Anger‐irritability as a mediator of attention deficit hyperactivity disorder risk for adolescent alcohol use and the contribution of coping skills

Abstract

Background Research on susceptibility to alcohol use disorder within the Attention-Deficit/Hyperactivity Disorder (ADHD) population has begun to expand examination of putative moderators and mediators in order to develop effective treatments. Specific dysregulated emotions have been separately associated with ADHD and with alcohol use difficulties. The current study is the first to conjointly study these variables by testing anger-irritability as a mediator of ADHD risk for adolescent alcohol use. Methods Frequency of binge drinking, drunkenness, and alcohol problems were examined for 142 children with ADHD followed into adolescence and compared to 100 demographically similar youth without ADHD. Parent-rated anger-irritability was tested as a mediator. Behavioral and cognitive coping skills, which are key clinical treatment targets, were studied as moderators of these associations. Results Childhood ADHD was positively associated with anger-irritability and the drinking outcomes in adolescence. Anger-irritability mediated the association between ADHD and alcohol use problems, but not binge drinking or drunkenness. Behavioral and cognitive, but not avoidant, coping played a moderating role, but only of the association between childhood ADHD and anger-irritability. Conclusions Active coping strategies by adolescents with ADHD may reduce the vulnerability to alcohol problems through a reduction of negative emotions. Future research on additional mediators and treatments that target these skills is encouraged.

Substance use through adolescence into early adulthood after childhood‐diagnosed ADHD: findings from the MTA longitudinal study

“…These findings are especially important given uncertainty of ADHD‐related risk for heavy marijuana use in the literature (Lee et al., ) and negative health consequences of chronic use, particularly among individuals with psychiatric symptoms (Compton, Volkov, & Lopez, ). Adolescents with ADHD have poorer coping skills (Harty, Gnagy, Pelham, & Molina, ), and when combined with increasing marijuana accessibility (Hasin et al., ), this may contribute to chronic use and associated negative sequelae. These results amplify concern about ADHD‐related risk of cannabis use disorder noted in our recent report (18.9% vs. 12.3%; Hechtman et al., ) because more MTA adults reported frequent marijuana use than met criteria for disorder.…”

Smoking-Specific Risk Factors in Early Adulthood That Mediate Risk of Daily Smoking by Age 29 for Children with ADHD

“…Our findings confirmed the importance of behavioral smoking risk factors in the 18 to 25-year-old age range—a major developmental period also known for its substance use vulnerability. Attainment of developmental milestones in this age range is impaired for individuals with ADHD histories (Altszuler et al, 2016; Hechtman et al, 2016) which may increase vulnerability to smoking as a coping strategy (Harty et al, 2017) rather than reinforcing abstention. Prevention and intervention may need to directly target this age range in order to abort a chronic smoking outcome in later adulthood.…”

Vitamin‐mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo‐controlled trial

“…While poor self‐control and emotional dysregulation are not considered core ADHD symptoms according to the DSM‐5, these symptoms are often more impairing than those identified as ‘core’ ADHD symptoms (Barkley & Fischer, ; Van Stralen, ). Management of emotional dysregulation presents a considerable therapeutic challenge for parents, teachers and clinicians (Shaw, Stringaris, Nigg, & Leibenluft, ) and children with poor emotional control tend to have poorer long‐term outcomes (Slutske, Moffitt, Poulton, & Caspi, ), including placing them at risk for future alcohol use (Harty, Gnagy, Pelham, & Molina, ). A growing body of literature points to the clinical relevance of a temperament‐ or personality‐based irritable subtype (Gomez & Corr, ; Karalunas et al., ; Sullivan et al., ), characterized by the negative emotionality and anger that improved in the participants who were randomized to micronutrients in this study.…”