GENDER AND ATTENTION DEFICITS IN CHILDREN DIAGNOSED WITH A FETAL ALCOHOL SPECTRUM DISORDER
Main Article Content
Keywords
Fetal Alcohol Syndrome (FAS), Fetal Alcohol Spectrum Disorders (FASD), Attention- Deficit/Hyperactivity Disorder (ADHD), Gender, Executive Functioning (EF)
Abstract
Background
A portion of children are born with Fetal Alcohol Spectrum Disorders (FASD). Most present with significant difficulties in attention, with attention-deficit/hyperactivity disorder (ADHD) being the most common psychiatric co-morbidity.
Objectives
The current study will describe behavioral and executive functioning (EF) deficits in attention in a group of children with FASD. Effects of gender and ADHD diagnosis will be explored.
Methods
Existing data from the University of Minnesota’s Pediatric Psychology clinic was utilized. Of 191 children with FASD in the database, 36 children (ages 6-16) had complete scores on measures of behavioral and EF attention deficits. Multivariate A nalyses of Variance (MANOVA) were used to examine the impact of gender and ADHD diagnosis on behavioral checklist scores and on a variety of EF measures.
Results
FASD males were significantly more likely to be diagnosed with ADHD (68%) than FASD females (29%). No impact of gender or diagnosis was found for behavioral measures of attention, but an interaction of gender and diagnosis emerged for EF. Females with ADHD evidenced deficits in EF compared to females without ADHD. However, males with ADHD performed better on measures of EF than their non-ADHD counterparts.
Conclusion
An ADHD diagnosis in FASD children needs to be reconsidered, especially for males.
References
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20. Nanson JL, Hiscock M. Attention deficits in children exposed to alcohol prenatally. Alcohol Clin Exp Res 1990;14: 656-661.
21. Oesterheld JR, Wilson A. ADHD and FAS. J Am Acad Child Adolesc Psychiatry 1997;36:1163.
22. O’Malley K, Kieran D, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Can J Psychiatry 2002;47:349-354.
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24. Rasmussen C, Horne K, Witol A. Neurobehavioral functioning in children with fetal alcohol spectrum disorder. Child Neuropsychol 2006;12:453-468.
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26. Seidman LJ, Biederman J, Monuteaux MC, Valera E, Doyle AE, Faraone SV. Impact of gender and age on executive functioning: Do girls and boys with and without Attention Deficit Hyperactivity Disorder differ neuropsychologically in preteen and teenage years? Dev Neuropsychol 2005;27:79-105.
27. Kodituwakku PW, Kalberg W, May PA. The effects of prenatal alcohol exposure on executive functioning. Alcohol Res Health 2001;25:192198.
28. Vaurio L, Riley EP, Mattson SN. Differences in executive functioning in children with heavy prenatal alcohol exposure or attentiondeficit/hyperactivity disorder. J Int Neuropsychol Soc 2008;14:119-129.
29. American Psychiatric Association. Diagnostic and statistical manual of mental disorders – Revised, DSM-IV-R, 4 th ed. Washington: Author, 2000.
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31. Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord 2002;5:143154.
32. Seidman LJ, Biederman J, Faraone SV, Weber W, Mennin D, Jones J. A pilot study of neuropsychological function in girls with ADHD. J Am Acad Child Adolesc Psychiatry 1997;36:366-373.
33. Elliott EJ, Payne JM, Morris A, Haan E, Bower CA. Fetal alcohol syndrome: a prospective national surveillance study. Arch Dis Child (published online at adc.bmj.com) 2007.
34. Stratton K, Howe C, Battaglia F. Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment. Washington: National Academy Press, 1996.
35. Wechsler D. Manual for the Wechsler Intelligence Scale for Children-III. New York: Psychological Corporation, 1991.
36. Sattler JM. Assessment of Children: Cognitive Applications, 4 th ed. California: Sattler Publisher, Inc., 2001.
37. Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtiss G. Wisconsin Card Sorting Test Manual Revised and Expanded. USA: Psychological Assessment Resources, 1981. 38. Leark RA, Dupuy TR, Greenberg LM, Corman CL, Kindschi CL. Test of Variables of Attention Professional Manual Version 7.0. California: Universal Attention Disorders, 1996.
39. Achenbach TM. Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry, 1991.
40. Merrell KW. Behavioral, Social, and Emotional Assessment of Children and Adolescents, 2 ed. New Jersey: Lawrence Erlbaum Associates, Inc., 2003.
41. Ouyang L, Fang X, Mercy J, Perou R, Grosse S. (in press). Attention-deficit/hyperactivity disorder symptoms and child maltreatment: A populationbased study. J Pediatr.
42. Snyder J, Nanson J, Snyder R, Block G. A study of stimulant medication in children with FAS. In A. Streissguth & J. Kanter, eds. The challenge of fetal alcohol syndrome: Overcoming secondary disabilities. Seattle: University of Washington Press, 1997:64-77.
2. Jones KL, Smith DW. Recognition of the fetal alcohol syndrome in early infancy. Lancet 1973;2:999-1001.
3. Substance Abuse and Mental Health Services Administration (SAMHSA) Fetal Alcohol Spectrum Disorders Center for Excellence. What You Need To Know: The Language of Fetal Alcohol Spectrum Disorders. DHHS Pub. No. (not yet available) Rockville: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2004.
4. Conry J. Neuropsychological deficits in fetal alcohol syndrome and fetal alcohol effects. Alcohol Clin Exp Res 1990;14:650-655.
5. Iosub S, Fuchs M, Bingol N, Gromisch DS. Fetal alcohol syndrome revisited. Pediatrics 1981;68:475-479.
6. Steinhausen HC, Nestler V, Spohr HL. Development and psychopathology of children with fetal alcohol syndrome. Behavioral Pediatrics 1982;3:49-54.
7. Kerns KA, Don A, Mateer CA, Streissguth AP. Cognitive deficits in nonretarded adults with fetal alcohol syndrome. J Learn Disabil 1997;30:685- 693.
8. LaDue RA, Streissguth AP, Randels SP. Clinical considerations pertaining to adolescents and adults with fetal alcohol syndrome. In T.B. Sonderegger, ed. Perinatal substance abuse: research findings and clinical implications. Baltimore: Johns Hopkins University Press, 1992:104-131.
9. Streissguth A, Barr H, Kogan J, Bookstein F. Primary and secondary disabilities in fetal alcohol syndrome. In A. Streissguth & J. Kanter, eds. The challenge of fetal alcohol syndrome: Overcoming secondary disabilities. Seattle: University of Washington Press, 1997:25-39.
10. Mattson SN, Goodman AM, Caine C, Delis DC, Riley EP. Executive functioning in children with heavy prenatal alcohol exposure. Alcohol Clin Exp Res 1999;23:1808-1815.
11. Fryer SL, McGee CL, Matt GE, Riley EP, Mattson SN. Evaluation of psychopathological conditions in children with heavy prenatal alcohol exposure. Pediatrics 2007;119:e733-e741.
12. Bhatara V, Loudenberg R, Ellis R. Association of Attention Deficit Hyperactivity Disorder and gestational alcohol exposure: An exploratory study and literature review. J Atten Disord 2006;9:1-8.
13. Kodituwakku P, Coriale G, Fiorentino, et al. Neurobehavioral characteristics of children with Fetal Alcohol Spectrum Disorders in communities from Italy: Preliminary Results. Alcohol Clin Exp Res 2006;30:1551-1561.
14. Barkley RA. Taking charge of ADHD: The complete authoritative guide for parents, Revised Edition. New York: Guilford Press, 2000.
15. Korkman M, Autti-Ramo I, Koivulehto H, Granstrom M. Neuropsychological effects at early school age of fetal alcohol exposure of varying duration. Child Neuropsychol 1998;4:199-212.
16. Mirsky AF, Duncan CC. A nosology of disorders of attention. Ann NY Acad Sci 2001;931:17-32.
17. Mirksy AF, Anthony BJ, Duncan CC, Ahern MB, Kellam SG. Analysis of the elements of attention: a neuropsychological approach. Neuropsychol Rev 1991;2:109-145.
18. Coles CD. Fetal alcohol exposure and attention: Moving beyond ADHD. Alcohol Res Health 2001;5:199-203.
19. Coles CD, Platzman KA, Raskind-Hood CL, Brown RT, Falek A, Smith IE. A comparison of children affected by prenatal alcohol exposure and attention deficit hyperactivity disorder. Alcohol Clin Exp Res 1997;21:150-161.
20. Nanson JL, Hiscock M. Attention deficits in children exposed to alcohol prenatally. Alcohol Clin Exp Res 1990;14: 656-661.
21. Oesterheld JR, Wilson A. ADHD and FAS. J Am Acad Child Adolesc Psychiatry 1997;36:1163.
22. O’Malley K, Kieran D, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Can J Psychiatry 2002;47:349-354.
23. Rasmussen C. Executive functioning and working memory in fetal alcohol spectrum disorder. Alcohol Clin Exp Res 2005;29:1359-1367.
24. Rasmussen C, Horne K, Witol A. Neurobehavioral functioning in children with fetal alcohol spectrum disorder. Child Neuropsychol 2006;12:453-468.
25. Rasmussen C, McAuley R, Andrew G. Parental ratings of children with fetal alcohol spectrum disorder on the Behavior Rating Inventory of Executive Function (BRIEF). J FAS Int 2007;5:18.
26. Seidman LJ, Biederman J, Monuteaux MC, Valera E, Doyle AE, Faraone SV. Impact of gender and age on executive functioning: Do girls and boys with and without Attention Deficit Hyperactivity Disorder differ neuropsychologically in preteen and teenage years? Dev Neuropsychol 2005;27:79-105.
27. Kodituwakku PW, Kalberg W, May PA. The effects of prenatal alcohol exposure on executive functioning. Alcohol Res Health 2001;25:192198.
28. Vaurio L, Riley EP, Mattson SN. Differences in executive functioning in children with heavy prenatal alcohol exposure or attentiondeficit/hyperactivity disorder. J Int Neuropsychol Soc 2008;14:119-129.
29. American Psychiatric Association. Diagnostic and statistical manual of mental disorders – Revised, DSM-IV-R, 4 th ed. Washington: Author, 2000.
30. Gaub M, Carlson L. Gender differences in ADHD: A meta-analysis and critical review. J Am Acad Child Adolesc Psychiatry 1997;36:1036-1046.
31. Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord 2002;5:143154.
32. Seidman LJ, Biederman J, Faraone SV, Weber W, Mennin D, Jones J. A pilot study of neuropsychological function in girls with ADHD. J Am Acad Child Adolesc Psychiatry 1997;36:366-373.
33. Elliott EJ, Payne JM, Morris A, Haan E, Bower CA. Fetal alcohol syndrome: a prospective national surveillance study. Arch Dis Child (published online at adc.bmj.com) 2007.
34. Stratton K, Howe C, Battaglia F. Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment. Washington: National Academy Press, 1996.
35. Wechsler D. Manual for the Wechsler Intelligence Scale for Children-III. New York: Psychological Corporation, 1991.
36. Sattler JM. Assessment of Children: Cognitive Applications, 4 th ed. California: Sattler Publisher, Inc., 2001.
37. Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtiss G. Wisconsin Card Sorting Test Manual Revised and Expanded. USA: Psychological Assessment Resources, 1981. 38. Leark RA, Dupuy TR, Greenberg LM, Corman CL, Kindschi CL. Test of Variables of Attention Professional Manual Version 7.0. California: Universal Attention Disorders, 1996.
39. Achenbach TM. Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington: University of Vermont, Department of Psychiatry, 1991.
40. Merrell KW. Behavioral, Social, and Emotional Assessment of Children and Adolescents, 2 ed. New Jersey: Lawrence Erlbaum Associates, Inc., 2003.
41. Ouyang L, Fang X, Mercy J, Perou R, Grosse S. (in press). Attention-deficit/hyperactivity disorder symptoms and child maltreatment: A populationbased study. J Pediatr.
42. Snyder J, Nanson J, Snyder R, Block G. A study of stimulant medication in children with FAS. In A. Streissguth & J. Kanter, eds. The challenge of fetal alcohol syndrome: Overcoming secondary disabilities. Seattle: University of Washington Press, 1997:64-77.
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Dec 8, 2018
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Herman, L. E., C Acosta, M., & Chang, P.-. N. (2018). GENDER AND ATTENTION DEFICITS IN CHILDREN DIAGNOSED WITH A FETAL ALCOHOL SPECTRUM DISORDER. Journal of Population Therapeutics and Clinical Pharmacology, 15(3). https://mail.jptcp.com/index.php/jptcp/article/view/234
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How to Cite
Herman, L. E., C Acosta, M., & Chang, P.-. N. (2018). GENDER AND ATTENTION DEFICITS IN CHILDREN DIAGNOSED WITH A FETAL ALCOHOL SPECTRUM DISORDER. Journal of Population Therapeutics and Clinical Pharmacology, 15(3). https://mail.jptcp.com/index.php/jptcp/article/view/234