Increased levels of secondary disabilities and psychiatric diagnoses are other common consequences of heavy prenatal alcohol exposure (Burd, Klug, Martsolf, & Kerbeshian, 2003; Famy, Streissguth, & Unis, 1998; Fryer, McGee, et al., 2007; Lynch, Coles, Corley, & Falek, 2003; O'Connor, 2001; O'Connor & Kasari, 2000; O'Connor & Paley, 2006; O'Connor, et al., 2002; Roebuck, Mattson, & Riley, 1999; Steinhausen & Spohr, 1998; Streissguth, Barr, Kogan, & Bookstein, 1996). As mentioned, children with FASD often have increased rates of mood disturbance. One study used structural equation modeling to construct a model of the relationship between prenatal alcohol exposure and childhood depression (O'Connor & Paley, 2006). This model considered both pre- and postnatal factors, and data suggested that higher levels of prenatal alcohol exposure are related to increased negative affect and depressive symptoms but that this relationship is mediated by mother-child interactions 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
