that occur over time, such as lower levels of emotional support and decreased expressions of positive affect from mothers. Because externalizing behaviors are also elevated in children with FASD, it is not surprising that rates of oppositional defiant disorder, conduct disorder, and ADHD are elevated (Burd, et al., 2003; D'Onofrio, et al., 2007; Disney, Iacono, McGue, Tully, & Legrand, 2008; Fryer, McGee, et al., 2007; Steinhausen & Spohr, 1998; Steinhausen, et al., 1993). One study indicated that within FASD, male participants were significantly more likely than female participants (86% compared to 29%) to be diagnosed with ADHD (Herman, Acosta, & Chang, 2008). In the greater population of children with ADHD, the ratio of boys to girls is estimated at 2 to 1 (Merikangas et al., 2010), although higher ratios (4:1) have been reported (Cantwell, 1996).
