Children with Alcohol Exposure with an Additional Diagnosis of ADHD - CIFASD – Collaborative Initiative on Fetal Alcohol Spectrum Disorders

Children with Alcohol Exposure Don’t Perform Worse Cognitively with an Additional Diagnosis of ADHD

Heavy prenatal alcohol exposure and attention-deficit/hyperactivity disorder (ADHD) can both result in cognitive impairment. This study looked at the interaction of heavy prenatal alcohol exposure and ADHD across a broad range of cognitive abilities using tests that required children to answer questions, solve problems, and complete puzzles. Both children with heavy prenatal alcohol exposure and children with ADHD struggled on tasks of overall intelligence (verbal abilities, perceptual abilities, and processing speed), and executive function (planning, attention, inhibitory control, working memory,). However, having ADHD affected children with histories of prenatal alcohol exposure differently than children without prenatal alcohol exposure. For non-exposed children, a diagnosis of ADHD led to significantly poorer performance than controls. However, for alcohol-exposed, having an ADHD diagnosis did not result in any additional lowering of scores on these measures. These results are different than what has been shown for behavior, where having both ADHD and heavy prenatal alcohol exposure leads to more communication issues and attention problems compared to alcohol-exposed children without ADHD. In addition, we found that children with prenatal alcohol exposure perform similarly to children with ADHD on measures of executive functioning but worse on measures of verbal understanding and perceptual reasoning. Overall, our results suggest that if a child is alcohol-exposed, having an additional ADHD diagnosis does not further negatively affect their cognitive abilities. Therefore, children with prenatal alcohol exposure, regardless of whether they have ADHD, may benefit from interventions targeted at improving these cognitive abilities, particularly for verbal and perceptual tasks where children with prenatal alcohol exposure are more impaired than children with ADHD alone.

For full story see: Glass, L., Ware, A. L., Crocker, N., Deweese, B. N., Coles, C. D., Kable, J. A., May, P.A., Kalberg, W.O., Sowell, E.R., Jones, K.L., Riley, E.P. & Mattson, S. N. (2013). Neuropsychological deficits associated with heavy prenatal alcohol exposure are not exacerbated by ADHD. Neuropsychology, 27(6), 713.

Research supported by NIAAA grants supporting CIFASD: U01 AA014834 (Mattson), U24 AA014811 (Riley), U24 AA014818 (Barnett), and U24 AA014815 (Jones). Additional support provided by NIAAA grant number T32 AA013525 (Riley).

Phase 4:

independently collected by project. Some participants have data in multiple projects. Please download this excel file for a more detailed list of projects, sample sizes, and available data for participants across project.

Phase 4 Projects

Genetic Data

GWAS – PLINK files are provided for GWAS data obtained on individuals with and without PAE, across phases 2-4
WES – VCF files are provided for whole exome sequencing data on individuals with PAE
Data extracted from health forms are available for children and adults who participated in an online study (DiGFASD). All participants had self-reported prenatal alcohol exposure. Most provided saliva and have GWAS and WES data available.

FASD-Tree Screening Tool

Data from physical exams are combined with data from parent questionnaires to estimate the likelihood of having an FASD using methods described in Mattson et al., 2023 (DOI: 10.1111/acer.14987).

Neurobehavior Data

Phase 1 – data include measures from the Leiter, NES3, DKEFS, CANTAB, CBC and other scales

Phase 2 – data include measures from the Leiter, DKEFS, CANTAB, BRIEF, ASEBA, Vineland, C-DISC, and other scales

Phase 3 – data include measures from the DAS-II, NEPSY-II, CANTAB, BRIEF, ASEBA, Vineland, C-DISC and other scales

Phase 1

[The => will link to detail when provided]

General Intellectual Ability=>Leiter International Performance Scale-Revised (Leiter-R)
Attention and Concentration=>NES3 – Continuous Performance Test (Animals)
Executive Function=>Delis-Kaplan Executive Function System (Verbal Fluency, Trail Making); Progressive Planning Test; Visual Discrimination Reversal Learning
Working Memory/Memory=>CANTAB (Spatial Working Memory; Spatial Span; Pattern Recognition Memory; Spatial Recognition Memory); Virtual Water Maze
Visual-Motor=>Visual-Motor Integration Test
Motor/Reaction Time: CANTAB (Motor Screening; Big/Little Circle); Grooved Pegboard Test
Interhemispheric Transfer=> Finger Localization Test
Psychological Symptomatology=> ASEBA (Child Behavior Checklist; Teacher Report Form; Youth Self Report); Disruptive Behavior Rating Scale; Sluggish Cognitive Tempo Scale; Pictorial Depression Scale

Phase 2

General Intellectual Ability=>Wechsler Intelligence Scale for Children – Fourth Edition
Executive Function=> Delis-Kaplan Executive Function System (Verbal Fluency, Trail Making; Color-Word Interference; Tower; 20 Questions; Design Fluency); CANTAB (Intra/Extradimensional Shift); BRIEF (Parent Version; Child Version)
Working Memory/Memory=> CANTAB (Spatial Working Memory; Delayed Matching to Sample)
Motor/Reaction Time=> CANTAB (Motor Screening; Big/Little Circle; Simple Reaction Time; Choice Reaction Time)
Psychological Symptomatology=> ASEBA (Child Behavior Checklist; Teacher Report Form; Youth Self Report); Disruptive Behavior Rating Scale; Sluggish Cognitive Tempo Scale; Vineland Adaptive Behavior Scales, 2nd Edition (Parent/Caregiver Rating Form; Teacher Rating Form); C-DISC Psychiatric Interview (Demographics; GAD; MDD; ADHD; ODD; CD modules)

Phase 3

General Intellectual Ability=> Differential Ability Scales – 2nd Ediction (DAS-II)
Attention and Concentration=> NEPSY-II (Speeded Naming; Arrows)
Executive Function=> CANTAB (Stockings of Cambridge); NEPSY-II (Word Generation; Inhibition); BRIEF (Parent Version)
Working Memory/Memory=> California Verbal Learning Test – Children’s Version (CVLT-C); NEPSY-II (Memory for Names; Memory for Designs: Memory for Faces; Narrative Memory)
Psychological Symptomatology=> ASEBA (Child Behavior Checklist; Teacher Report Form; Youth Self Report); Disruptive Behavior Rating Scale; Sluggish Cognitive Tempo Scale; Vineland Adaptive Behavior Scales, 2nd Edition (Parent/Caregiver Rating Form; Teacher Rating Form); C-DISC Psychiatric Interview (Demographics; GAD; MDD; ADHD; ODD; CD modules)

Phase 4

Wechsler Intelligence Scale for Children – 5th Edition (WISC-V)
Delis Kaplan Executive Function Scale (D-KEFS): Trail-making, Verbal Fluency, & Color Word Interference subtests
NIH Toolbox: Picture Sequence Memory, Dimensional Card Sort, Flanker, List Sorting subtests
Wechsler Individual Achievement Test – 3rd Edition (WIAT-III): Numerical operations, Word reading, Math problem solving subtests
Vineland Adaptive Behavior Scales
Behavior Assessment System for Children – 3rd Edition (BASC-3)
Child Behavior Checklist (CBCL)
Delis Rating of Executive Function (D-REF)

Early Predictors of FASD

Data were collected from infants in Ukraine in a prospective study.

Phase 2

Several variables are provided from an infant neurological exam and from the EEAC interview.

Phase 3

Several variables from the Conners scale, EEAC and other neurobehavioral exams are provided. Cytokine data are available.

3D Facial Imaging

3D Facial Imaging data were collected in all phases of CIFASD

Phase 1

Facial Data were acquired on an older Minolta laser system and include linear measurements for several anthropometric measures.

Phase 2

Facial Data were acquired on a 3dMD system and include linear measurements as well as x, y, z coordinates for the measures.

Phase 3

Facial Data were acquired on a 3dMD system and include linear measurements as well as x, y, z coordinates for the measures.

Phase 4

Facial data were acquired on 3dMD and Canfield systems and include linear measurements as well as x, y, z coordinates for the measures.

MRI

Phases 2 & 3: volumetric data
Phase 4: volumetric data, surface area, cortical thickness

Birth-related Data

Data describing birth (weight, length, maternal substance use) are available for a very limited subset of individuals, as most participants were adopted.

Phase 1:

Available data from Phase 1 were collected across five sites:
(1) Center for Behavioral Teratology, San Diego State University, San Diego, CA;
(2) Seven Northern Plains communities, including six Indian reservations;
(3) Institute of Psychiatry, Moscow, Russia;
(4) Moscow Region Institute of Obstetrics and Gynecology, Moscow, Russia, and
(5) Omni-Net sites at the Rivne Diagnostic Center, and the Kherson Children’s Hospital, Rivne and Kherson, Ukraine.

Subject recruitment varied between the sites, and subject population was racially and ethnically diverse.

Data for Neurobehavior, Dysmorphology Demographics, 3D Facial Imaging were collected from sites 1-3 for children between the ages of 5 -18 years, although the majority were 7-18 years old.

Data on current and recent maternal alcohol consumption, demographics and pregnancy history in a prospective study of prenatal alcohol exposure were collected from mothers and their babies from sites 4-5. Dysmorphology data was collected for all participants.

Phase 1 Projects

Phase 2:

Available data from Phase 2 were collected across six sites:
(1) Center for Behavioral Teratology, San Diego State University, San Diego, CA;
(2) Emory University, Atlanta, GA;
(3) the University of California, Los Angeles, Los Angeles, CA;
(4) University of New Mexico, Albuquerque, NM;
(5) Seven Northern Plains communities, including six Indian reservations; and
(6) Omni-Net locations in Ukraine: the Rivne Diagnostic Center and the Khmelnytsky Perinatal Center in Rivne and Khmelnytsky, Ukraine.

Subject recruitment varied between the sites, and subject population was racially and ethnically diverse.

Data for Neurobehavior, Dysmorphology, Demographics and Brain Volume were collected from sites 1-5 for children between the ages of 8-16 years. 3D Facial Imaging and Genetic data are also available for children from sites 1-3. Data from a longitudinal study were collected from site 6 for 350 moderately to heavily alcohol-exposed pregnant women and approximately 350 low or unexposed women.

Pregnancies were followed with serial ultrasounds and maternal blood samples were collected and analyzed for various nutrients and markers of oxidative stress and inflammation. Live born infants were given a dysmorphology exam, facial imaging, and neurobehavioral testing.

Phase 2 Projects

Phase 3:

Available data from Phase 3 were collected across five sites:
(1) San Diego State University,
(2) Emory University,
(3) University of California, Los Angeles and Children’s Hospital Los Angeles, CA,
(4) University of Minnesota; and
(5) Omni-Net locations in Ukraine: the Rivne Diagnostic Center and the Khmelnytsky Perinatal Center in Rivne and Khmelnytsky, Ukraine.

Subject recruitment varied between the sites, and subject population was racially and ethnically diverse.

Data for Neurobehavior, Dysmorphology, Demographics, 3D Facial Imaging, Genetics, and Brain Volume were collected from sites 1-4 for children ages 5-7 and 10-16 years under two age-based protocols. Data from maternal blood samples were collected from pregnant women and fetal data were collected via ultrasound from mothers and babies at site 5. Live born infants were given a dysmorphology exam, facial imaging, and neurobehavioral testing. Collection of blood, urine, and cheek cell samples were also included.

Phase 3 Projects