Transcript Child and Adolescent Psychopathology

Exposure to
Teratogens as a Risk
Factor for
Psychopathology
Chapter 9
Nicole A. Crocker, Susanna L. Fryer, and Sarah N.
Mattson
INTRODUCTION AND
ETIOLOGICAL FORMULATIONS
 A teratogen is an agent that causes birth defects by
altering the course of typical development.
 Examples of human teratogens exist in several classes
of substances including drugs of abuse, prescription
medications, environmental contaminants, and
diseases.
 Behavioral teratogenic exposures are diverse and may
include structural damage to the developing brain,
cognitive impairments, and emotional dysfunction
HISTORICAL CONTEXT
 Not until 1941 that an association between prenatal
exposure to the rubella virus and subsequent birth
defects was reported in the scientific literature.
 For the majority of the 20th century alcohol was not
recognized as a human teratogen.
 1989 the United States Government passed the
Alcoholic Beverage Warning Label Act.
 February 2005, the U.S. Surgeon General issued an
updated “Advisory on Alcohol Use and Pregnancy.”
TERMINOLOGICAL and
CONCEPTUAL ISSUES
 Fetal Alcohol Syndrome(FAS) is characterized by:
 Pre- and/or postnatal growth deficiency
 Dysmorphic facial features
 Central nervous system (CNS) dysfunction
 Cognitive deficits and behavioral abnormalities are
commonly observed following prenatal alcohol exposure
even in the absence of the growth deficiency and facial
stigmata required for clinical recognition of FAS.
MENTAL HEALTH OUTCOMES IN
FASD
 Disruptive Behavior Disorders
 The association between prenatal alcohol exposure and
disruptive behavior (i.e., ADHD, conduct disorder)
appears to be reliable and persistent, and it is evident at
relatively low exposure levels.
 However, whether this association between prenatal
alcohol exposure and delinquency is direct—or is
mediated by a more proximal linkage between FASD and
early-appearing attention/impulse control problems
and/or learning difficulties, which themselves predict later
conduct problems—is indeterminate (Hinshaw, 1992).
MENTAL HEALTH OUTCOMES IN
FASD
 Mood Disorders
 Elevated rates of depressive disorders have also been noted
in children with FASD, based on parent interviews.
 Prenatal alcohol exposure is a possible etiological factor in
increased negative affect and depressive symptoms. However,
this association appeared to also be mediated by the quality
and nature of mother-child interactions (O'Connor & Paley, 2006).
 Potential Mediating and Moderating Factors
 Maternal psychopathology may be a better predictor of
internalizing problems in children with FASD but that alcohol
exposure is more directly related to externalizing problems
(Staroselsky et al., 2009).
 Delinquency was not directly related to alcohol exposure but to
environmental and behavioral variables such as low parental
supervision, adolescent life stress, and self-reported drug use.
MENTAL HEALTH OUTCOMES IN
FASD
 In terms of family placement, higher rates of delinquent behavior were
endorsed by alcohol-exposed adolescents in biological and foster
homes versus those in adoptive homes (Schonfeld et al., 2005).
 Adaptive Dysfunction
 As alcohol-exposed individuals reached adulthood, their
overall adaptive abilities were equivalent to those of a
typically developing 7-year-old, with social skills showing
the most severe detriment (Streissguth et al., 1991).
 Socialization and communication skills of children with
FASD may be the most affected domain within adaptive
function (Crocker et al., 2009).
MENTAL HEALTH OUTCOMES IN
FASD
 Psychopathology in Adults With FASD
 Clinical difficulties associated with prenatal alcohol exposure,
such as impulsivity, mood disorder, and substance abuse,
place affected individuals at high risk for suicide.
 43% of adults with FASD reported suicide threats and 23%
reported a history of suicide attempts throughout the lifetime
(Streissguth et al., 1996).
 Possible Mechanisms of Action
 A multitude of possible mechanisms for causing the pathology
associated with FASD have been identified:
• Oxidative stress, changes in glucose metabolism, mitochondrial
damage, abnormal growth factor activity, dysregulation of
developmental gene expression, anomalous cell adhesion, and
abnormalities in the development and regulation of neurotransmitter
systems.
Psychopthology RELATED TO
OTHER PRENATAL EXPOSURES
 Nicotine
 Most commonly reported effects include increases in antisocial
or delinquent behavior and ADHD.
 Other Stimulant Drugs
 Stimulants may be associated with subtle neurobehavioral
alterations.
 Regarding psychopathology, increased levels of aggressive
behavior have been reported in cocaine-exposed children (Bada
et al., 2011).
 Possible Mechanisms of Action
 Atypical development of monoamine transmission may help to
explain the attention and arousal dysfunction observed in
prenatal exposure cases to stimulants.
psychopthology RELATED TO
OTHER PRENATAL EXPOSURES
 Behavioral effects of prenatal stimulant exposure are less
pronounced than those associated with alcohol and
nicotine teratogenesis and that environmental factors
related to caregivers may be especially important to
consider in stimulant exposure cases.
 Methylmercury and Lead
 Associated with neurobehavioral deficits, as a result of
both developmental and prenatal exposure (Gutter, & Rice,
2002).
 Some evidence for increased rates of delinquency in
children exposed prenatally to lead (Dietrich, Ris, Succop, Berger, &
Bornschein, 2001).
SYNTHESIS AND FUTURE
DIRECTIONS
 Insufficient data exist to determine conclusively whether
associations exist between all known teratogens and
psychopathology.
 The effect of prenatal alcohol exposure on the development
of psychiatric symptoms provides clear evidence that
teratogenic exposure can increase the risk of developing
psychopathology.
 Future studies might focus on developing a profile of
potential mental health problems for exposed individuals,
while also distilling factors that may prevent development of
mental health problems in these children.