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.

Contextual determinants and alcohol control policies in the United Kingdom.

In the United Kingdom, between 1960 and the 2000s, there were many sociodemographic and economic factors that played a part in the changing picture of alcohol consumption and its related harm. This paper describes some of these variables along with the political measures that were identified as correlated with changes in consumption and harm. The resulting picture is unclear. No consistent pattern was identified among the variables analyzed. Beverage choice changed over time with a reduction in beer consumption and an increase in wines and spirits. Nevertheless, the overall picture showed an increase in total alcohol consumption and resulting harm.

Conceiving risk, divergent responses: perspectives on the construction of risk of FASD in six countries.

Conceptualizations of risks related to women's alcohol use during pregnancy, and the attendant response to preventing fetal alcohol spectrum disorder (FASD), are examined in six countries: the United States, Canada, the United Kingdom, Uganda, Uruguay, and China. Considerable differences were found in how risks were conceptualized across countries and in contextual factors that influence research, prevention, and intervention efforts. Differences in conceptualizations were also apparent within countries. Differences also existed in the degree to which the issue of drinking during pregnancy has been minimized or amplified and in whether and how responses are linked to treatment or other public health interventions.

Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress.

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

Fetal alcohol spectrum disorders: an overview of current evidence and activities in the UK.

Estimates for the UK suggest that alcohol consumption during pregnancy and prevalence of fetal alcohol spectrum disorder (FASD)-the most common neurodevelopmental condition-are high. Considering the significant health and social impacts of FASD, there is a public health imperative to prioritise prevention, interventions and support. In this article, we outline the current state of play regarding FASD knowledge and research in the UK, which is characterised by a lack of evidence, a lack of dedicated funding and services, and consequently little policy formulation and strategic direction. We highlight progress made to date, as well as current knowledge and service gaps to propose a way forward for UK research.

The social consequences of binge drinking among 24- to 32-year-olds in six European countries.

Data were available from general population surveys carried out in six countries in the years 2000 to 2005 under the auspices of Gender, Alcohol and Culture: An International Study (GENACIS). A total of 2089 adults aged 24-32 in the Czech Republic, Denmark, the Isle of Man, Spain, Sweden, and the United Kingdom (UK) responded to questions about their drinking habits and social consequences directly resulting from their drinking. Survey methods varied from quota sampling with face-to-face interviewing in Spain and the UK to telephone surveys in Denmark and Sweden. Response rates varied from 50% to 72%. "Binge drinking" defined as a usual amount of more than 8 UK "units" for men and more than 6 units for women was more likely than moderate drinking to lead to social consequences, fights, or being asked to cut down on drinking. There were highly significant differences between the countries both in the percentages of "heavy" drinkers and in the adverse consequences of binge drinking. In Spain, the UK, and the Czech Republic binge drinking was more likely to lead to adverse consequences than was binge drinking in the other three countries. Male gender, low educational level, high drinking frequency, and single marital status were also significantly associated with adverse social consequences from drinking, but none of these variables explained the country differences. The presence of children had little effect.

Spreading or concentrating drinking occasions--who is most at risk?

AIMS: (a) To compare acute negative consequences for people who drink a given amount of alcohol on few occasions (concentrators) per week in comparison with the consequences for people who drink the same amount on more days in a week (spreaders). (b) To investigate whether these associations are cross-culturally stable. METHODS: Analysis is based on general population surveys of adults conducted in 7 European countries. RESULTS: It appeared that more drinking occasions in many countries lead to more consequences independent of the volume consumed. Risky single-occasion drinking was to be associated with higher risks for immediate health consequences and legal problems, accidents and fights. Among older respondents the same frequency pattern appeared, with the exception of immediate health consequences among women. Hence, more regular drinking seemed to have more beneficial effects on older individuals compared to younger ones, which may be related to the different drinking situation: younger people mostly drinking outside the home. Amongst the younger people, frequent drinking seemed to be associated with more acute consequences. Cultural and methodological variations must be taken into account. CONCLUSION: Even so, it is concluded that the credibility of these findings is strengthened by differences in the methods of the surveys.

Alcohol-related adverse consequences: cross-cultural variations in attribution process among young adults.

BACKGROUND: Social norms around what is culturally accepted in terms of alcohol consumption and drunken comportment appear important regarding the acceptance of alcohol-related adverse consequences; however, investigations often neglect to consider differences in terms of attribution. This study aims at assessing cross-cultural differences in the reporting of alcohol-related adverse consequences. It also considers differences across consequences that might explain which type of consequences (mainly acute or mainly chronic) are most affected by an attribution process. METHODS: Conditional regression models were estimated based on data from eight European countries participating in the Gender, Alcohol and Culture--An International Study (GENACIS) project. Cases were matched to controls based on usual drinking patterns in order to control for average volume of alcohol and frequency of 'risky single occasion drinking' (RSOD). RESULTS: Differences among the patterns of associations between countries and consequences were evident. The distinction between Nordic and other European countries was persistent. A higher variability of associations was observed for some consequences, namely the mainly acute instances. Finally, the Isle of Man and Switzerland showed specific trends with associations across consequences. CONCLUSION: Reporting of alcohol-related adverse consequences seemed strongly affected by cultural norms. The latter may be exemplified by viewing drinking as 'time-out' behaviour. Respondents in countries with a stereotypical history of being 'dry' or with a stereotyped 'binge' drinking culture were more likely to attribute consequences to their alcohol consumption than people in 'wet' countries. This was particularly true for consequences that related to episodic 'time-out' heavy drinking.

Beyond drinking: differential effects of demographic and socioeconomic factors on alcohol-related adverse consequences across European countries.

BACKGROUND/AIMS: Evidence underlines the importance of drinking patterns and individual characteristics in experiencing adverse alcohol-related consequences; however, little research has been conducted to explore who does and who does not experience consequences with similar drinking patterns. Using data from seven European countries, this study assesses the association between demographic and socioeconomic characteristics and six adverse consequences. METHODS: Conditional logistic regression models were estimated, cases (experiencing a consequence) being matched to controls (not experiencing the consequence) by drinking patterns. RESULTS: In general, protective effects with increasing age and being in a partnership were consistent. Gender effects were mixed, but mainly protective for women. Educational achievement and economic status showed consistent effects across countries, but different directions of effect across consequences. Consequences mostly associated with individual drinking pattern (injury, blackout, and loss of control over drinking) exhibited similar patterns of associations, but varying ones arose for consequences additionally influenced by societal reaction to drinking (guilt, role failure, and pressure to cut down drinking). CONCLUSION: Differences in strengths and directions of effects across consequences pointed to the possibility that the reporting of adverse consequences is not only influenced by alcohol consumption, but also by attributional processes related to demographic and socioeconomic statuses.

Childhood and adult sexual abuse: relationships with 'addictive' or 'problem' behaviours and health.

Questions concerning sexual abuse before and after the age of 16 years were included in a general population survey of a representative sample of 1052 UK women and 975 UK men. In relation to women 12.5% reported experiencing some form of sexual abuse before the age of 16 years. The corresponding figures for men in this category were 11.7%. After the age of 16 the figure for women remained at this level. However the proportion of men reporting these traumatic experiences dropped to 3.2%. Sexual abuse both pre and post age 16 was associated with 'addictive' or 'problem' behaviours such as those associated with eating too much (for women), sexual activity and Internet use (for men).

Life Stage, Alcohol Consumption Patterns, Alcohol-Related Consequences, and Gender.

This paper presents findings from a European collaborative study. A common framework for reanalysis of existing data was devised. Alcohol-related problems encountered were classified as "internal" and "external." Logistic regression analyses were then conducted to predict lifetime presence of any internal problem, any external problem, and any problem at all. The predictor variables were gender, life stage (corresponding roughly to young, middle and older age), past year's drinking level in four categories of grams of alcohol per month, and past year's "binge" drinking. All four predictor variables were associated with the presence of alcohol-related problems, with women and retired people having fewer problems and heavy drinkers and binge drinkers having more. At all levels of alcohol consumption, men were more likely than women to experience at least one adverse consequence. Internal problems were more common than external problems. Country differences are discussed and recommendations are made for further studies.

The social consequences of binge drinking: a comparison of young adults in six European countries.

A considerable amount of survey information was available from general population surveys carried out in six countries between 2000 and 2005. These studies were conducted under the auspices of Gender, Alcohol and Culture: An International Study (GENACIS). A total of 1,446 adults between 18 and 23 years of age and 2,482 adults between 24 and 32 years of age from the Czech Republic, Denmark, the Isle of Man, Spain, Sweden, and the United Kingdom responded to questions about their drinking habits and the social consequences directly resulting from their drinking. Survey methods varied from quota sampling with face-to-face interviewing in Spain and the United Kingdom to telephone surveys in Denmark and Sweden. Response rates varied from 50% to 72%. "Binge" or "heavy episodic" drinking was defined as a usual amount on one occasion of more than 8 UK "units" for men and more than 6 units for women. Consequences investigated comprised relationship, health and financial problems, being asked to cut down on drinking, and being involved in a fight. In Denmark and Sweden, the group aged 24 to 32 years was less likely to be binge drinkers than the 18 to 23 year olds. In the other countries, there was little difference. There was also little difference between the age groups in frequency of drinking, but there were considerable variations in this respect between countries. People in the United Kingdom, Sweden, the Czech Republic, and Denmark were more likely to suffer at least one consequence than those in Spain and the Isle of Man. In Spain, there was little change between the age groups in this respect. Fights were most common in the United Kingdom. Being asked to cut down one's drinking was less common in Spain and Sweden than it was elsewhere. Findings are discussed in terms of the varied drinking cultures in the different countries.

Spreading out or concentrating weekly consumption: alcohol problems and other consequences within a UK population sample.

AIMS: To consider the consequences, within a UK population sample, of consuming a given amount of alcohol weekly in one or two sessions as against spreading it out over several sessions. METHODS: A new analysis of data from the UK components of the GENACIS survey of adults aged > or =18, was carried out. RESULTS: At low levels of weekly alcohol consumption those subjects whose usual drinking frequency was several times per week ('spreaders'), if anything, reported more alcohol problems than those who consumed alcohol only once or twice per week ('bingers'). As weekly consumption increased above approximately 11 units per week 'bingers' began to experience more problems than 'spreaders'. At the highest levels of consumption 'bingers' reported more positive experiences from drinking than did 'spreaders'. Subjects >54 years showed lower levels of weekly alcohol consumption than other subjects, and relationships between problems, drinking level, and drinking pattern were less in evidence. Females drank less alcohol and experienced fewer alcohol-related problems than did their male counterparts. However, at high-consumption levels, female 'bingers' experienced fewer problems than male 'bingers'. CONCLUSIONS: For most but not all the variables studied, both drinking level and drinking pattern are important determinants of problems experienced. Binge drinking for people who drink more than approximately 11 units per week is an obvious target for harm minimization.