Date of Award


Document Type


Degree Name

Doctor of Psychology (PsyD)


Graduate Department of Clinical Psychology

First Advisor

Glena L. Andrews, PhD

Second Advisor

Elizabeth B. Hamilton, PhD

Third Advisor

Kathleen Gathercoal, PhD


ADHD is the most prevalent psychiatric disorder in children, affecting their executive and overall well-being as a result (Barkley, 2014; Shaw, Gogtay, & Rapoport, 2010). A rampant increase in new diagnoses of ADHD suggests the potential for misdiagnosis. Stimulants are the first line of treatment and associated with a number of deleterious long-term consequences for those misdiagnosed (Urban & Gao, 2014a). This is of particular concern for children prenatally exposed to substances as in utero use acts on similar neural mechanisms impacted by ADHD – leaving the children vulnerable to misdiagnosis and contraindicated intervention (Derauf, Kekatpure, Neyzi, Lester, & Kosofsky, 2009; Telford, 2012). Additionally, in drug-affected brains, inappropriate treatment with stimulants results in manic episodes, irritability, and other clinical issues (Uban et. al., 2015; Hoffman, 2017). The current study aimed to parse out subtle cognitive differences between ADHD and in utero polysubstance exposure toward clarifying definitive diagnoses and proper treatment planning. Participants were from an archived database from multiple school districts. Cognitive domains from the Woodcock Johnson III and IV were compared between students with ADHD or prenatal polysubstance exposure. Fluid Reasoning most potently predicted a diagnosis of prenatal polysubstance exposure. No cognitive domain predicted a diagnosis of ADHD. Significant differences were also observed for General Intellectual Ability, Long-term Retrieval, and Comprehension Knowledge, with lower scores for those prenatally exposed. These differences suggest an emergent cognitive profile for those prenatally exposed that differs from students with an ADHD diagnosis. This information may aid clinicians in differential diagnosis and proper treatment planning.