0145-6008/00/2407- 1084$03.00/0 ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH Vol. 24, No. 7 July 2000 Prenatal Alcohol Exposure and Depressive Features in Children Mary J. O’Connor and Connie Kasari Background This study examined the association between prenatal alcohol exposure and self-report of depressive symptoms in 5- to 6-year-old children. Higher levels of prenatal alcohol exposure were hypoth- esized to be associated with endorsement of a greater number of depressive symptoms in children. It was also hypothesized that maternal depression, although associated with drinking behavior, would contribute independently to outcome. Finally, the mother’s behavior toward the child, as well as current drinking practices, were postulated to mediate the relationship between prenatal alcohol exposure and child de- pressive symptoms. Methods: Participants were 41 mother-child dyads who had been followed longitudinally since the children were 1 year of age. Self-report questionnaires for maternal and child depression were used. Results: Results revealed that prenatal alcohol exposure, maternal depression, and child gender seemed to be highly associated with child depressive symptoms. Girls who had higher levels of prenatal alcohol exposure and whose mothers acknowledged higher levels of depression endorsed the highest number of depressive symptoms. Neither the mother’s behavior in interaction with the child nor her current level of alcohol consumption mediated the relationship. Conclusions: The importance of considering prenatal alcohol exposure as a risk variable in the predic- tion of childhood-onset depression and the possible neurological mechanisms underlying depression in children with alcohol exposure in utero are discussed. Key Words: Prenatal Alcohol Exposure, Childhood Depression. HILDREN EXPOSED TO alcohol prenatally present C with a number of neurobehavioral deficits that make their adaptation to the environment more difficult (Alcohol and Health, 1997). Both animal and human studies of prenatal alcohol exposure have revealed increased activity levels, attention deficits, problems in inhibition and state regulation, perseverative behavior, and expressive motor problems (Driscoll et al., 1990). Learning and memory problems in children exposed to alcohol prenatally have also been identified (Coles and Platzman, 1993; Mattson and Riley, 1998). These problems tend to persist into adult- hood (Streissguth, 1997). Despite the vast literature on the neurodevelopmental deficits of prenatally exposed children, there is very little research on the emotional functioning of these individuals. The limited research suggests significant depressive symp- toms in individuals exposed to alcohol prenatally. When compared with an age- and sex-matched control group, From the Department of Psychiatry (M.J.O., C.K), University of Califor- nia at Los Angeles, and Neuropsychiatric Institute (M.J.O.), Los Angeles, California. Received for publication September 30, 1999; accepted April 20, 2000. Reprint requests: Mary J. O’Connor, M.D., UCLA School of Medicine, Rm 68-265A; Neuropsychiatric Institute, 760 Westwood Plaza, Los Angeles, CA 90024; Fax: 31 0-825-2682; E-mail: moconnor@mednet.ucla.edu Copyright 0 2000 by the Research Society on Alcoholism. 1084 Roebuck et al. (1999) found significant differences on pa- rental report of symptoms of depression in a group of 3- to 16-year-old children with heavy prenatal alcohol exposure. According to the parental reports, prenatally exposed chil- dren scored between 1Y2 to 2 standard deviations above the mean for depression on the Personality Inventory for Chil- dren. The majority of children also were identified as hav- ing poor psychological adjustment and in need of psycho- logical evaluation. As the authors noted, a limitation of the study was that it did not allow for the determination of the extent to which the behavioral problems seen by caregivers were attributable to the direct teratogenic effect of alcohol exposure or to other environmental factors. Furthermore, measures of depression were based on parental rather than child self-report. In addition, many of the children in the sample were also mentally retarded, and mental retarda- tion has been shown to be associated with increased risk for psychiatric illness (King et al., 1997). However, two recent studies that examined the psychiat- ric functioning of individuals with prenatal alcohol expo- sure and IQs above 70 also found high rates of depression. Using psychiatric interviews, 27% of children evaluated in a clinic specializing in the diagnosis of fetal alcohol syn- drome were found to have depressive disorders, including unipolar depression and dysthymia (Shah et al., 1999). In a study of adults who were exposed to alcohol prenatally, 44% were found to be seriously depressed (Famy et al., Alcohol Clin Exp Res, Vol24, No 7,2000: pp 108&1092