Prenatal smoking exposure, low birth weight, and disruptive behavior disorders

Prenatal problems are among theorized etiologies for child disruptive behavior problems. A key question concerns whether etiological contributors are shared across the broad range of disruptive psychopathology or are partially or largely distinct.

We examined prenatal smoking exposure and low birth weight as risk factors for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) in a population-based longitudinal design from ages 6 to 17 years. Multiple informants were used, with emphasis on parent and teacher report for ADHD, parent- and self-report interview for ODD, and self-report interview for CD, in keeping with evidence about the most valid sources of information for these respective syndromes.

The association of prenatal smoking exposure with ADHD was highly confounded by family variables. In contrast, low birth weight independently predicted ADHD, even with family variables statistically controlled. The opposite pattern appeared for ODD and CD. Prenatal smoking exposure but not low birth weight predicted ODD independent of potential confounding variables. Prenatal smoking exposure also predicted CD. The effect on CD was via its effect on ODD.

Prenatal smoking exposure may contribute to ODD and via that route to later CD, but does not have a specific association with ADHD in this sample. Findings have implications for distinct etiological contributors to these often comorbid aspects of the disruptive behavior domain.