The teratogen affects behavior problems among the offspring (Loomans et al., 2012). Prenatal and parental exposure of alcohol is found to generate Attention Deficit Hyperactivity Disorder (ADHD) in children (Ware et al., 2012). ADHD causes over activity, impulsivity and are unable to sustain attention under the stereotypic school settings (Getahun et al., 2013). It also causes poor self-esteemed, mood swings, dysthymia and anxiety that tamper the academic performance of the students. However, exposure of alcohol is not the only reason behind the occurrence of ADHD among the children; there are also evidences of neurologic etiology (Frodl & Skokauskas, 2012). At the time of the discovery of the disease, ADHD was categorized as mild brain dysfunction (MBD) (Rubia et al., 2014). This is because, as the memory related problems are linked with neurological dysfunction and the reported cases of ADHD was mostly associated with the infants who are at the high-risk of pre and perinatal problems or with mother of high-risk pregnancies (Cussen et al., 2012). However, recent literature has reported the occurrence of ADHA among the children with no significant discernible brain dysfunction thus overruling the neurological basis of the disease (Cubillo et al., 2012). Therefore, the root cause of ADHD is confusing and varies in between stressful or disorganized environment and childhood psychiatric disorder.
ADHD is common in the families with prenatal alcohol exposure or children who are diagnosed with Fetal Alcohol Syndrome (FAS) or children born with alcoholic mothers or mothers who have consumed significant amount of alcohol during their time of pregnancy (Graham et al., 2013). However, the attempt made to link the etiology of ADHD with prenatal alcohol faced several problems because it is difficult to conceptually discriminate the prenatal effects from the other effects that are associated with the exposure of the postnatal environment like parental alcohol abuse (Silva et al., 2014). Therefore, it is still unclear that whether ADHD among the children is due to the post natal alcohol exposure or direct exposure of alcohol after birth. The main rationale of the study conducted by Brown et al., in the year 1991 is to discriminate these two guiding factors behind the reason of occurrence of ADHD among the children. The main hypothesis of the article entitled, Effects of prenatal alcohol exposure at school age. II. Attention and behavior is the school students who are exposed prenatal alcohol suffers from the ADHD.
For the study, authors here has chosen 68 mother-child pair from a large cohort (n = 228) in order the study the prenatal alcohol exposure on children and generation of ADHD. The age groups of the children include 10 months to 5 years. The population selected is black people for comes from low socioeconomic background. The selection of the sample was purely based on the study conducted in the research (Coles et al., 1991). The pool of subject belonged to the same bracket of the high-risk population including women who have reported consumption of alcohol during all the trimesters of pregnancy (n = 25) in spite of having proper educational intervention at the time of recruitment of the large university teaching hospital (1990 to 1983). Another group included randomly selected women who never consumed alcohol during the time of pregnancy and their children were free from alcohol intoxication (“never drank”, n = 21). Last and the final group included women who have reported drinking alcohol during their first trimester of pregnancy (statistically significant) but have stalled the consumption of alcohol altogether during rest of the tenure of pregnancy following the education intervention (“stopped drinking”, n= 22).
The study was conducted via a group of students who are master level graduate in psychology and the mode of study conduction was done with the help of disseminating questionnaire among the mothers and the children. Moreover, the participating children were kept blind about their maternal drinking status. The questionnaire was based on the Addiction Severity Index (ASI) (McClelland, Luborsky, O’Brien, 1983). The Child Behavior Checklist (CBL) accessed the internal and external behavior of the child (table 2 and table 3).
(Source: Brown et al., 1991)
(Source: Brown et al., 1991)
The sustained attention was analyzed via employing computerized vigilance task, which was identical to the Computerized Performance Tasks (CPTs). Matching Familiar Figures Test (MFFT) was employed to access the extent of impulsivity. Finally, in order to study the activity levels and interactional styles, videotaped observational procedure was employed.
In this study, the researchers want to study the effect of prenatal and post natal alcohol consumption on the development ADHD. Hence the amount and the extent of the alcohol consumption can be termed as an independent variable as it can be varied in order to modify the dependent variable which is the development of the ADHD among the school children.
The results showed that the children who are exposed to alcohol throughout their neonatal stage (pregnancy tenure) have deficits in their ability to maintain constant attention. They also showed frequent behavioral and attention related problems, as reported by their teachers. However, the reports recorded by their mother are not aligned with the teachers. When the current alcohol exposure of the children was controlled, only change or the modulation of the external behavior was observed with no effect on the internal behavior. The statistical significance of the test results was validated via applying Multivariate analysis of variance (MANOVA).
The hypothesis was aptly supported by the results as it showed that the children who are exposed with alcohol during their neonatal life, while they in the womb of their mother showed problem in maintaining attention, one of the principal symptoms of the ADHD.
Conclusion
From the research, Brown et al., (1991) concluded that the there lies an association of the ADHD symptoms with the parental alcoholism and the argument was supported by both postnatal environmental effects along with teratogenic affects. The results also showed that the children who were exposed to the alcohol throughout the pregnancy has significantly more behavioral problems in the eternalizing and internalizing domains in comparison to the mother who never consumed alcohol in their life or have ceased the intake of alcohol by the second trimester of pregnancy. The results also showed that when the effects of the present alcohol drinking were controlled, the internalizing effects weakened like withdrawal of depression and anxiety. The defects in the externalizing behavior however remain the same like cognitive performance and attention deficits.
The conclusion thus drawn from the research and obtained via the statistical analysis aptly supported the hypothesis of the study.
The research findings showed that the children born to the alcoholic mother (during the prenatal stages) are affected with the ADHD. Thus the research findings supported the conclusion drawn via linking the dependent and independent variables.
The researcher conclusion are in sync with the previous findings too. For example, Streissguth et al., (1986) showed that the heavily effected children commit more error in the CPT and reacted more slowly in comparison to other unaffected individual. However, apart from the attention related problems, no changes in their behavioral responses were reported. On the other hand, the results obtained by Borwn et al. (1991) overruled the findings of the Boyd et al. (1991) which showed no evidence of prenatal alcohol on the attention of the children coming from the low-income countries.
The main strength of the study is lies in its statistical analysis and the use of the wide range of the parameters in order to study the attention deficit problems among the children. However, there are certain weakness in the study like the study has included a very small group of respondents, 68 that might have led to the generation of biasness. Moreover, the selection of the black people as the principal focus group who are residing under the poor socio-economic bracket is another main weakness of the study, again generating biasness in the results.
The structure and the design of the study can be improved via including a large focus group and via studying the neurological basis of the children who are suffering from the ADHD in order to draw the a link between the alcohol exposure and the neurological predisposition in the development of the ADHD (Graham et al., 2013).
The research findings are extremely useful in ascertain the effect of the alcohol exposure during the prenatal tenure on the ADHD on the psychopathology and the behavior of the children (Ware et al., 2013).
References
Boyd, T. A., Ernhart, C. B., Greene, T. H., Sokol, R. J., & Martier, S. (1991). Prenatal alcohol exposure and sustained attention in the preschool years. Neurotoxicology and teratology, 13(1), 49-55.
Brown, R. T., Coles, C. D., Smith, I. E., Platzman, K. A., Silverstein, J., Erickson, S., & Falek, A. (1991). Effects of prenatal alcohol exposure at school age. II. Attention and behavior. Neurotoxicology and teratology, 13(4), 369-376. doi:10.3390/brainsci6010005
Coles, C. D., Brown, R. T., Smith, I. E., Platzman, K. A., Erickson, S., & Falek, A. (1991). Effects of prenatal alcohol exposure at school age. I. Physical and cognitive development. Neurotoxicology and teratology, 13(4), 357-367.
Cubillo, A., Halari, R., Smith, A., Taylor, E., & Rubia, K. (2012). A review of fronto-striatal and fronto-cortical brain abnormalities in children and adults with Attention Deficit Hyperactivity Disorder (ADHD) and new evidence for dysfunction in adults with ADHD during motivation and attention. Cortex, 48(2), 194-215. https://doi.org/10.1016/j.cortex.2011.04.007
Cussen, A., Sciberras, E., Ukoumunne, O. C., & Efron, D. (2012). Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. European journal of pediatrics, 171(2), 271-280. DOI: https://doi.org/10.1007/s00431-011-1524-4
Frodl, T., & Skokauskas, N. (2012). Meta?analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatrica Scandinavica, 125(2), 114-126. DOI: 10.1111/j.1600-0447.2011.01786.x
Getahun, D., Jacobsen, S. J., Fassett, M. J., Chen, W., Demissie, K., & Rhoads, G. G. (2013). Recent trends in childhood attention-deficit/hyperactivity disorder. JAMA pediatrics, 167(3), 282-288. doi:10.1001/2013.jamapediatrics.401
Graham, D. M., Crocker, N., Deweese, B. N., Roesch, S. C., Coles, C. D., Kable, J. A., … & Riley, E. P. (2013). Prenatal alcohol exposure, attention?deficit/hyperactivity disorder, and sluggish cognitive tempo. Alcoholism: Clinical and Experimental Research, 37(s1). DOI: 10.1111/j.1530-0277.2012.01886.x
Loomans, E. M., Hofland, L., Van der Stelt, O., Van der Wal, M. F., Koot, H. M., Van den Bergh, B. R., & Vrijkotte, T. G. (2012). Caffeine intake during pregnancy and risk of problem behavior in 5-to 6-year-old children. Pediatrics, 130(2), e305-e313.
McClelland, A. T., Luborsky, L., O’Brien, C. P. (1983). An improved validation instrument for substance abuse patients: The addiction sever- ity index. J. Nerv. Ment. Dis., 168, 26-33.
Rubia, K., Alegria, A. A., Cubillo, A. I., Smith, A. B., Brammer, M. J., & Radua, J. (2014). Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biological Psychiatry, 76(8), 616-628. https://doi.org/10.1016/j.biopsych.2013.10.016
Silva, D., Colvin, L., Hagemann, E., & Bower, C. (2014). Environmental risk factors by gender associated with attention-deficit/hyperactivity disorder. Pediatrics, 133(1), e14-e22.
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Ware, A. L., Crocker, N., O’brien, J. W., Deweese, B. N., Roesch, S. C., Coles, C. D., … & Jones, K. L. (2012). Executive function predicts adaptive behavior in children with histories of heavy prenatal alcohol exposure and attention?deficit/hyperactivity disorder. Alcoholism: Clinical and Experimental Research, 36(8), 1431-1441. DOI: 10.1111/j.1530-0277.2011.01718.x
Ware, A. L., O’brien, J. W., Crocker, N., Deweese, B. N., Roesch, S. C., Coles, C. D., … & Jones, K. L. (2013). The Effects of Prenatal Alcohol Exposure and Attention?Deficit/Hyperactivity Disorder on Psychopathology and Behavior. Alcoholism: Clinical and Experimental Research, 37(3), 507-516. DOI: 10.1111/j.1530-0277.2012.01953.x
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