Smoking during pregnancy and ADHD risk: A genetically informed, multiple-rater approach

Valerie S. Knopik, Kristine Marceau, L. Cinnamon Bidwell, Rohan H.C. Palmer, Taylor F. Smith, Alexandre Todorov, Allison Schettini Evans, Andrew C. Heath

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Maternal smoking during pregnancy (SDP) is a significant public health concern with adverse consequences to the health and well-being of the developing child, including behavioral outcomes such as Attention–Deficit Hyperactivity Disorder (ADHD). There is substantial interest in understanding the nature of this reported association, particularly in light of more recent genetically informed studies that suggest that the SDP-ADHD link is less clear than once thought. In a sample of families (N = 173) specifically selected for sibling pairs discordant for prenatal smoking exposure, we use a sibling-comparison approach that controls for shared genetic and familial influences to assess the effects of SDP on ADHD symptom dimensions. ADHD was measured by both parent and teacher report on the Conners report forms and the Child Behavior Checklist/Teacher Report Form (CBCL/TRF). Results for the CBCL/TRF Total ADHD score are consistent with prior genetically informed approaches and suggest that previously reported associations between SDP and ADHD are largely due to familial confounding rather than causal teratogenic effects. However, results from the Conners parent report suggest a potentially causal effect of SDP on hyperactive/impulsive and, to a lesser extent, total ADHD symptoms; SDP results in increased parent-reported hyperactive/impulsive and total ADHD symptoms even after accounting for genetic and familial confounding factors. This suggests that the Conners assessment (parent-report) may provide a sensitive measure for use in studies examining child specific SDP effects on continuous and dimensional aspects of ADHD.

Original languageEnglish
Pages (from-to)971-981
Number of pages11
JournalAmerican Journal of Medical Genetics, Part B: Neuropsychiatric Genetics
Issue number7
StatePublished - Oct 1 2016


  • ADHD
  • CBCL
  • Conners
  • genetics
  • multiple reporters
  • sibling comparison design
  • smoking during pregnancy


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