Developmental progression to early adult binge drinking and marijuana use from worsening versus stable trajectories of adolescent attention deficit/hyperactivity disorder and delinquency

Abstract

Aims To examine the association between developmental trajectories of inattention, hyperactivity-impulsivity, and delinquency through childhood and adolescence (ages 8-16) and subsequent binge drinking and marijuana use in early adulthood (age 21). Design Prospective naturalistic follow-up of children with attention-deficit/hyperactivity disorder (ADHD) previously enrolled in a randomized controlled trial (RCT). Treatment-phase assessments occurred at 3, 9, and 14 months after randomization; follow-up assessments occurred at 24 months, 36 months, and 6, 8, and 12 years after randomization. Setting Secondary analysis of data from the Multimodal Treatment Study of ADHD (MTA), a multi-site RCT comparing the effects of careful medication management, intensive behavior therapy, their combination, and referral to usual community care. Participants 579 children with DSM-IV ADHD combined type, aged 7.0 and 9.9 years old at baseline (M=8.5, SD=.80). Measurements Ratings of inattention, hyperactivity-impulsivity, and delinquency were collected from multiple informants at baseline and through the 8-year follow-up. Self-reports of binge drinking and marijuana use were collected at the 12-year follow-up (M age 21). Findings Trajectories of worsening inattention symptoms and delinquency (and less apparent improvement in hyperactivity-impulsivity) were associated with higher rates of early adult binge drinking and marijuana use, compared with trajectories of stable or improving symptoms and delinquency (of 24 comparisons, 22 p-values <.05), even when symptom levels in stable trajectories were high. Conclusions Worsening inattention symptoms and delinquency during adolescence are associated with increased-levels of early adult substance use; this pattern may reflect a developmental course of vulnerability to elevated substance use in early adulthood.

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

“…Chassin and colleagues also reported more parental alcoholism, peer drinking, and drug use for adolescents whose binge drinking escalated rapidly. These risk factors, common for children with ADHD (Howard et al., ; Molina, Gnagy, Joseph, & Pelham, 2016), likely combine to reinforce SU after initiation.…”

“…It is clear from the MTA data that risk for adult SU begins at a young age. Future analyses will consider the contribution of symptom persistence (Hechtman et al., ), the parallel unfolding of conduct problems that should exacerbate risk above those occurring in childhood (Howard et al., ), extended treatment effects (Swanson et al., ), and additional mediators and moderators suggested by the deepening literature on mechanisms of substance abuse risk in ADHD (e.g., Groenman et al., ; Molina & Pelham, ).…”

Between- and within-person associations between negative life events and alcohol outcomes in adolescents with ADHD.

“…A number of studies have shown that symptom persistence in adolescence is associated with other externalizing problems such as oppositional defiant disorder and conduct disorder, (i.e. Costello & Maughan, 2015), emotion problems, suicidality and academic failure and dropout (Costello & Maughan, 2015; Kessler et al, 2014), as well as early adult substance use (Howard et al, 2015) including, in this sample, an association between ADHD symptom persistence, delinquency, and frequency of alcohol use (Molina et al, 2012, and replicated in the current study).…”

Progression of impairment in adolescents with attention-deficit/hyperactivity disorder through the transition out of high school: Contributions of parent involvement and college attendance.

“…Our finding of modest average increases over time summarizes a great deal of individual variability. Studies of symptom trajectories of children with ADHD show that about 25% to 30% exhibit a worsening pattern over time (Howard et al, 2015; Malone, Van Eck, Flory, & Lamis, 2010; Pingault et al, 2014; Swanson et al, 2007). In the present study, 27% of MTA probands persisted with clinically significant impairment before and after the transition out of high school, and impairments were most severe for the minority of adolescents with persistent externalizing comorbidity.…”