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)     

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)     

The influence of general identity disturbance on reports of lifetime substance use disorders and related outcomes among sexual minority adults with a history of substance use.

Previous research has shown that sexual minority (i.e., nonheterosexual) individuals report increased problematic substance use involvement, compared with their sexual majority counterparts. We hypothesize that feelings of an unstable sense of self (i.e., identity disturbance) may potentially drive problematic substance use. The purpose of the current study is to examine identity disturbance among sexual minorities as a potential explanatory mechanism of increased sexual minority lifetime rates of substance dependence. Measures of identity disturbance and three indicators of sexual orientation from lifetime female (n = 16,629) and male (n = 13,553) alcohol/illicit drug users in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Findings generally showed that the increased prevalence of alcohol dependence, illicit drug dependence, and combined alcohol/illicit drug dependence as well as a younger age of alcohol use initiation among sexual minority women was associated with elevated levels of identity disturbance. The results were consistent with a mediational role for identity disturbance in explaining the association between sexual minority status and substance dependence and were generally replicated among male sexual minority respondents. The current research suggests that identity disturbance, a predictor of substance use, may contribute to heightened risk for substance dependence among certain subgroups of sexual minority individuals. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome

Most delinquent youths have conduct disorder (CD), often with comorbid substance use disorder (SUD), attention-deficit/hyperactivity disorder (ADHD) and depression. Some youths' conduct problems later abate, while those of others persist into adult antisocial personality disorder. Earlier CD onset and ADHD reportedly predict persisting antisocial problems, but predictors of persisting SUD are poorly understood. Males aged 13-19 years (n = 89), most referred by criminal justice and social service agencies, received residential treatment for comorbid CD and SUD. They had diagnostic assessments for SUD at intake and for CD, ADHD, and depression (as well as drug-use assessments) at intake and 6, 12 and 24 months later. At intake nearly all had DSM-III-R substance dependence (usually on alcohol and marijuana) and CD with considerable violence and criminality. The 2-year follow-ups revealed improvements in criminality, CD, depression and ADHD, but substance use remained largely unchanged. Various aspects of conduct, crime and substance outcomes at 2 years were predicted by intake measures of intensity of substance involvement, and by CD severity and onset age, but not by severity of either ADHD or depression, nor by treatment duration. Earlier CD onset, more severe CD and more drug dependence predicted worse outcomes, supporting the validity of these diagnoses in adolescents.     

Psychosocial adjustment and educational outcome in adolescents with a childhood diagnosis of attention deficit disorder

OBJECTIVE: To conduct a retrospective follow-up study of psychosocial adjustment and educational outcome in adolescents with a childhood diagnosis of attention deficit disorder (ADD) and a group of clinical controls. METHODS: Groups included male and female subjects aged 14 to 18 years at time of follow-up with childhood diagnosis of ADD (cases; n = 48) versus other neurodevelopmental disorders (clinical controls; n = 37). Cases were also subdivided based on the presence of conduct disorder (CD) at follow-up. All groups were compared on measures of academic performance, self-esteem, behavior, alcohol and substance use, and adaptive functioning. RESULTS: Cases had significantly lower academic performance and poorer social, emotional, and adaptive functioning than clinical controls. Cases with CD had significantly lower academic performance, greater externalizing behaviors and emotional difficulties, and lower adaptive functioning than cases without CD. Cases with CD fared worse than clinical controls on self-report measures of behavior, socialization skills, and alcohol and substance use. CONCLUSIONS: These academic and psychosocial problems in adolescents with a childhood diagnosis of ADD suggest potential long-term ramifications for vocational and psychological functioning into adulthood. In addition, the presence of CD in some of these cases during adolescence appears to further increase the risk for maladaptive outcome.     

Interactive effects of attention deficit hyperactivity disorder and conduct disorder on early adolescent substance use.

This study examined the interactive effects of attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) diagnosis on early adolescent substance use in a cross-sectional study of 202 middle school students. ADHD diagnosis alone did not suggest increased risk for substance use, but more adolescents with both ADHD and CD reported use of tobacco, alcohol, marijuana, and other drugs than did adolescents with either disorder alone. Dimensionally scored impulsivity-hyperactivity symptoms, not symptoms of inattention, appeared to account for the association with ADHD. Results illustrate the need to continue examination of the role of ADHD in the development of substance use and later abuse, especially as it relates to the onset of conduct problems in adolescence that mark liability for early onset substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting Future Antisocial Personality Disorder in Males From a Clinical Assessment in Childhood.

It is essential to identify childhood predictors of adult antisocial personality disorder (APD) to target early prevention. It has variously been hypothesized that APD is predicted by childhood conduct disorder (CD), attention-deficit/hyperactivity disorder (ADHD), or both disorders. To test these competing hypotheses, the authors used data from a single childhood diagnostic assessment of 163 clinic-referred boys to predict future APD during early adulthood. Childhood Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) CD, but not ADHD, significantly predicted the boys' subsequent APD. An interaction between socioeconomic status (SES) and CD indicated that CD predicted APD only in lower SES families, however. Among children who met criteria for CD, their number of covert but not overt CD symptoms improved prediction of future APD, controlling for SES. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation between adolescent substance use and young adult internalizing symptoms: Findings from a high-risk longitudinal sample.

The present study examined the role of adolescent substance use and its antecedent behavioral and familial risk factors in the prediction of young adult internalizing symptoms 10 years later, using a community sample of children of alcoholics (n = 194) and demographically matched controls (n = 209). Using growth curve modeling, the authors found that initial levels of adolescent alcohol and drug use (μage = 13) and growth in drug use during adolescence predicted higher levels of internalizing symptoms in young adulthood, even after including in the models shared risk factors for both internalizing symptoms and adolescent substance use. These effects remained significant after including concurrent substance use in adulthood, suggesting that adolescent substance use exerts a long-term impact on young adult internalizing symptoms over and above the effects of persistent substance use over time. The present investigation further revealed that initial levels of alcohol and drug use in adolescence mediate the relation between parental alcoholism and young adult internalizing symptoms. Findings provide evidence for the long-term effects of adolescent substance use on young adult functioning and can help inform both etiological and prevention research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A mixture-model approach to linking ADHD to adolescent onset of illicit drug use.

Prior research findings have been mixed as to whether attention-deficit/hyperactivity disorder (ADHD) is related to illicit drug use independent of conduct problems (CP). With the current study, the authors add to this literature by investigating the association between trajectories of ADHD symptoms across childhood and adolescence and onset of illicit drug use, with and without controlling for CP. In a longitudinal panel study of a community sample of 754 girls and boys recruited in kindergarten, this research question was examined with a combination of growth mixture modeling (to model parent-reported ADHD symptom trajectories) and survival analysis (to model youth-reported initiation of illicit drug use). Results revealed a 3-class model of ADHD trajectories, with 1 class exhibiting no or minimal symptoms throughout childhood and adolescence, another class showing a convex shape (an increase, then a decrease in symptoms) across time, and a third class showing a concave shape (a decrease, then a slight increase in symptoms) over time. The concave-trajectory class demonstrated significantly earlier onset of illicit drug use than the minimal-problem class, with the convex-trajectory class falling between (but not significantly different from either of the other two classes). These results did not change when the authors added CP to the model as a covariate. Implications of findings for theory and practice are discussed. (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)     

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. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Waxing and waning in concert: Dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 17 years among clinic-referred boys.

Six waves of structured diagnostic assessments were conducted of 168 clinic-referred 7- to 12-year-olds, over 7 years. Wave-to-wave changes in the number of conduct disorder (CD) behaviors were paralleled by correlated changes in the numbers of symptoms of oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. In addition, CD in Wave 1 predicted levels of ODD, ADHD, depression, and anxiety in later waves when initial levels of those symptoms were controlled, but only ODD in Wave I predicted CD in later waves when initial CD levels were controlled. These findings indicate a striking degree of dynamic comorbidity between CD and other types of psychopathology and provide an initial empirical framework for needed developmental models of comorbidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Barkley et al. (2011).

Reports an error in "Correspondence and disparity in the self- and other ratings of current and childhood ADHD symptoms and impairment in adults with ADHD" by Russell A. Barkley, Laura E. Knouse and Kevin R. Murphy (Psychological Assessment, , , np). There was an omission in the author note. The author note should have included a disclosure as follows, “Russell A. Barkley receives royalties for books, videos, and rating scales from Guilford Publications, and is the author of Barkley Adult ADHD Rating Scale-IV (BAARS-IV), Barkley Deficits in Executive Functioning Scale (BDEFS), and Barkley Functional Impairment Scale (BFIS), all published by Guilford Press.” (The following abstract of the original article appeared in record 2011-04636-001.) Experts recommend that clinicians evaluating adults for attention-deficit/hyperactivity disorder (ADHD) obtain information from others who know the patient well. The authors examined correspondence between the self- and other-ratings of ADHD symptoms and impairment using 3 groups of adults recruited on the basis of their severity of ADHD: ADHD diagnosis (n = 146), clinical controls self-referring for ADHD but not diagnosed (n = 97), and community controls (n = 109). The influences of diagnostic group, informant relationship, sex of participant, IQ, and comorbid anxiety and depression on self-informant disparities were also examined. Results indicated moderate to high agreement (.59–.80) between self and others on current functioning and slightly lower levels (.53–.75) between self- and parent ratings of childhood functioning. Examination of difference scores between self- and other ratings revealed small mean disparities (?0.1 to +5.0 points) but substantial variation (SDs = –2.4 to 8.9 points) for both current and childhood ratings. Clinic referrals not diagnosed with ADHD, particularly women, had higher disparities than was evident in the ADHD and community groups. Age, IQ, and education were not associated with disparities in most ratings. Higher anxiety, in contrast, was associated with greater disparities on all current and childhood measures of both ADHD and impairment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Familial transmission of substance dependence: alcohol, marijuana, cocaine, and habitual smoking: a report from the Collaborative Study on the Genetics of Alcoholism

BACKGROUND: Alcoholism and substance dependence frequently co-occur. Accordingly, we evaluated the familial transmission of alcohol, marijuana, and cocaine dependence and habitual smoking in the Collaborative Study on the Genetics of Alcoholism. METHODS: Subjects (n=1212) who met criteria for both DSM-III-R alcohol dependence and Feighner definite alcoholism and their siblings (n=2755) were recruited for study. A comparison sample was also recruited (probands, n=217; siblings, n=254). Subjects were interviewed with the Semi-Structured Assessment for the Genetics of Alcoholism. The familial aggregation of drug dependence and habitual smoking in siblings of alcohol-dependent and non-alcohol-dependent probands was measured by means of the Cox proportional hazards model. RESULTS: Rates of alcohol, marijuana, and cocaine dependence and habitual smoking were increased in siblings of alcohol-dependent probands compared with siblings of controls. For siblings of alcohol-dependent probands, 49.3% to 50.1% of brothers and 22.4% to 25.0% of sisters were alcohol dependent (lifetime diagnosis), but this elevated risk was not further increased by comorbid substance dependence in probands. Siblings of marijuana-dependent probands had an elevated risk of developing marijuana dependence (relative risk [RR], 1.78) and siblings of cocaine-dependent probands had an elevated risk of developing cocaine dependence (RR, 1.71). There was a similar finding for habitual smoking (RR, 1.77 in siblings of habitual-smoking probands). CONCLUSIONS: Alcohol, marijuana, and cocaine dependence and habitual smoking are all familial, and there is evidence of both common and specific addictive factors transmitted in families. This specificity suggests independent causative factors in the development of each type of substance dependence.     

Development of substance use and psychiatric comorbidity in an epidemiologic study of white and American Indian young adolescents the Great Smoky Mountains Study

The progression of substance use and the patterns of comorbidity of substance use and psychiatric disorders are explored prospectively in young adolescents enrolled in the Great Smoky Mountains Study. This study is an epidemiologic study of white and American Indian youths living in rural Southern Appalachia. Results from this study indicate that alcohol use without permission predicts subsequent use of illicit drugs and regular tobacco use. Use of tobacco was not associated with either later alcohol or drug use. Patterns of comorbidity showed strong cross-sectional relationships between substance use and behavioral disorders, but not emotional disorders. Use of alcohol was also associated with psychiatric diagnosis at a later interview. There were some differences between white and American Indian youths in the pattern of comorbidity of tobacco use and psychiatric disorder and the relationship between prior psychiatric disorder and later alcohol use. These findings suggest that alcohol use without permission may be an important marker for youths who are at risk for illicit drug use and/or psychiatric diagnoses.     

Rate and predictors of divorce among parents of youths with ADHD.

Numerous studies have asserted the prevalence of marital conflict among families of children with attention-deficit/hyperactivity disorder (ADHD), but evidence is surprisingly less convincing regarding whether parents of youths with ADHD are more at risk for divorce than are parents of children without ADHD. Using survival analyses, the authors compared the rate of marital dissolution between parents of adolescents and young adults with and without ADHD. Results indicated that parents of youths diagnosed with ADHD in childhood (n = 282) were more likely to divorce and had a shorter latency to divorce compared with parents of children without ADHD (n = 206). Among a subset of those families of youths with ADHD, prospective analyses indicated that maternal and paternal education level; paternal antisocial behavior; and child age, race/ethnicity, and oppositional-defiant/conduct problems each uniquely predicted the timing of divorce between parents of youths with ADHD. These data underscore how parent and child variables likely interact to exacerbate marital discord and, ultimately, dissolution among families of children diagnosed with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correspondence and disparity in the self- and other ratings of current and childhood ADHD symptoms and impairment in adults with ADHD.

[Correction Notice: An erratum for this article was reported in Vol 23(2) of Psychological Assessment (see record 2011-09525-001). There was an omission in the author note. The author note should have included a disclosure as follows, “Russell A. Barkley receives royalties for books, videos, and rating scales from Guilford Publications, and is the author of Barkley Adult ADHD Rating Scale-IV (BAARS-IV), Barkley Deficits in Executive Functioning Scale (BDEFS), and Barkley Functional Impairment Scale (BFIS), all published by Guilford Press.”] Experts recommend that clinicians evaluating adults for attention-deficit/hyperactivity disorder (ADHD) obtain information from others who know the patient well. The authors examined correspondence between the self- and other-ratings of ADHD symptoms and impairment using 3 groups of adults recruited on the basis of their severity of ADHD: ADHD diagnosis (n = 146), clinical controls self-referring for ADHD but not diagnosed (n = 97), and community controls (n = 109). The influences of diagnostic group, informant relationship, sex of participant, IQ, and comorbid anxiety and depression on self-informant disparities were also examined. Results indicated moderate to high agreement (.59–.80) between self and others on current functioning and slightly lower levels (.53–.75) between self- and parent ratings of childhood functioning. Examination of difference scores between self- and other ratings revealed small mean disparities (?0.1 to +5.0 points) but substantial variation (SDs = –2.4 to 8.9 points) for both current and childhood ratings. Clinic referrals not diagnosed with ADHD, particularly women, had higher disparities than was evident in the ADHD and community groups. Age, IQ, and education were not associated with disparities in most ratings. Higher anxiety, in contrast, was associated with greater disparities on all current and childhood measures of both ADHD and impairment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Young-adult malt liquor drinkers: Prediction of alcohol problems and marijuana use.

Malt liquor (ML) is a cheap, high alcohol content beverage that is marketed to appeal to young adults. Findings from the few published studies of ML use suggest that it may be associated with excessive drinking, alcohol problems, and the use of illicit drugs. The authors conducted separate hierarchical multiple regressions to examine the role of ML use and psychosocial variables (e.g., personality, ML motives) in alcohol-related problems and marijuana use. Demographic characteristics served as controls. The sample consisted of 639 (456 men, 183 women) young adults (M = 22.9 years, SD = 4.2) who regularly (≥40 oz/week) consumed ML. ML use significantly and positively predicted alcohol problems, ML-specific problems, and marijuana use, above and beyond their associations with typical alcohol use. Marijuana was the illicit drug of choice, and 46% reported concurrent use of marijuana and ML. Those who concurrently used ML and marijuana began drinking at a younger age and reported more substance use (particularly marijuana) and more alcohol-related problems than did nonconcurrent users. These results suggest that ML use may represent a risk for alcohol problems and marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood victimization and illicit drug use in middle adulthood.

Using a prospective cohort design, the authors examined in this study whether childhood victimization increases the risk for illicit drug use and related problems in middle adulthood. Court-documented cases of childhood physical and sexual abuse and neglect and matched controls (N = 892) were first assessed as young adults (mean age = 29 years) during 1989-1995 and again in middle adulthood (mean age = 40 years) during 2000-2002. In middle adulthood, abused and neglected individuals were about 1.5 times more likely than controls to report using any illicit drug (in particular, marijuana) during the past year and reported use of a greater number of illicit drugs and more substance-use-related problems compared with controls. The current results reveal the long-term impact of childhood victimization on drug use in middle adulthood. These new results reinforce the need for targeted interventions with abused and neglected children, adolescents, and adults, and particularly for women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.