FREE ORAL COMMUNICATIONS 4: ALCOHOL DEPENDENCE: TREATMENT APPROACHES * O4.1 * EFFECTIVENESS OF STIMULANT MEDICATION IN FETAL ALCOHOL SPECTRUM DISORDERS

Abstract

Fetal alcohol spectrum disorders (FASDs) are often characterized by symptoms of inattention and hyperactivity. Many children with FASDs receive a diagnosis of attention-deficit/hyperactivity disorder (ADHD). However, it is unclear whether treatment with standard stimulant medication is effective in FASDs. This study evaluated response to stimulant medication in a group of children with heavy prenatal alcohol exposure and ADHD (ALC-ADHD) and nonexposed children with ADHD (Con-ADHD). Children, aged 7–15, were assessed with the QuotientTM ADHD System, which provides an objective measure of three core symptoms of ADHD (motion, attention and shifts in attention state). Subjects were evaluated twice, with and without stimulant medication. A significant group × stimulant interaction was found for measures of accuracy (P = 0.06), commission errors (P = 0.02), head movement (P = 0.03), head displacement (P < 0.01) and magnitude of head movement (P = 0.02). Subjects in the Con-ADHD group evidenced greater improvement with stimulant medication than those in the ALC-ADHD group. Importantly, in contrast, children in the ALC-ADHD group performed worse on several measures when tested on stimulant medication than when tested without a stimulant. These findings suggest that stimulant treatment for attention deficits in children with FASD is questionable. They also suggest that prenatal alcohol exposure should be considered as a contributory factor in the etiology of ADHD in individuals who do not show a positive response to stimulant medication. Future research should evaluate which aspects of ADHD are affected by stimulants in individuals with FASD and whether other treatments, including nonstimulant medication, may be more effective. (The research was supported by NIAAA grants R01 AA010417 T32 AA013525 to EPR and AA019605 to SNM.)