0
Article |

Association Between Attention-Deficit/Hyperactivity Disorder in Adolescence and Substance Use Disorders in Adulthood FREE

David W. Brook, MD; Judith S. Brook, EdD; Chenshu Zhang, PhD; Jonathan Koppel, MA
[+] Author Affiliations

Author Affiliations: Department of Psychiatry, New York University School of Medicine, New York.


Arch Pediatr Adolesc Med. 2010;164(10):930-934. doi:10.1001/archpediatrics.2010.180.
Text Size: A A A
Published online

Objectives  To determine whether attention-deficit/hyperactivity disorder (ADHD) in adolescence is related to substance use disorders (SUDs) in adulthood and whether conduct disorder (CD) mediates this relationship.

Design  A prospective design incorporating 5 assessments in participants spanning the mean ages of 14 to 37 years. Two baseline assessments were taken at ages 14 and 16 years, and 3 outcome assessments were taken between ages 27 and 37 years.

Setting  United States.

Participants  A community sample of individuals initially drawn from upstate New York in 1975 and observed to a mean age of 37 years.

Interventions  The Diagnostic Interview Schedule for Children was used to assess ADHD and CD and the University of Michigan Composite International Diagnostic Interview was used to assess SUDs.

Main Outcome Measure  A diagnosis of SUDs given to participants in adulthood.

Results  The odds ratios for ADHD and CD in adolescence as related to SUDs in adulthood were 1.9 and 3.5, respectively. The association between ADHD and SUDs, however, was indirect because CD served as a mediator between ADHD and SUDs.

Conclusions  Pediatricians should focus on adolescent ADHD when it progresses to CD because CD is a major predictor of SUDs in adulthood.

Substance use disorders (SUDs) are associated with psychiatric disorders and with low educational levels, unemployment, and risky sexual behavior.13 Given the negative consequences of SUDs, it is important to identify its predictors. One factor that researchers have identified as being related to the development of SUDs is the presence of attention-deficit/hyperactivity disorder (ADHD). Cross-sectional and longitudinal research410 indicate that ADHD in childhood or adolescence is associated with an increased risk of substance use or dependence later in adolescence or in early adulthood. Another factor shown to be related to SUDs is conduct disorder (CD).11In addition to their relationship to SUDs, ADHD and CD are strongly correlated with one another.12,13 Researchers have attempted to identify the independent association of ADHD with the onset of SUDs, most often by statistically controlling for the presence of CD or other psychiatric disorders.710

These attempts to link diagnoses of ADHD to SUDs have generally not found an independent prospective association between ADHD and SUDs. For example, Elkins et al9 examined the relationship between diagnoses of ADHD on the one hand and 3 types of SUDs (nicotine dependence, alcohol abuse/dependence, and cannabis abuse/dependence) on the other. Diagnoses of ADHD were unrelated to the diagnosis of SUDs at age 18 years, once analyses were adjusted to control for childhood CD. Similarly, after controlling for other psychiatric disorders, including CD, Biederman et al8 found that ADHD in childhood and adolescence was related to lifetime and 1-year prevalences of nicotine dependence at 10-year follow-up but not of drug or alcohol dependence.

To our knowledge, only 1 study10 has found that a diagnosis of ADHD is independently, prospectively linked to the subsequent development of SUDs. Gau et al10 found that a diagnosis of ADHD at age 12 years was related to the development of SUDs in the next 3 years, even after controlling for other psychiatric disorders, including CD. One possible explanation for the discrepancy between the findings of Gau et al and those of other researchers noted previously herein is that Gau et al used a shorter longitudinal timeframe than did other studies, and their outcome assessment occurred at a younger age. Because ADHD is most prevalent in childhood and early adolescence,14,15 it may be that the disorder exerts a direct effect on SUDs at these early ages, but the effect is mediated with time.

Given that the literature suggests a stronger relationship between CD and SUDs than between ADHD and SUDs, we hypothesized a mediational model.16 To test the mediational hypothesis, we applied the 3 conditions of Baron and Kenny16 for a possible mediational pathway: (1) the independent variable (ADHD) is related to the potential mediator (CD), (2) the mediator (CD) is related to the dependent variable (SUDs) despite controlling for the independent variable, and (3) the relationship between the independent and dependent variables is rendered nonsignificant once there is statistical control for the effect of the mediator.

After the mediational model, we tested the following hypotheses: (1) ADHD is related to CD; (2) CD in adolescence is associated with SUDs in adulthood, even after controlling for ADHD; and (3) ADHD in adolescence is associated with SUDs in adulthood, but this effect no longer holds after controlling for CD.

We extend the literature in 2 important respects. First, to our knowledge, this study is the first to formally test for CD as a mediator between ADHD and SUDs. As noted previously herein, we proposed that CD is the mediator because its relationship with SUDs is more powerful than is the relationship between ADHD and adult SUDs.9 Second, we observed the sample to a much later age than have other researchers who studied the relationship between ADHD and SUDs. Thus, these data allow us to investigate the association between ADHD in adolescence and SUDs in adulthood.

PARTICIPANTS AND PROCEDURE

Data for the participants in this study came from a community-based random sample residing in 2 upstate New York counties (Albany and Saratoga) first assessed for drug use in 1983. The sample was taken from an earlier study using maternal interviews in 1975 (T1). The original maternal/youth study assessed problem behavior in youngsters. The sampled families were generally representative of the population of families in Albany and Saratoga for sex, family intactness, family income, and education. Interviews of mothers and youths were conducted in 1983 (T2, n = 756), 1985-1986 (T3, n = 739), and 1992 (T4, n = 750). Three more interviews of the second generation were conducted in 1997 (T5, n = 749), 2002 (T6, n = 673), and 2005-2006 (T7, n = 607). Some participants who were not interviewed in previous years were interviewed in later waves of data collection.

The mean (SD) ages of participants at the interviews were 14.1 (2.8) years at T2, 16.3 (2.8) years at T3, 22.3 (2.8) years at T4, 27 (2.8) years at T5, 31.9 (2.8) years at T6, and 36.6 (2.8) years at T7. In the present analyses, we included 485 participants whose measurements of SUDs at T5 through T7 and of ADHD and CD at T2 and T3 were available and who had no history of SUDs assessed in adolescence (T2). Excluding the 30 participants who were diagnosed as having SUDs at T2 helped us identify adolescent ADHD and CD in a cohort that was free of the outcome (SUD) at the outset of the study. Using the T2 sample (n = 756) as the baseline, there was a significantly higher percentage of female participants in the group of 485 individuals included in this study than in the 271 not included (57.5% and 38.0%, χ21 = 27.2, P < .001). There was a significantly lower percentage of participants with ADHD at T2 in the 485 included individuals than in the 271 not included (9.1% and 18.4%, χ21 = 12.8, P < .001). There was a significantly lower percentage of participants with CD at T2 in the 485 included individuals than in the 271 not included (7.1% and 21.3%, χ21 = 31.4, P < .001).

Extensively trained and supervised lay interviewers administered interviews in private. Written informed consent was obtained from participants and their mothers in 1983, 1986, and 1992 and from participants only in 1997, 2002, and 2007. The institutional review board of New York University School of Medicine authorized the use of human subjects in this research study. Additional information regarding the study methods is available in previous publications.17

MEASURES
ADHD and CD at T2 and T3

The parent and youth versions of the Diagnostic Interview Schedule for Children were administered in 1983 (T2) and again in 1985-1986 (T3) to assess psychiatric disorders, including ADHD and CD. Symptoms of ADHD include an unusually high and long-term level of inattention, hyperactivity, or both. Some items were added to the Diagnostic Interview Schedule for Children to make the diagnosis of ADHD consistent with that of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV).18 Criteria from the DSM-IV were used to classify the participants for ADHD. According to the DSM-IV, CD is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms are violated, as manifested by the presence of 3 (or more) of several criteria in the past 12 months, with at least 1 criterion present in the past 6 months.

Major Depressive Disorder at T2

Adolescent major depressive disorder (MDD) at T2 was diagnosed if participants had a change in functioning reflected by 5 or more of the following DSM-IV criteria during the same 2-week period: (1) depressed mood most of the day, nearly every day, or (2) markedly diminished interest or pleasure in all, or almost all, activities (1 must be present); (3) significant weight loss or gain when not dieting; (4) hypersomnia or insomnia nearly every day; (5) psychomotor agitation or retardation; (6) feeling tired nearly every day; (7) feeling worthless or inappropriate guilt; (8) problems concentrating; and (9) recurrent thoughts about death.

SUDs at T5 Through T7

At T5 through T7, SUDs (dependence or abuse) was assessed using the University of Michigan Composite International Diagnostic Interview SUDs measure.19 We adapted this measure to make it consistent with the criteria used in the DSM-IV. We ascertained substance dependence by the presence of 3 or more of the following criteria for each substance (marijuana or other illicit drug, eg, cocaine/crack, heroin, LSD [lysergic acid diethylamide], ecstasy, and amphetamines) used during the 12 months before the interviews at T5 through T7: (1) use of more of the substance than usual to get the same effect, or the same amount has less of an effect than it used to; (2) the presence of withdrawal symptoms or the use of the substance to avoid withdrawal symptoms; (3) the use of much larger amounts of the substance than intended, or use for a longer period than intended; (4) the presence of such a strong desire or urge to use the substance that the person could not resist using it; (5) a period of 1 month or more in which the person spent a great deal of time using the substance or getting over its effects; (6) the person gave up activities because of use of the substance; or (7) emotional or psychological problems resulting from using the substance, such as feeling uninterested in things, depressed, suspicious of people, or paranoid or having strange ideas. If a participant did not meet the criteria for substance dependence, substance abuse was ascertained by the presence of at least 1 of the following 4 criteria during the same 12-month period: (1) being under the effects of the substance or experiencing its after-effects while at work or at school or while taking care of children, (2) being under the effects of the substance or feeling its after-effects in a situation that increased the user's chances of getting hurt (ie, when driving a car or boat, using knives or guns or machinery, crossing against traffic, climbing, or swimming), (3) having legal problems because of use of the substance, or (4) having problems getting along with other people because of use of the substance.

Analytic Plans

χ2 Tests were used to test whether sex, age, and adolescent MDD were associated with adolescent ADHD, adolescent CD, and adult SUDs and whether adolescent ADHD and CD were associated with adult SUDs. We then conducted 3 separate logistic regression analyses to examine the association between earlier adolescent ADHD (at T2 or T3) and later adult SUDs (at T5, T6, or T7): (1) without any controls (ie, sex, age, adolescent CD, and adolescent MDD), (2) controlling only for earlier adolescent CD, and (3) controlling for earlier adolescent CD, sex, age, and adolescent MDD. We also conducted 3 separate logistic regression analyses to examine the association between earlier adolescent CD (at T2 or T3) and later adult SUDs (at T5, T6, or T7): (1) without any controls (ie, sex, age, adolescent ADHD, and adolescent MDD), (2) controlling only for earlier adolescent ADHD, and (3) controlling for earlier adolescent ADHD, sex, age, and adolescent MDD. Next, we conducted a logistic regression analysis to examine the relationship between adolescent ADHD and CD, with CD as the dependent variable and ADHD as the independent variable. To calculate the mediational effect of earlier adolescent CD, which operated between earlier adolescent ADHD and later adult SUDs, we used the SAS macro20 based on the formula of MacKinnon and Dwyer21 and selected the option that the mediator and the outcome are binary. We used 1-tailed tests throughout the analyses.

At T5, T6, or T7, 11.1% of the adults were diagnosed as having SUDs according to DSM-IV criteria; at T2 or T3, 11.6% of the adolescents were diagnosed as having ADHD and 12.0% were diagnosed as having CD (Table). In total, 19.1% of the adolescents were diagnosed as having either ADHD alone (7.2%), CD alone (7.6%), or both ADHD and CD (4.3%). The percentage of adult SUDs was significantly higher in those who had adolescent ADHD (17.9%) than in those who did not (10.3%) (odds ratio [OR], 1.9; 95% confidence interval [CI], 0.9-4.0). The percentage of adult SUDs was significantly higher in those who had adolescent CD (25.7%) than in those who did not (9.1%) (OR, 3.5; 95% CI, 1.8-6.8). The percentage of adolescent CD was significantly higher in those who had adolescent ADHD (37.5%) than in those who did not (8.6%) (OR, 6.4; 95% CI, 3.4-12.0). The Table also provides the percentages of adolescent ADHD, adolescent CD, and adult SUDs by sex, age group, and adolescent MDD.

Table Graphic Jump LocationTable. Adolescent ADHD, Adolescent CD, and Adult SUDs by Characteristics of the 485 Participants

The logistic regression analyses revealed that without any controls, adolescents who had earlier ADHD at T2 or T3 were 1.9 times (95% CI, 0.9-4.0 times; P = .047) more likely to have later adult SUDs than were those who did not have earlier ADHD. However, the association between earlier ADHD and later SUDs was no longer significant with earlier CD controlled for (adjusted OR, 1.3; 95% CI, 0.6-2.9; P = .27). The relationship between ADHD in adolescence and later SUDs in adulthood was also no longer significant when controlling for CD at T2 or T3, sex, age, and earlier MDD (adjusted OR, 1.4; 95% CI, 0.6-3.2; P = .22).

The logistic regression analyses revealed that without any controls, adolescents who had earlier CD at T2 or T3 were 3.5 times (95% CI, 1.8-6.8 times; P < .001) more likely to have later adult SUDs than were those who did not have earlier CD. Participants who had earlier CD remained significantly more likely to have later SUDs with earlier ADHD controlled for (adjusted OR, 3.2; 95% CI, 1.6-6.6; P < .001). In addition, earlier adolescent CD remained significantly associated with later adult SUDs when controlling for ADHD at T2 or T3, sex, age, and earlier MDD (adjusted OR, 3.1; 95% CI, 1.5-6.4; P = .001).

In addition, males were 2.3 times (95% CI, 1.3-4.2 times; P < .01) more likely to have later adult SUDs than were females after adjusting for other factors, that is, earlier ADHD, earlier CD, age, and earlier MDD. The adjusted ORs for age (0.96, P = .23) and earlier MDD (0.41, P = .27) were not significantly different from 1.

We then conducted logistic regression analyses to examine the association between ADHD (at T2 or T3) and CD (at T2 or T3). The results indicated that adolescents with ADHD were 6.4 times more likely to have CD (P < .001) than were those who did not have ADHD. Therefore, the findings suggest a mediational effect of ADHD on adult SUDs via CD. The mediational effect was 0.6 on a scale from 0 to 1 and significant (SE = 0.2, t = 2.8, P = .005).

These findings support the hypotheses. First, ADHD is related to CD. Second, CD is highly related to SUDs, even after controlling for ADHD. Third, ADHD is related to SUDs, but this effect is not maintained after controlling for CD. Thus, these findings support a meditational model: the association between ADHD and SUDs is mediated by CD.

This study contributes to the literature as the first investigation to longitudinally study a sample of adolescents with and without ADHD, CD, and SUDs observed to a later stage of development, namely, their 30s.710 In following the sample to a later stage of development than have previous investigators,710we confirmed that the relationship between adolescent ADHD and SUDs is indirect at this developmental stage (ie, adulthood). The present findings related to the mediational model are consistent with those of several researchers who have emphasized the importance of CD in predicting SUDs.7,22,23For example, Fergusson et al22 maintained that after allowing for their high intercorrelation, attentional problems and conduct problems have differential consequences for later development. Specifically, conduct problems are directly related to later substance abuse, whereas attentional problems are not.

Although ADHD and CD are separate dimensions, they are significantly correlated.12,13 Several factors may contribute to this association. Family and peer factors may mediate the relationship between ADHD and CD.24 More specifically, individuals with ADHD may have difficulty in relating to family members and may associate with deviant peers, which, in turn, may be related to the development of CD.25 Shared genetic influences are probably a contributing factor.26 For example, Nadder et al27 noted that twin studies suggest a common genetic component underlying ADHD and CD. Perinatal complications,28 temperament,29 and impaired cognitive functioning30 have also been shown to be associated with ADHD and CD.

The present findings have important implications for the risk factors that predict SUDs. Given the symptom profile that characterizes CD, it is perhaps not surprising that adolescent CD is independently associated with the development of SUDs. That is, CD is typified by aggression (eg, showing physical cruelty to people or using a dangerous weapon) or delinquent behavior (eg, destroying property, lying, or stealing), both of which are reliable predictors of the development of SUDs.31,32 The association between aggressive and delinquent behavior on the one hand and SUDs on the other may also be accounted for by problem behavior theory,33 which posits that problem behaviors cluster within individuals. In the present study, it is particularly striking that the interval between the first baseline assessment and the final outcome assessment spanned more than 20 years. Therefore, the adverse effects of CD on the risk of SUDs are not temporally limited but persist across a considerable length of time.

Several factors may serve to mediate the relationship between CD and SUDs. Adolescents with CD may seek out peers who are delinquent and use drugs.34 The peer group may then supply the individuals with drugs or otherwise reinforce their drug use. In adolescents, CD may evoke difficulty in the mutual attachment relationship between parent and child. A distant parent-child mutual attachment relationship has been found to predict substance use.35

This study has several limitations. First, the sample was predominantly white. The results, therefore, may not be generalizable to samples of ethnic minorities. Second, we are limited to self-report measures of substance abuse and dependence. Self-report measures of substance use, however, have generally been found to be reasonably accurate.36 In the present study, the prevalences of adolescents with ADHD and CD are higher than those in some other national samples.37 However, note that in the present study, we focused on relationships among the variables. Furthermore, measures that involved assessments at 2 time points might be more valid assessments of ADHD and CD than those that assessed these diagnoses only at 1 time point. Further research might be necessary to address this important issue. Third, there was a differential attrition rate between those (eg, males) who may have been more likely to incur adult SUDs and those (eg, females) with a lower risk. Fourth, we did not address how ADHD and CD can be handled in school and clinical programs without the negative label assigned to adolescents with these disorders.

These findings hold relevance for pediatricians because they demonstrate that the presence of adolescent ADHD, CD, or both is related to SUDs in one's 20s and 30s. However, where CD has a direct effect in predicting the development of substance abuse and dependence by adulthood, the effect of ADHD is mediated through CD. In sum, adolescents with ADHD remain at risk for SUDs, particularly if there are indicators of CD. For CD, a diagnosis indicates that the individual may be at risk for SUDs not only in the several years after diagnosis but for more than 20 years. Furthermore, for pediatricians, because ADHD generally develops earlier than CD,37 ADHD may be an important diagnostic cue for later CD and perhaps, ultimately, SUDs. At the same time, CD, because of its proximal effect on SUDs, serves as a major risk factor for SUDs. Given the clinical and public health importance of the progression of ADHD, CD, and SUDs, further research about the specific mechanisms explaining this developmental pattern is indicated. From a clinical perspective, early interventions should focus on CD, particularly in children with ADHD, because this may put the youngsters at risk for later SUDs.

Correspondence: Judith S. Brook, EdD, Department of Psychiatry, New York University School of Medicine, 215 Lexington Ave, 15th Floor, New York, NY 10016 (judith.brook@nyumc.org).

Accepted for Publication: March 31, 2010.

Author Contributions: All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: D. W. Brook, J. S. Brook, and Zhang. Acquisition of data: J. S. Brook and Zhang. Analysis and interpretation of data: D. W. Brook, J. S. Brook, Zhang, and Koppel. Drafting of the manuscript: D. W. Brook,J. S. Brook, Zhang, and Koppel. Critical revision of the manuscript for important intellectual content: D. W. Brook, J. S. Brook, and Zhang. Statistical analysis: J. S. Brook and Zhang. Obtained funding: D. W. Brook and J. S. Brook. Administrative, technical, and material support: J. S. Brook, Zhang, and Koppel. Study supervision: D. W. Brook and J. S. Brook.

Financial Disclosure: None reported.

Funding/Support: This research was supported by research grant CA94845 from the National Cancer Institute (Dr J. S. Brook), by research grant DA003188 from the National Institute on Drug Abuse (Dr J. S. Brook), and by Senior Scientist Award DA00244 from the National Institute on Drug Abuse (Dr J. S. Brook).

Additional Contributions: Martin Whiteman, PhD, and Stephen Finch, PhD, provided helpful comments.

Compton  WM  IIICottler  LBPhelps  DLBen Abdallah  ASpitznagel  EL Psychiatric disorders among drug dependent subjects: are they primary or secondary? Am J Addict 2000;9 (2) 126- 134
PubMed
Grant  BFStinson  FSDawson  DA  et al.  Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2004;61 (8) 807- 816
PubMed
Rohde  PLewinsohn  PMSeeley  JRKlein  DNAndrews  JASmall  JW Psychosocial functioning of adults who experienced substance use disorders as adolescents. Psychol Addict Behav 2007;21 (2) 155- 164
PubMed
Fayyad  JDe Graaf  RKessler  R  et al.  Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007;190 (5) 402- 409
PubMed
Kessler  RCAdler  LBarkley  R  et al.  The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006;163 (4) 716- 723
PubMed
Szobot  CMRohde  LABukstein  O  et al.  Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? a community-based case-control study. Addiction 2007;102 (7) 1122- 1130
PubMed
August  GJWinters  KCRealmuto  GMFahnhorst  TBotzet  ALee  S Prospective study of adolescent drug use among community samples of ADHD and non-ADHD participants. J Am Acad Child Adolesc Psychiatry 2006;45 (7) 824- 832
PubMed
Biederman  JMonuteaux  MCMick  E  et al.  Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med 2006;36 (2) 167- 179
PubMed
Elkins  IJ McGue  MIacono  WG Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry 2007;64 (10) 1145- 1152
PubMed
Gau  SSChong  MYYang  PYen  CFLiang  KYCheng  ATA Psychiatric and psychosocial predictors of substance use disorders among adolescents: longitudinal study. Br J Psychiatry 2007;190 (1) 42- 48
PubMed
Kessler  RCChiu  WTDemler  OMerikangas  KRWalters  EE Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. 2005;62(7):709]. Arch Gen Psychiatry 2005;62 (6) 617- 627
PubMed
Spencer  TJ ADHD and comorbidity in childhood. J Clin Psychiatry 2006;67 ((suppl 8)) 27- 31
PubMed
Volk  HENeuman  RJTodd  RD A systematic evaluation of ADHD and comorbid psychopathology in a population-based twin sample. J Am Acad Child Adolesc Psychiatry 2005;44 (8) 768- 775
PubMed
Biederman  JMick  EFaraone  SV Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 2000;157 (5) 816- 818
PubMed
Costello  EJMustillo  SErkanli  AKeeler  GAngold  A Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 2003;60 (8) 837- 844
PubMed
Baron  RMKenny  DA The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51 (6) 1173- 1182
PubMed
Cohen  PCohen  J Life Values and Adolescent Mental Health.  Mahwah, NJ Lawrence Erlbaum Associates1996;
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC American Psychiatric Association1994;
Wittchen  HUKessler  RC Modifications of the CIDI in the National Comorbidity Survey: the development of the UM-CIDI. http://www.hcp.med.harvard.edu/ncs/ftpdir/um-cidi.pdf. Accessed November 12, 2009
Jasti  SDudley  WNGoldwater  E SAS macros for testing statistical mediation in data with binary mediators or outcomes. Nurs Res 2008;57 (2) 118- 122
PubMed
MacKinnon  DPDwyer  JH Estimating mediated effects in prevention studies. Eval Rev 1993;17 (2) 144- 158
Fergusson  DMHorwood  LJRidder  EM Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study. Drug Alcohol Depend 2007;88 ((suppl 1)) S14- S26
PubMed
Looby  A Childhood attention deficit hyperactivity disorder and the development of substance use disorders: valid concern or exaggeration? Addict Behav 2008;33 (3) 451- 463
PubMed
Waschbusch  DA A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems. Psychol Bull 2002;128 (1) 118- 150
PubMed
Brook  JSBrook  DWGordon  ASWhiteman  MCohen  P The psychosocial etiology of adolescent drug use: a family interactional approach. Genet Soc Gen Psychol Monogr 1990;116 (2) 111- 267
PubMed
Rhee  SHWillcutt  EGHartman  CAPennington  BFDeFries  JC Test of alternative hypotheses explaining the comorbidity between attention-deficit/hyperactivity disorder and conduct disorder. J Abnorm Child Psychol 2008;36 (1) 29- 40
PubMed
Nadder  TSRutter  MSilberg  JLMaes  HHEaves  LJ Genetic effects on the variation and covariation of attention deficit-hyperactivity disorder (ADHD) and oppositional-defiant disorder/conduct disorder (Odd/CD) symptomatologies across informant and occasion of measurement. Psychol Med 2002;32 (1) 39- 53
PubMed
Nigg  JTBreslau  N Prenatal smoking exposure, low birth weight, and disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry 2007;46 (3) 362- 369
PubMed
Rettew  DCAlthoff  RRDumenci  LAyer  LHudziak  JJ Latent profiles of temperament and their relations to psychopathology and wellness. J Am Acad Child Adolesc Psychiatry 2008;47 (3) 273- 281
PubMed
Oosterlaan  JLogan  GDSergeant  JA Response inhibition in AD/HD, CD, comorbid AD/HD + CD, anxious, and control children: a meta-analysis of studies with the stop task. J Child Psychol Psychiatry 1998;39 (3) 411- 425
PubMed
Fergusson  DMHorwood  LJRidder  EM Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J Child Psychol Psychiatry 2005;46 (8) 837- 849
PubMed
Tarter  REKirsci  LRidenour  TVanyukov  M Prediction of cannabis use disorder between childhood and young adulthood using the child behavior checklist. J Psychopathol Behav Assess 2008;30 (4) 272- 278
Jessor  RJessor  SL Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth.  New York, NY Academic Press1977;
Fergusson  DMHorwood  LJ Prospective childhood predictors of deviant peer affiliations in adolescence. J Child Psychol Psychiatry 1999;40 (4) 581- 592
PubMed
Brook  JSWhiteman  MFinch  S Role of mutual attachment in drug use: a longitudinal study. J Am Acad Child Adolesc Psychiatry 1993;32 (5) 982- 989
PubMed
Harrison  LDMartin  SSEnev  THarrington  D Comparing Drug Testing and Self-report of Drug Use Among Youths and Young Adults in the General Population.  Rockville, MD Substance Abuse and Mental Health Services Administration, Office of Applied Studies2007;DHHS publication SMA 07-4249, Methodology Series M-7
Kessler  RCBerglund  PDemler  OJin  RMerikangas  KRWalters  EE Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. 2005;62(7):768]. Arch Gen Psychiatry 2005;62 (6) 593- 602
PubMed

Figures

Tables

Table Graphic Jump LocationTable. Adolescent ADHD, Adolescent CD, and Adult SUDs by Characteristics of the 485 Participants

References

Compton  WM  IIICottler  LBPhelps  DLBen Abdallah  ASpitznagel  EL Psychiatric disorders among drug dependent subjects: are they primary or secondary? Am J Addict 2000;9 (2) 126- 134
PubMed
Grant  BFStinson  FSDawson  DA  et al.  Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2004;61 (8) 807- 816
PubMed
Rohde  PLewinsohn  PMSeeley  JRKlein  DNAndrews  JASmall  JW Psychosocial functioning of adults who experienced substance use disorders as adolescents. Psychol Addict Behav 2007;21 (2) 155- 164
PubMed
Fayyad  JDe Graaf  RKessler  R  et al.  Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007;190 (5) 402- 409
PubMed
Kessler  RCAdler  LBarkley  R  et al.  The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006;163 (4) 716- 723
PubMed
Szobot  CMRohde  LABukstein  O  et al.  Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? a community-based case-control study. Addiction 2007;102 (7) 1122- 1130
PubMed
August  GJWinters  KCRealmuto  GMFahnhorst  TBotzet  ALee  S Prospective study of adolescent drug use among community samples of ADHD and non-ADHD participants. J Am Acad Child Adolesc Psychiatry 2006;45 (7) 824- 832
PubMed
Biederman  JMonuteaux  MCMick  E  et al.  Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med 2006;36 (2) 167- 179
PubMed
Elkins  IJ McGue  MIacono  WG Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry 2007;64 (10) 1145- 1152
PubMed
Gau  SSChong  MYYang  PYen  CFLiang  KYCheng  ATA Psychiatric and psychosocial predictors of substance use disorders among adolescents: longitudinal study. Br J Psychiatry 2007;190 (1) 42- 48
PubMed
Kessler  RCChiu  WTDemler  OMerikangas  KRWalters  EE Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. 2005;62(7):709]. Arch Gen Psychiatry 2005;62 (6) 617- 627
PubMed
Spencer  TJ ADHD and comorbidity in childhood. J Clin Psychiatry 2006;67 ((suppl 8)) 27- 31
PubMed
Volk  HENeuman  RJTodd  RD A systematic evaluation of ADHD and comorbid psychopathology in a population-based twin sample. J Am Acad Child Adolesc Psychiatry 2005;44 (8) 768- 775
PubMed
Biederman  JMick  EFaraone  SV Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 2000;157 (5) 816- 818
PubMed
Costello  EJMustillo  SErkanli  AKeeler  GAngold  A Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 2003;60 (8) 837- 844
PubMed
Baron  RMKenny  DA The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51 (6) 1173- 1182
PubMed
Cohen  PCohen  J Life Values and Adolescent Mental Health.  Mahwah, NJ Lawrence Erlbaum Associates1996;
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC American Psychiatric Association1994;
Wittchen  HUKessler  RC Modifications of the CIDI in the National Comorbidity Survey: the development of the UM-CIDI. http://www.hcp.med.harvard.edu/ncs/ftpdir/um-cidi.pdf. Accessed November 12, 2009
Jasti  SDudley  WNGoldwater  E SAS macros for testing statistical mediation in data with binary mediators or outcomes. Nurs Res 2008;57 (2) 118- 122
PubMed
MacKinnon  DPDwyer  JH Estimating mediated effects in prevention studies. Eval Rev 1993;17 (2) 144- 158
Fergusson  DMHorwood  LJRidder  EM Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study. Drug Alcohol Depend 2007;88 ((suppl 1)) S14- S26
PubMed
Looby  A Childhood attention deficit hyperactivity disorder and the development of substance use disorders: valid concern or exaggeration? Addict Behav 2008;33 (3) 451- 463
PubMed
Waschbusch  DA A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems. Psychol Bull 2002;128 (1) 118- 150
PubMed
Brook  JSBrook  DWGordon  ASWhiteman  MCohen  P The psychosocial etiology of adolescent drug use: a family interactional approach. Genet Soc Gen Psychol Monogr 1990;116 (2) 111- 267
PubMed
Rhee  SHWillcutt  EGHartman  CAPennington  BFDeFries  JC Test of alternative hypotheses explaining the comorbidity between attention-deficit/hyperactivity disorder and conduct disorder. J Abnorm Child Psychol 2008;36 (1) 29- 40
PubMed
Nadder  TSRutter  MSilberg  JLMaes  HHEaves  LJ Genetic effects on the variation and covariation of attention deficit-hyperactivity disorder (ADHD) and oppositional-defiant disorder/conduct disorder (Odd/CD) symptomatologies across informant and occasion of measurement. Psychol Med 2002;32 (1) 39- 53
PubMed
Nigg  JTBreslau  N Prenatal smoking exposure, low birth weight, and disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry 2007;46 (3) 362- 369
PubMed
Rettew  DCAlthoff  RRDumenci  LAyer  LHudziak  JJ Latent profiles of temperament and their relations to psychopathology and wellness. J Am Acad Child Adolesc Psychiatry 2008;47 (3) 273- 281
PubMed
Oosterlaan  JLogan  GDSergeant  JA Response inhibition in AD/HD, CD, comorbid AD/HD + CD, anxious, and control children: a meta-analysis of studies with the stop task. J Child Psychol Psychiatry 1998;39 (3) 411- 425
PubMed
Fergusson  DMHorwood  LJRidder  EM Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J Child Psychol Psychiatry 2005;46 (8) 837- 849
PubMed
Tarter  REKirsci  LRidenour  TVanyukov  M Prediction of cannabis use disorder between childhood and young adulthood using the child behavior checklist. J Psychopathol Behav Assess 2008;30 (4) 272- 278
Jessor  RJessor  SL Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth.  New York, NY Academic Press1977;
Fergusson  DMHorwood  LJ Prospective childhood predictors of deviant peer affiliations in adolescence. J Child Psychol Psychiatry 1999;40 (4) 581- 592
PubMed
Brook  JSWhiteman  MFinch  S Role of mutual attachment in drug use: a longitudinal study. J Am Acad Child Adolesc Psychiatry 1993;32 (5) 982- 989
PubMed
Harrison  LDMartin  SSEnev  THarrington  D Comparing Drug Testing and Self-report of Drug Use Among Youths and Young Adults in the General Population.  Rockville, MD Substance Abuse and Mental Health Services Administration, Office of Applied Studies2007;DHHS publication SMA 07-4249, Methodology Series M-7
Kessler  RCBerglund  PDemler  OJin  RMerikangas  KRWalters  EE Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. 2005;62(7):768]. Arch Gen Psychiatry 2005;62 (6) 593- 602
PubMed

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles