Guidelines for identification and treatment of individuals with attention deficit/hyperactivity disorder and associated fetal alcohol spectrum disorders based upon expert consensus.

BACKGROUND: The association of attention deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorders (FASD) results in a complex constellation of symptoms that complicates the successful diagnosis and treatment of the affected individual. Current literature lacks formal guidelines, randomized control trials, and evidence-based treatment plans for individuals with ADHD and associated FASD. Therefore, a meeting of professional experts was organized with the aim of producing a consensus on identification and treatment guidelines that will aid clinicians in caring for this unique patient population. METHODS: Experts from multiple disciplines in the fields of ADHD and FASD convened in London, United Kingdom, for a meeting hosted by the United Kingdom ADHD Partnership (UKAP; www.UKADHD.com ) in June 2015. The meeting provided the opportunity to address the complexities of ADHD and FASD from different perspectives and included presentations, discussions, and group work. The attendees worked towards producing a consensus for a unified approach to ADHD and associated FASD. RESULTS: The authors successfully came to consensus and produced recommended guidelines with specific regards to identification and assessment, interventions and treatments, and multiagency liaisons and care management, highlighting that a lifespan approach to treatment needs to be adopted by all involved. Included in the guidelines are: 1) unique 'red flags', which when identified in the ADHD population can lead to an accurate associated FASD diagnosis, 2) a treatment decision tree, and 3) recommendations for multiagency care management. CONCLUSIONS: While clinically useful guidelines were achieved, more research is still needed to contribute to the knowledge base about the diagnosis, treatment, and management of those with ADHD and associated FASD.

An acoustic-based method for locating maternity colonies of rare woodland bats.

Locating colonies of rare bats can be a time consuming process, as it is often difficult to know where to focus survey effort. However, identifying peaks of bat activity via acoustic monitoring may provide insights into whether a colony is locally present, and help screen out sites with low potential. Using a triage approach, we developed a survey methodology for locating colonies of the woodland-specialist barbastelle bat (Barbastella barbastellus). We investigated whether woodland occupancy by a colony could be predicted by acoustic data, and assessed the influence of survey effort (number of acoustic detectors deployed) on detectability. The methodology was then trialled in citizen science surveys of 77 woodlands, with follow-up radio-tracking surveys by specialists being used to confirm presence or absence. Using Receiver Operating Characteristic (ROC) curve analysis, we found that a threshold of four barbastelle passes recorded by at least one detector within one hour of sunset optimised the balance between the true- and false-positive rates. Subsequently, we found that a minimum survey effort of one detector per 6.25 hectares of woodland was needed to ensure a colony would be detected using this threshold, based on a survey sensitivity of 90%. Radio-tracking surveys in a subset of the woodlands, identified as having a high probability of being occupied by a colony based on acoustic monitoring, confirmed the presence of five previously unknown barbastelle maternity colonies. These results demonstrate that a triage system, in which high probability woodland sites are identified based on acoustic survey data, can be used to prioritise sites for future specialist surveys and conservation action.

Roost selection by Mauritian tomb bats (Taphozus mauritianus) in Lilongwe city, Malawi - importance of woodland for sustainable urban planning.

Increasing urbanisation has led to a greater use of artificial structures by bats as alternative roost sites. Despite the widespread presence of bats, roost availability may restrict their distribution and abundance in urban environments. There is limited quantitative information on the drivers of bat roost selection and roosting preferences, particularly in African bats. We explore the factors influencing roost selection in the Mauritian tomb bat (Taphozous mauritianus), within an urban landscape in Lilongwe city, Malawi. Eight building and five landscape features of roosts were compared with both adjacent and random control buildings throughout the city. Bat occupied buildings were situated closer to woodland (mean 709m) compared to random buildings (mean 1847m) but did not differ in any other landscape features explored. Roosts were situated on buildings with larger areas and taller walls, suggesting bats select features for predator-avoidance and acoustic perception when leaving the roost. Bats preferred buildings with exposed roof beams which may provide refuge from disturbance. Whilst roosts are situated more often on brick walls, this feature was also associated with landscape features, therefore its importance in roost selection is less clear. These results are indicative that T. mauritianus selects roosts at both the building and landscape level. The selectivity of T. mauritianus in relation to its roost sites implies that preferred roosts are a limited resource, and as such, conservation actions should focus on protecting roost sites and the woodland bats rely on.

Binge drinking during pregnancy as a predictor of psychiatric disorders on the Structured Clinical Interview for DSM-IV in young adult offspring.

OBJECTIVE: This study explored the extent to which the high frequency of psychiatric problems reported in clinical groups with fetal alcohol spectrum disorders might also be observed in a nonclinical group of young adults and the psychiatric conditions that are related to prenatal alcohol exposure in this group. METHOD: From a longitudinal prospective study beginning with interviews of 1,529 pregnant women, a birth cohort of about 500 newborns was chosen to include all of the most heavily alcohol exposed plus a sampling of the continuum of alcohol exposures from total abstinence through heavy drinking. At an average age of 25.7 years, 400 members of this birth cohort were administered valid Structured Clinical Interviews for DSM-IV (SCID), including both the SCID for axis I disorders and the SCID for axis II personality disorders. RESULTS: The odds of the appearance of six psychiatric disorders and traits were more than double in adults exposed to one or more binge alcohol episodes in utero. Three of these six odds ratios were uniformly stable against confounding: axis I substance dependence or abuse disorders and axis II passive-aggressive and antisocial personality disorders or traits. CONCLUSIONS: Prenatal exposure to alcohol may be a risk factor for specific psychiatric disorders and traits in early adulthood, even in a nonclinical group.

Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder.

OBJECTIVE: To provide an overview of the animal and human research literature on the link between fetal alcohol spectrum disorder (FASD) and attention-deficit hyperactivity disorder (ADHD). METHOD: We conducted a comprehensive literature review that addressed the history of, and current research on, fetal alcohol syndrome (FAS) and FASD, as well as that on ADHD in children. RESULTS: In animal and human research, there is emerging clinical, neuropsychological, and neurochemical evidence of a link between FASD and ADHD. CONCLUSIONS: The evidence of the link between these 2 conditions has implications for clinical management. The clinical quality of ADHD in children with FASD often differs from that of children without FASD. For children with FASD, ADHD is more likely to be the earlier-onset, inattention subtype, with comorbid developmental, psychiatric, and medical conditions. Children with FASD are commonly not mentally retarded but present complex learning disabilities, especially a mixed receptive-expressive language disorder with deficits in social cognition and communication (reminiscent of sensory aphasia and apraxia), working memory problems, and frequently, a mathematics disorder. Comorbid psychiatric conditions include anxiety, mood, conduct, or explosive disorders. As well, cardiac, renal, or skeletal problems are more likely to be present. Because these children have a disturbance in brain neurochemistry, or even brain structure (that is, in the corpus callosum), their response to standard psychostimulant medication can be quite unpredictable.

Fetal alcohol spectrum disorder and ADHD: diagnostic implications and therapeutic consequences.

The first association between prenatal alcohol exposure and a teratogenic effect in the developing fetus was made in 1968 by pediatrician Paul Lemoine in France. A few years later, Jones and Smith defined the fetal alcohol syndrome which combined dysmorphic facial, growth and CNS features. The classic fetal alcohol syndrome has been recently reviewed. Current research is beginning to acknowledge that exposure to differing levels of prenatal alcohol cause a spectrum of clinical conditions which can be grouped under the umbrella term fetal alcohol spectrum disorder. There are three subtypes to fetal alcohol spectrum disorder: full fetal alcohol syndrome, partial fetal alcohol syndrome (where there is only partial facial dysmorphology) and alcohol-related neurodevelopmental disorder (where there is no facial dysmorphology and often absence of growth features). The term alcohol-related neurodevelopmental disorder is gradually replacing the older term fetal alcohol effects. These subtypes were initially described by Stratton and colleagues in 1996. It is also becoming clearer that the full fetal alcohol syndrome as originally described by Jones and Smith, and diagnosed in dysmorphic clinics, is the least common clinical subtype resulting from prenatal alcohol exposure. In addition, current and ongoing research on brain structure, shape and function indicates that the brain abnormality is not correlated with the facial dysmorphology or intelligence quotient. Therefore, the presence of full fetal alcohol syndrome does not necessarily mean that the patient has the most severe CNS impairments. Genetic research has suggested that genetic factors may have a role in a modulating a woman's susceptibility to having a baby with fetal alcohol spectrum disorder (specifically the full fetal alcohol syndrome subtype). Thus, genetic factors may increase the variability of the teratogenic effect of prenatal exposure to alcohol on the developing fetus.