Abstract
Attention-deficit/hyperactivity disorder (ADHD) is frequently diagnosed in children with Tourette syndrome (TS). The basis for this co-occurrence is uncertain. This study aimed to determine if specific pre- and perinatal risk factors, including heavy maternal smoking and severe psychosocial stress during pregnancy, were associated with one or both disorders, or neither. We compared maternal report data on pre- and perinatal risk factors on 222 children between the ages of 7 and 18 years including 45 individuals with TS alone, 52 individuals with ADHD alone, 60 individuals with condition of comorbid TS + ADHD, and 65 unaffected control children. Pre- and perinatal histories as well as psychiatric assessments were performed using standardized questionnaires and semi-structured interviews with the mothers and children. Logistic regression was used to determine the odds ratio for each variable of interest. Compared to the mothers of unaffected control children, the mothers of children with ADHD alone reported higher rates of heavy smoking (>10 cigarettes per day) during pregnancy and higher levels of severe psychosocial stress during pregnancy (OR = 13.5, p < 0.01 and OR = 6.8, p < 0.002, respectively). The TS + ADHD and the TS alone patients also had higher rates heavy maternal smoking and high levels of psychosocial stress compared to the control children, but these differences failed to reach statistical significance (heavy smoking: OR = 8.5, p < 0.052, OR = 4.6, p < 0.19, respectively; severe psychosocial stress: OR = 3.1, p < 0.07, OR = 2.6, p < 0.11, respectively). Heavy maternal smoking and severe levels psychosocial stress during pregnancy were independently associated with a diagnosis of ADHD. TS patients also had higher rates of these risk factors, but the ORs failed to reach statistical significance. Efforts are needed to reduce the frequency of these risk factors in high-risk populations. Future studies, using genetically sensitive designs, are also needed to sort out the causal pathways.
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Abbreviations
- TS:
-
Tourette syndrome
- ADHD:
-
Attention-deficit/hyperactivity disorder
- OCD:
-
Obsessive compulsive disorder
- LBW:
-
Low birth weight
- YGTSS:
-
Yale global tic severity scale
- CY-BOCS:
-
Children’s Yale brown obsessive compulsive scale
- MSRPFED:
-
Modified schedule for risk and protective factors in early development
- RCMAS:
-
Revised children’s manifest anxiety scale
- LSS:
-
Level of stress severity scale
- CAS:
-
Coping ability scale
- PCS:
-
Pregnancy complication scale
- SMSPC:
-
Severe maternal stress with poor coping
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Acknowledgments
This research was funded in part by the Tourette Syndrome Association, Children and Adults with Attention Deficit Disorder, Betsy Henley-Cohn, Sam Gejdenson, the Rembrandt Foundation, Echlin Foundation, and the Kaiser Family. This research was also supported by NIH Grants MH066187, P01MH049351 (JFL), K05 MH076273 (JFL), K02 MH01527 (PJL), K02 MH074677-01 (BSP), 1R01 MH066187-01A2 (HL), K01 MH079317 (YSK), R01 MH59139 (BSP) and RR00125. The authors also wish to thank Virginia Eicher for her invaluable assistance in completing this study.
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Motlagh, M.G., Katsovich, L., Thompson, N. et al. Severe psychosocial stress and heavy cigarette smoking during pregnancy: an examination of the pre- and perinatal risk factors associated with ADHD and Tourette syndrome. Eur Child Adolesc Psychiatry 19, 755–764 (2010). https://doi.org/10.1007/s00787-010-0115-7
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DOI: https://doi.org/10.1007/s00787-010-0115-7