Inattention In Children Research Articles

Inattention, hyperactivity and low parental education in children with conduct problems and poor reading skills

Concerns over the poor reading performance of children with conduct problems are often expressed by their parents and teachers. In order to intervene effectively with these children, it is necessary to know what their difficulties are, both at school and at home. To date, there is still a lot of ambiguity in relation to the specific difficulties children with conduct problems and coexisting poor reading experience in important academic domains and in the family context. The aim of the present study was to compare the problems of attention and hyperactivity in the classroom and parental education in four groups of children: conduct problems only (CP); conduct problems and coexisting poor reading (CP‐PR); poor reading only (PR); and a comparison group (COM). A sample of 2nd Grade Greek children (n = 113) was selected on the basis of the Conners' Teacher Rating Scale‐28 (CTRS‐28), Conduct Problems Scale and the Reading Ability Detection Test. The CTRS‐28, Inattention and Hyperactivity scales and a brief questionnaire on parental education were used to assess attention, hyperactivity and level of parental education, respectively. The results showed that children with CP‐PR were significantly more inattentive and hyperactive than the other groups of children. Their parents were also more likely to have spent fewer years in school than the parents of CP only and COM children. The earlier findings have implications for intervention planning and theoretical understanding of childhood conduct problems.

Atypical modulation of distant functional connectivity by cognitive state in children with Autism Spectrum Disorders

We examined whether modulation of functional connectivity by cognitive state differed between pre-adolescent children with Autism Spectrum Disorders (ASD) and age and IQ-matched control children. Children underwent functional magnetic resonance imaging (fMRI) during two states, a resting state followed by a sustained attention task. A voxel-wise method was used to characterize functional connectivity at two levels, local (within a voxel's 14 mm neighborhood) and distant (outside of the voxel's 14 mm neighborhood to the rest of the brain) and regions exhibiting Group × State interaction were identified for both types of connectivity maps. Distant functional connectivity of regions in the left frontal lobe (dorsolateral [BA 11, 10]; supplementary motor area extending into dorsal anterior cingulate [BA 32/8]; and premotor [BA 6, 8, 9]), right parietal lobe (paracentral lobule [BA 6]; angular gyrus [BA 39/40]), and left posterior middle temporal cortex (BA 19/39) showed a Group × State interaction such that relative to the resting state, connectivity reduced (i.e., became focal) in control children but increased (i.e., became diffuse) in ASD children during the task state. Higher state-related increase in distant connectivity of left frontal and right angular gyrus predicted worse inattention in ASD children. Two graph theory measures (global efficiency and modularity) were also sensitive to Group × State differences, with the magnitude of state-related change predicting inattention in the ASD children. Our results indicate that as ASD children transition from an unconstrained to a sustained attentional state, functional connectivity of frontal and parietal regions with the rest of the brain becomes more widespread in a manner that may be maladaptive as it was associated with attention problems in everyday life.

Inattention and hyperactivity in children at risk of obesity: a community cross-sectional study

ObjectiveThere is a link between the symptoms of hyperactivity/inattention and overweight in children. Less is known about the factors which might influence this relationship, such as physical and sedentary activity...

Validity and reliability of a teacher's scale developed in Brazil for assessment of hyperactive: impulsive behavior and inattention in children and adolescents

This study was designed to develop and assess the internal consistency and factor structure of a teacher's scale for the assessment of hyperactive/impulsive and inattentive behavior in a sample of 221 children from different cities in the State of Rio de Janeiro, Brazil. Forty-five teachers rated the children. The internal consistency of the scale was evaluated using Cronbach's alpha. An orthogonal varimax rotation that maximizes the variance of the squared loadings for each factor was used to find the simplest possible factor structure. There is no internal discrepancy in the item content of the scale. Exploratory factor analysis showed four primary factors (hyperactivity/impulsivity; inattention; social isolation; self-confidence) that are psychologically meaningful. When factor analysis was carried out there was no substantial difference from other studies when compared with the results of other western and oriental countries. It was concluded that this teacher's scale can be a useful aid to clinicians in the identification of children with hyperactivity/impulsivity and inattention problems.

White matter tract integrity of frontostriatal circuit in attention deficit hyperactivity disorder: association with attention performance and symptoms.

The frontostriatal circuit has been postulated to account for the core symptoms such as inattention in attention deficit/hyperactivity disorder (ADHD). This study investigated the white matter integrity of frontostriatal fiber tracts using diffusion spectrum imaging (DSI) tractography and its correlations with measures of multi-dimensional aspects of inattention based on psychiatric interview and attention tasks in 25 children with ADHD and 25 matched typically developing (TD) children. All the subjects were assessed with comprehensive psychiatric interviews and the Conner's Continuous Performance Test (CCPT). DSI data were acquired on a 3-Tesla MRI system. The frontostriatal fiber pathways were reconstructed by deterministic tractography, and generalized fractional anisotropy values were measured along individual targeted tracts to investigate alterations in microstructure integrity. Children with ADHD performed worse than TD children in the dimensions of focused attention, sustained attention, impulsivity, and vigilance of the CCPT, and showed impaired integrity in four bilateral frontostriatal tracts, namely the dorsolateral-caudate, medial prefrontal-caudate, orbitofrontal-caudate, and ventrolateral-caudate tracts, and in global white matter as well. The integrity of the left orbitofronto-caudate tract was associated with the symptom of inattention in children with ADHD, compatible with the attention deficit and motivational dysfunction theories in ADHD. The integrity of the frontostriatal tracts was associated with the attention performance only in TD children, suggestive of possible recruitment of tracts other than the frontostriatal tracts implicated in attention deficits in children with ADHD. In conclusion, our results demonstrate the functional involvement of the frontostriatal circuit with respect to clinical symptoms and attention performance.

Event-rate effects in the flanker task: ERPs and task performance in children with and without AD/HD

Demanding tasks require a greater amount of effort, in which case individuals are required to alter their energetic-state to a level appropriate to perform the task. According to the Cognitive-Energetic Model (CEM), children with AD/HD are unable to effectively modulate their energetic state, leading to task underperformance. Using an Eriksen flanker task with varying event-rates, the current study compared the ability of typically-developing children and children with AD/HD to modulate their energetic state. In line with the CEM, it was predicted that children with AD/HD would underperform in the fast and slow event-rates. Results indicated that the groups did not differ in commission errors (i.e., incorrect responses). However, children with AD/HD made more omission errors to incongruent stimuli at the fast and slow event-rates, compared to controls. N2 amplitude was significantly larger for the AD/HD than control group in the slow event-rate. It is concluded that the energetic state modulation dysfunction in children with AD/HD results in an inability to attend to the task, as opposed to an inability to perform the task itself. Furthermore, these task performance differences did not manifest in either the N2 or P3 ERP components. Therefore, inattention in children with AD/HD may have its locus in response preparation, as opposed to stimulus processing, but more research is required to validate these conjectures.

Long-Term Temporal Stability of Measured Inattention and Impulsivity in Typical and Referred Children

Objective: This study investigates the stability of measured inattention and impulsivity in children. Method: The Gordon Diagnostic System (GDS) assesses inattention and impulsivity and has been administered in the same manner since its 1983 publication. GDS scores were compared between the 1983 standardization sample and a recent typical sample of 445 children, 562 children with ADHD-Combined (ADHD-C) type, 235 with ADHD-Inattentive (ADHD-I) type, and 231 with autism. Results: Typical children earned a GDS composite standard score of 100, consistent with the normal mean of 100 in the 1983 standardization sample. Means for children with ADHD-C, ADHD-I, and autism were 70, 78, and 76, respectively, approximately two standard deviations below the normal mean. Conclusion: As measured by the GDS, children are no more or less inattentive and impulsive today than in 1983, suggesting that inattention and impulsivity are stable neurobiological traits largely unaffected by cultural, educational, and environmental factors.

A Cross-Lagged Model of the Development of ADHD Inattention Symptoms and Rapid Naming Speed

Although previous research has identified contemporaneous associations between cognitive deficits and symptom phenotypes in Attention Deficit/Hyperactivity Disorder, no studies have as yet attempted to identify direction of effect. The present study used cross-lagged path modeling to examine competing hypotheses about longitudinal associations between rapid naming speed and symptoms of inattention in children. 1,506 school-age twins from Australia and the U.S. were tested for inattention, hyperactivity/impulsivity, and rapid naming speed at three and four time points, respectively. Symptom severity of inattention from Kindergarten to fourth grade is consistently predicted by previous rapid naming, over and above auto-regressive and correlational associations in the model. Likewise, inattention symptoms have a small but significant predictive effect on subsequent rapid naming. The findings support a reciprocal relationship between naming speed and ADHD inattentive symptoms.

Short sleep duration is associated with teacher-reported inattention and cognitive problems in healthy school-aged children.

PurposePediatric, clinical, and research data suggest that insufficient sleep causes tiredness and daytime difficulties in terms of attention-focusing, learning, and impulse modulation in children with attention deficit hyperactivity disorder (ADHD) or in those with ADHD and primary sleep disorders. The aim of the present study was to examine whether sleep duration was associated with ADHD-like symptoms in healthy, well-developing school-aged children.Patients and methodsThirty-five healthy children (20 boys, 15 girls), aged 7–11 years participated in the present study. Each child wore an actigraphic device on their nondominant wrist for two nights prior to use of polysomnography to assess their typical sleep periods. On the third night, sleep was recorded via ambulatory assessment of sleep architecture in the child’s natural sleep environment employing portable polysomnography equipment. Teachers were asked to report symptoms of inattention and hyperactivity/impulsivity on the revised Conners Teacher Rating Scale.ResultsShorter sleep duration was associated with higher levels of teacher-reported ADHD-like symptoms in the domains of cognitive problems and inattention. No significant association between sleep duration and hyperactivity symptoms was evident.ConclusionShort sleep duration was found to be related to teacher-derived reports of ADHD-like symptoms of inattention and cognitive functioning in healthy children.

The Role of Inattention on Academics, Fluid Reasoning, and Visual–Spatial Functioning in Two Subtypes of ADHD

The purpose of this study was to determine whether subtype differences and the role of inattention in children with attention-deficit hyperactivity disorder-combined type (ADHD-C) and ADHD-predominately inattentive type (ADHD-PI) and controls on measures of achievement, problem solving, and visual–spatial abilities are present. A secondary purpose was to evaluate the relation between ADHD symptoms and performance on visual–spatial–motor tasks. Children with ADHD-C and ADHD-PI and controls, all aged 8 to 16 years old, were compared on tests of achievement, fluid reasoning, and visual–motor skills. Children with ADHD-C and ADHD-PI performed significantly poorer on the mathematics calculation, written expression, fluid reasoning, and visual–motor tests compared with the controls. Inattention, but not hyperactivity or impulsivity, was found to significantly predict performance on these measures. The role of inattention on these tasks is important for understanding why children with both subtypes of ADHD experience significant academic problems even when performing in the average range on achievement tests.

Neurofeedback in ADHD: a single-blind randomized controlled trial

Neurofeedback treatment has been demonstrated to reduce inattention, impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder (ADHD). However, previous studies did not adequately control confounding variables or did not employ a randomized reinforcer-controlled design. This study addresses those methodological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD: EEG neurofeedback (NF) aiming at theta/beta ratio reduction and EMG biofeedback (BF) aiming at forehead muscle relaxation. Thirty-five children with ADHD (26 boys, 9 girls; 6-14years old) were randomly assigned to either the therapy group (NF; n=18) or the control group (BF; n=17). Treatment for both groups consisted of 30 sessions. Pre- and post-treatment assessment consisted of psychophysiological measures, behavioural rating scales completed by parents and teachers, as well as psychometric measures. Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups, respectively. Parents reported significant reductions in primary ADHD symptoms, and inattention improvements in the NF group were higher compared to the control intervention (BF, d (corr)=-.94). NF training also improved attention and reaction times on the psychometric measures. The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests. However, regarding hyperactivity and impulsivity symptoms, the results imply that non-specific factors, such as behavioural contingencies, self-efficacy, structured learning environment and feed-forward processes, may also contribute to the positive behavioural effects induced by neurofeedback training.

Efficacy of Duloxetine and Agomelatine Does Not Exceed That of Other Antidepressants in Patients With Autistic Disorder

To the Editor: Autistic disorder is characterized by qualitative impairments in reciprocal social interaction, verbal and nonverbal communication, and imaginative activity with a markedly restricted repertoire of activities and interests. The development of efficacious and safe therapeutic interventions remains an area of significant need in this disorder. Additionally, hyperactivity, poor attention span, and impulsivity are often prominent associated clinical features and have been target symptoms in previous medication trials.1 In an earlier open trial of dextroamphetamine, autistic children had an adverse response.2 Jaselskis et al3 report poor efficacy of clonidine treatment of hyperactive autistic children. Open trials suggested that methylphenidate4 and atomoxetine5 use in hyperactive autistic children may ameliorate hyperactivity, inattention, and impulsivity in children with autistic disorder. Neuroleptics are somewhat effective in reducing hyperactivity, impulsivity, and inattention in children with autistic disorder.6 However, chronic use of neuroleptics may be complicated by cognitive blunting and the often irreversible side effect of tardive dyskinesia.7 Atypical neuroleptics are also somewhat effective and are associated with fewer adverse side effects.8 Antidepressants (tricyclic antidepressants and selective serotonin reuptake inhibitors) have been reported to have some effect, especially on target symptoms of anxiety and repetitive behaviors, but include the risk of agitation.9,10 Therapeutic effects in other disorders with similar target symptoms may guide development of treatments for children with autistic disorder. This switch leads to the hypothesis that new antidepressants could have unexpected effects in patients suffering from autism. Duloxetine is a serotonin and norepinephrine agonist mainly used in treating depression. It has been described to have few side effects (dizziness, headache, and paresthesia) and almost no abuse liability or sedative effects, compared to benzodiazepines. Agomelatine is a new antidepressant that raises serotonin level and enhances melatonin production. It has also been described to have few side effects (dizziness, headache, and paraesthesia) and almost no abuse liability or sedative effects, compared to benzodiazepines. Because of the actions and favorable side effect profile of duloxetine and agomelatine, we hypothesized that both could improve autistic symptomatology. Case report. Two male patients with autistic disorder, recruited from the community and diagnosed by ICD-10 criteria, completed our 10-week trial of duloxetine (40 mg daily); a third patient received agomelatine (25 mg daily). Full-scale IQs were between 41–79 (Wechsler Intelligence Scale Revised11). The patients’ eye contact and expressive language12 were inadequate for their developmental level. They had not tolerated or responded to other psychopharmacologic treatments. Blood pressure and possible side effects were checked weekly by an interview. Ratings on the Aberrant Behavior Checklist factors were as follows (duloxetine/agomelatine, with values for duloxetine representing the mean for the 2 patients): irritability (before treatment 13.8/13, after treatment 11.8/11); hyperactivity (before treatment 19.7/19, after treatment 16.4/16); inadequate eye contact (before treatment 8.3/8.6, after treatment 7.8/7); and inappropriate speech (before treatment 6.2/6, after treatment 4.3/4). The symptom checklist scores11 were as follows: drowsiness (before treatment 1.6/1, after treatment 3.5/3) and decreased activity (before treatment 2.8/2, after treatment 3.7/3). We did not observe severe side effects. Our results show that the efficacy of duloxetine as well as of agomelatine does not seem to exceed that of other antidepressants, which are in use for various target symptoms of patients suffering from autism.

Prenatal exposure to maternal and paternal smoking on attention deficit hyperactivity disorders symptoms and diagnosis in offspring.

The study examined the effect of maternal and paternal smoking during pregnancy on the child's inattention and hyperactivity/impulsivity symptoms, and the risk for attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Generalized estimating equations, incorporating data from multiple informants (parents and teachers), was used to evaluate levels of ADHD as a function of parental smoking. The risk for ADHD, ODD, and comorbid ADHD and ODD was evaluated using polytomous logistic regression. We found that maternal, but not paternal, smoking was significantly associated with elevated inattention, hyperactivity/impulsivity, and total ADHD symptoms in children. Children of smoking, relative to nonsmoking, mothers had a significant increased risk for comorbid ADHD and ODD and ADHD, but not ODD. Although father's smoking was not associated with an increased risk, as it strongly influenced mothers' smoking, intervention for both parents may be most effective in preventing the pathway to ADHD-related problems in the children.

Guanfacine Extended-Release

Guanfacine, an alpha(2A)-adrenoceptor agonist, is available in the US as an extended-release (ER) tablet for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents (aged 6-17 years). In two large, randomized, double-blind, placebo-controlled trials of 8 and 9 weeks' duration, guanfacine ER (1-4 mg once daily) was effective in reducing the symptoms of ADHD (hyperactivity, impulsivity and inattention) in children and adolescents. There were significant reductions (denoting improvements) from baseline in ADHD rating scale IV (ADHD-RS-IV) total scores (the primary endpoint), compared with placebo. Oppositional symptoms were also significantly reduced from baseline in children with ADHD with oppositional symptoms who received guanfacine ER in a randomized, double-blind, placebo-controlled trial. Improvements in ADHD symptoms were sustained over 24 months in two noncomparative, open-label extension trials in children and adolescents who received guanfacine ER at an optimized dosage of 1-4 mg/day. Guanfacine ER was relatively well tolerated in clinical trials in children and adolescents. The most common treatment-emergent adverse events were somnolence-related, and tended to resolve over time.

Poor visual fixation in children and its possible role in attention deficit disorder (ADD)

To consider if poor (immature) visual fixation in children aged 4–15 years could contribute to aspects of attention deficit disorder within a triad of symptoms – dyslexia, dyspraxia and attention deficit – of developmental delay. Although visual fixation and developmental delay have been widely researched the link between a possible retained visual reflex and attention deficit has not been established. A prospective epidemiological study of 100 children. Within a group of children that constituted Group 1 of a case series of children with a primary diagnosis of dyslexia, dyspraxia, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and Tourette's syndrome of childhood a significant number of children (57%) demonstrated, on testing, aspects of convergence insufficiency/failure. On revisiting the original data it was found that a significant number of children demonstrated poor visual fixation as measured by an inability to maintain gaze on a fixed target during standard confrontational testing for the peripheral visual fields. This new data was then related to patterns of comorbidity and the presence of convergence insufficiency. It is suggested that a retained primitive visual reflex may contribute to aspects of inattention in children which, as a consequence, may be wrongly considered as a behavioural issue and may also impact upon the child's ability to learn. A prospective epidemiological study.

Maternal pre‐pregnancy obesity and risk for inattention and negative emotionality in children

This study aimed to replicate and extend previous work showing an association between maternal pre-pregnancy adiposity and risk for attention deficit hyperactivity disorder (ADHD) symptoms in children. A Swedish population-based prospective pregnancy-offspring cohort was followed up when children were 5 years old (N = 1,714). Mothers and kindergarten teachers rated children's ADHD symptoms, presence and duration of problems, and emotionality. Dichotomized outcomes examined difficulties of clinical relevance (top 15% of the distribution). Analyses adjusted for pregnancy (maternal smoking, depressive symptoms, life events, education, age, family structure), birth outcomes (birth weight, gestational age, infant sex) and concurrent variables (family structure, maternal depressive symptoms, parental ADHD symptoms, and child overweight) in an attempt to rule out confounding. Maternal pre-pregnancy overweight and obesity predicted high inattention symptom scores and obesity was associated with a two-fold increase in risk of difficulties with emotion intensity and emotion regulation according to teacher reports. Means of maternal ratings were unrelated to pre-pregnancy body mass index (BMI). Presence and duration of problems were associated with both maternal over and underweight according to teachers. Despite discrepancies between maternal and teacher reports, these results provide further evidence that maternal pre-pregnancy overweight and obesity are associated with child inattention symptoms and extend previous work by establishing a link between obesity and emotional difficulties. Maternal adiposity at the time of conception may be instrumental in programming child mental health, as prenatal brain development depends on maternal energy supply. Possible mechanisms include disturbed maternal metabolic function. If maternal pre-pregnancy obesity is a causal risk factor, the potential for prevention is great.

Dopaminergic Haplotype as a Predictor of Spatial Inattention in Children With Attention-Deficit/Hyperactivity Disorder

A distinct pattern of selective attention deficits in attention-deficit/hyperactivity disorder (ADHD) has been difficult to identify. Heterogeneity may reflect differences in underlying genetics. To document an objective deficit of selective attention in a large sample of children with and without ADHD using spatial orienting paradigms. By stratifying samples according to the gene dosage of a risk haplotype of the dopamine transporter gene (DAT1), we could determine whether genetic factors predict spatial inattention in ADHD. A case-control design was used. Children with ADHD were recruited from clinics or support groups in Ireland. Typically developing children were recruited from schools in and around Dublin, Ireland. One hundred fifteen children were recruited (ADHD = 50, control = 65). Groups were matched for age but differed in estimated intelligence. Two versions of a visual spatial orienting task in which attention was directed by valid, neutral, or invalid cues to target locations. Sudden-onset peripheral cues (exogenous) and centrally presented predictive cues (endogenous) were used. To isolate an attention deficit in ADHD, groups were first compared using analysis of variance on the spatial orienting tasks. Multiple regression was used to assess the main effect of DAT1 haplotype status (heterozygous vs homozygous) and the interaction of diagnosis and genotype on those variables that discriminated children with and without ADHD. Children with ADHD displayed deficits in reorienting attention from invalidly cued spatial locations, particularly for targets in the left visual field. DAT1 haplotype status predicted spatial reorienting deficits for left visual field targets (P = .007) but there was also a significant interaction of diagnosis and genotype (P = .02), which revealed the greatest impairment in children with ADHD homozygous for the DAT1 haplotype. Heterogeneity in selective attention in ADHD can be explained by a replicated genetic risk factor for ADHD, the 10/3 DAT1 haplotype.

Gene-environment interactions in attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder characterized by inattention, impulsivity, and/or hyperactivity in children and adults. Putative environmental risk factors for ADHD include toxin and prenatal smoke exposure, low socioeconomic status, and parental marital instability and discord. Genetic associations with ADHD have been found in the dopaminergic, serotonergic, and noradrenergic neurotransmitter systems, but findings are inconsistent across studies. Herein, we review studies of gene-environment interactions for ADHD to better understand how genetic and environmental risk factors may contribute to the disorder in a nonindependent fashion, which may account in part for the inconsistent findings on genetic associations. Although evidence of interactions between prenatal substance exposure and the dopamine genes DAT1 and DRD4 was found, findings across studies have been mixed. We discuss these findings and the future directions and limitations of current gene-environment research.

Alpha-2 Adrenergic Agonists in Children with Inattention, Hyperactivity and Impulsiveness

Although originally developed for the treatment of hypertension, alpha(2)-agonists have been used to treat Tourette's syndrome, attention-deficit hyperactivity disorder (ADHD), developmental disorders and substance abuse for nearly three decades. Based on studies of clonidine, alpha(2)-agonists were presumed to reduce arousal by decreasing the firing of noradrenaline neurons in locus ceruleus. Accumulated preclinical evidence indicates that guanfacine has features in common with clonidine, in addition to other pharmacological effects. Clonidine binds to the three subtypes of alpha(2)-receptors, A, B and C, whereas guanfacine binds more selectively to alpha(2A)-receptors, which appears to enhance prefrontal function. Several reports on the use of the alpha(2)-agonists show improvements in children with ADHD and improvements in hyperactivity, impulsiveness and inattention in children with tic disorders and pervasive developmental disorders. Both clonidine and guanfacine are associated with sedation, fatigue and somnolence. Reductions in heart rate and blood pressure are modest and rarely lead to discontinuation of treatment across these trials.

Is prenatal alcohol exposure related to inattention and hyperactivity symptoms in children? Disentangling the effects of social adversity

Studies concerning whether exposure to low levels of maternal alcohol consumption during fetal development is related to child inattention and hyperactivity symptoms have shown conflicting results. We examine the contribution of covariates related to social adversity to resolve some inconsistencies in the extant research by conducting parallel analyses of three cohorts with varying alcohol consumption and attitudes towards alcohol use. We compare three population-based pregnancy-offspring cohorts within the Nordic Network on ADHD from Denmark and Finland. Prenatal data were gathered via self-report during pregnancy and birth outcomes were abstracted from medical charts. A total of 21,678 reports concerning inattention and hyperactivity symptoms in children were available from the Strengths and Difficulties Questionnaire or the Rutter Scale completed by parents and/or teachers. Drinking patterns differed cross-nationally. Women who had at least some social adversity (young, low education, or being single) were more likely to drink than those better off in the Finnish cohort, but the opposite was true for the Danish cohorts. Prenatal alcohol exposure was not related to risk for a high inattention-hyperactivity symptom score in children across cohorts after adjustment for covariates. In contrast, maternal smoking and social adversity during pregnancy were independently and consistently associated with an increase in risk of child symptoms. Low doses of alcohol consumption during pregnancy were not related to child inattention/hyperactivity symptoms once social adversity and smoking were taken into account.