Health Outcomes Associated with Prenatal Alcohol Exposure: Genetic and Environmental Factors

“…Of that number, 28 % met criteria for a mood or anxiety disorder, but the majority met criteria for externalizing disorders such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or conduct disorder (CD). Moreover, recent findings from the same lab revealed that individuals with PAE were more likely to have a greater number of comorbid psychiatric illnesses than unexposed control subjects, and that the presence of a diagnosis of ADHD conferred the greatest degree of comorbid psychiatric risk [37].…”