MedicalResearch.com Interview with:
Brooke S. G. S Molina, PhD
Professor of Psychiatry, Psychology and Pediatrics
University of Pittsburgh
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There has been inconsistency across previous studies of children with ADHD and their risk of substance use in adolescence and in adulthood. This study closely examined substance use by children with and without ADHD over a long period of time, considering that experimenting with some substances, such as alcohol and cigarettes, is typical after teens reach high-school age.
This study found that children with attention deficit hyperactivity disorder (ADHD) engaged in substance use at a younger age than those without ADHD and had a significantly higher prevalence of regular marijuana and cigarette use into adulthood.
We also found that children diagnosed with ADHD had a faster progression of substance use during childhood and adolescence.
We confirmed a finding for the ADHD group that is widely replicated in the general population – that early substance use strongly predicts adult substance use. However, more of the children with ADHD were found to be early substance users, such as having a drink of alcohol before the age of 15.
We did not find higher rates of binge alcohol consumption among young adults with ADHD. However, alcohol use is still an important part of the bigger picture.
The amount of alcohol consumption was self-reported in a questionnaire where the average age of all participants was 25. Binge drinking is very common in early adulthood, but given our findings of children with ADHD starting to drink at younger ages, it’s important to continue this research so we know how many young drinkers with ADHD continue to have serious, chronic problems with drinking as they age.
MedicalResearch.com: What should readers take away from your report?
Response: It’s very important to understand from our findings that substance abuse begins at a young age – often before high school. Parents and providers need to understand this and continually assess risk.
We are concerned about the long-term consequences of these substance use patterns. We do not know how many of these individuals will experience painful and expensive middle age outcomes of chronic substance abuse and associated problems such as divorce, employment problems, injuries, poor health and shortened life expectancy. Some will be resilient and decrease their substance use. We need to learn what predicts these outcomes.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The marijuana use finding is also concerning given the increasing availability of cannabis in the United States and the risk and consequences for children with ADHD needs further study.
MedicalResearch.com: Is there anything else you would like to add?
Response: These results suggest a crucial need for routine clinical practice to include early screening and interventions to prevent early substance use, including cigarette smoking, among children with ADHD.
Many children with ADHD end up being cared for in primary care settings, so pediatricians are the front-line treatment care providers and conversations about substance use need to begin early. When children with ADHD are being treated, we need to start monitoring their potential risk for substance use at a young age, and not only treating with medication, but considering the range of factors that increase their risk for becoming dependent on nicotine and for developing substance use disorders.
J Child Psychol Psychiatry. 2018 Jan 8. doi: 10.1111/jcpp.12855. [Epub ahead of print]
Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study.
Molina BSG1, Howard AL2, Swanson JM3, Stehli A3, Mitchell JT4, Kennedy TM5, Epstein JN6, Arnold LE7, Hechtman L8, Vitiello B9, Hoza B10.
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