ADHD Diagnosis-Drinking Alcohol during Pregnancy

Drinking alcohol during pregnancy may cause ADHD behavior problems in children later in life.

This news item has shown up many times in national publications and broadcast briefs in the past year. It seems to me that this just points out that experts consider alcohol ingestion during pregnancy as a cause of future ADHD behavior to be a very important topic-one deserving of the public being often reminded.

No one knows just how much alcohol a pregnant woman can drink before her growing baby suffers direct damage to his or her developing nervous system. It may be as little as one drink or as much as one drink a day, but there is no doubt that drinking alcohol during pregnancy can affect a developing baby’s brain and nervous system and potential for normal physical growth and development.

It appears that alcohol consumed during pregnancy causes direct damage to the parts of the brain and to nerves that help a child concentrate, make decisions, store memories, and co-ordinate muscles to work with everything else.  

Fetal alcohol syndrome (FAS) is the term we use to describe the effects of alcohol on a developing fetus.

So, it’s no surprise that children and teens exposed to alcohol during pregnancy might have problems focusing on task, may be inattentive, be poorly organized, be unable to remember studies, and show poor co-ordination. Many of these kids will have impulsive and disruptive behaviors because their higher brain functions-decision making capabilities are damaged and they are slow to perceive clues that normally would make most of us delay or altogether decide against a particular action.

As a result of this decreased ability to reason and the lack of restraint, FAS children may get up and wander around the classroom, blurt-out answers out of turn, and appear hyper and out of control. FAS teens might have multiple legal problems-speeding tickets, illegal or legal drug abuse-and experiment in risky behaviors such as unprotected sex.

Alcohol ingestion during pregnancy might just be the reason a child makes poor grades or has bad behavior at school or at the mall…Both behaviors found in children with ADHD!

All of this sounds a lot like ADHD behavior-doesn’t it?

Then, it won’t surprise you to discover that fetal alcohol syndrome is one of the things that can produce ADHD-like behaviors that can mimic ADHD, causing ADHD misdiagnosis.

That’s right…Just having a few beers, a couple of glasses of wine, a mixed drink or taking an alcohol containing medicine (e.g. cough syrup) during pregnancy may cause an unborn child to have ADHD behavior symptoms at as young as age tree years or at any point through adolescence and young adult life.

These ADHD behaviors could result in that child being wrongfully diagnosed as ADHD, mislabeled as ADHD, and inappropriately treated with ADHD drugs instead of being treated for what is really wrong-fetal alcohol syndrome!

ADHD experts and childhood developmental physicians advise pregnant women to completely avoid use of alcohol as soon as they suspect they’re pregnant. As I noted above, even the use of alcohol containing mouthwashes, cough syrups and cold medications might cause FAS, leading to future behavior and learning problems.

If you suspect a child might have a mild form of FAS, please discuss your concerns with your child’s family doctor or pediatrician as soon as possible. Using multidisciplinary behavior training and learning training techniques, specialists may be able to help such a child learn how to focus and better learn and remember and how to better control unwanted behavior.

Dr. Frank

Here are a couple of links you might want to take a look at:

What Every Woman Should Know about Alcohol and Pregnancy

Alcohol During Pregnancy: How Dangerous Is It Really?


Here are previous posts dealing with fetal alcohol syndrome:

Alcohol Use during Pregnancy may Cause ADHD Misdiagnosis in Young Kids

Fetal Alcohol Syndrome: Evaluation and Treatment

Treating Fetal Alcohol Syndrome

Treatment Options for Fetal Alcohol Syndrome

In yesterday’s blog post, we explored the things to watch for when suspecting a child’s behavior might be caused by fetal alcohol syndrome and began our discussion of treatment options for affected kids.

Today, I’d like to finish this series by outlining both behavior and medication based therapies for children suffering from intrauterine alcohol exposure.

Cognitive Behavior Training (CBT) for FAS

CBT for kids suffering FAS involves using professionals specifically trained in the detection, evaluation and treatment of neurodevelopmental disorders such as fetal alcohol spectrum disorders (FASD). These professionals will:

  • Identify the child’s strengths and weaknesses (disabling traits and physical characteristics)
  • Evaluate and measure deficits in memory , language and speech, and emotional maturity
  • Assess levels of executive thought processing such as impulsivity control, attention span, and distractibility (all core symptoms of ADHD)
  • Test for learning disability
  • Evaluate for hand-eye coordination, visual-auditory stereotaxis, and spatial recognition abilities.

Once these essentials have been assessed, the therapist will ask the child’s parents and the rest of the family to become an active part of the therapy plan, by buying into a game plan with specific goals. Such goals may include improving word use and language skills, speech training to decrease slur and mispronunciation, and memory training to improve retention. Usually, this means parents, siblings, grandparents and other caregivers will need special training to learn how to best help the child grow and mature in a “as normal as possible” fashion.

Some FAS kids will need changes in certain elements of their living and learning environments in order to decrease the effects of any physical disabilities (e.g. hearing aids, braces for malformed knees and hip problems, special shoes, dental appliances to assist with speech and swallowing, and special lenses for vision problems).

Drug therapy for FAS

Since there is no known cure for Fetal Alcohol Syndrome, any medications used to treat these kids are used solely to decrease the emotional and behavior-based symptoms most likely to cause the child a disability and keep him or her from reaching goals.

For example, if a child suffering Fetal Alcohol Spectrum Disorder is:

  • Depressed, sad, and cries a lot…. We use an antidepressant such as fluoxetine
  • Irritable, anxious, excitable…. An anxiolytic such as buspirone might be needed
  • Having mood swings and problems with anger… Bipolar Disorder might be present and require lithium therapy or treatment with lamotrigine
  • Displaying the ADHD symptoms of inattentiveness, impulsivity, and hyperactivity… he or she may need an amphetamine or methylphenidate (both ADHD drugs).

A word of caution:
Fetal Alcohol Syndrome is one of the more than 50 conditions that may be confused with or mistaken for ADHD causing ADHD misdiagnosis!

As we finish our discussion, please allow me to remind you of these things about FAS:

  • The effects of Fetal Alcohol Syndrome may  be so mild as to be very difficult to detect or so severe as to be hard to miss
  • The earlier the condition is detected and treated, the better the outcome
  • The ultimate goal in FAS therapy is to help the child deal with any physical, emotional, psychiatric or neurological disabilities to the extent he or she is able to live as normal a life as possible.

Successful treatment for FAS requires well-planned cooperation between the affected child’s parents, other family members, caregivers and all-of-the professionals involved. As I pointed out earlier, our goal in treating FAS is to reduce any disabilities to the point that that have the smallest impact on the child’s ability to live as-normal-a-life-as-possible!

Anyone have suggestions about helping these kids in the classroom? Or while studying at home?
Please share…

Dr, Frank

Alcohol Use during Pregnancy may Cause ADHD Misdiagnosis in Young Kids

It seems we continue to discover medical problems that might be mistaken for ADHD and cause mislabeling and misdiagnosis every day! Fetal alcohol syndrome (FAS) is one such Zebra that might cause confusion when diagnosing ADHD in younger kids.

Doctors have long known that alcohol use during pregnancy directly affects the growing (fetus’) child’s nervous system (brain and spinal cord) and may cause both motor-coordination difficulties (poor coordination), as well as various behavior problems. Kids born of moms who drank alcohol during pregnancy are more likely to have:

  • Hyperactivity
  • Impulsivity
  • Inattentiveness (poor focus)
  • Learning disabilities (speech delay, memory and speech problems)
  • Poor social skills (don’t play well with others)
  • Bouts of anxiety and depression.

Wow! Kids suffering FAS have many of the behavior problems seen in children suffering from ADHD! That means it would be really easy for a parent, a teacher or a doctor to mistake a kid with fetal alcohol syndrome as ADHD, when in reality he or she is not.

Warning! Let’s stop here and let me point out a few very important things:

  • Not every child whose mom drank alcohol during pregnancy will suffer FAS
  • No one knows exactly how much alcohol has to be consumed and how often a pregnant woman has to drink alcohol to cause FAS
  • The effect of alcohol on the growing fetus may be so mild as to be undetectable in childhood or so severe as to cause a child to be disabled and incapable of growing normally. Fetal alcohol syndrome is truly a spectrum of signs, behaviors and syndromes (FASD).

What other things would you notice in a child with FAS?

  • Low birth weight and size
  • Poor growth and development as compared to normal
  • Clumsiness and problems with coordination
  • Language and speech problems
  • Slow mentation
  • Joint problems
  • Dental problems.

How is the diagnosis of fetal alcohol syndrome made?

A child suspected of FAS should be evaluated by a professional trained in neurodevelopmental abnormalities and behavior disorders. While the physical characteristics of these kids may lead us to suspect FAS, specific psychological, behavioral, learning, and social integration testing will help confirm the diagnosis and give us a good starting point for therapy. 

In my next post, we’ll discuss more about evaluation and treatment options for FAS.

Dr. Frank

You might wish to take a look at:

“Fetal Alcohol Syndrome Often Mistaken for Other Disorders”

How to Detect ADHD and ADDS in Kids Under Age 6