Questions and Answers-cont.

Page 1
When is "inattentiveness" an "attention deficit disorder?"
When is hyperactivity abnormal?
Are girls with ADHD more prone to learning impairments than boys?
Page 2
Does fetal exposure to alcohol, marijuana, or cigarettes increase the risk of ADHD?
Are PCBs and other environmental toxins potential causes of ADHD?
Page 3
What is oppositional defiant disorder?
How is a conduct disorder defined?
How are mood disorders recognized?
Page 4
What are the principal forms of therapy of ADHD?
What are the roles of the psychologist and psychiatrist in the management of the child with ADHD?
Why are motivational techniques emphasized in parent counseling and training sessions?
Page 5
What types of special education placements are available for children with ADHD in public schools?
What are some of the professional support services available in public schools?
Can I expect my child to outgrow the ADHD?

  Q: Does fetal exposure to alcohol, marijuana, or cigarettes increase the risk of ADHD?

A: Behavioral problems are one of the characteristics of the "fetal alcohol syndrome" (FAS) that affects children born to mothers who consume alcohol during pregnancy. Alcohol use before a pregnancy has no adverse effect, but during pregnancy and breast feeding, alcohol may cause delay in an infant's development.

      In addition to cognitive and behavior problems, the child with FAS has a small head, growth retardation, and facial peculiarities of development, or dysmorphisms. Premature infants of mothers who are high alcohol consumers are at increased risk for brain hemorrhage, according to a study of 349 infants at Michigan State University, East Lansing, MI (Holzman C et al, 1995).

     Biological, not psychosocial, factors are responsible for ADHD in children with fetal alcohol syndrome.

     Maternal cigarette smoking has been linked to impairments of cognitive function and memory, academic under-achievement, and behavioral problems in children exposed during pregnancy (Drews CD et al, 1996). In a follow-up study of 6 year old children studied at Carleton University, Ottawa, Canada, prenatal marijuana was associated with errors of omission in tasks of vigilance, reflecting a deficit in sustained attention (Fried PA et al, 1992).

     Cigarette smoking, marijuana use, and alcohol excess during pregnancy may have adverse effects on the behavior and attention of the infant and child, but a definite causative role in ADHD has not been established.

Q: Are PCBs and other environmental toxins potential causes of ADHD?

A:   Environmental contaminants of our food and water supplies include PCBs (polychlorinated biphenyls), PBBs (polybrominated biphenyls), nitrates, DDT, dioxin, and PCBs have not been produced since the 1970's. Despite the ban on the manufacture of these chemicals, dangerous concentrations persist in the water of rivers and inland lakes.

      PCBs were dumped years ago as waste products from electrical transformer, capacitor, and plasticizer factories. From the sediment at the bottom of harbors, hazardous waste residues pollute the water and are eaten by microscopic organisms and fish. From fish the chemicals are passed to birds and humans, causing various ailments including cancer and reproductive problems (Millichap JG, 1993, 1995). Man is the final consumer in the food chains, and he is exposed to the greatest concentrations of any environmental poison.

     While regulatory control measures have substantially reduced the PCB contamination of animal feeds and food products by spillage, those subgroups of the population who regularly consume fish caught in lakes and streams are still at risk of poisoning. Surveys and analyses of fish from the Hudson River in New York State and from Lake Michigan showed significant levels of contamination with PCBs in excess of 5 ppm.

     Studies designed to assess the health of hazard of PCB exposure from Lake Michigan fish showed a correlation between the quantity of fish consumed and the concentration of PCB in blood and breast milk of participants in the studies. Those eating higher amounts of fish had significantly higher blood levels of PCB. Children born to women who routinely consumed Lake Michigan sportfish displayed poorer short-term memory function on both verbal and quantitative tests. The cognitive function was tested at 11 years of age in 212 children exposed prenatally to PCBs and examined at Wayne State University, Detroit, MI (Jacobson JL, Jacobson SW, 1996). Long-term intellectual impairment affected memory, attention, and reading ability, deficits frequently found in children with ADHD.

     Subtle alterations in neuropsychological functioning caused by exposure to these environmental toxins are proposed as potential causes for some cases of ADHD and learning disabilities.

Copyright©1998 J. Gordon Millichap,M.D., F.R.C.P.,Editor
All Rights Reserved

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