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BMC Psychiatry
Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

Guidelines for identification and treatment of individuals with attention deficit/hyperactivity disorder and associated fetal alcohol spectrum disorders based upon expert consensus

Authors: Susan Young, Michael Absoud, Carolyn Blackburn, Polly Branney, Bill Colley, Emad Farrag, Susan Fleisher, Ges Gregory, Gisli H. Gudjonsson, Keira Kim, Kieran D. O’Malley, Moira Plant, Alina Rodriguez, Susan Ozer, Inyang Takon, Emma Woodhouse, Raja Mukherjee

Published in: BMC Psychiatry | Issue 1/2016

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Abstract

Background

The association of attention deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorders (FASD) results in a complex constellation of symptoms that complicates the successful diagnosis and treatment of the affected individual. Current literature lacks formal guidelines, randomized control trials, and evidence-based treatment plans for individuals with ADHD and associated FASD. Therefore, a meeting of professional experts was organized with the aim of producing a consensus on identification and treatment guidelines that will aid clinicians in caring for this unique patient population.

Methods

Experts from multiple disciplines in the fields of ADHD and FASD convened in London, United Kingdom, for a meeting hosted by the United Kingdom ADHD Partnership (UKAP; www.​UKADHD.​com) in June 2015. The meeting provided the opportunity to address the complexities of ADHD and FASD from different perspectives and included presentations, discussions, and group work. The attendees worked towards producing a consensus for a unified approach to ADHD and associated FASD.

Results

The authors successfully came to consensus and produced recommended guidelines with specific regards to identification and assessment, interventions and treatments, and multiagency liaisons and care management, highlighting that a lifespan approach to treatment needs to be adopted by all involved. Included in the guidelines are: 1) unique ‘red flags’, which when identified in the ADHD population can lead to an accurate associated FASD diagnosis, 2) a treatment decision tree, and 3) recommendations for multiagency care management.

Conclusions

While clinically useful guidelines were achieved, more research is still needed to contribute to the knowledge base about the diagnosis, treatment, and management of those with ADHD and associated FASD.
Literature
1.
Polanczyk G, et al. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942–8.CrossRefPubMed
2.
3.
Peadon E, Elliott EJ. Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders in children: clinical guidelines. Neuropsychiatr Dis Treat. 2010;6:509–15.CrossRefPubMedPubMedCentral
4.
Burd L, Christensen T. Treatment of fetal alcohol spectrum disorders: are we ready yet? J Clin Psychopharmacol. 2009;29(1):1–4.CrossRefPubMed
5.
Rasmussen C, Bisanz J. Executive functioning in children with fetal alcohol spectrum disorders: profiles and age-related differences. Child Neuropsychol. 2009;15(3):201–15.CrossRefPubMed
6.
Gray R, Mukherjee R. A psychiatrist’s guide to foetal alcohol spectrum disorders in mothers who drank heavily during pregnancy. Adv Ment Health Learn Disabil. 2007;1(3):19–26.CrossRef
7.
Spencer T, Biederman J, Mick E. Attention-deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology. J Pediatr Psychol. 2007;32(6):631–42.CrossRefPubMed
8.
American Psychiatric Association. The diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association. 2013.
9.
Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med. 2006;36(2):159–65.CrossRefPubMed
10.
Weiss G, Hechtman LT. Hyperactive children grown up: ADHD in children, adolescents, and adults. New York: Guilford Press; 1993.
11.
Thomas R, et al. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135(4):994–1001.CrossRef
12.
Valera EM, et al. Meta-analysis of structural imaging findings in attention-deficit/hyperactivity disorder. Biol Psychiatry. 2007;61(12):1361–9.CrossRefPubMed
13.
14.
Young S, et al. A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med. 2015;45(2):247–58.CrossRefPubMed
15.
16.
World Health Organization. International classification of diseases. 10th ed. Geneva: World Health Organization. 1992.
17.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, text revision. 4th ed. Washington, DC: American Psychiatric Association. 2000.
18.
19.
British Medical Association; Board of Science. Fetal alcohol spectrum disorders: a guide for healthcare professionals. 2007.
20.
21.
Jones KL, Smith DW. Recognition of the fetal alcohol syndrome in early infancy. Lancet. 1973;302(7836):999–1001.CrossRefPubMed
22.
Institute of Medicine: Committee to Study Fetal Alcohol Syndrome, Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment, ed. K. Stratton, C. Howe, and F.C. Battaglia. 1996, Washington D.C.: National Academies Press.
23.
Streissguth AP, O’Malley K. Neuropsychiatric implications and long-term consequences of fetal alcohol spectrum disorders. Semin Clin Neuropsychiatry. 2000;5(3):177–90.CrossRefPubMed
24.
Crocker N, et al. Comparison of adaptive behavior in children with heavy prenatal alcohol exposure or attention-deficit/hyperactivity disorder. Alcohol Clin Exp Res. 2009;33(11):2015–23.CrossRefPubMedPubMedCentral
25.
Fryer SL, et al. Evaluation of psychopathological conditions in children with heavy prenatal alcohol exposure. Pediatrics. 2007;119(3):e733–41.CrossRefPubMed
26.
Streissguth AP, et al. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. J Dev Behav Pediatr. 2004;25(4):228–38.CrossRefPubMed
27.
28.
May PA, Gossage JP. Estimating the prevalence of fetal alcohol syndrome. A summary. Alcohol Res Health. 2001;25(3):159–67.PubMed
29.
May PA, et al. The epidemiology of fetal alcohol syndrome and partial FAS in a South African community. Drug Alcohol Depend. 2007;88(2–3):259–71.CrossRefPubMed
30.
May PA, et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Dev Disabil Res Rev. 2009;15(3):176–92.CrossRefPubMed
31.
32.
Lange S, et al. Prevalence of fetal alcohol spectrum disorders in child care settings: a meta-analysis. Pediatrics. 2013;132(4):e980–95.CrossRefPubMed
33.
Chasnoff IJ, Wells AM, King L. Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure. Pediatrics. 2015;135(2):264–70.CrossRefPubMed
34.
Gregory G, Reddy V, Young C. Identifying children who are at risk of FASD in Peterborough: working in a community clinic without access to gold standard diagnosis. Adopt Foster. 2015;39(3):225–34.CrossRef
35.
Spadoni AD, et al. Neuroimaging and fetal alcohol spectrum disorders. Neurosci Biobehav Rev. 2007;31(2):239–45.CrossRefPubMed
36.
Archibald SL, et al. Brain dysmorphology in individuals with severe prenatal alcohol exposure. Dev Med Child Neurol. 2001;43(3):148–54.CrossRefPubMed
37.
Popova S, et al. Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis. Lancet. 2016;387(10022):978–87.CrossRefPubMed
38.
Brown NN, Gudjonsson G, Connor P. Suggestibility and fetal alcohol spectrum disorders: i’ll tell you anything you want to hear. J Psychiatry Law. 2011;39(1):39–71.CrossRef
39.
Substance Abuse and Mental Health Services Administration. Results from the 2007 national survey on drug use and health: national findings. Rockville: Health and Human Services; 2008.
40.
Floyd RL, et al. Recognition and prevention of fetal alcohol syndrome. Obstet Gynecol. 2005;106(5 Pt 1):1059–64.CrossRefPubMed
41.
Bertrand J, Floyd LL, Weber MK. Guidelines for identifying and referring persons with fetal alcohol syndrome. MMWR Recomm Rep. 2005;54(RR-11):1–14.PubMed
42.
Kodituwakku PW. Defining the behavioral phenotype in children with fetal alcohol spectrum disorders: a review. Neurosci Biobehav Rev. 2007;31(2):192–201.CrossRefPubMed
43.
Olson H. Advancing recognition of fetal alcohol spectrum disorders: the proposed DSM-5 diagnosis of “neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE)”. Curr Dev Disord Rep. 2015;2(3):187–98.CrossRef
44.
O’Malley KD. The knotted cord. Transgenerational alcohol related neurodevelopmental disorder (ARND). New York: Nova; 2014.
45.
Glass L, et al. Neuropsychological deficits associated with heavy prenatal alcohol exposure are not exacerbated by comorbid adhd. Neuropsychology. 2013;27(6):713–24.CrossRefPubMedPubMedCentral
46.
Coles CD, et al. A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder. Alcohol Clin Exp Res. 1997;21(1):150–61.CrossRefPubMed
47.
Crocker N, et al. Comparison of verbal learning and memory in children with heavy prenatal alcohol exposure or attention-deficit/hyperactivity disorder. Alcohol Clin Exp Res. 2011;35(6):1114–21.CrossRefPubMedPubMedCentral
48.
Bhatara V. Association of attention deficit hyperactivity disorder and gestational alcohol exposure: an exploratory study. J Atten Disord. 2006;9(3):515–22.CrossRefPubMed
49.
Burd L, Carlson C, Kerbeshian J. Fetal alcohol spectrum disorders and mental illness. Int J Disabil Hum Dev. 2007;6(4):383–96.CrossRef
50.
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):349–54.CrossRefPubMed
51.
Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol use disorders identifcation test. World Health Organization: Department of Mental Health and Substance Dependence. Geneva: 2001.
52.
Li Q, et al. Fetal alcohol spectrum disorders: a population based study of premature mortality rates in the mothers. Matern Child Health J. 2012;16(6):1332–7.CrossRefPubMedPubMedCentral
53.
Gudjonsson GH, et al. A national epidemiological study investigating risk factors for police interrogation and false confession among juveniles and young persons. Soc Psychiatry Psychiatr Epidemiol, 2015;51;359-367.
Metadata
Title
Guidelines for identification and treatment of individuals with attention deficit/hyperactivity disorder and associated fetal alcohol spectrum disorders based upon expert consensus
Authors
Susan Young
Michael Absoud
Carolyn Blackburn
Polly Branney
Bill Colley
Emad Farrag
Susan Fleisher
Ges Gregory
Gisli H. Gudjonsson
Keira Kim
Kieran D. O’Malley
Moira Plant
Alina Rodriguez
Susan Ozer
Inyang Takon
Emma Woodhouse
Raja Mukherjee
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-1027-y

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