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Open Access Highly Accessed Research article

Factors associated with attention deficit/hyperactivity disorder among US children: Results from a national survey

Ravi K Lingineni, Swati Biswas*, Naveed Ahmad, Bradford E Jackson, Sejong Bae and Karan P Singh

BMC Pediatrics 2012, 12:50  doi:10.1186/1471-2431-12-50

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Authors' response to the comment "ADHD and FASD"

Swati Biswas   (2012-06-28 16:03)  University of North Texas Health Science Center email

Thank you very much for your interest in our work and bringing up this important issue. The data that we used for this study (NCSH) didn't have any information on prenatal exposures so even though we are aware of importance of those exposure variables, we couldn't use them in our analyses. The cross-sectional nature of our data has been mentioned as a limitation in the paper.

Competing interests




Bruce Ritchie   (2012-06-11 16:33)  FASlink Fetal Alcohol Disorders Society email

Prenatal exposure to alcohol is a major factor in ADHD, with ADHD co-occurring more than 90% of the time with Fetal Alcohol Spectrum Disorders. I am concerned that prenatal alcohol exposure was not a factor considered in this study. In Canada, 37% of babies have been exposed to binge drinking of 5 or more drinks per occasion on multiple occasions during the pregnancy. Another 42% have been exposed to 1 to 4 drinks of alcohol multiple times during the pregnancy. Only 21% of females giving birth do not drink alcohol. There is no known safe level of alcohol exposure during pregnancy. The most vulnerable time is the first trimester. The pregnancy may not have been confirmed for three or more months. More than half of the pregnancies are unplanned. Alcohol crosses the placental barrier and is a toxin, teratogen, and mutagen, affecting more than 1000 gene and cell processes including proliferation, transport and communications. More than 20% of Canadian Children are receiving Special Education, more than half of those for conditions of types known to be caused by prenatal alcohol exposure. Failure to consider prenatal alcohol exposure as a risk factor for ADHD is a serious omission in this study. Please see:

Competing interests

None declared


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