The Effects of Childhood ADHD Symptoms on Early-onset Substance Use: A Swedish Twin Study

Research has documented that children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of substance use problems. Few studies, however, have focused on early-onset substance use. This study therefore investigated how the two symptom dimensions of ADHD (hyperactivity/impulsivity and inattention) are associated with early-onset substance use, the role of persistent ADHD for the association, and to what extent the association is influenced by genetic and environmental factors. Twins (1,480 pairs) in the Swedish Twin Study of Child and Adolescent Development were followed from childhood to adolescence. ADHD symptoms were measured at age 8–9 and age 13–14 via parent-report, whereas substance use was assessed at age 13–14 via self-report. Results revealed that hyperactive/impulsive symptoms predicted early-onset “sometimes” tobacco use (adjusted odds ratios, 1.12, for one symptom count), controlling for inattentive symptoms and conduct problem behaviors. There is no independent effect of inattentive symptoms on early-onset substance use. Children with persistent hyperactivity/impulsivity (defined as scoring above the 75th percentile at both time points) had a pronounced risk of both early-onset tobacco and alcohol use (adjusted odds ratios from 1.86 to 3.35, compared to the reference group). The associations between hyperactivity/impulsivity and early-onset substance use were primarily influenced by genetic factors. Our results indicated that hyperactivity/impulsivity, but not inattention, is an important early predictor for early-onset substance use, and a shared genetic susceptibility is suggested to explain this association.     

Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD

Children diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 142) were prospectively monitored into adolescence (13-18 years old) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD (n = 100). Probands reported higher levels of alcohol, tobacco, and illicit drug use than did controls. Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses. Within probands, severity of childhood inattention symptoms predicted multiple substance use outcomes: childhood oppositional defiant disorder/conduct disorder (ODD/CD) symptoms predicted illicit drug use and CD symptoms. Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls. Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted.     

Do executive and reactive disinhibition mediate the effects of familial substance use disorders on adolescent externalizing outcomes?

The present study examined the potential mediating roles of executive and reactive disinhibition in predicting conduct problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, and substance use among adolescents with and without a family history of substance use disorders. Using data from 247 high-risk adolescents, parents, and grandparents, structural equation modeling indicated that reactive disinhibition, as measured by sensation seeking, mediated the effect of familial drug use disorders on all facets of the adolescent externalizing spectrum. Executive disinhibition, as measured by response disinhibition, spatial short term memory, and "trait" impulsivity, was associated with ADHD symptoms. Moreover, although executive functioning weakness were unrelated to familial substance use disorders, adolescents with familial alcohol use disorders were at risk for "trait" impulsivity marked by a lack of planning. These results illustrate the importance of "unpacking" the broad temperament style of disinhibition and of studying the processes that underlie the commonality among facets of the externalizing spectrum and processes that predict specific externalizing outcomes.     

Cognition at risk: Gestalt/feature-intensive processing,attention deficit,and substance abuse

Attention deficit hyperactive disorder (ADHD) is associated with elevated levels of substance abuse, but the cognitive linkages involved have been little explored. The present study builds upon earlier work showing that more gestalt, as opposed to feature-intensive, styles of processing are conductive to substance abuse, especially in those with ADHD symptoms. The work reported here indicates that a protective factor against substance abuse may lie in relatively efficient heuristic processing, especially synthetic or inferential heuristic processing, but further demonstrates that those with ADHD symptoms tend to have poorer abilities in this regard, even at the subclinical, nondiagnosed level. Results are discussed in terms of the gestalt/featureintensive processing theory of cognition.     

Cognition at risk: Gestalt/feature-intensive processing, attention deficit, and substance abuse

Attention deficit hyperactive disorder (ADHD) is associated with elevated levels of substance abuse, but the cognitive linkages involved have been little explored. The present study builds upon earlier work showing that more gestalt, as opposed to feature-intensive, styles of processing are conductive to substance abuse, especially in those with ADHD symptoms. The work reported here indicates that a protective factor against substance abuse may lie in relatively efficient heuristic processing, especially synthetic or inferential heuristic processing, but further demonstrates that those with ADHD symptoms tend to have poorer abilities in this regard, even at the subclinical, nondiagnosed level. Results are discussed in terms of the gestalt/featureintensive processing theory of cognition.     

Contribution of ADHD symptoms to substance problems and delinquency in conduct-disordered adolescents

We examined adolescents with conduct disorder (CD) and substance problems to determine if those with attention deficit hyperactivity disorder (ADHD) symptomatology had more severe delinquency and substance involvement. ADHD symptomatology was assessed in two ways: (1) by self-reports using the Diagnostic Interview Schedule for Children (DISC) and (2) by use of DISC plus reports of others (parents, program staff, and program teacher). We divided boys into three ADHD groups based on DISC: those who met criteria, those who reported at least eight current symptoms, and those who reported fewer than eight symptoms. We also divided the same boys into two groups: those with reports of ADHD by two or more sources and those without this multisource ADHD. Examining these definitions of ADHD revealed that boys with either self- or multisource ADHD had more CD symptoms, earlier age of CD onset, more substance dependence diagnoses, and more comorbid depression and anxiety.This investigation was supported by the National Institute on Drug Abuse Grant No. DAO6941.     

Cigarette Smoking Among Youth with Attention-Deficit/Hyperactivity Disorder: Clinical Phenomenology, Comorbidity, and Genetics

Cigarette smoking and other forms of tobacco use among children and adolescents is a significant public health concern. The negative consequences of prolonged exposure to such substances are numerous, and include higher prevalence rates of cardiopulmonary dysfunction and certain cancers, and may lead to other forms of drug use. Identifying subgroups of youth who may be at greater risk than others to develop a nicotine habit is an important step forward in preventing smoking initiation, and controlling tobacco use. One such subgroup is children with attention-deficit/hyperactivity disorder (ADHD). This is because the prevalence of smoking among these youngsters is nearly twice as high as it is among those who are unaffected with ADHD. However, the etiology of this association is not known. It is possible that a constellation of social, behavioral, and biological factors influences this process, resulting in higher prevalence rates. To further our understanding of this problem, we reviewed each of these factors in relationship to smoking and to ADHD. Using the primary care population as a model, we then discuss clinical research methods that may shed additional light on this topic, as well as the strengths and limitations of current smoking prevention and cessation options for ADHD-affected youth who are assessed and treated in medical settings.     

Autism and attention deficit hyperactivity disorder: assessing attention and response control with the integrated visual and auditory continuous performance test.

Symptoms of attention deficit hyperactivity disorder (ADHD) have been widely reported in children with autism spectrum disorder (ASD). The current study investigated attention and response control in children with ASD, ADHD, and typical development using the Integrated Visual and Auditory Continuous Performance Test. Results indicate that many children with ASD show significant deficits in visual and auditory attention and greater deficits in impulsivity than children with ADHD or typical development. These findings suggest that many of the children with ASD demonstrate significant ADHD-like deficits. These findings are discussed in the context of symptoms, subtypes, and comorbidity.     

Genetic Support for the Dual Nature of Attention Deficit Hyperactivity Disorder: Substantial Genetic Overlap Between the Inattentive and Hyperactive–impulsive Components

Objective Attention deficit hyperactivity disorder (ADHD) is a common, complex and highly heritable disorder, characterised by inattentive, impulsive and overactive behaviour. Evidence for the heritability of ADHD measures in twin population samples has come from the analysis of total scores that combine inattentive and hyperactive–impulsive symptoms subscales. This study investigated, in a community sample, the aetiology of ADHD-like traits and the aetiological overlap between the two dimensions that define the ADHD disorder. Materials and Methods Parents of 6,222 approximately 8-year-old twin pairs from the Twins Early Development Study (TEDS) population sample completed the two subscales of the Conners’ 18-item DSMIV checklist, a screening instrument for ADHD symptoms. Results Both subscales were highly heritable (hyperactive–impulsive: 88%; inattentive: 79%). Bivariate genetic modelling indicated substantial genetic overlap between the two components; however, there were significant independent genetic effects. Conclusions These findings suggest that many genes associated with the hyperactivity–impulsivity dimension will also be associated with the inattentive dimension but that there is significant genetic heterogeneity as well. These results provide genetic support for combining the two behavioural dimensions that define ADHD, but also suggest that some symptom-specific genes will also be identified. Correspondence and reprint requests to Gráinne McLoughlin, SGDP Centre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, Tel: +44(0) 207-848-5261; Email: g.mcloughlin@iop.kcl.ac.uk.     

基于时间顺序的多动症共病的概述

多动症是一种常见的行为障碍,它以注意力不集中、多动、行为冲动为主要特征。同时多动症是一组异质性疾病,常与一种或几种精神或非精神障碍相伴发生。以往关于多动症合并症状的研究,大都局限在一个或几个合并症状上,缺乏关于其合并症状的系统认识。基于以往研究,文章以多动症合并症状发生的时间顺序为线索,将其分为前期、同期、后期合并症,并逐一详细介绍。未来应该加强关于多动症患者的纵向研究,以了解症状的发展状况,更好的诊断和治疗多动症。     

Externalizing Outcomes of Youth with and without ADHD: Time-Varying Prediction by Parental ADHD and Mediated Effects

Although parental attention-deficit/hyperactivity disorder (ADHD) is a risk factor for multiple negative youth outcomes, it is unknown how change in parental ADHD symptoms over time affects change in child ADHD symptoms; moreover, mediators of these predictions are largely unknown. Parents of 230 5–10 year-old children (68 % male) with (n = 120) and without ADHD (n = 110) were followed prospectively for 6–7 years across three separate waves. Parents self-reported their ADHD and depression symptoms and similarly rated offspring ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms; youth self-reported their substance use. Temporally-ordered mediators consisted of parental expressed emotion (EE), derived from the Five Minute Speech Sample, and self-reported positive and negative parenting behavior. Controlling for key demographics and parental depression symptoms, increasing parental ADHD symptoms were a time-varying predictor of worsening youth ADHD and ODD, although it was unrelated to change in CD and alcohol/substance use. Next, although EE facets (i.e., criticism, emotional over-involvement) did not mediate these predictions, negative parenting behavior significantly mediated predictions of youth ADHD (and marginally in predictions of ODD) from parental ADHD symptoms. These quasi-experimental findings suggest that parental ADHD symptoms are a potential unique causal risk factor for offspring ADHD and ODD; also, preventing negative parenting behavior secondary to parental ADHD symptoms is critical to improve trajectories of youth ADHD and ODD. We consider parental ADHD symptoms and family factors underlying emergent externalizing problems utilizing a developmental psychopathology framework, including implications for intervention and prevention.     

Errors on a computer task and subclinical symptoms of attention‐deficit/hyperactivity disorder (ADHD)

Previous reports have found increased error rate for children with attention‐deficit/hyperactivity disorder (ADHD ) on response time (RT ) computer tasks. Here we attempt the conceptual replication and extension of two studies that examined error rate in a general population of children (N = 203). Study 1 followed Johnstone and Galletta but considered associations between scores on a dimensional measure of ADHD symptoms (rather than comparing those with or without an ADHD diagnosis) and the frequency of commission and omission errors. Study 2 followed Shiels, Tamm & Epstein and examined post‐error adjustment in the same group of children as for Study 1. Study 1 did not replicate previous findings of no increase in errors of commission in those with higher ADHD symptoms (Johnstone & Galletta). Instead, we found that younger children with lower ADHD symptoms were more likely to make commission errors, while omission errors did not vary with age. Study 2 replicated the previous finding of less RT slowing in children with more ADHD symptoms, extending this finding to a general population of children. Namely, as ADHD symptoms increase, RT slowing is less likely, putting children with higher ADHD symptoms at risk of additional errors. Overall, we extend previous ADHD research to typically developing children with ADHD symptoms.     

Antisocial behavior reduces the association between subdimensions of ADHD symptoms and alcohol use in a large population‐based sample of adolescents

The aim of this study was to investigate possible effects of antisocial behavior on reducing the association between subdimensions of ADHD symptoms (inattention, hyperactivity and impulsivity) and alcohol use. Boys and girls were analyzed separately using a population‐based Swedish adolescent sample. A randomly selected cross‐sectional survey was performed in secondary and upper secondary schools in Västmanland County during 2010. Participants were a population of 2,439 15–16 year‐olds and 1,425 17–18 year‐olds (1,947 girls and 1,917 boys). Psychosocial adversity, antisocial behaviors, symptoms of ADHD and alcohol use were assessed by questionnaires. Except for girls' inattention, subdimensions of ADHD symptoms were not associated with alcohol use when variance due to antisocial behavior was accounted for. Among boys, instead of an indirect effect of antisocial behavior on the association between impulsivity and alcohol use, a moderating effect was found. Among girls, the inattention component of ADHD was independently associated with alcohol use even when adjusted for antisocial behavior. The reduced associations between symptoms of hyperactivity, impulsivity, and alcohol use for boys and girls after adjusting for antisocial behavior suggest a considerable overlap between hyperactivity, impulsivity, and antisocial behavior. The direct pathway between inattention and alcohol use among girls suggests that girls with inattention symptoms are at risk of alcohol use regardless of antisocial behavior. Special attention should be given to these girls. Accounting for antisocial behavior reduced the relation between subdimensions of ADHD symptoms and alcohol use, and antisocial behaviors should therefore be screened for when symptoms of ADHD are present.     

Substance use and delinquency among adolescents with childhood ADHD: The protective role of parenting

Several domains of parenting have been identified as important for adolescent well-being. Whether these same domains are equally beneficial for adolescents with ADHD histories remains an empirical and clinically important question. This study examined whether parental knowledge of their teen's activities and whereabouts, consistency, support, and parent-adolescent conflict are associated with substance use and delinquency similarly for adolescents with and without a diagnosis of ADHD in childhood. A sample of 242 adolescents, 142 diagnosed with ADHD in childhood and prospectively followed into adolescence, and 100 without ADHD in childhood, were the focus of study. The relations between adolescent-reported outcomes (i.e., substance use and delinquency) and parenting behaviors were tested using latent variable modeling to determine both the effects of general (common) and specific (unique) parenting behaviors for participants with and without a history of ADHD. Adolescents' report of parental knowledge was a significant correlate of delinquency and substance use above and beyond other parenting variables and the variance in common across the parenting variables. More knowledge was associated with less delinquency and substance use for all participants, but parental knowledge was more strongly associated with alcohol use for adolescents with versus without childhood ADHD. These correlational findings suggest that, despite the increased difficulty of parenting youths with ADHD histories, actions taken by parents and youth to increase parental awareness may provide some protection against behavioral transgressions known to be elevated in this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Gray’s revised Reinforcement Sensitivity Theory in relation to Attention-Deficit/Hyperactivity and Tourette-like behaviors in the general population

Attention-Deficit/Hyperactivity Disorder (ADHD) and Tourette syndrome (TS) present as distinct conditions clinically; however, they show comorbidity and inhibitory control deficits have been proposed to underlie both. The role of reinforcement sensitivity in ADHD has been studied previously, but no study has addressed this in relation to TS-like behaviors in the general population. The present study examined these associations within the remit of the revised Reinforcement Sensitivity Theory (rRST). One hundred and thirty-eight participants completed psychometric measures of the rRST, and self-report checklists for ADHD- and TS-like behaviors. The results show that whilst ADHD-inattention was only linked to increased anxiety (BIS), ADHD-hyperactivity/impulsivity was linked to increased impulsivity (BAS-fun seeking), anxiety (BIS) and punishment sensitivity (FFFS), and to reduced reward sensitivity (BAS-reward responsiveness), independently of ‘comorbid’ TS-like behaviors. TS-related phonic tics were associated with increased BIS and FFFS, and TS-related obsessive–compulsive behaviors (OCBs) with increased goal-orientation (BAS-drive) and reduced impulsivity (BAS-fun seeking). However, these associations were driven by ADHD-like behaviors or OCB co-occurrence, respectively, suggesting little role of the rRST in pure TS-like behaviors. The results are discussed in light of mixed findings in the literature and the importance of distinguishing between multiple processing models of the rRST in distinct disorder phenotypes.     

Preliminary Evidence for Associations of CHRM2 with Substance Use and Disinhibition in Adolescence

Evidence for shared heritable influences across domains of substance use suggests that some genetic variants influence broad risk for externalizing behaviors. Theories of externalizing psychopathology also suggest that genetic liability for substance use manifests as temperamental risk factors, particularly those related to behavioral disinhibition, during adolescence. The cholinergic muscarinic receptor 2 gene (CHRM2) is a promising candidate for studying genetic influences on broad-based risk for externalizing traits. This study examined a candidate CHRM2 polymorphism (rs1455858) in relation to substance use and personality measures of disinhibition in a sample of high-risk adolescents (n?=?124). Bivariate analyses and structural equation modeling (SEM) evaluated associations of rs1455858 with measures of drug involvement (alcohol, tobacco and marijuana) and disinhibition (indexed by impulsivity and sensation seeking scores). Bivariate analyses showed significant associations of CHRM2 with several behavioral phenotypes. In SEM analyses CHRM2 related significantly to latent measures of substance use and disinhibition; additionally, disinhibition mediated the association of CHRM2 with substance use. These results suggest that CHRM2 variants are potentially relevant for adolescent substance use and that temperamental risk factors could contribute to these associations.     

Profiles of Social Anxiety and Impulsivity Among College Students: A Close Examination of Profile Differences in Externalizing Behavior

Prior work indicates the presence of a subtype of Social Anxiety (SA) characterized by disinhibition or high externalizing behaviors such as substance use and Attention Deficit Hyperactivity Disorder (ADHD) symptoms. A sample of 375 undergraduates completed an online study including measures of SA, substance use, ADHD symptoms and impulsivity. Latent class analyses revealed three classes of individuals who evidenced: (a) low SA and low impulsivity, (b) high SA and low impulsivity, and (c) high SA and high impulsivity. Individuals high in both SA and impulsivity evidenced greater likelihoods of exhibiting externalizing behavior, relative to the two other classes. Post-hoc analyses revealed the largest and most significant differences between classes were seen with regard to ADHD. This finding extends previous work by replicating distinct profiles of SA and impulsivity, and highlighting that how these profiles relate to externalizing behaviors may depend on the externalizing domain.     

Developmental aspects of delinquency and internalizing problems and their association with persistent juvenile substance use between ages 7 and 18.

Analyzed longitudinal data from 3 samples of the Pittsburgh Youth Study on boys ages 7 to 18 to examine the co-occurrence of persistent substance use with other problem behaviors, including attention deficit hyperactivity disorder (ADHD), persistent delinquency, and persistent internalizing problems (i.e., depressed mood, anxiety, shy or withdrawn behavior). In preadolescence, persistent substance users also tended to be persistent delinquents, and half of this group displayed persistent internalizing problems as well. In adolescence, a third of the persistent substance users did not manifest other persistent problems. Across the samples, the least common substance users were those who manifested persistent internalizing problems only. Logistic regression analyses showed that persistent substance use in preadolescence was predicted by persistent delinquency and internalizing problems and in adolescence by persistent delinquency only. The combination of persistent substance use and delinquency was predicted by oppositional defiant disorder in middle childhood and by persistent internalizing problems in middle to late childhood. ADHD was not a predictor of persistent substance use (and delinquency) in any of the analyses. Results are discussed in terms of developmental models of multiproblem youth with an eye on improving early interventions.     

Parents,Peers, and Places: Young Urban Adolescents’ Microsystems and Substance Use Involvement

Limited research is available that explains complex contextual and interactive effects of microsystems such as family relationships, peer networks, and place-based influences have on urban adolescent substance use. We contend that research into these complex processes is improved by integrating psychological, social, and geographic data to better understand urban adolescent substance use involvement. Accordingly, we tested a longitudinal, 3-way moderation model to determine if the direct effect of teen–parent relationships on substance use involvement is moderated by peer network characteristics, which in turn is moderated by the risk and protective attributes within urban adolescents’ activity spaces, among a sample of 248 adolescents. Results revealed that peer networks moderate the effects of relations with parents on substance use involvement for those adolescents with higher levels of risk attributes within their activity space, but not for those who spend time in locations with less risk. Thus, the teen–parent relationship interacts with peer network characteristics, for those urban adolescents whose activity space is constituted within high-risk environments. We conclude that peer networks have important interactive effects with family relationships that influence substance use, and that this is particularly salient for young adolescents who are exposed to risky environments. This finding underscores the importance of continued study into the interrelations among microsystems of urban adolescents, and provides further support that substance use is a social practice that is constituted within the unique geography of young adolescents’ lives.     

Comorbidity of attention Deficit Hyperactivity Disorder and Post-Traumatic Stress Disorder

Attention Deficit Hyperactivity Disorder (ADHD) and Post-Traumatic Stress Disorder (PTSD) show a high degree of comorbidity in traumatized children. Two hypotheses may help explain this relationship: children with ADHD are at higher risk for trauma due to their impulsivity, dangerous behaviors, and parents who may have a genetic predisposition for impairment of their own impulse control; and hyperarousal induced by severe trauma and manifested by hypervigilance and poor concentration may impair attention to create an ADHD-like syndrome. Four illustrative cases are presented, and implications for treatment are discussed.