SANTA BARBARA, CALIF. — The psychiatric and behavioral consequences of heavy prenatal alcohol exposure on children are abundantly clear by midchildhood and adolescence, according to studies presented at the annual meeting of the Research Society on Alcoholism.
One study found that children exposed prenatally to alcohol were far more likely than their peers to meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, tic disorders, and mood disorders by the time they were 8–14 years old.
Another study assessed social problem-solving skills and executive functioning in adolescents who were heavily exposed to alcohol in utero. Profound impairments were found in both types of skills, which are integral to academic achievement and social interaction. The studies were conducted by researchers from the Center for Behavioral Teratology at San Diego State University, and were presented in poster form.
Sarah N. Mattson, Ph.D., a senior author on the studies, said in an interview that “heavy alcohol exposure” was equivalent to about a case of beer or a fifth of hard liquor a day.
Susanna L. Fryer, a doctoral student at the center, explored childhood psychopathologies in 43 alcohol-exposed and 22 nonexposed children using structured interviews with primary caregivers. “The difference within the ADHD category was, by far, the largest [group] effect observed,” she concluded.
By the numbers, 42 of 43 alcohol-exposed children met diagnostic criteria for ADHD, compared with 1 of 22 nonexposed children matched by age and socioeconomic status.
Nearly a third (13 of 43) of the alcohol-exposed children had oppositional defiant disorder, but just one nonexposed child met the criteria for that diagnosis. Mood disorders were found in eight alcohol-exposed children, tic disorders in four, and conduct disorder in five. No child in the control group met the diagnostic criteria for any of those illnesses.
“Certain psychiatric disorders may be more prevalent than others in fetal alcohol spectrum disorders; disruptive psychopathologies were particularly common in our sample, while anxiety disorders were not,” wrote Ms. Fryer. Similarly, children exposed to alcohol prenatally were no more likely than controls to have simple phobias.
Christie L. McGee, who is also a doctoral student at the center, reported on social problem-solving deficits in 43 adolescents aged 13–18 years, 24 of whom were prenatally exposed to heavy alcohol use. The adolescents completed the Revised Social Problem-Solving Inventory (SPSI-R), which measures an individual's ability to resolve the problems of everyday living. The teenagers' parents or caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF), which includes subscales on such characteristics as a child's emotional control, working memory, and ability to plan and organize. Responses were anonymous.
Very large differences were found between the alcohol-exposed and nonexposed adolescents, with effect sizes ranging from 1.32 to 1.41 for problem solving skills and 1.96 to 4.61 for executive functioning.
Those exposed to alcohol in utero “approached problems with a pessimistic orientation and indicated a low frustration tolerance,” said Ms. McGee.
“[They] rated themselves as less effective at identifying problems, generating solutions, making decisions, and implementing and verifying the chosen solution … [and they were] more likely to endorse an avoidant, careless, or impulsive approach to solving their everyday problems,” she continued.