产前酒精暴露和注意力缺陷多动障碍对适应性功能的影响。
Effects of prenatal alcohol exposure and attention-deficit/hyperactivity disorder on adaptive functioning.
作者信息
Ware Ashley L, Glass Leila, Crocker Nicole, Deweese Benjamin N, Coles Claire D, Kable Julie A, May Philip A, Kalberg Wendy O, Sowell Elizabeth R, Jones Kenneth L, Riley Edward P, Mattson Sarah N
机构信息
Center for Behavioral Teratology , San Diego State University, San Diego, California.
出版信息
Alcohol Clin Exp Res. 2014 May;38(5):1439-47. doi: 10.1111/acer.12376. Epub 2014 Mar 21.
BACKGROUND
Heavy prenatal alcohol exposure and attention-deficit/hyperactivity disorder (ADHD) are associated with adaptive behavior deficits. This study examined the interaction between these 2 factors on parent ratings of adaptive behavior.
METHODS
As part of a multisite study, primary caregivers of 317 children (8 to 16 years, M = 12.38) completed the Vineland Adaptive Behavior Scales-Second Edition (VABS-II). Four groups of subjects were included: children with prenatal alcohol exposure with ADHD (AE+, n = 82), children with prenatal alcohol exposure without ADHD (AE-, n = 34), children with ADHD (ADHD, n = 71), and control children (CON, n = 130). VABS-II domain scores (Communication, Daily Living Skills, Socialization) were examined using separate 2 (Alcohol Exposure [AE]) × 2 (ADHD diagnosis) between-subjects analyses of covariance.
RESULTS
There were significant main effects of AE (p < 0.001) and ADHD (p < 0.001) on all VABS-II domains; alcohol-exposed children had lower scores than children without prenatal alcohol exposure and children with ADHD had lower scores than those without ADHD. There was a significant AE × ADHD interaction effect for Communication, F(1, 308) = 7.49, p = 0.007, partial η(2) = 0.024, but not Daily Living Skills or Socialization domains (ps > 0.27). Follow-up analyses in the Communication domain indicated the effects of ADHD were stronger in comparison subjects (ADHD vs. CON) than exposed subjects (AE+ vs. AE-), and the effects of alcohol exposure were stronger in subjects without ADHD (AE- vs. CON) than in subjects with ADHD (AE+ vs.
ADHD) CONCLUSION: As found previously, both prenatal alcohol exposure and ADHD increase adaptive behavior deficits in all domains. However, these 2 factors interact to cause the greatest impairment in children with both prenatal alcohol exposure and ADHD for communication abilities. These results further demonstrate the deleterious effects of prenatal alcohol exposure and broaden our understanding of how ADHD exacerbates behavioral outcomes in this population.
背景
孕期大量饮酒与注意力缺陷多动障碍（ADHD）均与适应性行为缺陷有关。本研究考察了这两个因素在家长对适应性行为评分上的交互作用。
方法
作为一项多地点研究的一部分，317名儿童（8至16岁，平均年龄12.38岁）的主要照料者完成了《文兰适应性行为量表第二版》（VABS-II）。研究纳入了四组受试者：患有ADHD的孕期酒精暴露儿童（AE+，n = 82）、未患ADHD的孕期酒精暴露儿童（AE-，n = 34）、患有ADHD的儿童（ADHD，n = 71）以及对照儿童（CON，n = 130）。使用独立的2（酒精暴露[AE]）×2（ADHD诊断）组间协方差分析来检验VABS-II各领域得分（沟通、日常生活技能、社交）。
结果
AE（p < 0.001）和ADHD（p < 0.001）在所有VABS-II领域均有显著主效应；酒精暴露儿童的得分低于未孕期酒精暴露的儿童，患有ADHD的儿童得分低于未患ADHD的儿童。在沟通方面存在显著的AE×ADHD交互效应，F(1, 308) = 7.49，p = 0.007，偏η(2) = 0.024，但在日常生活技能或社交领域不存在交互效应（p > 0.27）。沟通领域的后续分析表明，ADHD在对照受试者（ADHD与CON对比）中的效应比在暴露受试者（AE+与AE-对比）中更强，酒精暴露在未患ADHD的受试者（AE-与CON对比）中的效应比在患ADHD的受试者（AE+与ADHD对比）中更强。结论：如先前研究发现，孕期酒精暴露和ADHD都会增加所有领域的适应性行为缺陷。然而，这两个因素相互作用，会使孕期酒精暴露且患有ADHD的儿童在沟通能力方面出现最大程度的损害。这些结果进一步证明了孕期酒精暴露的有害影响，并拓宽了我们对ADHD如何加剧该人群行为后果的理解。
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