Relapse in Alcohol- and Drug-Disordered Adolescents With Comorbid Psychopathology: Changes in Psychiatric Symptoms.

This study examined reciprocal relationships between posttreatment substance use and psychiatric symptoms in adolescents with both a substance use disorder and an Axis I mental health disorder. Participants (13-18 years old) were recruited from inpatient treatment centers and interviewed during treatment and monthly for 6 months. Participants who relapsed (N = 103; 48% female) reported the incidence and severity of psychiatric symptoms experienced before and after their 1st posttreatment substance use. The number of symptoms and depression symptoms experienced were related to use of stimulants and other drugs during relapse. There was evidence for both self-medication (symptom reduction) and rebound (symptom exacerbation) effects of substance use on symptom severity. These results demonstrate that, for adolescents with both substance use and mental health disorders, psychiatric symptoms are 1 factor influencing posttreatment substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention-deficit/hyperactivity disorder and conduct disorder symptomatology in adolescents with alcohol use disorder.

This study tested the hypothesis that attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) comorbidity is associated with substance use and deviance severity in 395 adolescents with alcohol use disorder. Thirty percent of the adolescents had high ADHD symptom counts, and 73% had 3 or more CD symptoms. ADHD-CD was associated with nonalcohol substance use disorder, drinking levels, and CD severity, but in general substance use was not uniquely elevated or problematic among the comorbid cases. In general, CD and CD severity were more important. The findings did not differ between boys and girls, revealing that in a treatment sample of adolescents, ADHD-CD comorbidity may need to be assessed and treated, but it is not broadly indicative of severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity.

A literature review on community studies of adolescent substance use, abuse, or dependence (SU/A/D) and psychiatric comorbidity yielded 22 articles from 15 studies with information on rates, specificity, timing, and differential patterns of comorbidity by gender, race/ethnicity, and other factors. Results revealed that 60% of youths with SU/A/D had a comorbid diagnosis, and conduct disorder (CD) and oppositional defiant disorder (not attention-deficit/hyperactivity disorder) were most commonly associated with SU/A/D, followed by depression. Child psychopathology (particularly CD) was associated with early onset of substance use and abuse in later adolescence. The authors suggest that available data relevant to SU/A/D and psychiatric comorbidity can be used to better address such questions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child Anxiety Treatment: Outcomes in Adolescence and Impact on Substance Use and Depression at 7.4-Year Follow-Up.

Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood ADHD and Adolescent Substance Use: An Examination of Deviant Peer Group Affiliation as a Risk Factor.

Deviant peer group affiliation was evaluated as a risk factor for substance use in adolescents with childhood attention-deficit/hyperactivity disorder (ADHD). Results showed that deviant peer affiliation mediated the relationship between ADHD and substance use, suggesting that children with ADHD are more likely than children without ADHD to become involved with deviant peers and, as a result, more likely to use substances. Moreover, the relationship between deviant peer affiliation and substance use was stronger for adolescents with ADHD, suggesting that once they are immersed in a deviant peer group, adolescents with ADHD are more vulnerable to the negative social influences of that group. This study is the first step in identifying high-risk pathways from childhood ADHD to substance use in adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence Self-Efficacy and Abstinence 1 Year After Substance Use Disorder Treatment.

To better understand the relationship between abstinence self-efficacy and treatment outcomes in substance use disorder patients, experts in the field need more information about the levels of abstinence self-efficacy most predictive of treatment outcomes. Participants (N = 2,967) from 15 residential substance use disorder treatment programs were assessed at treatment entry, discharge, and 1-year follow-up. A signal detection analysis compared the ability of different measures of self-efficacy to predict 1-year abstinence and identified the optimal cutoffs for significant predictors. The maximal level of abstinence self-efficacy (i.e., 100% confident) measured at discharge was the strongest predictor of 1-year abstinence. Treatment providers should focus on obtaining high levels of abstinence self-efficacy during treatment with the goal of achieving 100% confidence in abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of Executive Function Deficits and Attention-Deficit/Hyperactivity Disorder (ADHD) on Academic Outcomes in Children.

The association between executive function deficits (EFDs) and functional outcomes were examined among children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Participants were children and adolescents with (n = 259) and without (n = 222) ADHD, as ascertained from pediatric and psychiatric clinics. The authors defined EFD as at least 2 executive function measures impaired. Significantly more children and adolescents with ADHD had EFDs than did control participants. ADHD with EFDs was associated with an increased risk for grade retention and a decrease in academic achievement relative to (a) ADHD alone, (b) controlled socioeconomic status, (c) learning disabilities, and (d) IQ. No differences were noted in social functioning or psychiatric comorbidity. Children and adolescents with ADHD and EFDs were found to be at high risk for significant impairments in academic functioning. These results support screening children with ADHD for EFDs to prevent academic failure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking Among Psychiatric Outpatients: Relationship to Substance Use, Diagnosis, and Illness Severity.

To understand the elevated smoking rates among psychiatric patients, the authors investigated whether psychiatric diagnosis, illness severity, and other substance use predicted smoking status in a diverse sample (N=2,774) of psychiatric outpatients. Results indicated that 61% smoked daily and that 18% smoked heavily. Smoking was related to psychiatric diagnosis and illness severity as well as caffeine consumption and substance abuse. Diagnoses of bipolar disorder, schizoaffective disorder, and schizophrenia were independently related to smoking status, an association that was most pronounced among persons treated at clinics serving more impaired patients. Thus, diagnosis and illness severity contribute to elevated smoking rates, even after controlling for other substance use. Cessation programs are needed to reduce tobacco use in this vulnerable population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of generalized anxiety disorder diagnostic criteria in the National Comorbidity Survey and Virginia Adult Twin Study of Psychiatric and Substance Use Disorders.

The authors investigated measurement properties of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, generalized anxiety disorder (GAD) criteria in the National Comorbidity Survey and the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD). The two studies used different widely used instruments. There were significant (p     

Gender differences in psychiatric comorbidity among adolescents with substance use disorders.

The authors examined gender differences in rates of comorbid psychiatric disorders among adolescents with 1 or more psychoactive substance use disorders. Baseline diagnostic data were obtained from 135 adolescents, ages 12 to 19, and their parents-guardians, who participated in a study to develop and efficacy test Integrated Family and Cognitive-Behavioral Therapy. Rates of attention-deficit/hyperactivity disorder and conduct disorder were higher among drug-abusing male adolescents compared with drug-abusing female adolescents. However, high rates of disruptive behavior disorders also characterized drug-abusing female adolescents. Similarly, drug-abusing female adolescents exhibited a higher rate of major depression compared with drug-abusing male adolescents. However, rates of dysthymia, double depression (i.e., major depression and dysthymia), and bipolar disorder were equivalent between genders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Potential Mediators of Cognitive-Behavioral Therapy for Adolescents With Comorbid Major Depression and Conduct Disorder.

Several possible mediators of a group cognitive-behavioral therapy (CBT) for depressed adolescents were examined. Six measures specific to CBT (e.g., negative cognitions, engagement in pleasurable activities) and 2 nonspecific measures (therapeutic alliance, group cohesion) were examined in 93 adolescents with comorbid major depressive disorder and conduct disorder who were randomly assigned to the Adolescent Coping With Depression (CWD-A) course or a life skills control condition. Change on the Automatic Thoughts Questionnaire (S. D. Hollon & P. C. Kendall, 1980) appeared to mediate treatment effects on depressive symptoms. Therapeutic alliance by the 3rd session was higher among the CWD-A participants but did not predict reductions in depressive symptoms. Findings suggest that reducing negative thinking may be the primary mechanism through which the CWD-A intervention reduces depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: Individuals with symptoms of attention-deficit/hyperactivity disorder are uniquely at risk.

Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully accounts for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms, and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms, were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms, such that individuals with high levels of both ADHD and CD had the highest levels of these outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Les caractéristiques familiales des enfants présentant un trouble déficitaire de l'attention avec ou sans hyperactivité: Recension critique des écrits.

This article provides a critical summary of the most recent research on the family and parental characteristics of children with attention deficit disorder with or without hyperactivity (ADD/H). These variables interact and influence the development and the presence of ADD/H. This influence is more pronounced when the child also presents with oppositional defiant disorder (ODD) or a concomitant conduct disorder (CD). Most of the studies on families with children who have ADD/H suggest that the presence of ADD/H tends to be linked to a less functional family, especially if the child has concomitant CD/ODD. In addition, the psychopathological and non-pathological characteristics of the parents (attributing causality, feeling competent, personality, marital conflicts) are linked to the manifestation of symptoms in the child. The evolution of a child with ADD/H and the child's family are, therefore, influenced by family and parental characteristics, especially if the child exhibits concomitant CD/ODD. Most of the articles found on this subject seem to indicate that there is a reciprocal influence among the characteristics of the family, the parents, and the CD/ODD symptoms. In this article, we present a critique of the existing research and make suggestions regarding future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working Alliance, Treatment Satisfaction, and Patterns of Posttreatment Use Among Adolescent Substance Users.

This longitudinal study examined the relationships among the working alliance, treatment satisfaction, and posttreatment use among adolescents in treatment for substance abuse. Adolescents (N = 600) from the Cannabis Youth Treatment study (M. L. Dennis et al., 2002) completed measures of working alliance and treatment satisfaction as well as substance use and substance-related problems at intake and 3, 6, 9, 12, and 30 months' postintake. When controlling for initial substance use and substance-related problems, working alliance, but not treatment satisfaction, predicted use at 3 and 6 months' postintake. Neither working alliance nor treatment satisfaction were predictive of longitudinal patterns of posttreatment use. Implications for the assessment of working alliance and treatment satisfaction are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation and treatment of neurodevelopmental deficits in sexually aggressive children and adolescents.

Recent advances in developmental psychopathology demonstrate that comorbidities routinely appear in clinical samples of children and adolescents, particularly in those youngsters with disruptive behavior disorders and problems with aggressive behavior. This article discusses (a) the prevalence of comorbid neurodevelopmental deficits, particularly attention-deficit/hyperactivity disorder, in a clinical sample of 72 children and adolescents, ages 6-17, who displayed sexually aggressive behavior; (b) the theoretical implications of these findings; and (c) the relevance of this comorbidity for the clinical evaluation and treatment of sexually aggressive youth. Because adult models of psychopathology are limited, the need for a developmentally appropriate model for understanding sexual aggression in children is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways to Violence in the Children of Mothers Who Were Depressed Postpartum.

The impact of postnatal depression on a child's risk for violent behavior was evaluated in an urban British community sample (N=122 families). Mothers were interviewed during pregnancy, at 3 months postpartum, and when the child was 1, 4, and 11 years of age. Mothers, teachers, and children reported on violent symptoms at age 11. Structural equation modeling revealed that the child's violence was predicted by the mother's postnatal depression even when her depression during pregnancy, her later history of depression, and family characteristics were taken into account. Violence was associated with symptoms of attention-deficit/hyperactivity disorder and problems with anger management. Children were most violent if mothers had been depressed at 3 months and at least once thereafter. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Atomoxetine: A Selective Norepinephrine Reuptake Inhibitor for the Treatment of Attention-Deficit/Hyperactivity Disorder.

This column offers data related to attention deficit disorder with hyperactivity and related psychopharmacological treatments. The author focuses on atomoxetime, a selective norepinephrine reuptake inhibitor, and offers efficacy and safety data. Conclusions point out the limitations of stimulant use and praise the alleged non-abusive nature of atomoxetine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delay and reward choice in ADHD: An experimental test of the role of delay aversion.

Children with attention deficit/hyperactivity disorder (ADHD) choose smaller sooner (SS) over larger later (LL) rewards more than controls. Here we assess the contributions of impulsive drive for immediate rewards (IDIR) and delay aversion (DAv) to this pattern. We also explore the characteristics of, and the degree of familiality in, ADHD SS responders. We had 360 ADHD probands; 349 siblings and 112 controls (aged between 6 to 17 years) chose between SS (1 point after 2 s) and LL reward (2 points after 30 s) outcomes on the Maudsley Index of Delay Aversion (Kuntsi, Oosterlaan, & Stevenson, 2001): Under one condition SS choice led to less overall trial delay under another it did not. ADHD participants chose SS more than controls under both conditions. This effect was larger when SS choice reduced trial delay. ADHD SS responders were younger, had lower IQ, more conduct disorder and had siblings who were more likely to be SS responders themselves. The results support a dual component model in which both IDIR and DAv contribute to SS choice in ADHD. SS choice may be a marker of an ADHD motivational subtype. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on substance use disorder and posttraumatic stress disorder comorbidity.

A body of 2 complementary, albeit independent, research literatures has emerged that documents a strong relationship between substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) in both community and clinical samples. Research on the concomitants and consequences of PTSD has found that substance abuse is a frequent comorbid problem among individuals diagnosed with PTSD. Researchers from the substance abuse field are now investigating the interrelationship between PTSD and SUDs and finding that PTSD has a notable effect on SUD course and treatment response. Here, a brief summary of the prevalence of SUD-PTSD comorbidity is provided and the 5 articles of the special section are introduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)