Alcohol Abuse during Pregnancy and ADHD Symptoms

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Research suggests that there is a relationship between maternal alcohol use during pregnancy and ADHD. Previous studies have found similar associations between alcohol in pregnancy and ADHD. Three different approaches were used to control for measured and unmeasured confounding: statistical adjustment for covariates, negative control comparison against maternal pre-pregnancy alcohol use, and comparison among differentially exposed siblings. For this proposal data will be drawn from the Norwegian mother and child cohort study (Moba), recruited to the Norwegian mother and child birth cohort study between 1999 and 2008. Self-reported measurements of alcohol use were obtained in week 30 during the pregnancy. This study will seek to identify the prevalence of ADHD symptoms as the cohort children until the 5th grade. A stratified random sample of 120 children will be selected and standardized ADHD measures will be administered to their parents and teachers. It is hypothesized that exposure to alcohol in the womb will increase the likelihood of children to display ADHD symptoms during their elementary school years.

Introduction

Attention-deficit hyperactivity disorder (ADHD), is usually characterized by inattention and/or hyperactivity-impulsivity, it is the most common behavioral disorder in childhood, it manifests at an early age and affects approximately 5% of children worldwide. Many mothers continue to drink alcohol during pregnancy which is often linked to ADHD. Ethanol enhances migration of nerve cells, which is hypothesized to be involved in behavioral difficulties in childhood. It also interferes with the production of neuroendocrine hormones, which may perturb brain growth. A positive association between maternal alcohol use during pregnancy and symptoms of ADHD in children has been reported in several studies several studies have been done however studies have not been directly done on children within this age group.
The aim of this study is to investigate whether maternal alcohol use during pregnancy is related to offspring ADHD in children in elementary school age. We administered two measures of ADHD for this study. These measures are the Conners Rating ScaleRevised (CRS-R) and the Child Behavior Checklist-Attention Problem (CBCL-AP) scale.

The Conners Rating Scales-Revised (CRS-R) is a thorough assessment of attention-deficit/hyperactivity disorder (ADHD). They are paper and pencil screening questionnaires designed to be completed by parents and teachers to assist in evaluating children for attention-deficit/hyperactivity disorder (ADHD). The CBCL-AP is a parent rated questionnaire for assessing a wide range of child emotional and behavioral problems it is hypothesized that exposure to alcohol in the womb will increase the likelihood of children within this age range to display ADHD

Literature Review

Attention-deficit hyperactivity disorder (ADHD), characterized by inattention and/or hyperactivity-impulsivity, it is the most common behavioral disorder in childhood, manifests at an early age and affects approximately 5% of children worldwide. Maternal alcohol use during pregnancy has repeatedly been associated with development of attention-deficit hyperactivity disorder (ADHD) in the offspring. Alcohol is considered one of the risk factors for Attention Deficit Hyperactivity Disorder (ADHD).

In Eilertsen et al.’s (2017) summary article reviewing maternal alcohol use during pregnancy and offspring attention-deficit hyperactivity disorder (ADHD) it was found that an overall positive association between maternal alcohol use during pregnancy and offspring ADHD symptoms, which was only marginally attenuated after inclusion of measured covariates. For offspring ADHD symptoms, they found a weak, but possibly causal association with maternal alcohol use during pregnancy, but no such effect was observed for clinical ADHD diagnosis
A follow up study by Gronimus, Ridout, Sandberg, and Santosh (2009) studied maternal alcohol consumption. The study found out that Children who have been exposed to alcohol in utero are 2.33 times more likely to have ADHD than non-exposed children. Children who have been exposed to heavy consumption of alcohol in utero are 2.27 times more likely to have ADHD than children exposed to mild consumption. In this study their meta-analysis suggests that children exposed to alcohol during pregnancy are at risk for ADHD. However, evidence is sparse, and it remains uncertain whether a causal association exists. Further research is needed into doseresponse relationship, timing of exposure, influence of genetic factors involved in maternal alcohol abuse and the role of FASD in ADHD-like symptoms.

A similar study by Linnet et al (2003) studied maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors. This study found that alcohol is widely recognized as a teratogenic agent causing CNS dysfunction and impaired mental functioning, including fetal alcohol effect and fetal alcohol syndrome, which incorporates the core symptoms of ADHD.

A cohort study by Knopik et al (2006) looked at the maternal alcohol use disorder and offspring ADHD. this study states that children of alcoholics are significantly more likely to experience high-risk environmental exposures, including prenatal substance exposure, and are more likely to exhibit externalizing problems. They found that Offspring of twins with a history of AUD, as well as offspring of non-AUD monozygotic twins whose co-twin had AUD, were significantly more likely to exhibit ADHD than offspring of controls. This pattern is consistent with a genetic explanation for the association between maternal AUD and increased offspring risk of ADHD.

Mick, Biederman, Faraone, Sayer, and Kleinman (2002) studied Attention-Deficit Hyperactivity Disorder and maternal smoking, alcohol use, and drug use during pregnancy. This study found that ADHD cases were 2.5 times more likely to have been exposed to alcohol in utero than were the non-ADHD control subjects.

Ware et al (2014) examined the interaction between prenatal alcohol exposure and ADHD on parent-rated adaptive behavior in four groups: children with prenatal alcohol exposure and ADHD (AE+), children with prenatal alcohol exposure without ADHD (AE€’), children with ADHD (ADHD), and control children (CON). They found in this study that the significant interaction between ADHD and prenatal alcohol exposure was significant only for the Communication domain.

This proposal will seek to see whether maternal alcohol use during pregnancy is related to offspring ADHD in children whose mothers consumed alcohol during their pregnancy compared to children whose mothers did not. the Conner’s Rating ScaleRevised (CRS-R) and the Child Behavior Checklist-Attention Problem (CBCL-AP) scale will be administered to parents and teachers during the fall break to allow enough time for the teachers to be acquainted with the children to ensure a better result.

Definitions

Attention-Deficit/Hyperactivity Disorder (ADHD) according to the DSM-5 manual is defined as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by
Inattention which is characterized by failing to give close attention to details, has difficulty sustaining attention in tasks or play activities, often does not seem to listen when spoken to directly, often does not follow through on instructions and fails to finish schoolwork, chores, or duties etc. That is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.

Hyperactivity and impulsivity are characterized by Often fidgeting with or taps hands or feet or squirms in seat. Often leaves seat in situations when remaining seated is expected ,Often runs about or climbs in situations where it is inappropriate, Often unable to play or engage in leisure activities quietly, Is often “on the go” acting as if “driven by a motor ,Often talks excessively, Often blurts out an answer before a question has been completed, Often has difficulty waiting his or her turn (e.g., while waiting in line), Often interrupts or intrudes on others This symptom must have persisted for at leastv6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.

Conners Rating Scales-Revised (CRS-R) are paper and pencil screening questionnaires designed to be completed by parents and teachers to assist in evaluating children for attention-deficit/hyperactivity disorder (ADHD).

CBCL Attention Problem (CBCL-AP) subscale is frequently used as a diagnostic tool for ADHD and has strong discriminatory power for detecting ADHD in children.

Method

This proposal will seek to see whether maternal alcohol use during pregnancy is related to offspring ADHD in children whose mothers consumed alcohol during their pregnancy compared to children whose mothers did not

Participants

Participants in this study included 250 children (Fifth graders) from 232 mothers’ 127 males and 123 females. These participants were representative of the participants recruited to the Norwegian Mother and Child Birth Cohort Study between 1999 and 2008.All participants in this study were volunteers. Written informed consent was obtained from all participants upon recruitment.

Materials

Self-reported measurements of alcohol use were obtained in week 30 during the pregnancy. Mothers rated offspring ADHD symptoms at 5 years on two measures that were used for this study. These measures are the Conners Rating ScaleRevised (CRS-R) and the Child Behavior Checklist-Attention Problem (CBCL-AP) scale. the Conners Rating Scales-Revised (CRS-R) are paper and pencil screening questionnaires designed to be completed by parents and teachers to assist in evaluating children for attention-deficit/hyperactivity disorder (ADHD).

It is used as part of a comprehensive examination and are designed to be easily administered and scored to assist in determining whether children between the ages of three and 17 years might suffer from ADHD. CBCL-AP is a parent rated questionnaire for assessing a wide range of child emotional and behavioral problems.

The CBCL Attention Problem (CBCL-AP) subscale, 1 of the 8 empirically derived clinical syndrome subscales of the CBCL-AP, is frequently used as a diagnostic tool for ADHD and has strong discriminatory power for detecting ADHD in children.

Design and Procedure

The Conners Rating ScaleRevised (CRS-R) was administered to teachers and parents of the children in this sample. Symptoms of ADHD at 5 years of age were assessed by maternal report. The scale consists of 12 four-point items which were summed to a score ranging from 12 to 48. The Child Behavior Checklist-Attention Problem (CBCL-AP) scale was also used and this included six three-point items summed to a score ranging from 6 to 18. Both measures were standardized to zero mean and unit variance prior to analyses. This assessment was scored to determine the percentage of children in the sample who met the criteria for ADHD compared with other children whose mother did not consume any alcohol during pregnancy.

Measurements of Maternal Alcohol Use

Alcohol use was measured using the Alcohol Use Disorder Identification Test Consumption (AUDIT-C) designed to identify harmful patterns of usage. The scale consists of three five-point items measuring drinking frequency, quantity and binge drinking, summed to a score ranging from 0 to 12. The questionnaire was administered around week 30 in pregnancy, and mothers reported on their use pre-pregnancy and during the first trimester. Both measurements were standardized to zero mean and unit variance prior to analysis.
Statistical analysis

To facilitate comparisons across analyses of ADHD symptoms, we restricted the sample to mothers with two or more birth records in MoBa, comprising 300 mothers and 250 children. Symptoms were modelled using linear multilevel regression models with random intercepts for mothers, allowing for residual correlations (familial dependence) in responses of siblings. The two outcome measures were analyzed separately.

A crude estimate of the association with the outcome measures was obtained by including maternal alcohol use during pregnancy as a fixed effect in the models we used maternal alcohol use before the pregnancy as a negative control we also compared siblings differentially exposed to alcohol during pregnancy.

It is hypothesized that there will be higher rate of ADHD in children whose mothers consumed alcohol during their pregnancy compared to children whose mothers did not.ADHD symptoms measured by the CPRS-R scale were associated with maternal alcohol use during pregnancy even under our most stringent control, indicating a possible causal effect. A positive association between maternal alcohol use during pregnancy and offspring ADHD symptoms, which remained after controlling for the covariates. This pattern replicated across both ADHD symptom measures. The results conform to other findings and suggest that maternal alcohol use during pregnancy is related to ADHD.

References

  1. Eilertsen, E. M., Gjerde, L. C., Reichborn-Kjennerud, T., ??rstavik, R. E., Knudsen, G. P., Stoltenberg, C., . . . Ystrom, E. (2017). Maternal alcohol use during pregnancy and offspring attention-deficit hyperactivity disorder (ADHD): A prospective sibling control study. International Journal of Epidemiology, 46(5), 1633-1640.
  2. Gronimus, R., Ridout, D., Sandberg, S., & Santosh, P. (2009). Maternal alcohol consumption. London Journal of Primary Care, 2(1), 28-35.
  3. Knopik, V. S., Heath, A. C., Jacob, T., Slutske, W. S., Bucholz, K. K., Madden, P. A., . . . Martin, N. G. (2006). Maternal alcohol use disorder and offspring ADHD: Disentangling genetic and environmental effects using a children-of-twins design. Psychological Medicine, 36(10), 1461.
  4. Linnet, K. M., Dalsgaard, S., Obel, C., Wisborg, K., Henriksen, T. B., Rodriguez, A., . . . Jarvelin, M. (2003). Maternal Lifestyle Factors in Pregnancy Risk of Attention Deficit Hyperactivity Disorder and Associated Behaviors: Review of the Current Evidence. American Journal of Psychiatry,160(6), 1028-1040.
  5. Mick, E., Biederman, J., Faraone, S. V., Sayer, J., & Kleinman, S. (2002). Case-Control Study of Attention-Deficit Hyperactivity Disorder and Maternal Smoking, Alcohol Use, and Drug Use During Pregnancy. Journal of the American Academy of Child & Adolescent Psychiatry, 41(4), 378-385.
  6. Ware, A. L., Glass, L., Crocker, N., Deweese, B. N., Coles, C. D., Kable, J. A., . . . Mattson, S. N. (2014). Effects of Prenatal Alcohol Exposure and Attention-Deficit/Hyperactivity Disorder on Adaptive Functioning. Alcoholism: Clinical and Experimental Research, 38(5), 1439-1447.
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Alcohol Abuse during Pregnancy and ADHD symptoms. (2020, May 08). Retrieved from https://papersowl.com/examples/alcohol-abuse-during-pregnancy-and-adhd-symptoms/

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