This article from Medscape shows the correlation between pre-mature and or low birth weight infants and attention deficit disorders. It states that these children have the type of attentional problems not associated with hyperactivity or conduct disorders.

Full article.
http://www.medscape.com/viewarticle/461571_3

Attention and Executive Functioning

Premature, low birth weight children demonstrate poorer attention and executive functioning skills in relation to full-term children.[24,72-74] Research has shown that deficits in attention are associated with problems in executive functioning.[74]

Both attentional processes and executive functioning are regulated within the cerebral cortex, an area of the brain that is still developing in the premature infant. It is posited that preterm infants' early exposure to the nonuterine environment may have a negative impact on the neurological processes occurring in the brain, apart from the effects of specific adverse medical conditions. In particular, the organization, differentiation, and selective pruning of specific neurons may be disrupted, thus resulting in less organized, less efficient information processing.[8]
Many studies have found higher rates of attentional problems in premature, low birth weight children.[73,75] A recent meta-analysis found that 10 of the 15 studies reviewed demonstrated a significantly greater prevalence of attention problems in premature versus full-term children.[24]

In a study by Sterqvist and Svenningsen,[76] 20% of 10-year-old very low birth weight, preterm children (compared with 8% of full-term children) were found to suffer from attention deficits. Similarly, Botting et al[77] found that 23% of very low birth weight children (v 6% of full-term peers) exhibited attention deficit disorders.

It has been noted that premature, low birth weight children are more likely to have the type of attentional problems that are not associated with hyperactivity or conduct disorder, which are often seen in the general population.[78-80]
A study by Whitaker et al[81] found that parenchymal lesions and enlarged ventricles in premature, low birth weight neonates are significantly predictive of later attention deficit disorders. Children prenatally exposed to drugs have also demonstrated problems with attention as well as executive functioning.[70,82]

Attentional capacities are believed to be a fundamental component of higher order processes such as executive functioning. Executive functioning can be defined as the central processing, organization, and integration of separate pieces of information.

It is posited that overall cognitive and learning deficits seen in premature, low birth weight children may be the result of a central deficit in simultaneous processing of multiple pieces of information across one or more sensory modalities.[78,83]

As previously reported, Rose et al[64,84] found that preterm, low birth weight infants demonstrate poorer unimodal and cross-modal processing and integration of visual and tactile information, which is linked to later problems with cognition and learning.

A study by Wall[74] found that 5- to 7-year-old children born preterm performed significantly worse than full-term controls on executive functioning tasks such as Visual Search, Verbal Fluency, and the Tower of Hanoi; the lower performance of these preterm children was associated with lower IQ scores as well as higher levels of attentional problems—namely impulsivity and hyperactivity. It is likely that deficits in executive functioning and attention are related to the many learning disabilities that emerge in premature, low birth weight children once they reach school.[78]

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Thanks Mike

The US Surgeon General's Report on Mental Health : Chapter 3 (Disorders of Infancy, Childhood & Adolesence) has excellent background info on this as well.

Basically, the more complicated the birth,the higher the risk factor.

You've touched on why it's so important for clinicians to know as much as possible about pre & peri natal care.

One of the other major risk factors is nicotine use during pregnancy.

Okay the attention problems may have a higher incidence in low birth weight people. However not all people who are ADHD (hyper, impulsive,) had low birth weights or were exposed to pre-birth medications.

I weighted 8 pounds my mom didn't smoke drink or take any thing but pre-natal vitimans. I was born late if any thing and have been late to every thing else scense!!! Also when awake I actually have a slightly higher than average IQ. I believe that ADD caused by brain stresses, injury or even low birth weight is one type the kind that is caused by genetics is different. The sysmptoms may appear simular however brain injury/stressors can and often do effect IQ. Those who have ADHD "naturally" tend to have a normal to above normal IQ / intellengence.

That's true.


Those are simply "risk factors." There's a lot more to it than just one variable, however, it pays to know what those are.

That's how a clinician starts to "build a case" if you will, for what might be the problem.

My mom did heavy drugs the whole time she was pregnant.Acid,speed you name it!I went through withdrawls as a baby.I would eat through anything wood!I weighed under 7 lbs.Thats not bad for a drug baby!
Very interesting topic,I must say.

It has been noted that premature, low birth weight children are more likely to have the type of attentional problems that are not associated with hyperactivity or conduct disorder, which are often seen in the general population.[78-80]The full article states that many pre-term and low birth weight children also have normal IQ's. This is but one type of Ad/HD disorder and due possibly in whole or in part for the aforementioned conditions as noted in the title.

The article does not purport to be a catch-all diagnosis. For those who were born under said conditions or may have suffered a hypoxic episode as I mentioned in another post it may help to validate their diagnosis of ADD as these are peer reviewed articles based upon lenghty research and observation. They may have also had a gentic predisposition which was exacerbated by their birth trauma.

Knowledge as it pertains to a condition like AD/HD is useful for an individual to validate the diagnosis in their own mind and to help ameliorate the emotional damage caused by self blame.

I personally was carried to term but weighed only 44 ounces at birth due to a traumatic pregnancy. After being brought home I stopped breathing due to an intestinal blockage which caused me to aspirate formula into my lungs. I received the last rites and emergency surgery. Lucky me I lived. I then experienced the joys of an orphanage then foster homes for 15 years.

Finding these articles helps to confirm in my mind what I've suspected as a possible cause for my ADD like behavior. That while not helped by my less than auspicious start in life there is a possible rational and scientific basis for at least some of my shortcomings.

Someone from my background as a foster kid may have the tendency to believe that all their problems stem from their childhood which is not the case. Reading relevant information such as this article acts as a catharsis.:soapbox: :)


hypoxia and Ad/hd thread
http://www.addforums.com/forums/showthread.php?t=21709

Another study which states that:

"In particular, twin studies have shown that ADHD heritability is high, ranging from 75% to 90%. In addition, these studies indicate that the rest of the variance in the ADHD phenotype (10%–25%) is accounted for mostly by nonshared environmental factors (experienced by 1 member of the family to the exclusion of his or her siblings). In contrast, the involvement of shared environmental factors (shared by all the individuals in the same family) in increasing the risk for ADHD is estimated to be minimal."

"Case–control epidemiologic studies indicate that pregnancy, labour/delivery and neonatal complications (PLDNC) are more frequent environmental factors in children diagnosed with ADHD compared with healthy controls.<SUP>9 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=551167#r9-6)</SUP><SUP>,</SUP><SUP>10 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=551167#r10-6)</SUP><SUP>,</SUP><SUP>11 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=551167#r11-6)</SUP><SUP>,</SUP><SUP>12 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=551167#r12-6)</SUP> It is believed that such early trauma on the brain during crucial periods of development may have long-lasting effects on cognition and behaviour,<SUP>13 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=551167#r13-6)</SUP> although the relevant mechanisms mediating the effects of these events remain undetermined."

Full Article:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=551167

Another study From medscape:

Etiology of ADHD

ADHD is a highly heritable disorder. However, it can also be acquired, and some individuals have a combination of genetic and acquired ADHD. At the present time, it is not possible to distinguish between these two types of ADHD—they both look the same, and both usually respond to treatment with the same psychostimulant medication.

The behaviors associated with ADHD can also arise from environmental factors that disrupt normal brain growth, before, during, and after birth. Such insults give rise to behaviors that are indistinguishable from the behaviors seen in ADHD of genetic origin. It is not unusual to see individuals who have both a genetic and an acquired form.
The dopamine system is exquisitely sensitive to hypoxia, particularly in the fetus or infant. Thus, any events pre- or postnatally that disrupt the flow of blood or oxygen to the brain might set the stage for later ADHD behaviors. This observation is supported both by laboratory studies<SUP>[103,104]</SUP> and a study of ex-premature infants who had documented cerebral ischemia at birth and were re-examined in early adolescence.<SUP>[105]</SUP>

Full Article (requires free registration):
http://www.medscape.com/viewarticle/495640_3

I wasn't a preemie - I was just shy of 7 lbs at birth. Statistically, just slightly smaller than average.

However, my biological mom was also only about 16. Impulsivity, perhaps? Genetics?

Thanks again Mike


I previously posted on the Etiologies of ADHD and how it's 80% genetic.

I think it was in repsonse to someone "attacking" my "Here's the Proof" post.


At any rate, its in there somewhere.:)

Maybe a poll should be taken. In my opinion this is an interesting and exciting topic. I weighed 5 pounds at birth and was 2 weeks overdue. My mom also smoked.
Donna

I was reading a huge reference text earlier tonight entitled Childhood Psychopathology.

It was edited by Russ Barkely and covers all childhood disorders.

It's about the size of the Encyclopedia Brittanca...lol.

I'm presenting in 2 weeks and I want to be sure I've got things organized.

In the ADHD section, which Russ wrote, it covers research that said the low birth weight is not as significant as it was once thought to be, while premature birth is probably the most significant risk factor of all.

One of the things I've got to show my colleagues is that nicotine use during pregnancy is one of the other significant risk factors.

One theory of ADHD says that it is an evolutionary trait, the 'outside-the-box' thinking by the ADHD individuals has helped advance civilization.

Then there are articles like this that seem to link ADHD to environmental factors, with an eye towards how to reduce the incidence of it in the future.

How do we reconcile the two views?

In this case, is it likely that the low birth weight/nicotine exposed babies might have had ADHD anyway, but the more hyperactive type? Does there need to be a genetic predisposition, or can anyone get it if exposed to the right (wrong) kind of factors?

FWIW, my mother smoked during pregnancy, I had low birth weight and have always been the inattentive type with difficulties with organization.

The accepted standard of research on the Etiologies of ADHD is overwhelming in favor of genetics;largely thru twin studies.

In the ADHD section, which Russ wrote, it covers research that said the low birth weight is not as significant as it was once thought to be, while premature birth is probably the most significant risk factor of all.Sorry to hear that -- my poor gal's got it coming and going -- she was 6 weeks premature (4 1/2 lbs) and has an ADD parents.

Scattered

Mike/NYThis is fascinating reading.
You've put here for us. Thanks.
My mother was born pre mature. 3 pounds in the 7th month.
She does not have ADD.
I was born in the 9th month weighed 5 pounds and I do have ADD.
I feel in my case it was inherited from my ADD father.

Interesting topic!

I don't know for sure if my mom smoked while pregnant with me, but she smoked during my childhood (she began smoking in high school) and it was the late 60's so, I'd say it's quite likely she smoked while pregnant. I'm not sure if I want to ask her. If the answer is yes, why make her feel guilty for something that can't be changed now?

I do know my mom had a difficult pregnancy with me. Her blood type is A-negative and I'm A-positive and that causes problems (which they now have a shot or something they give to mom's with negative blood types I believe). Because of having me my mom has antibodies in her blood or something.

She had a hole in her water that would leak when she stood up so was put on bed rest, and as it was I was born 6 weeks early. I weighed about 4.5 pounds and couldn't go home from the hospital until I weighed 5 pounds. I was in an incubator, I think for about a week. Once I wondered if I was truly early because if you count backwards, if I was born 6 weeks later I would have basically had to been conceived around their honeymoon or not long after. But that's possible, and the low birth-weight is evidence for being a premie.

~~bythesea

This Article is interesting the full PDF version of the study which was conducted by researchers at Kings College in London can be found here:
http://www.erin.utoronto.ca/~w3psygs/04PSY210F/Tully.pdf#search='adhd%20low%20birth%20weight'

ADHD may be moderated by mom's love, study finds
Print version: page 16


<!---body here--->Maternal affection, or warmth, is related to lower rates of attention-deficit hyperactivity disorder (ADHD) among low-birth-weight twins, says a report published this spring in the Journal of Counseling and Clinical Psychology (Vol. 72, No. 2).

In their study of 2,232 5-year-old twins, half of whom had low birth weight, researchers found a significant interaction between children's birth weight and maternal warmth in predicting mothers' and teachers' ratings of ADHD, says lead researcher Terrie Moffitt, PhD, a professor of psychology at King's College in London and the University of Wisconsin-Madison.

The study stemmed from observations of lingering problems with hyperactivity and intellectual deficits among Romanian orphans who were adopted into English families. Psychiatrist Sir Michael Rutter, MD, of the Institute of Psychiatry in London, had previously argued that deprivation of caregiver warmth in the orphanage might be a key factor in that finding. Moffitt and her team sought to investigate his claim.

"We also reasoned from other studies that warmth is a good indicator of a parent's overall investment in child-rearing, so it might be a factor that could prevent hyperactivity and intellectual deficits in at-risk children, such as those with low birth weight," she adds.

In the current study, maternal warmth was coded from mothers' audiotaped answers to open-ended questions about their feelings for their children, she says. Then, both teachers and parents were asked to rate the children's ADHD symptoms. Each child also took an IQ test. (The study found no significant indication that maternal warmth affected IQ.)

The researchers coded a mother's warmth on a six-point scale, based on tone of voice, spontaneity, sympathy and empathy toward the child. They indicated "high warmth" and "moderately high warmth" when mothers expressed definite warmth, enthusiasm, interest in and enjoyment of the child, exemplified by comments like "she is a delight; she is so happy; I love taking her out; she is my ray of sunshine." They coded "some warmth" when mothers showed a detached and rather clinical approach, with little or no warmth of tone but moderate understanding, sympathy and concern. "Very little warmth" showed up when there was only a slight amount of understanding, sympathy, concern or enthusiasm about or interest in the child.

Within the sample, 20 percent of twins had mothers who expressed low warmth, 37 percent had mothers who expressed moderate warmth and 43 percent had mothers who expressed high warmth. The results of twins with the same mother, but varying degrees of warmth expressed toward them were particularly useful to the researchers, Moffitt says.

Low-birth-weight children who had more warm, loving relationships with their mothers were less likely to be described as having ADHD symptoms by parents and teachers, a correlational finding that may suggest that high levels of warmth protect some children from poor behavioral outcomes, Moffitt says. Moreover, low levels of warmth appeared to exacerbate the behavioral problems associated with low birth weight.

"Some researchers have argued lately that what parents do has little effect on their children," Moffitt says. "Some have said that parents' actions only matter if the acts are very extreme, such as child abuse. This paper provides one small bit of initial evidence to the contrary. A simple natural parental inclination to be warm and affectionate toward children did matter for children's outcomes in this study."

The findings suggest emphasizing warmth might be a useful addition to parent education curricula, she says.



"Parent training programs have been proven to be effective, but in addition to emphasizing monitoring, control and consistent discipline, they might wish to encourage parents to express affection too," Moffitt says. --K. KERSTING





Another interesting study:
http://pediatrics.aappublications.org/cgi/content/full/111/5/969
PEDIATRICS Vol. 111 No. 5 May 2003, pp. 969-975
<!--PEDIATRICS Vol. 111 No. 5 May 2003, pp. 969-975
--><!-- PEDIATRICS (ISSN 1098-4275). Copyright ©2003 by the American Academy of Pediatrics ("") -->
Psychopathology and Social Competancies of Adolescents Who Were Extremely Low Birth Rate

Fascinating. That covers so much in such a short space.

Having worked with Romanian orphans, I can tell you that the deprivation they suffered (as a whole) was of horrific proportions.

There's usually some attachment problems associated with these children, however, I believe that I read somewhere that the earlier the intervention the better the prognosis.

Thanks again.

While I don't doubt at all that maternal warmth can help modulate the effects of ADHD on at risk children, there is a two way street. Sometimes one can observe a mother showing less warmth to their child because the child is less responsive to the warmth she is and has shown. A child who responds positively to his mother's attention is going to be very reinforcing to the mother. If a child turns or pulls away as ADHD children are more likely to do as are children who have attachment disorder due to lack of early bonding opportunities in an orphanage, the mother may in turn invest less emotional warmth. You have to be careful about which way the causation runs in studies. Barkley found in a study he did on mothers and their ADHD sons that the mother's interactions with their children changed once the child was taking medication -- so the child's behavior was more of a causative factor it would appear.

Again, please don't see me demeaning maternal warmth! I just don't want adoptive parents who have a child with inherited and/or early environmental deprivation feeling guilty because they weren't warm enough toward their child. Some children have a very difficult time taking in that warmth and most of us can't continue to give at our highest level with little to no response.


Scattered