Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review

Abstract

Given the clinical and public health significance of substance disorders and the need to identify their early risk factors, we examined the association of childhood attention-deficit/hyperactivity disorder (ADHD) with substance use (e.g., nicotine, alcohol) and abuse/dependence outcomes (nicotine, alcohol, marijuana, cocaine, other). To strengthen a potential causal inference, we meta-analyzed longitudinal studies that prospectively followed children with and without ADHD into adolescence or adulthood. Children with ADHD were significantly more likely to have ever used nicotine and other substances, but not alcohol. Children with ADHD were also more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine, and other substances (i.e., unspecified). Sex, age, race, publication year, sample source, and version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose ADHD did not significantly moderate the associations with substance outcomes that yielded heterogeneous effect sizes. These findings suggest that children with ADHD are significantly more likely to develop substance use disorders than children without ADHD and that this increased risk is robust to demographic and methodological differences that varied across the studies. Finally, few studies addressed ADHD and comorbid disruptive behavior disorders (DBD), thus preventing a formal meta-analytic review. However, we qualitatively summarize the results of these studies and conclude that comorbid DBD complicates inferences about the specificity of ADHD effects on substance use outcomes.

Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls

“…Two meta‐analyses, by Charach and Lee 82, 83, have concluded that children diagnosed with ADHD have a higher risk for developing substance use disorders than children without ADHD. The results from this study support previous findings, but in contrast to the Lee study, which could not identify any significant gender interaction effects, our data supports the existence of a sex difference.…”

Mental health differences between frequent cannabis users with and without dependence and the general population

“…The mental health of non-dependent frequent cannabis users was better than expected from studies of all (including dependent) frequent users [3,[10][11][12][13][14][15][16]20]: although mental disorders were more common in non-dependent users than in the general population (OR = 5.35, P < 0.001), this was largely attributable to (childhood) externalizing disorders (OR = 8.91, P < 0.001), whereas there was no difference in the presence of internalizing disorders. Dependent D+ frequent cannabis users with 12-month diagnosis of cannabis dependence (n = 252); D-frequent cannabis users who have never fulfilled criteria for cannabis dependence (n = 269); N2 non-users and non-frequent users in the general population (n = 1072).…”

“…More robust associations were found between externalizing disorders and both cannabis use and dependence, especially with regard to attention deficit and hyperactivity disorder (ADHD) and conduct disorder (CD) [12,14,20,21]. Nevertheless, as general population studies either investigate frequency of use or dependence, a direct comparison between frequent cannabis users with and without dependence is lacking.…”

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

“…For example, compared to their peers, adolescents with ADHD experience higher rates of family conflict (Deault 2010), peer problems (Gardner and Gerdes 2013), academic failure (DuPaul and Langberg 2014), comorbid mental health problems (Larson et al 2011), substance use (Lee et al 2011), and driving citations/crashes (Barkley et al 1996). As discussed above, sleep is also related to each of these functioning domains.…”