THE IMPACT OF AN ADHD CO-MORBIDITY ON THE DIAGNOSIS OF FASD
Main Article Content
Keywords
Fetal Alcohol Spectrum Disorder (FASD), Prenatal Alcohol Exposure (PAE), ADHD, diagnosis, neurobehavioral
Abstract
Objective
Many children with Fetal Alcohol Spectrum Disorders (FASD) also have co-morbid ADHD. The goal of this study was to examine the impact of having a co-morbid ADHD diagnosis on FASD diagnostic results. We compared children with FASD to those with FASD and co-morbid ADHD across the neurobehavioral domains recommended by the Canadian Guidelines in the diagnosis of FASD.
Methods
We retrospectively analyzed data from 52 children, aged 4 to 17 years, diagnosed with an FASD at a hospital FASD clinic. Thirty-three of these children had a co-morbid diagnosis of ADHD and 19 did not. Children with FASD and those with FASD and co-morbid ADHD were compared on the following neurobehavioral domains: sensory/motor, cognition, communication, academic achievement, memory, executive functioning, attention, and adaptive behavior.
Results
Children with FASD and ADHD performed significantly worse than those without ADHD on attention but better on academic achievement. No other group differences were significant.
Conclusions
Having an ADHD co-morbidity had little effect on the FASD diagnosis. The results of this project will inform the diagnostic process for FASD and have implications for standardizing diagnostic processes across clinics.
References
1. Streissguth AP. Fetal Alcohol Syndrome: A Guide for Families and Communities. Baltimore, MD: Paul H Brookes Publishing; 1997.
2. (NIAAA) NIoAAaA. Seventh Special Report to the U.S. Congress on Alcohol and Health: U.S. Government Printing Office; 1990.
3. Kodituwakku PW. Defining the behavioral phenotype in children with Fetal Alcohol Spectrum Disorders: A review. Neurosci Biobehav Rev. 2007;31(2):192-201.
4. Jones KL, Smith DW. Recognition of Fetal Alcohol Syndrome in early infancy. Lancet. 1973;2:999-1001.
5. Clarren S, Smith D. The Fetal Alcohol Syndrome. N Engl JMed. 1978;298:1063-1067.
6. Institute of Medicine (IOM), Stratton KR, Howe CJ, Battaglia FC (eds.). Fetal Alcohol Syndrome: Diagnosis, epidemiology, prevention and treatment. Washington, DC: National Academy Press, 1996.
7. Astley SJ. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-digit diagnostic code. 3rd ed. University of Washington, Seattle: FASD Diagnostic and Prevention Netword; 2004.
8. Astley SJ, Clarren SK. Diagnostic Guide for Fetal Alcohol Syndrome and Related Conditions: The 4- Digit Diagnostic Code. University of Washington, Seattle: University Publication Services; 1997.
9. Astley SJ, Clarren SK. Diagnostic Guide for Fetal Alcohol Syndrome and Related Conditions: The 4- Digit Code. 2nd ed. University of Washington, Seattle: FAS Diagnostic and Prevention Network; 1999.
10. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal Alcohol Spectrum Disorder: Canadian guidelines for diagnosis. CMAJ. 2005;172:S1-S21.
11. Rasmussen C, Horne K, Witol A. Neurobehavioral functioning in children with Fetal Alcohol Spectrum Disorder. Child Neuropsychol. 2006;12:1-16.
12. Streissguth AP, O'Malley K. Neuropsychiatric implications and long-term consequences of Fetal Alcohol Spectrum Disorders. Semin Clin Neuropsychiatry. 2000;5:177-190.
13. Coles CD, Platzman K, Lynch M, Freides D. Auditory and visual sustained attention in adolescents prenatally exposed to alcohol. Alcoholism Clin Exp Res. 2002;26(2):263-271.
14. Mattson SN, Calarco KE, Lang AR. Focused and shifting attention in children with heavy prenatal alcohol exposure. Neuropsychology. 2006;20(3):361-369.
15. Nanson JL, Hiscock M. Attention deficits in children exposed to alcohol prenatally. Alcohol Clin Exp Res. 1990;14(5):656-661.
16. Streissguth AP, Barr HM, Kogan J, et al. Understanding the occurrence of secondary disabilities in clients with Fetal Alcohol Syndrome (FAS) and fetal alcohol effects (FAE): Final report to the Centers for Disease control and Prevention. Seattle, WA: University of Washington, Fetal Alcohol and Drug Unit; 1996.
17. Clark E, Lutke J, Minnes P, et al. Secondary disabilities among adults with Fetal Alcohol Spectrum Disorder in British Columbia. J of FAS Int. 2004;2:1-12.
18. Fryer SL, McGee CL, Matt GE, Riley EP, Mattson SN. Evaluation of psychopathological conditions in children with heavy prenatal alcohol exposure. Pediatrics. 2007;119(3):e733-e741.
19. Mick E, Biederman J, Farone SV, Sayer J, Kleinman S. Case-control study of attention deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. J Am Acad Child Adolesc Psychiatry. 2002;41:378-385.
20. Bhatara V, Loudenberg R, Ellis R. Association of attention deficit hyperactivity disorder and gestational alcohol exposure: An exploratory study. J Atten Disord. 2006;9(3):515-522.
21. O'Malley KD, Nanson J. Clinical implications of a link between Fetal Alcohol Spectrum Disorder and attention-deficit hyperactivity disorder. Can J Psychiatry. 2002;47(4):349-354.
22. Toplak ME, Bucciarelli SM, Jain U, et al. Executive functions: Performance-based measures and the Behavior Rating Inventory of Executive Function (BRIEF) in adolescents with attention deficit/hyperactivity disorder (ADHD). Child Neuropsychol. 2009;15:53-72.
23. Loe IM, Feldman HM. Academic and educational outcomes of children with ADHD. J Pediatr Psychol. 2007;32:643-654.
24. Martinussen R, Hayden J, Hogg-Johnson S, et al. A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2005;44:377-384.
25. Stavro GM, Ettenhofer ML, Nigg JT. Executive functions and adaptive functioning in young adult attention-deficit/hyperactivity disorder. J Int Neuropsychol Soc. 2007;13:324-334.
26. Cohen, NJ, Vallance DD, Barwick M, et al. The interface between ADHD and language impairment: An examination of language, achievement, and cognitive processing. J Child Psychol Psychiatry. 2000;41:353-362.
27. Streissguth A. Offspring effects of prenatal alcohol exposure from birth to 25 years: The Seattle prospective longitudinal study. J Clin Psychol Med Settings 2007;14:81-101.
28. Mattson SN, Riley EP. A review of the neurobehavioral deficits in children with Fetal Alcohol Syndrome or prenatal exposure to alcohol. Alcoholism Clin Exp Res 1998;22(2):279-294.
29. Sampson PD, Streissguth AP, Bookstein FL, Barr H. On categorizations in analyses of alcohol teratogenesis. Environ Health Perspect 2000;108:421-8.
30. Abkarian GG. Communication effects of prenatal alcohol exposure. J Commun Disord 1992;25(4):221-240.
31. Coggins TE, Friet T, Morgan T. Analysing narrative productions in older school-age children and adolescents with Fetal Alcohol Syndrome: An experimental tool for clinical applications. Clin Linguist Phon 1998;12(3):221-236.
32. Whaley S, O'Connor M, Gunderson B. Comparison of the adaptive functioning of children prenatally exposed to alcohol to a nonexposed clinical sample. Alcoholism Clin Exp Res 2001;25: 1018-1024.
33. Rasmussen C. Executive functioning and working memory in Fetal Alcohol Spectrum Disorder. Alcoholism Clin Exp Res 2005;29:1359-1367.
34. Burd L, Klug MG, Martsolf JT, Kerbeshian J. Fetal Alcohol Syndrome: Neuropsychiatric phenomics. Neurotoxicol Teratol 2003;25(6):697- 705.
35. O'Connor MJ, Shah B, Whaley S, Cronin P, Gunderson B, Graham J. Psychiatric illness in a clinical sample of children with prenatal alcohol exposure. Am J Drug Alcohol Abuse 2002;28(4): 743-754.
36. Steinhausen H-C, Spohr H-L. Long-term outcome of children with Fetal Alcohol Syndrome: Psychopathology, behavior, and intelligence. Alcoholism Clin Exp Res 1998;22(2):334-338.
37. Chen CP, Kuhn P, Advis JP, Sarkar DK. Prenatal ethanol exposure alters the expression of period genes governing the circadian function of Bendorphin neurons in the hypothalamus. J Neurochem 2006;97:1026-1033.
38. Sakata-Haga H, Dominguez HD, Sei H, Fukui Y, Riley EP, Thomas JD. Alterations in circadian rhythm phase shifting ability in rats following ethanol exposure during the third trimester brain growth spurt. Alcoholism Clin Exp Res 2006;30(5):899-907.
39. 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: 119-29.
40. Coles CD, Platzman KA, Raskind-Hood CL, Brown RT, et al. A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder. Alcoholism Clin Exp Res 1997;21(1):150-61.
41. O'Malley KD, Koplin B, Dohner VA. Psychostimulant clinical response in Fetal Alcohol Syndrome. Can J Psychiatry 2000;45(1):90-1.
2. (NIAAA) NIoAAaA. Seventh Special Report to the U.S. Congress on Alcohol and Health: U.S. Government Printing Office; 1990.
3. Kodituwakku PW. Defining the behavioral phenotype in children with Fetal Alcohol Spectrum Disorders: A review. Neurosci Biobehav Rev. 2007;31(2):192-201.
4. Jones KL, Smith DW. Recognition of Fetal Alcohol Syndrome in early infancy. Lancet. 1973;2:999-1001.
5. Clarren S, Smith D. The Fetal Alcohol Syndrome. N Engl JMed. 1978;298:1063-1067.
6. Institute of Medicine (IOM), Stratton KR, Howe CJ, Battaglia FC (eds.). Fetal Alcohol Syndrome: Diagnosis, epidemiology, prevention and treatment. Washington, DC: National Academy Press, 1996.
7. Astley SJ. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-digit diagnostic code. 3rd ed. University of Washington, Seattle: FASD Diagnostic and Prevention Netword; 2004.
8. Astley SJ, Clarren SK. Diagnostic Guide for Fetal Alcohol Syndrome and Related Conditions: The 4- Digit Diagnostic Code. University of Washington, Seattle: University Publication Services; 1997.
9. Astley SJ, Clarren SK. Diagnostic Guide for Fetal Alcohol Syndrome and Related Conditions: The 4- Digit Code. 2nd ed. University of Washington, Seattle: FAS Diagnostic and Prevention Network; 1999.
10. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal Alcohol Spectrum Disorder: Canadian guidelines for diagnosis. CMAJ. 2005;172:S1-S21.
11. Rasmussen C, Horne K, Witol A. Neurobehavioral functioning in children with Fetal Alcohol Spectrum Disorder. Child Neuropsychol. 2006;12:1-16.
12. Streissguth AP, O'Malley K. Neuropsychiatric implications and long-term consequences of Fetal Alcohol Spectrum Disorders. Semin Clin Neuropsychiatry. 2000;5:177-190.
13. Coles CD, Platzman K, Lynch M, Freides D. Auditory and visual sustained attention in adolescents prenatally exposed to alcohol. Alcoholism Clin Exp Res. 2002;26(2):263-271.
14. Mattson SN, Calarco KE, Lang AR. Focused and shifting attention in children with heavy prenatal alcohol exposure. Neuropsychology. 2006;20(3):361-369.
15. Nanson JL, Hiscock M. Attention deficits in children exposed to alcohol prenatally. Alcohol Clin Exp Res. 1990;14(5):656-661.
16. Streissguth AP, Barr HM, Kogan J, et al. Understanding the occurrence of secondary disabilities in clients with Fetal Alcohol Syndrome (FAS) and fetal alcohol effects (FAE): Final report to the Centers for Disease control and Prevention. Seattle, WA: University of Washington, Fetal Alcohol and Drug Unit; 1996.
17. Clark E, Lutke J, Minnes P, et al. Secondary disabilities among adults with Fetal Alcohol Spectrum Disorder in British Columbia. J of FAS Int. 2004;2:1-12.
18. Fryer SL, McGee CL, Matt GE, Riley EP, Mattson SN. Evaluation of psychopathological conditions in children with heavy prenatal alcohol exposure. Pediatrics. 2007;119(3):e733-e741.
19. Mick E, Biederman J, Farone SV, Sayer J, Kleinman S. Case-control study of attention deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. J Am Acad Child Adolesc Psychiatry. 2002;41:378-385.
20. Bhatara V, Loudenberg R, Ellis R. Association of attention deficit hyperactivity disorder and gestational alcohol exposure: An exploratory study. J Atten Disord. 2006;9(3):515-522.
21. O'Malley KD, Nanson J. Clinical implications of a link between Fetal Alcohol Spectrum Disorder and attention-deficit hyperactivity disorder. Can J Psychiatry. 2002;47(4):349-354.
22. Toplak ME, Bucciarelli SM, Jain U, et al. Executive functions: Performance-based measures and the Behavior Rating Inventory of Executive Function (BRIEF) in adolescents with attention deficit/hyperactivity disorder (ADHD). Child Neuropsychol. 2009;15:53-72.
23. Loe IM, Feldman HM. Academic and educational outcomes of children with ADHD. J Pediatr Psychol. 2007;32:643-654.
24. Martinussen R, Hayden J, Hogg-Johnson S, et al. A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2005;44:377-384.
25. Stavro GM, Ettenhofer ML, Nigg JT. Executive functions and adaptive functioning in young adult attention-deficit/hyperactivity disorder. J Int Neuropsychol Soc. 2007;13:324-334.
26. Cohen, NJ, Vallance DD, Barwick M, et al. The interface between ADHD and language impairment: An examination of language, achievement, and cognitive processing. J Child Psychol Psychiatry. 2000;41:353-362.
27. Streissguth A. Offspring effects of prenatal alcohol exposure from birth to 25 years: The Seattle prospective longitudinal study. J Clin Psychol Med Settings 2007;14:81-101.
28. Mattson SN, Riley EP. A review of the neurobehavioral deficits in children with Fetal Alcohol Syndrome or prenatal exposure to alcohol. Alcoholism Clin Exp Res 1998;22(2):279-294.
29. Sampson PD, Streissguth AP, Bookstein FL, Barr H. On categorizations in analyses of alcohol teratogenesis. Environ Health Perspect 2000;108:421-8.
30. Abkarian GG. Communication effects of prenatal alcohol exposure. J Commun Disord 1992;25(4):221-240.
31. Coggins TE, Friet T, Morgan T. Analysing narrative productions in older school-age children and adolescents with Fetal Alcohol Syndrome: An experimental tool for clinical applications. Clin Linguist Phon 1998;12(3):221-236.
32. Whaley S, O'Connor M, Gunderson B. Comparison of the adaptive functioning of children prenatally exposed to alcohol to a nonexposed clinical sample. Alcoholism Clin Exp Res 2001;25: 1018-1024.
33. Rasmussen C. Executive functioning and working memory in Fetal Alcohol Spectrum Disorder. Alcoholism Clin Exp Res 2005;29:1359-1367.
34. Burd L, Klug MG, Martsolf JT, Kerbeshian J. Fetal Alcohol Syndrome: Neuropsychiatric phenomics. Neurotoxicol Teratol 2003;25(6):697- 705.
35. O'Connor MJ, Shah B, Whaley S, Cronin P, Gunderson B, Graham J. Psychiatric illness in a clinical sample of children with prenatal alcohol exposure. Am J Drug Alcohol Abuse 2002;28(4): 743-754.
36. Steinhausen H-C, Spohr H-L. Long-term outcome of children with Fetal Alcohol Syndrome: Psychopathology, behavior, and intelligence. Alcoholism Clin Exp Res 1998;22(2):334-338.
37. Chen CP, Kuhn P, Advis JP, Sarkar DK. Prenatal ethanol exposure alters the expression of period genes governing the circadian function of Bendorphin neurons in the hypothalamus. J Neurochem 2006;97:1026-1033.
38. Sakata-Haga H, Dominguez HD, Sei H, Fukui Y, Riley EP, Thomas JD. Alterations in circadian rhythm phase shifting ability in rats following ethanol exposure during the third trimester brain growth spurt. Alcoholism Clin Exp Res 2006;30(5):899-907.
39. 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: 119-29.
40. Coles CD, Platzman KA, Raskind-Hood CL, Brown RT, et al. A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder. Alcoholism Clin Exp Res 1997;21(1):150-61.
41. O'Malley KD, Koplin B, Dohner VA. Psychostimulant clinical response in Fetal Alcohol Syndrome. Can J Psychiatry 2000;45(1):90-1.