A retrospective, hospital-based, case-control study of attention deficit hyperactivity disorder (ADHD) and prenatal exposure to maternal cigarette smoking, drug use, and alcohol was conducted in 280 ADHD cases and 242 non-ADHD controls at the Massachusetts General Hospital, Boston, MA. Questions in direct interviews included; ‘Did you smoke a pack a day for at least 3 months?’ ‘Did you drink an alcoholic beverage daily?’ Patients with ADHD were 2.1 times more likely (p=.02) to have been exposed to cigarettes and 2.5 times more likely (p=.03) to have been exposed to alcohol in utero compared to non-ADHD controls. The effects of cigarette, alcohol, and drug exposure were not significantly different in male and female patients. None had fetal alcohol syndrome. Potential confounding factors, including familial ADHD, maternal depression, comorbid conduct disoder, and Rutter’s indicators of social adversity, did not explain the effect of prenatal exposure to alcohol or cigarette nicotine. Research aimed at identifying and preventing the risks of alcohol and nicotine abuse during pregnancy needs to be developed. 
COMMENT. A two-fold or greater increased risk of ADHD is associated with significant prenatal exposure to nicotine and alcohol, confirming previous studies and showing that the risk cannot be explained by familial, maternal and social confounding factors. ADHD is an additional deleterious effect to the known fetal alcohol syndrome associated with maternal alcohol abuse or exposure. Clinicians should continue to enquire regarding the habit of smoking in parents of children with ADHD, and expectant mothers should be warned regarding the added dangers of smoking as well as drinking in pregnancy.
Quality of life assessment in children with ADHD and families was studied at the Department of Pediatrics, Harvard Medical School . A parent-completed questionnaire is developed and implemented to measure the effect of ADHD and its treatment on the quality of life of patients and families. Significant differences were determined in quality of life of children with ADHD inattentive and ADHD combined types. The questionnaire may be used to measure the outcome of care for ADHD.