Kate Flory

Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review.

Given the clinical and public health significance of substance disorders and the need to identify their early risk factors, we examined the association of childhood attention-deficit/hyperactivity disorder (ADHD) with substance use (nicotine, alcohol, marijuana) and abuse/dependence outcomes (nicotine, alcohol, marijuana, cocaine, other). To strengthen a potential causal inference, we meta-analyzed longitudinal studies that prospectively followed children with and without ADHD into adolescence or adulthood. Children with ADHD were significantly more likely to have ever used nicotine and other substances, but not alcohol. Children with ADHD were also more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine, and other substances (i.e., unspecified). Sex, age, race, publication year, sample source, and version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose ADHD did not significantly moderate the associations with substance outcomes that yielded heterogeneous effect sizes. These findings suggest that children with ADHD are significantly more likely to develop substance use disorders than children without ADHD and that this increased risk is robust to demographic and methodological differences that varied across the studies. Finally, few studies addressed ADHD and comorbid disruptive behavior disorders (DBD), thus preventing a formal meta-analytic review. However, we qualitatively summarize the results of these studies and conclude that comorbid DBD complicates inferences about the specificity of ADHD effects on substance use outcomes.

The role of personality dispositions to risky behavior in predicting first-year college drinking

AIMS US college student drinking is associated with enormous risks to health, safety and productivity. Recent advances in personality research that have delineated multiple, separate dispositions to engage in risky behaviors may help to clarify the personality contribution to risk for this problem. DESIGN The authors compared the prospective roles of sensation seeking, lack of planning, lack of perseverance, negative urgency and positive urgency (dispositions to engage in rash action when in an unusually negative or positive mood, respectively) in predicting increases in drinking frequency, drinking quantity and negative outcomes from consumption across the first year of college. SETTING University of Kentucky campus. PARTICIPANTS A total of 418 first-year US college students enrolled in an Introduction to Psychology course during the first assessment; 293 participants completed both phases of the study. MEASUREMENTS Participants completed self-report measures of personality and drinking behavior twice during the first year of college [the UPPS-R Impulsive Behavior Scale, positive urgency measure (PUM) and Drinking Styles Questionnaire (DSQ)]. FINDINGS Whereas sensation seeking related to increases in the frequency with which college students drank alcohol, positive urgency predicted increases in (i) the quantity of alcohol students consumed at any given drinking episode and (ii) negative outcomes experienced from drinking. CONCLUSIONS It appears that although sensation seeking is a risk factor for participation in drinking behaviors, risk for increased quantity of consumption and its negative outcomes may be more a function of dyscontrol stemming from high positive mood for college students.

Childhood ADHD Predicts Risky Sexual Behavior in Young Adulthood

This study compared young adults (ages 18 to 26) with and without childhood attention deficit hyperactivity disorder (ADHD) on self-reported risky sexual behaviors. Participants were 175 men with childhood ADHD and 111 demographically similar men without ADHD in the Pittsburgh ADHD Longitudinal Study (PALS). Childhood ADHD predicted earlier initiation of sexual activity and intercourse, more sexual partners, more casual sex, and more partner pregnancies. Although childhood conduct problems did contribute significantly to risky sexual behaviors among participants with ADHD, there was also an independent contribution of ADHD, suggesting that the characteristic deficits of the disorder or other associated features may be useful childhood markers of later vulnerability.

Thinness and eating expectancies predict subsequent binge-eating and purging behavior among adolescent girls.

Ones expectancies for reinforcement from eating or from thinness are thought to represent summaries of ones eating-related learning history and to thus influence the development of binge-eating and purging behavior. In a 3-year longitudinal study, the authors tested this hypothesis and the hypothesis that binge eating also influences subsequent expectancy development. The authors used trajectory analysis to identify groups of middle school girls who followed different trajectories of binge eating, purging, eating expectancies, and thinness expectancies. Initial eating and thinness reinforcement expectancies identified girls whose binge eating and purging increased during middle school, and expectancies differentiated girls who began these problem behaviors from girls who did not. Initial binge-eating scores differentiated among eating expectancy developmental trajectories. The onset of most behaviors can be understood in terms of learned expectancies for reinforcement from these behaviors. The same model can be applied to the risk for eating disorders.

Expectancy influences the operation of personality on behavior.

The authors investigated the moderating effect of expectancies on personality for 2 different addictive behavior processes: (a) drinking and (b) binge eating and purging characteristic of bulimia nervosa. Study 1 found that positive expectancies for social facilitation from drinking moderated the effect of extraversion on drinking behavior among undergraduate men and women. Study 2 found that the expectancy that eating will help manage negative affect moderated the effect of trait urgency on bulimic symptoms among undergraduate women. Thus, the relationships of the trait risk factors to these 2 addictive behaviors are stronger if one also holds certain expectancies for reinforcement from those behaviors.

Why does ADHD Confer Risk for Cigarette Smoking? A Review of Psychosocial Mechanisms

Research has documented that adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking, but less attention has examined why this risk exists. The current paper reviews the literature on different psychosocial mechanisms [self-medication hypothesis, social factors (social modeling, social impairments), cognitive factors (attitudes, coping skills), and psychological variables (ADHD symptom dimensions, comorbidity)] that might explain this increased smoking risk. Results of the review suggest that, while the self-medication hypothesis has some theoretical merit, it has not been adequately examined among adolescents and young adults with ADHD. Further, cognitive and social factors may be important mechanisms that help to explain the association between ADHD and cigarette smoking, but research in these areas is sparse. Finally, a larger body of literature suggests that different psychological aspects of ADHD (e.g., comorbidity, symptom dimensions) are related to smoking. Interpretation of findings of many of these studies was hindered due to significant methodological problems and the lack of a guiding theoretical orientation. Potential theories that might facilitate future work in this area are discussed. Future research should continue to explore these important psychosocial mechanisms as well as gene–environment interactions in examining the link between ADHD and cigarette smoking.

Feasibility and Preliminary Efficacy of an After-School Program for Middle Schoolers with ADHD: A Randomized Trial in a Large Public Middle School.

Objective: This pilot study tests the feasibility and preliminary efficacy of an after-school treatment program for middle schoolers with ADHD using a randomized clinical trial design. Method: A total of 23 students with ADHD (25% female, 48% African American) from a large public middle school were randomly assigned to a 10-week program or to community comparison. Manualized treatment targeted educational, social, and recreational skills, homework completion, and school and home behavior. Parents participated. Results: Recruitment and randomization targets were easily met (87% completion). Parent and teacher satisfaction was positive. Small to medium treatment effects resulted despite greater medication use in the control group, with improvements in functioning for the program-treated youth or absence of deterioration relative to the comparison group. Conclusion: Despite testing an abbreviated version of the after-school program (< 5 months), this study reveals feasibility and palatability for this intervention and modest beneficial effects on behavioral and academic outcomes. (J. of Att. Dis. 2008; 12(3) 207-217)

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.

Are symptoms of ADHD related to substance use among college students

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder that often persists into adolescence and adulthood and has been associated with an increased risk for substance use. Due to improved treatment and educational policies, more students with high levels of ADHD symptoms are attending college despite continued ADHD symptoms. Little research has examined whether college students with higher levels of ADHD symptoms are at increased risk for heavy substance use compared to college students with few ADHD symptoms. The current study examined the relation of ADHD symptoms to substance use (e.g., cigarette smoking, alcohol use, marijuana use, and cocaine use). We hypothesized that greater ADHD symptomatology (inattentive, hyperactive/impulsive, and total ADHD) would be related to higher rates of cigarette smoking, alcohol use, alcohol-problems, and illicit drug use. Participants were 889 college undergraduates who completed an online survey. Results suggest that ADHD symptoms, particularly inattentive symptoms, were positively associated with cigarette smoking and problems associated with alcohol after controlling for conduct disorder (CD) symptoms. ADHD symptoms were not significantly associated with alcohol use or illicit drug use after the effects of CD symptoms were accounted for. Results have important implications for prevention and treatment of college student substance use. Limitations and future directions are discussed.

Symptoms of ADHD and close friendships in adolescence.

Objective: This study examined the relationship of ADHD symptoms to different aspects of close friendship quality as rated by both adolescents (target adolescent and a close friend) within a friendship dyad. Method: Participants were 41 same-sex friendship dyads who completed questionnaires about their friendship. Separate symptom dimensions of ADHD (inattention and hyperactivity-impulsivity) were examined. Teacher and parent ratings of social functioning were also used. Results: Symptoms of inattention, hyperactivity-impulsivity, and overall ADHD were positively related to target-reported friendship quality, and symptoms of inattention and total ADHD were positively associated with friend-reported friendship quality. Potential explanations for these surprising findings were explored. Conclusion: Results suggest that the close friendships of adolescents with symptoms of ADHD may be distinct from the peer rejection commonly faced by this population and that adolescents with symptoms of ADHD may have at least one close, positive friendship. Treatment implications and future research directions are discussed.