Within-Family Effects of Smoking during Pregnancy on ADHD: the Importance of Phenotype
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We sought to test within- and between- family associations of smoking during pregnancy (SDP) and attention deficit-hyperactivity disorder (ADHD) symptoms using a structured interview based on the conventional Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) symptoms and the Strengths and Weaknesses of ADHD-Symptoms and Normal-Behavior (SWAN) scale, which is a population based measure that grew out of the notion that an ADHD diagnosis exists on the extreme end of a continuum of normative behaviors and includes both above- and below- average performance on attention and activity. We used a sibling-comparison approach in a sample of 173 families including siblings aged 7–16 years (52% male) drawn from the state of Missouri, USA, wherein mothers smoked during one pregnancy but not the other. There was a within-family effect of smoking during pregnancy on SWAN hyperactivity/impulsivity and SWAN total ADHD behaviors. The associations between SDP and DSM-IV-based ADHD symptom dimensions as well as SWAN inattention were explained by familial confounds. These findings suggest that SDP exerts a potentially causal effect on increased ADHD hyperactive/impulsive behaviors and that this SDP effect is best captured when hyperactivity/impulsivity is assessed more normatively across the population, rather than specifically assessing problematic behaviors via DSM symptoms. Thus, any potentially causal effect of SDP on ADHD symptom dimensions may be restricted to hyperactive/impulsive behaviors rather than inattention, and normative, non-DSM-IV based behavioral measures may provide a more sensitive test of mechanisms of SDP-ADHD symptom associations, particularly in non-clinical samples.
KeywordsAttention deficit hyperactivity disorder DSM-iv Family research Prenatal exposure Smoking
This work supported by NIH grants: DA023134 (Knopik), DA17671 (Knopik), AA07728 (Heath), AA09022 (Heath), AA11998 (Heath), HD049024 (Heath), AA017688 (Heath), AA021492 (Heath), MH083823 (Todorov). Dr. Marceau was supported by T32 MH019927 (Spirito) and K01 DA039288 (Marceau) and Dr. Bidwell is supported by K23 DA033302. HCK is supported by National Science Foundation Graduate Research Fellowship Program, Grant DGE 1144083. Dr. Palmer is supported by K01 AA021113 and L30 TR001045. We gratefully acknowledge all of the families who took part in this study, the MO-MATCH project coordinators Tina Nolte and Laura Nichols, as well as the entire MO-MATCH interviewing team.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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