Public Release: 

Severity of ADHD in children increases risk of drug use in adolescence

Inattention symptoms appears to be culprit of early drug use and multiple substance use

American Psychological Association

WASHINGTON -- Children diagnosed with attention-deficit/hyperactivity disorder (ADHD) are more at risk for using illicit drugs, having problems with alcohol, smoking cigarettes, and using marijuana in their adolescence than children without ADHD, say researchers who report their findings on childhood predictors of later substance use in the August issue of the Journal of Abnormal Psychology, published by the American Psychological Association (APA). Furthermore, childhood ADHD is linked to earlier first use of cigarettes, earlier progression to daily smoking and earlier use of illicit drugs.

According to the study, those children with the most severe attention problems in childhood were most at risk for alcohol and marijuana problems and cigarette smoking by their teens. Those children with ADHD with other behavior problems, such as defying parents and fighting, were also at risk for illicit drug use, but severity of attention problems was a better predictor for drinking, tobacco, and marijuana outcomes. This could be, say the researchers, because problems with paying attention in childhood have an immediate effect on school learning and social relationships, which may set the stage for other problems later on that include drug use and abuse.

Psychologists Brooke S. G. Molina, Ph.D., and William E. Pelham, Jr., Ph.D. compared drug use between 142 teenagers (13-18 years of age) diagnosed with ADHD in childhood with 100 children (same ages) without ADHD, using measures of ADHD and antisocial behavior reported by the teachers and parents. Because the children with ADHD had been diagnosed and followed from childhood, the researchers were able to evaluate whether the severity of symptoms in the ADHD group predicted elevated drug use in adolescence.

The presence of ADHD in childhood was found to increase the risk for elevated use and abuse of alcohol and heavier drugs and the earlier use of tobacco and other drugs by the teenage years, said the authors. Furthermore, said Dr. Molina, "childhood ADHD symptoms, particularly the inattention dimension of ADHD, predicted later substance use to a greater degree than childhood antisocial behaviors." This suggests that the severity of ADHD is a leading factor for the early emergence of substance use behavior, said Molina. Thus, it was not surprising that those children who still had ADHD in adolescence (about 72% of them) reported more drunkenness from alcohol, more alcohol problems, and more cigarette smoking than the adolescents without childhood ADHD. Children with ADHD who developed severe conduct problems by adolescence (about 26% of them) reported the highest levels of drinking, smoking, and drug use.

The ADHD symptom of inattention versus hyperactivity and oppositional defiant disorder/conduct disorder (ODD/CD) better predicts later substance use, suggest the authors, because "executive functions associated with inattention and not hyperactivity may be at the root of the progression to substance use. A child may begin having poor academic performance and peer difficulties and then gravitate toward nonconformist peer groups as an adolescent where substance abuse is accepted as a way of life," said Molina.

The study may not have found strong prediction from symptoms of impulsivity because they are few and confounded with the hyperactivity symptoms. Both inattention and impulsivity are likely to play important roles in prediction of later substance use outcomes for ADHD children.

This study sheds light on the importance of early identification and treatment of problems with paying attention in childhood. Knowing the early signs of ADHD, providing early intervention, and providing help to teachers and parents through the teenage years, may help teachers and parents recognize risk factors and intervene before a child's use of alcohol and drugs turns into a life long dependence, said the authors.

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Article: "Childhood Predictors of Adolescent Substance Use in a Longitudinal Study of Children With ADHD," Brooke S. G. Molina, Ph.D., Western Psychiatric Institute and Clinic and University of Pittsburgh School of Medicine and William E. Pelham, Jr., Ph.D., State University of New York at Buffalo; Journal of Abnormal Psychology, Vol. 112, No. 3.

Full text of the article is available from the APA Public Affairs Office or at http://www.apa.org/journals/abn/press_releases/august_2003/abn1123497.html

Brooke S. G. Molina, PhD can be reached by phone at 412-624-4633.

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 53 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

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