Early adolescent psychopathology as a predictor of alcohol use disorders by young adulthood

A prospective longitudinal model predicting early adult alcohol problems: evidence for a robust externalizing pathway

BACKGROUND

Risk factors for alcohol problems (AP) include biological and environmental factors that are relevant across development. The pathways through which these factors are related, and how they lead to AP, are optimally considered in the context of a comprehensive developmental model.

METHOD

Using data from a prospectively assessed, population-based UK cohort, we constructed a structural equation model that integrated risk factors reflecting individual, family and peer/community-level constructs across childhood, adolescence and young adulthood. These variables were used to predict AP at the age of 20 years.

RESULTS

The final model explained over 30% of the variance in liability to age 20 years AP. Most prominent in the model was an externalizing pathway to AP, with conduct problems, sensation seeking, AP at age 17.5 years and illicit substance use acting as robust predictors. In conjunction with these individual-level risk factors, familial AP, peer relationships and low parental monitoring also predicted AP. Internalizing problems were less consistently associated with AP. Some risk factors previously identified were not associated with AP in the context of this comprehensive model.

CONCLUSIONS

The etiology of young adult AP is complex, influenced by risk factors that manifest across development. The most prominent pathway to AP is via externalizing and related behaviors. These findings underscore the importance of jointly assessing both biologically influenced and environmental risk factors for AP in a developmental context.

Which adolescents develop persistent substance dependence in adulthood? Using population-representative longitudinal data to inform universal risk assessment

BACKGROUND

To our knowledge, there are no universal screening tools for substance dependence that (1) were developed using a population-based sample, (2) estimate total risk briefly and inexpensively by incorporating a relatively small number of well-established risk factors, and (3) aggregate risk factors using a simple algorithm. We created a universal screening tool that incorporates these features to identify adolescents at risk for persistent substance dependence in adulthood.

METHOD

Participants were members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-1973 and followed prospectively to age 38 years, with 95% retention. We assessed a small set of childhood and adolescent risk factors: family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status. We defined the outcome (persistent substance dependence in adulthood) as dependence on one or more of alcohol, tobacco, cannabis, or hard drugs at ⩾3 assessment ages: 21, 26, 32, and 38 years.

RESULTS

A cumulative risk index, a simple sum of nine childhood and adolescent risk factors, predicted persistent substance dependence in adulthood with considerable accuracy (AUC = 0.80).

CONCLUSIONS

A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.

Cross-sectional study to evaluate the longitudinal development of child and adolescent psychiatric diagnoses of inpatients in Vorarlberg, Austria

Clinical experience has repeatedly shown evidence for continuity between mental disorders in children and adolescents and mental disorders in adulthood. Up to now, Austria has had no epidemiologic data on psychiatric diseases in children and adolescents and their development into adulthood. How often do children and adolescents with psychiatric diseases have psychiatric diseases in adulthood? Is there any association between psychiatric diagnoses in childhood/adolescence and adulthood? Electronic medical records provided us with data on 2210 children and adolescents who were admitted to any hospital in the State of Vorarlberg, Austria, between 1997 and 2012 because of psychiatric diseases. In this cross-sectional study, diagnoses were coded according to ICD-10 and ICD-9 criteria. The three main reasons for admission of children and adolescents were substance abuse, emotional disorders and conduct disorders. Of the admitted children and adolescents, 9.8 % were readmitted to a psychiatric institution in adulthood. The main reason for readmission in adulthood appears to be disorders due to psychoactive substances (42.1 %). Of young patients with psychoactive substance use, 9.7 % were rehospitalized in adulthood, 70.8 % of them showed a diagnosis in the same category (F1) on admission. Children and adolescents admitted for schizophrenia, schizotypal, and delusional disorders (F2) were significantly more likely to be readmitted in adulthood (40.9 %) compared to any other child psychiatric diagnosis.

CONCLUSION

This study once again shows the continuity of psychiatric disorders from childhood and adolescence to adulthood. It also gives further information about the transmission of diagnoses when patients reached the age of 18 years and their outcome.

WHAT IS KNOWN

Until now, there is hardly any information about the outcome of children and adolescents with psychiatric diagnoses in Austria.

WHAT IS NEW

We want to bring up more knowledge on that issue. Research findings may improve prevention and clinical assessment of children and adolescents with mental health problems.

Reciprocal Effects of Internalizing and Oppositional Defiance Symptoms on Heavy Drinking and Alcohol-Related Harms in Young Adulthood

There is a need for longitudinal research to understand how psychopathology relates to the onset and maintenance of substance use from adolescence into young adulthood. Hence, we investigate the longitudinal, reciprocal influences of internalizing (anxiety and depression) and externalizing (oppositional defiance) symptoms on heavy episodic drinking (HED; ≥5 drinks per occasion) and alcohol-related harms in a community-based sample of youth aged 12–27 years. Participants were chosen from the Victoria Healthy Youth Survey, followed six times, biennially between 2003 and 2013 (N = 662). Analyses used cross-lagged panel models to examine reciprocal relations over time. Differences across age and sex were also tested. Defiance symptoms predicted increases in HED, which reciprocally predicted increases in defiance symptoms for females. Internalizing symptoms were related to HED within time for females. Alcohol-related harms had reciprocal positive associations with internalizing and defiance symptoms for both males and females. Associations were largely invariant across age groups, suggesting that the presence and strength of associations persisted across development. While psychopathology preceded the onset of HED and harms, the overall findings suggest that these risk processes are mutually reinforcing across development and that youth may become entrenched in an interdependent cycle that significantly increases their risk of comorbid disorders in adulthood.

Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances

BACKGROUND

Sexual minority youth, especially girls, are at risk for alcohol, cigarette, and marijuana use when these substances are examined individually. However, little is known about concurrent use of these substances (i.e., three-substance use) in relation to sexual orientation.

OBJECTIVES

The present study compared profiles of past year alcohol, cigarette, and marijuana use between SMGs and heterosexual girls. In addition, because internalizing and externalizing symptoms are associated with substance use, we examined whether sexual orientation was associated with substance use profile over and above co-occurring psychopathology.

METHODS

Mixture modeling was used to identify patterns of alcohol (including binge drinking), cigarette, and marijuana use in the past year using a cross-sectional sample of urban adolescent girls (Pittsburgh Girls Study; N = 2,064; mean age = 17). Approximately 8% (n = 173) of the girls endorsed a lesbian or bisexual identity.

RESULTS

Five substance using classes were identified: low-level substance use (72%), marijuana use (5%), cigarette use (8%), alcohol use (8%), and three-substance use (7%). SMGs were at an increased risk for substance use than heterosexual girls, particularly three-substance use (OR = 6.69, p < .001), cigarette use (OR = 6.26, p < .001), and marijuana use (OR = 3.86, p < .001) classes. Substance use patterns were regressed on sexual orientation, internalizing symptoms (i.e., depression, anxiety), and externalizing symptoms (i.e., conduct problems, oppositional defiant disorder). The disparities remained robust after controlling for internalizing and externalizing symptoms.

CONCLUSIONS/IMPORTANCE

Clinicians and researchers should be aware of potential three-substance use among SMGs. Substance use interventions for SMG may benefit from targeting risk factors that cut-across several substances, particularly externalizing symptoms.

Relations Among Internalizing and Externalizing Symptoms and Drinking Frequency During Adolescence

BACKGROUND

In adolescence, internalizing (e.g., anxious, depressive, and withdrawn) and externalizing (e.g., aggressive, oppositional, delinquent, and hyperactive) symptoms are related with alcohol use. However, the directionality among internalizing symptoms, externalizing symptoms, and alcohol use during adolescence is equivocal. Moreover, gender differences and similarities among these behaviors are not definitive in existing literature.

OBJECTIVES

This study examined longitudinal relationships between internalizing and externalizing symptoms and past-month alcohol use among adolescent boys and girls.

METHODS

Using longitudinal survey data from a study of community-dwelling adolescents (n = 724), we estimated cross-lagged structural equation models to test relations between internalizing and externalizing symptoms (as measured by the Youth Self Report, YSR [Achenbach, 1991]) and self-report alcohol use in the past month among adolescents. Gender differences were tested in a multiple group structural equation model.

RESULTS

Alcohol use at age 12 was a predictor of internalizing and externalizing symptoms at age 15 for both boys and girls. With regard to gender differences, girls demonstrated an association between internalizing symptoms and drinking at age 12, whereas boys showed a stronger association between externalizing symptoms and drinking at age 18.

CONCLUSIONS/IMPORTANCE

Early alcohol use is problematic for youth, and results of this study lend support to prevention programs for youth. Preventing or curbing early drinking may offset later externalizing and internalizing symptoms, as well as ongoing alcohol use, regardless of gender.

Drinking patterns of alcohol intoxicated adolescents in the emergency department: A latent class analysis

INTRODUCTION

The increasing number of children and adolescents in need of emergency medical treatment following acute alcohol intoxication has been a major public health concern in Europe in recent years. However, little is known about drinking habits and associated risks in this population. To our knowledge, this is the first study to examine drinking patterns and associated risks in adolescent emergency department patients following alcohol intoxication. The aim of this study is to establish a classification system for admitted adolescents

METHODS

Latent class analysis was used to identify subgroups of adolescents with distinct patterns of habitual drinking as defined by the quantity of consumed alcohol on a typical drinking occasion, frequency of binge drinking and drunkenness, alcohol-related problems, prior alcohol-related hospitalizations and alcohol-related risk behaviors. Subgroup characteristics were examined with regard to sociodemographics, other substance use and psychosocial problems using analysis of variance (ANOVA) and chi-square tests.

RESULTS

A total of 316 adolescents aged 12-17 treated in 6 urban emergency departments in Germany were analyzed. Five classes of drinking patterns were identified: one class representing low-risk drinking (class 1 "low-risk" (61.2%)), two classes representing risky drinking (class 2 "moderate-risk" (5.7%) and class 3 "frequent drunk" (15.8%)), as well as two classes representing high-risk drinking (class 4 "alcohol-related problems" (11.4%) and class 5 "excessive drinking" (5.1%)). Membership of classes 4 and 5 was associated with the most severe psychosocial problems, especially with regard to aggressive-dissocial behaviors. The CRAFFT-d and brief RAPI screening tools allowed identifying the two risky drinking classes and two high-risk drinking classes.

CONCLUSIONS

Our findings provide the first in-depth analysis of habitual drinking in this study population and may help practitioners to better tailor interventions to patients' needs by using the identified classes as a form of classification system for admitted adolescents.

Separate dimensions of anxiety differentially predict alcohol use among male juvenile offenders

INTRODUCTION

Although research has documented robust prospective relationships between externalizing symptomatology and subsequent adolescent alcohol use, the extent to which internalizing symptoms such as anxiety may increase risk for alcohol consumption remains controversial. Recent evidence suggests that one possible reason for mixed findings is that separate dimensions of anxiety differentially confer risk for alcohol use. The present study tested two dimensions of anxiety, worry and physiological anxiety symptoms, as predictors of alcohol use and misuse in a longitudinal sample of juvenile offenders.

METHODS

Participants were 818 male juvenile offenders drawn from a larger multi-site, longitudinal study. Zero-inflated Poisson regression models estimated the influence of anxiety symptoms on typical drinking quantity, frequency of binge drinking, and alcohol dependence symptoms.

RESULTS

Results indicate that physiological anxiety and worry symptoms showed differential relations with alcohol use risk. Physiological anxiety was positively associated with increased risk for typical alcohol involvement, frequency of binge drinking, and alcohol dependence symptoms, whereas worry was negatively associated with all alcohol use outcomes.

CONCLUSIONS

Current findings underscore the importance of considering anxiety as a multidimensional construct when examining the prospective relation between anxiety and adolescent alcohol use risk.

Adolescent-Peer Relationships, Separation and Detachment from Parents, and Internalizing and Externalizing Behaviors: Linkages and Interactions

Most research exploring the interplay between context and adolescent separation and detachment has focused on the family; in contrast, this investigation directs its attention outside of the family to peers. Utilizing a latent variable approach for modeling interactions and incorporating reports of behavioral adjustment from 14-year-old adolescents (N = 190) and their mothers, we examine how separation and detachment relate to adolescent peer relationships, and whether peer relationships moderate how separation and detachment relate to adolescent internalizing and externalizing behaviors. Positive peer relationships were both associated with lower detachment and sharply attenuated relations between detachment and higher adolescent internalizing and externalizing. Separation from parents was unrelated to peer relationships, and regardless of whether peer relationships were positive, separation was not related to adolescent internalizing and externalizing. We integrate these findings with those from family-focused investigations and discuss their substantive and clinical implications.

Inherited and environmental influences on a childhood co-occurring symptom phenotype: Evidence from an adoption study

Risk factors for the childhood development of co-occurring internalizing and externalizing symptoms are not well understood, despite a high prevalence and poor clinical outcomes associated with this co-occurring phenotype. We examined inherited and environmental risk factors for co-occurring symptoms in a sample of children adopted at birth and their birth mothers and adoptive mothers (N = 293). Inherited risk factors (i.e., birth mothers' processing speed and internalizing symptoms) and environmental risk factors (i.e., adoptive mothers' processing speed, internalizing symptoms, and uninvolved parenting) were examined as predictors for the development of internalizing-only, externalizing-only, or co-occurring symptoms using structural equation modeling. Results suggested a unique pattern of predictive factors for the co-occurring phenotype, with risk conferred by adoptive mothers' uninvolved parenting, birth mothers' slower processing speed, and the birth mothers' slower processing speed in tandem with adoptive mothers' higher internalizing symptoms. Additional analyses indicated that when co-occurring-symptom children were incorporated into internalizing and externalizing symptom groups, differential risk factors for externalizing and internalizing symptoms emerged. The findings suggest that spurious results may be found when children with co-occurring symptoms are not examined as a unique phenotypic group.

Romantic relationship status and alcohol use and problems across the first year of college

OBJECTIVE

We examined the associations between romantic relationship status and alcohol use and problems in a large sample of first-year college students.

METHOD

Participants (n = 2,056) came from a longitudinal study of college students who answered questions about relationship status (single, in an exclusive relationship, or dating several people), alcohol use, and alcohol problems at two time points across their first year.

RESULTS

After we controlled for a number of covariates (parental alcohol problems, high school conduct problems, peer deviance, and extraversion), we found that dating several people was associated with higher alcohol use and problems, compared with being single or being in an exclusive relationship, at the follow-up assessment only, with modest effect sizes. Being in an exclusive relationship was not associated with lower alcohol use or problems compared with being single. Relationship dissolution was associated with a modest longitudinal increase in alcohol problems.

CONCLUSIONS

It is important to consider alternative relationship statuses (e.g., dating several people) for understanding the association of romantic status with alcohol use and problems in college-aged samples. Involvement in an exclusive romantic relationship (vs. being single) in this age group is not associated with the behavioral health benefits documented in older-adult samples. College students dating several people may be at risk for high levels of alcohol use or problems and may benefit from targeted interventions. Those who have recently experienced a breakup also may be at risk for increases in alcohol problems, although the clinical relevance of this finding should be tempered by the small observed effect size.

Childhood cognitive measures as predictors of alcohol use and problems by mid-adulthood in a non-Western cohort

This study examined the relationship between childhood cognitive functioning and academic achievement and subsequent alcohol use and problems in a non-Western setting. We examined longitudinal data from a birth cohort sample (N = 1,795) who were assessed at age 11 years on cognitive measures and then approximately 25 years later on lifetime alcohol use and alcohol use disorder symptom count. The sample was from Mauritius (eastern Africa), which allowed us to examine these relationships in a non-Western society with a different social structure than is typical of prior cognitive studies on primarily White samples in Western societies. Poorer performance on the Trail Making Test B-A in childhood predicted being a lifetime drinker, even after covarying for gender, childhood psychosocial adversity, and Muslim religion. Lower academic achievement and verbal IQ, but not performance IQ, were predictive of subsequent alcohol problems after including demographic covariates; the relationship between verbal IQ and alcohol problems was stronger in females than males. A nonlinear relationship emerged for Trails, suggesting that only more extreme impairment on this measure was indicative of later alcohol problems. Results of this study provide evidence that verbal deficits and poor academic performance exist in a general cohort sample by age 11 years (when 99% were nondrinkers) for those who go on to develop alcohol problems. (PsycINFO Database Record

Structural zeroes and zero-inflated models

Summary

In psychosocial and behavioral studies count outcomes recording the frequencies of the occurrence of some health or behavior outcomes (such as the number of unprotected sexual behaviors during a period of time) often contain a preponderance of zeroes because of the presence of ‘structural zeroes’ that occur when some subjects are not at risk for the behavior of interest. Unlike random zeroes (responses that can be greater than zero, but are zero due to sampling variability), structural zeroes are usually very different, both statistically and clinically. False interpretations of results and study findings may result if differences in the two types of zeroes are ignored. However, in practice, the status of the structural zeroes is often not observed and this latent nature complicates the data analysis. In this article, we focus on one model, the zero-inflated Poisson (ZIP) regression model that is commonly used to address zero-inflated data. We first give a brief overview of the issues of structural zeroes and the ZIP model. We then given an illustration of ZIP with data from a study on HIV-risk sexual behaviors among adolescent girls. Sample codes in SAS and Stata are also included to help perform and explain ZIP analyses.

Co-development of early adolescent alcohol use and depressive feelings: The role of the mu-opioid receptor A118G polymorphism

Alcohol use and depressive feelings are often related among early adolescents. However, the nature and underlying mechanisms of this association are not yet clear. The aim of this study was to investigate the co-development of alcohol use and depressive feelings over time and to examine the effects of the mu-opioid receptor (OPRM1) A118G genotype on such co-development. Data from a five-wave longitudinal, genetically informed survey study, with intervals of 4 months among a group of 739 normative early adolescents (12-13 years of age at baseline), were analyzed using a dual latent growth curve approach. OPRM1 status was evaluated from saliva-derived DNA samples. The results indicated a positive association between alcohol use and depressive feelings both at the initial levels and over time, indicating co-development in early adolescence. Compared to OPRM1 118G carriers, homozygous 118A carriers showed a greater increase in frequency of alcohol use and higher levels of depressive feelings over time. Evidence for co-development was only found within the group of homozygous 118A carriers, whereas in OPRM1 118G carriers the development of alcohol use and depressive feelings over time were not significantly associated. These results highlight the potential of OPRM1 as a common etiological factor for the development of alcohol use and depressive feelings in early adolescence.

The effects of acute alcohol administration on the human brain: insights from neuroimaging

Over the last quarter century, researchers have peered into the living human brain to develop and refine mechanistic accounts of alcohol-induced behavior, as well as neurobiological mechanisms for development and maintenance of addiction. These in vivo neuroimaging studies generally show that acute alcohol administration affects brain structures implicated in motivation and behavior control, and that chronic intoxication is correlated with structural and functional abnormalities in these same structures, where some elements of these decrements normalize with extended sobriety. In this review, we will summarize recent findings about acute human brain responses to alcohol using neuroimaging techniques, and how they might explain behavioral effects of alcohol intoxication. We then briefly address how chronic alcohol intoxication (as inferred from cross-sectional differences between various drinking populations and controls) may yield individual brain differences between drinking subjects that may confound interpretation of acute alcohol administration effects. This article is part of the Special Issue Section entitled 'Neuroimaging in Neuropharmacology'.

Adolescent alcohol use is positively associated with later depression in a population-based U.K. cohort

OBJECTIVE

Alcohol use and internalizing problems are often positively associated during adolescence and adulthood. However, the basis of this relationship remains poorly understood, and longitudinal data collected in population-based samples could improve the development of etiological models.

METHOD

Using a prospective population-based U.K. cohort, the current study examined the relationship between frequency of drinking during adolescence (ages 13-15, N = 7,100) with problems with depression and anxiety at average age 17 years 10 months (n = 4,292). Analyses were conducted separately by sex and adjusted by the inclusion of potential individual- and familial-level confounders.

RESULTS

Among boys, drinking frequency was positively associated with later depression but not anxiety. This association was robust to adjustment for covariates/confounders. Among girls, drinking frequency was related to later depression and anxiety in univariable analyses. In multivariable analyses, only the association with depression remained after adjustment for covariates/confounders. RESULTS were comparable across sexes, although the effect size of drinking frequency was higher among boys.

CONCLUSIONS

Higher adolescent alcohol use, even at sub-clinical levels, is associated with an increased risk of later problems with depression but may not be associated with an aggregate measure of anxiety. Future research should consider the possibility of differential relationships between multiple measures of adolescent alcohol use and distinct internalizing outcomes later in development.

Who are those "risk-taking adolescents"? Individual differences in developmental neuroimaging research

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Rates of development differ across brain regions linked to reward and inhibition.

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Adolescent risk-taking has been attributed in part to normative neurodevelopment.

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Significant risky behavior in mid-adolescence is not characteristic of typical youth.

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Youth with behavior disorders show increased behavioral and brain responses to reward.

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Maturational theories of adolescent risk-taking can consider individual differences.

Functional magnetic resonance imaging (fMRI) has illuminated the development of human brain function. Some of this work in typically-developing youth has ostensibly captured neural underpinnings of adolescent behavior which is characterized by risk-seeking propensity, according to psychometric questionnaires and a wealth of anecdote. Notably, cross-sectional comparisons have revealed age-dependent differences between adolescents and other age groups in regional brain responsiveness to prospective or experienced rewards (usually greater in adolescents) or penalties (usually diminished in adolescents). These differences have been interpreted as reflecting an imbalance between motivational drive and behavioral control mechanisms, especially in mid-adolescence, thus promoting greater risk-taking. While intriguing, we caution here that researchers should be more circumspect in attributing clinically significant adolescent risky behavior to age-group differences in task-elicited fMRI responses from neurotypical subjects. This is because actual mortality and morbidity from behavioral causes (e.g. substance abuse, violence) by mid-adolescence is heavily concentrated in individuals who are not neurotypical, who rather have shown a lifelong history of behavioral disinhibition that frequently meets criteria for a disruptive behavior disorder, such as conduct disorder, oppositional-defiant disorder, or attention-deficit hyperactivity disorder. These young people are at extreme risk of poor psychosocial outcomes, and should be a focus of future neurodevelopmental research.

Interaction matters: quantifying conduct problem × depressive symptoms interaction and its association with adolescent alcohol, cigarette, and marijuana use in a national sample

Substance use is a major contributor to morbidity and mortality among American adolescents. Conduct problems and depressive symptoms have each been found to be associated with adolescent substance use. Although they are highly comorbid, the role of the interaction of conduct problems and depressive symptoms in substance use is not clear. In national samples of 8th-, 10th-, and 12th-grade students from the Monitoring the Future study, latent moderated structural equation modeling was used to estimate the association of conduct problems, depressive symptoms, and their interaction to the use of alcohol (including binge drinking), cigarettes, and marijuana. Moderation by age and sex was tested. The interaction of conduct problems with depressive symptoms was a strong predictor of substance use, particularly among younger adolescents. With few exceptions, adolescents with high levels of both conduct problems and depressive symptoms used substances most frequently. Conduct problems were a strong positive predictor of substance use, and depressive symptoms were a weak positive predictor. Whereas conduct problems are often thought to be a primary predictor of substance use, this study revealed that depressive symptoms potentiate the relation of conduct problems to substance use. Therefore, substance use prevention efforts should target both depressive symptoms and conduct problems.

On the implication of structural zeros as independent variables in regression analysis: applications to alcohol research

In alcohol studies, drinking outcomes such as number of days of any alcohol drinking (DAD) over a period of time do not precisely capture the differences among subjects in a study population of interest. For example, the value of 0 on DAD could mean that the subject was continually abstinent from drinking such as lifetime abstainers or the subject was alcoholic, but happened not to use any alcohol during the period of interest. In statistics, zeros of the first kind are called structural zeros, to distinguish them from the sampling zeros of the second type. As the example indicates, the structural and sampling zeros represent two groups of subjects with quite different psychosocial outcomes. In the literature on alcohol use, although many recent studies have begun to explicitly account for the differences between the two types of zeros in modeling drinking variables as a response, none has acknowledged the implications of the different types of zeros when such modeling drinking variables are used as a predictor. This paper serves as the first attempt to tackle the latter issue and illustrate the importance of disentangling the structural and sampling zeros by using simulated as well as real study data.

Psychodynamic therapy for adolescents suffering from co-morbid disorders of conduct and emotions in an in-patient setting: a randomized controlled trial

BACKGROUND

Co-morbid disorders of conduct and emotions can be regarded as childhood antecedents of further negative developments (e.g. manifestation of personality disorders in adulthood). We evaluated a manualized psychodynamic therapy (PDT) for adolescents with these co-morbid disorders.

METHOD

In a randomized controlled trial (RCT), 66 adolescents diagnosed with mixed disorders of conduct and emotions (F92 in ICD-10) were randomly assigned to a manualized in-patient PDT group or a waiting list/treatment-as-usual (WL/TAU) control condition. Diagnoses according to DSM-IV were also documented. Patients were compared using rates of remission as the primary outcome. The Global Severity Index (GSI) and the Strengths and Difficulties Questionnaire (SDQ) were used as secondary measures. Assessments were performed at baseline, post-treatment and at the 6-month follow-up.

RESULTS

The sample consisted of severely impaired adolescents with high rates of further co-morbid disorders and academic failure. Patients in the treatment group had a significantly higher rate of remission [odds ratio (OR) 26.41, 95% confidence interval (CI) 6.42-108.55, p < 0.001]. Compared with the control group, the PDT group resulted in significantly better outcomes on the SDQ (p = 0.04) but not the GSI (p = 0.18), with small between-group effect sizes (SDQ: d = 0.38, GSI: d = 0.18). However, the scores of patients treated with PDT were post-treatment no longer significantly different from normative data on the GSI and within the normal range on the SDQ. The effects in the treatment group were stable at follow-up. Furthermore, most patients were reintegrated into educational processes.

CONCLUSION

PDT led to remarkable improvement and furthered necessary preconditions for long-term stabilization. In future, PDT should be compared to other strong active treatments.

A personalized and control systems engineering conceptual approach to target childhood anxiety in the contexts of cultural diversity

In the child and adolescent anxiety area, some progress has been made to develop evidence-based prevention protocols, but less is known about how to best target these problems in children and families of color. In general, data show differential program effects with some minority children benefiting significantly less. Our preliminary data, however, show promise and suggest cultural parameters to consider in the tailoring process beyond language and cultural symbols. It appears that a more focused approach to culture might help activate intervention components and its intended effects by focusing, for example, on the various facets of familismo when working with some Mexican parents. However, testing the effects and nuances of cultural adaption vis-à-vis a focused personalized approach is methodologically challenging. For this reason, we identify control systems engineering design methods and provide example scenarios relevant to our data and recent intervention work.

Cumulative and recent psychiatric symptoms as predictors of substance use onset: does timing matter?

AIMS

We examined two questions about the relationship between conduct disorder (CD), depression and anxiety symptoms and substance use onset: (i) what is the relative influence of recent and more chronic psychiatric symptoms on alcohol and marijuana use initiation and (ii) are there sensitive developmental periods when psychiatric symptoms have a stronger influence on substance use initiation?

DESIGN

Secondary analysis of longitudinal data from the Pittsburgh Youth Study, a cohort study of boys followed annually from 7 to 19 years of age.

SETTING

Recruitment occurred in public schools in Pittsburgh, Pennsylvania, USA.

PARTICIPANTS

A total of 503 boys.

MEASUREMENTS

The primary outcomes were age of alcohol and marijuana use onset. Discrete-time hazard models were used to determine whether (i) recent (prior year); and (ii) cumulative (from age 7 until 2 years prior to substance use onset) psychiatric symptoms were associated with substance use onset.

FINDINGS

Recent anxiety symptoms [hazard ratio (HR) = 1.10, 95% confidence interval (CI) = 1.03-1.17], recent (HR = 1.59, 95% CI = 1.35-1.87), cumulative (HR = 1.45, 95% CI = 1.03-2.03) CD symptoms, and cumulative depression symptoms (HR = 1.04, 95% CI = 1.01-1.08) were associated with earlier alcohol use onset. Recent (HR = 1.39, 95% CI = 1.22-1.58) and cumulative CD symptoms (HR = 1.38, 95% CI = 1.02-1.85) were associated with marijuana use onset. Recent anxiety symptoms were only associated with alcohol use onset among black participants.

CONCLUSIONS

Timing matters in the relationship between psychiatric symptoms and substance use onset in childhood and adolescence, and the psychiatric predictors of onset are substance-specific. There is no single sensitive developmental period for the influence of psychiatric symptoms on alcohol and marijuana use initiation.

Early adolescent growth in depression and conduct problem symptoms as predictors of later substance use impairment

Most studies of adolescent substance use and psychological comorbidity have examined the contributions of conduct problems and depressive symptoms measured only at particular points-in-time. Yet, during adolescence, risk factors such as conduct problems and depression exist within a developmental context, and vary over time. Though internalizing and comorbid pathways to substance use have been theorized (Hussong et al. Psychology of Addictive Behaviors 25:390-404, 2011), the degree to which developmental increases in depressive symptoms and conduct problems elevate risk for substance use impairment among adolescents, in either an additive or potentially a synergistic fashion, is unclear. Using a school-based sample of 521 adolescents, we tested additive and synergistic influences of changes in depressive symptoms and conduct problems from 6th to 9th grade using parallel process growth curve modeling with latent interactions in the prediction of late adolescent (12th grade) substance use impairment, while examining gender as a moderator. We found that the interaction between growth in depression and conduct disorder symptoms uniquely predicted later substance use problems, in addition to main effects of each, across boys and girls. Results indicated that adolescents whose parents reported increases in both depression and conduct disorder symptoms from 6th to 9th grade reported the most substance use-related impairment in 12th grade. The current study demonstrates that patterns of depression and conduct problems (e.g., growth vs. decreasing) are likely more important than the static levels at any particular point-in-time in relation to substance use risk.

Prevalence of mental health disorders among low-income African American adolescents

PURPOSE

Data on the prevalence of mental health disorders for low-income, urban African American adolescents are scarce. This study presents data about the burden of mental disorders for this understudied population.

METHODS

Mental disorders were assessed using the Diagnostic Interview Schedule for Children (C-DISC), Youth Self-Report (YSR), and Child Behavior Checklist (CBCL) among a sample of adolescents and their caregivers from very impoverished neighborhoods in a Southern city.

RESULTS

Based on the C-DISC, 3.8, 5.1 and 7.7% of adolescents met diagnostic criteria for major depression, post-traumatic stress disorder, and conduct disorder, respectively. There were significant differences among some of the mental health disorders based on adolescent and caregiver characteristics such as sex, school status, caregiver work status, and income level. We found a low prevalence of alcohol, marijuana, and substance abuse and dependence disorders.

CONCLUSIONS

Information about the prevalence of mental health disorders in specific communities and populations can assist in addressing unmet needs, planning for services and treatment, and reducing health disparities.

Impact of a 2-year multimodal intervention for disruptive 6-year-olds on substance use in adolescence: randomised controlled trial

BACKGROUND

Adolescent substance use is associated with both earlier childhood behavioural problems and serious lifetime addiction problems later in life.

AIMS

To examine whether, and through which mechanisms, targeting risk factors in early childhood prevents substance use across adolescence.

METHOD

Disruptive kindergarten boys (n = 172) living in Montreal were randomly allocated to a preventive intervention and a control condition. The intervention was delivered over 2 years (7-9 years of age) with two main components: (a) social and problem-solving skills training for the boys; and (b) training for parents on effective child-rearing skills.

RESULTS

Adolescent substance use, up to 8 years post-intervention, was reduced in those who received the intervention (d = 0.48-0.70). Of most interest, the intervention effects were explained partly by reductions in impulsivity, antisocial behaviour and affiliation with less deviant peers during pre-adolescence (11-13 years).

CONCLUSIONS

Adolescent substance use may be indirectly prevented by selectively targeting childhood risk factors that disrupt the developmental cascade of adolescent risk factors for substance use.

Prospective effects of adolescent indicators of behavioral disinhibition on DSM-IV alcohol, tobacco, and illicit drug dependence in young adulthood

OBJECTIVE

To identify robust predictors of drug dependence.

METHODS

This longitudinal study included 2361 male and female twins from an ongoing longitudinal study at the Center for Antisocial Drug Dependence (CADD) at the University of Colorado Boulder and Denver campuses. Twins were recruited for the CADD project while they were between the ages of 12 and 18. Participants in the current study were on average approximately 15years of age during the first wave of assessment and approximately 20years of age at the second wave of assessment. The average time between assessments was five years. A structured interview was administered at each assessment to determine patterns of substance use and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Fourth Edition) attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and drug dependence symptoms. Cloninger's Tridimensional Personality Questionnaire was also used to assess novelty seeking tendencies (NS). At the second wave of assessment, DSM-IV dependence symptoms were reassessed using the same interview. Path analyses were used to examine direct and indirect mechanisms linking psychopathology and drug outcomes.

RESULTS

Adolescent substance use, CD, and NS predicted young adult substance dependence, whereas the predictive effects of ADHD were few and inconsistent. Furthermore, CD and NS effects were partially mediated by adolescent substance use.

CONCLUSIONS

Adolescent conduct problems, novelty seeking, and drug use are important indices of future drug problems. The strongest predictor was novelty seeking.

National study of the role of recent illicit substance use on the relationship between depressive symptoms and sexual risk behavior among child welfare-involved adolescents

OBJECTIVE

The present study examined the association between early-adolescent depressive symptoms and lifetime sexual risk behavior and whether that association was moderated by recent illicit substance use among adolescents reported for maltreatment.

METHOD

Data came from Waves 1 (baseline) and 4 (36-month follow-up) of the National Survey of Child and Adolescent Well-Being, a national probability study of youths undergoing investigation for abuse or neglect (n = 861). Multivariate logistic regression was used to explore main effects and moderation models among baseline depressive symptoms, lifetime sexual risk behavior, and recent illicit substance use.

RESULTS

Baseline depressive symptoms and recent illicit drug use played little role in predicting ever having intercourse, age at first intercourse, or pregnancy. Recent use of illicit substances moderated the relationship between early-adolescent depressive symptoms and condom use behavior (odds ratio = 0.85, p < .001) such that individuals who were more depressed at baseline and who used illicit drugs within the last 30 days were less likely to have often/always used condoms. Conversely, individuals with higher levels of depressive symptoms at baseline who had not engaged in illicit substance use in the last 30 days were more likely to often use condoms during sexual activity.

CONCLUSIONS

Results suggest that among adolescents reported for maltreatment, use of illicit substances may moderate the relationship between elevated levels of depressive symptoms during early adolescence and condom use as children age thorough adolescence. Interventions for child welfare-engaged youths should focus on prevention and treatment of depression and substance use.

Negative affect shares genetic and environmental influences with symptoms of childhood internalizing and externalizing disorders

The co-occurrence of internalizing and externalizing disorders suggests that they may have common underlying vulnerability factors. Research has shown that negative affect is moderately positively correlated with both internalizing and externalizing disorders in children. The present study is the first to provide an examination of negative affect in relation to a wide spectrum of childhood internalizing and externalizing problems using a biometric model. This study extends prior findings of more narrowly focused associations by using a factor approach including multiple disorders. The sample for this study included families of 691 same-sex 7- to 13-year old twin pairs. A multifactorial independent pathway model was used to examine the genetic and environmental influences underlying the covariation of parent-reported negative affect, internalizing symptoms, and externalizing symptoms. Results of the current study suggest that negative affect shares genetic and environmental influences with both internalizing and externalizing disorders in childhood. These common influences may partially explain their comorbidity. Understanding that negative affect is at least one contributor to the covariation among these disorders may highlight avenues for early risk assessment, intervention, and perhaps prevention.

Psychosocial problems and recruitment of incentive neurocircuitry: exploring individual differences in healthy adolescents

Maturational differences in brain responsiveness to rewards have been implicated in the increased rates of injury and death in adolescents from behavior-related causes. However, much of this morbidity is related to drug intoxication or other externalizing behaviors, and may be concentrated in a subset of adolescents who are at psychosocial or neurobiological risk. To examine whether individual differences in psychosocial and behavioral symptomatology relate to activation of motivational neurocircuitry, we scanned 26 psychiatrically healthy adolescents using fMRI as they performed a monetary incentive delay task. Overall Problem Density on the Drug Use Screening Inventory (DUSI-OPD) correlated positively with activation of ventral mesofrontal cortex (mFC) during anticipation of responding for rewards (vs responding for no incentive). In addition, DUSI-OPD correlated positively with right ventral striatum recruitment during anticipation of responding to win rewards (vs responding for no incentive or to avoid losses of identical magnitudes). Finally, a psychophysiological interaction (PPI) analysis indicated that increased connectivity between nucleus accumbens and portions of anterior cingulate and mFC as a function of reward prospects also correlated with DUSI-OPD. These findings extend previous reports demonstrating that in adolescents, individual differences in reactivity of motivational neurocircuitry relate to different facets of impulsivity or externalizing behaviors.

Automatic processes in at-risk adolescents: the role of alcohol-approach tendencies and response inhibition in drinking behavior

AIMS

This study examined the association between automatic processes and drinking behavior in relation to individual differences in response inhibition in young adolescents who had just started drinking. It was hypothesized that strong automatic behavioral tendencies toward alcohol-related stimuli (alcohol-approach bias) were associated with higher levels of alcohol use, especially amongst adolescents with relatively weak inhibition skills.

DESIGN

To test this hypothesis structural equation analyses (standard error of mean) were performed using a zero inflated Poisson (ZIP) model. A well-known problem in studying risk behavior is the low incidence rate resulting in a zero dominated distribution. A ZIP-model accounts for non-normality of the data.

SETTING

Adolescents were selected from secondary Special Education schools (a risk group for the development of substance use problems).

PARTICIPANTS

Participants were 374 adolescents (mean age of M = 13.6 years).

MEASUREMENTS

Adolescents completed the alcohol approach avoidance task (a-AAT), the Stroop colour naming task (Stroop) and a questionnaire that assessed alcohol use.

FINDINGS

The ZIP-model established stronger alcohol-approach tendencies for adolescent drinkers (P < 0.01) and the interaction revealed a stronger effect of alcohol-approach tendencies on alcohol use in the absence of good inhibition skills (P < 0.05).

CONCLUSION

Automatically-activated cognitive processes are associated with the drinking behavior of young, at-risk adolescents. It appears that alcohol-approach tendencies are formed shortly after the initiation of drinking and particularly affect the drinking behavior of adolescents with relatively weak inhibition skills. Implications for the prevention of problem drinking in adolescents are discussed.

Prevalence and persistence of psychiatric disorders in youth after detention: a prospective longitudinal study

CONTEXT

Psychiatric disorders are prevalent among incarcerated juveniles. Most juveniles eventually return to their communities, where they become the responsibility of the community mental health system. However, no large-scale study has examined psychiatric disorders after youth leave detention.

OBJECTIVE

To examine changes in the prevalence and persistence of psychiatric disorders during the 5 years after detention, focusing on sex and racial/ethnic differences.

DESIGN

Prospective longitudinal study with up to 5 interviews (1829 youth: 1172 males and 657 females). To ensure representation of key demographic subgroups, the randomly selected sample was stratified by sex, race/ethnicity (African American, non-Hispanic white, and Hispanic), age, and legal status (juvenile or adult court).

SETTING

The Northwestern Juvenile Project, sampling youth from the Cook County Juvenile Temporary Detention Center, Chicago, Illinois.

PARTICIPANTS

Detained youth, aged 10 to 18 years at baseline interview.

MAIN OUTCOME MEASURES

At baseline, the Diagnostic Interview Schedule for Children Version 2.3. At follow-up interviews, the Diagnostic Interview Schedule for Children Version IV (Child and Young Adult versions) and the Diagnostic Interview Schedule Version IV (substance use disorders and antisocial personality disorder).

RESULTS

Five years after baseline, more than 45% of males and nearly 30% of females had 1 or more psychiatric disorders with associated impairment. More than 50% of males and more than 40% of females had 1 or more psychiatric disorders without impairment. Substance use disorders were the most common; males, however, had higher rates over time (5 years after baseline, adjusted odds ratio [AOR], 2.61; 95% CI, 1.96-3.47). Non-Hispanic whites and Hispanics also had higher rates of substance use disorders vs African Americans (AOR, 1.96; 95% CI, 1.54-2.49 and AOR, 1.59; 95% CI, 1.24-2.03). Females had higher rates of major depression over time (AOR, 1.59; 95% CI, 1.22-2.08).

CONCLUSIONS

Although prevalence rates of most psychiatric disorders declined as youth aged, a substantial proportion of delinquent youth continue to have disorders. There are notable sex and racial/ethnic differences in the prevalence and persistence of psychiatric disorders in this population.

School performance and hospital admission due to unipolar depression: a three-generational study of social causation and social selection

PURPOSE

Both "social causation" and "social selection" offer plausible explanations for an association between education and mental health. We aimed to explore these processes in unipolar depression, with a specific focus on school performance and family tradition of education.

METHOD

Grandchildren (N = 28,089, 49% female, aged 13-47 years in 2002) of a cohort born in Uppsala, Sweden, in 1915-1929 were studied in national registers. We obtained data on final grade point average (GPA) in compulsory school, hospitalizations for unipolar depression, grandparental/parental education and other parental social characteristics. Hospitalization in adolescence and adulthood were studied separately, as were hospitalization for depression with or without a lifetime externalizing disorder.

RESULTS

Low compulsory school GPA (1-2 SD or >2 SD below average vs. average GPA) was associated with increased rate of adolescent hospitalization for unipolar depression, both with externalizing comorbidity [hazard ratio (HR) point estimates of 66-80] and without (HR point estimates of 4-6). By contrast, low GPA was only associated with first-time hospitalization in adulthood for the subgroup with externalizing comorbidity (HR point estimates of 4-6). These associations were largely independent of family education and social characteristics. Overall, low parental/grandparental education was not related to increased rates of hospitalization.

CONCLUSION

The association between school performance and hospitalization for depression depended on adolescent hospitalization or externalizing comorbidity, suggesting that disorders with an early onset are decisive. Contrary to the social patterning of many health outcomes, low grandparental/parental education did not appear to increase the rate of hospitalization for unipolar depression in the offspring.

The longitudinal prediction of alcohol consumption-related harms among young adults

This study explores the longitudinal pathways by which risk and protective factors influence the development of alcohol-related harms in a representative community sample of 941 young adults (19-20 years) from Victoria, Australia, focusing on the role of concurrent risky drinking. Impulsivity at 15-16 years, alcohol-related harms at 15-16 years and 17-18 years, frequency of intoxication at 17-18 years, and antisocial behavior, friends' drinking and living arrangements at 19-20 years were directly related to alcohol-related harms, as well as indirectly related to harms through increased risky drinking. Paternal drinking at 17-18 years was directly related to alcohol-related harms. Friends' drinking at 19-20 years and alcohol-related harms at age 17-18 interacted with risky drinking to increase the likelihood of alcohol-related harms. Implications for intervention efforts are discussed.

Morphological evidence of an altered process of synaptic transcytosis in adult rats exposed to ethanol

AIMS

The effects of ethanol exposure on synaptic structure were investigated in the nucleus of solitary tract (NST) in rats, using the horse-radish peroxidase (HRP) method.

METHODS

Eight-week-old experimental rats were allowed free access to a liquid diet containing ethanol for 3 weeks, while controls were given an isocaloric diet. Some of the control and experimental animals were given an injection of wheat germ agglutinin conjugated with HRP (WGA-HRP) into the vagus nerve toward the end of the treatment period. After the treatment, the neuropil region of the NST was examined under an electron microscope.

RESULTS

We observed that a few terminals were characterized by deep indentation of axodendritic membranes into the post-synaptic neurons. This appeared to be similar to that commonly seen in exocrine glands. Interestingly, the indented portion often contained various sizes of vacuoles and flattened cisternae. HRP-reaction product (RP) transported to terminals was recognized easily as an electron-dense lysosomal substance when lead citrate staining was omitted. Terminals containing HRP-RP also revealed quite a similar structure with indentation of axodendritic membranes as described earlier. The results are considered to confirm that terminals forming 'apocrine-like structures' observed in the ethanol-fed animals with no injection of WGA-HRP originate from afferent fibers of the vagus nerve.

CONCLUSION

The present study suggests the possibility that the alteration of the synaptic structure induced by ethanol exposure can lead to the neuronal transcytosis of materials including proteins which is different from the normal vesicular exocytosis involved in chemical synaptic transmission.

Prevalence, patterns, and correlates of co-occurring substance use and mental disorders in the United States: variations by race/ethnicity

OBJECTIVE

This study examines racial/ethnic differences in the prevalence, patterns, and correlates of co-occurring substance use and mental disorders (COD) among Whites, Blacks, Latinos, and Asians using data from the Collaborative Psychiatric Epidemiology Studies.

METHOD

We first estimated the prevalence of various combinations of different co-occurring depressive and anxiety disorders among respondents with alcohol, drug, and any substance use (alcohol or drug) disorders in each racial/ethnic group. We then estimated the prevalence of different patterns of onset and different psychosocial correlates among individuals with COD of different racial/ethnic groups. We used weighted linear and logistic regression analysis controlling for key demographics to test the effect of race/ethnicity. Tests of differences between specific racial/ethnic subgroups were only conducted if the overall test of race was significant.

RESULTS

Rates of COD varied significantly by race/ethnicity. Approximately 8.2% of Whites, 5.4% of Blacks, 5.8% of Latinos, and 2.1% of Asians met criteria for lifetime COD. Whites were more likely than persons in each of the other groups to have lifetime COD. Irrespective of race/ethnicity, most of those with COD reported that symptoms of mental disorders occurred before symptoms of substance use disorders. Only rates of unemployment and history of psychiatric hospitalization among individuals with COD were found to vary significantly by racial/ethnic group.

CONCLUSIONS

Our findings underscore the need to further examine the factors underlying differences between minority and nonminority individuals with COD as well as how these differences might affect help seeking and utilization of substance abuse and mental health services.

Emotional health predictors of substance use initiation during middle school

This study aimed to evaluate whether emotional health factors, including anxiety and depression, stress, and social support, are associated with earlier youth initiation of alcohol and illicit substances during middle school (from the sixth to the eighth grade). Data for this study were from the Developmental Pathways Project, a longitudinal study of 521 youth sampled from the Seattle Public Schools. Discrete time survival analyses were used to assess the effects of depression, anxiety, stress, and support on initiation of substance use, measured every 6 months at five time points between sixth and eighth grade. Youth who had initiated prior to sixth grade had significantly higher levels of depressive symptoms. In multivariate survival analyses controlling for child race/ethnicity, gender, and socioeconomic status, and accounting for conduct problems, youth who reported higher levels of separation anxiety/panic symptoms were at decreased risk for early alcohol initiation. Children with higher levels of perceived teacher support had a significantly lower risk of alcohol initiation during early follow-up periods. Recent stressful life events in Grade 6 were associated with significantly greater risk of initiating an illicit substance by Grade 8. The current findings highlight the role of stress in the initiation of illicit substance use and suggest that teacher support is associated with lower risk for very early alcohol use. Future research examining anxiety as a predictor of substance use should distinguish between subtypes of anxiety.

Developmental pathways linking externalizing symptoms, internalizing symptoms, and academic competence to adolescent substance use

This study extends previous research investigating the developmental pathways predicting adolescent alcohol and marijuana use by examining the cascading effects of externalizing and internalizing symptoms and academic competence in the prediction of use and level of use of these substances in adolescence. Participants (N=191) were drawn from a longitudinal study of first-born children of low-income mothers. Using data from ages 7, 9, 12, and 16 years, a series of nested two-part (semi-continuous) path models from a developmental cascade modeling framework were compared. Controlling for gender, SES, mother's age at child's birth, and minority status, we found (a) within-domain rank-order stability across time, (b) significant cross-domain effects over time, (c) higher externalizing symptoms significantly predicted use of alcohol and marijuana as well as higher levels of use in adolescence, and (d) higher levels of academic competence significantly added to the prediction of use of alcohol.

A systematic review of global publication trends regarding long-term outcomes of ADHD

There is increased global recognition of attention deficit hyperactivity disorder (ADHD) as a serious medical condition with long-term consequences. Although originally conceived of as a childhood disorder, ADHD is being increasingly recognized in adults. Individual geographic regions may have specific interests and objectives for the study of ADHD. A systematic review of long-term outcomes (LTOs) in ADHD was conducted to evaluate research on ADHD LTOs on a global scale. Studies that were at least 2 years in duration were examined. A total of 351 studies were identified in the final analysis. We identified nine outcomes of interest and classified studies by specific geographical regions, age groups studied and study design by region and over time. Published studies of LTOs in ADHD have increased in all geographical regions over the past three decades, with a peak number of 42 publications in 2008. This rise in publications on ADHD LTOs may reflect a rise in global interest and recognition of consequences and impairment associated with ADHD. Although many world regions have published on ADHD LTOs, the majority of studies have emerged from the US and Canada, followed by Europe. While investigators in the US and Canada were predominantly interested in drug addiction as a LTO, European researchers were more interested in antisocial behavior, and Eastern Asian investigators focused on both of these LTOs as well as self-esteem. Geographical differences in the focus of ADHD LTO studies may reflect regional variations in cultural values. Proportionally fewer prospective longitudinal studies and proportionally more retrospective and cross-sectional studies have been published in more recent decades. Finally, more studies focusing on ADHD in adolescents and adults have been conducted in recent years, and particularly adolescents in Eastern Asia. These changes in basic study design may reflect an increase in the recognition that ADHD is a lifetime chronic disorder. This systematic review analysis of publication trends in ADHD LTOs reflects geographically based interests that change over time.

Anxiety disorders and substance use disorders: different associations by anxiety disorder

Anxiety disorders (ADs) and substance use disorders (SUDs) often occur together, but the strength of this association and their apparent order of onset differ across studies. The goals of this study were to examine: (1) which ADs were associated with which SUDs, and (2) among people who experienced both an AD and a SUD, which disorder had an earlier onset. Lifetime diagnoses from the National Comorbidity Survey-Replication (n=9282) were used. Social phobia, generalized anxiety disorder, panic disorder, and agoraphobia were positively associated with all SUDs. Among people with both an AD and a SUD, the order of onset differed by anxiety type: social phobia nearly always had an onset prior to any SUD; panic disorder and agoraphobia tended to occur prior to some SUDs; and generalized anxiety disorder tended to occur after the onset of at least one SUD. Therefore, all ADs are positively associated with SUDs, but ADs differ in the timing of their onset relative to comorbid SUDs.

Association of adolescent symptoms of depression and anxiety with alcohol use disorders in young adulthood: findings from the Victorian Adolescent Health Cohort Study

OBJECTIVE

To examine the association of adolescent depression and anxiety symptoms with alcohol abuse or dependence in young adulthood.

DESIGN, SETTING AND PARTICIPANTS

Cohort study of the health and wellbeing of adolescents and young adults in Victoria, assessed at 8 waves (periods) of data collection, from age 14 to 24 years, between 1992 and 2003. Young people who participated in the cohort study at least once during the six adolescent assessment points (conducted 6 months apart, from age 14 to 17 years), at least once during young adulthood and who were alive at Wave 8 (n = 1758).

MAIN OUTCOME MEASURE

Alcohol abuse or dependence assessed using the alcohol and substance abuse modules of the Composite International Diagnostic Interview at age 24 years.

RESULTS

Adolescents with moderate to high levels of depression and anxiety symptoms (measured by the revised Clinical Interview Schedule) had an increased risk of alcohol abuse or dependence in young adulthood, compared with young adults with low levels of adolescent depression and anxiety symptoms, after adjusting for potential confounding factors. Risk was higher for those with symptoms at more than two adolescent assessment points (odds ratio [OR] 1.9; 95% CI, 1.7-2.0) and for those with symptoms at one or two assessment points (OR 1.3; 95% CI, 1.2-1.4), compared with those with no above-threshold symptoms in adolescence.

CONCLUSIONS

Adolescents with depression and anxiety symptoms are at increased risk for alcohol use disorders into young adulthood. They warrant vigilance from primary care providers in relation to alcohol use well into adulthood.

Personality correlates of the common and unique variance across conduct disorder and substance misuse symptoms in adolescence

Externalising behaviours such as substance misuse (SM) and conduct disorder (CD) symptoms highly co-occur in adolescence. While disinhibited personality traits have been consistently linked to externalising behaviours there is evidence that these traits may relate differentially to SM and CD. The current study aimed to assess whether this was the case, after examining the nature of the relationship between SM and CD symptoms in an adolescent sample (N = 392), using structural equation modelling. Similar to those found in adults (Krueger et al. Journal of Abnormal Psychology 116: 645-666, 2007), results showed that CD and SM symptoms were organized hierarchically, with symptoms explaining a single broad, coherent construct of externalising behaviour, but also explaining specific factors of SM and CD that vary independently from the general externalising factor. Furthermore, disinhibited personality traits related differentially to these factors, with results showing that, even controlling for inhibited personality traits, impulsivity was associated with CD and the common variance shared by CD and SM, while sensation seeking was specifically associated with SM only. Hopelessness was also associated with the common variance shared by SM and CD. Results confirm impulsivity, hopelessness and sensation seeking as key correlates of externalising behaviour problems in adolescence, identifying them as clear targets for intervention and prevention strategies.

Friends or foes: social anxiety, peer affiliation, and drinking in middle school

OBJECTIVE

The relation between social anxiety and alcohol consumption suggests aspects of both risk and protection, but most research has focused on late adolescents and emerging adults.

METHOD

We investigated the synergistic impact of social anxiety, a need for affiliation with others, and perceived peer alcohol use on drinking in a sample of more than 1,500 early adolescents from southern California (48% girls). Via school-wide surveys, middle school students completed the Social Anxiety Scale for Children-Revised, a modified version of the Interpersonal Orientation Scale, as well as measures of perceived peer drinking and self-reported lifetime and current drinking.

RESULTS

For socially anxious youths, high levels of perceived peer use in conjunction with high levels of affiliation need was associated with greater alcohol use on average and more frequent episodic drinking. Specific to heavy episodic drinking, the interaction of social anxiety and perceived peer drinking seemed to affect girls and boys differentially. Sex differences emerged for the moderation of social anxiety's influence on drinking initiation by perceived peer influence.

CONCLUSIONS

These findings suggest that alcohol-related risks associated with social anxiety might be gender specific and more important in earlier stages of alcohol use than previously believed.

Conduct disorder and psychosocial outcomes at age 30: early adult psychopathology as a potential mediator

Conduct disorder (CD) is associated with a number of adverse psychosocial outcomes in adulthood. There is consistent evidence that CD is predictive of antisocial behavior, but mixed evidence that CD is predictive of other externalizing and internalizing disorders. Further, externalizing and internalizing disorders are often associated with similar psychosocial outcomes as CD. However, relatively little work has examined whether forms of psychopathology (e.g., externalizing and/or internalizing disorders) mediates the relationship between youth CD and adult psychosocial outcomes. The present study examined associations between youth CD and adult psychosocial outcomes and sought to identify forms of psychopathology that may potentially mediate this relationship. Participants completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and young adulthood. Analyses found that most domains of adult psychosocial functioning were associated with youth CD. Adult antisocial behavior was the only form of psychopathology predicted by CD. Adult antisocial behavior appeared to mediate the relationship between CD and marital status, life satisfaction, and being in jail and partially mediated the relationship between CD and family support and global functioning. These data suggest that reducing the progression to adult antisocial behavior may improve multiple psychosocial outcomes among those with a history of CD.

Personality moderates the longitudinal relationship between psychological symptoms and alcohol use in adolescents

BACKGROUND

A great deal of research has emerged on the comorbidity between alcohol misuse and psychological symptoms (e.g., depression, anxiety, and antisocial behavior or conduct disorder) in adolescence. Research has also shown that personality traits underlie vulnerability to alcohol use and psychological symptoms, but how personality moderates this association has not been comprehensively examined. The goals of this study are to clarify (i) whether early alcohol use effects the rate of change of psychological symptoms and vice versa, (ii) whether initial levels and rate of change in both domains vary according to individual differences in personality traits, and (iii) whether personality moderates the relationship between alcohol use and psychological symptoms.

METHODS

Self-reported alcohol use, depression, anxiety, and antisocial behavior were collected from 393 adolescents at four separate time points across an 18-month period. Parallel growth models were used to assess the main objectives of the study. Personality traits [anxiety sensitivity (AS), hopelessness (H), impulsivity (IMP), and sensation seeking (SS)] were included as time-invariant predictors of initial levels and rates of change of each construct.

RESULTS

The results indicated that elevated levels of depression predicted faster rates of increase in alcohol use. Personality-specific relationships were demonstrated across all models. IMP was shown to moderate the relationship between alcohol use and depression, suggesting that adolescents who showed a susceptibility to elevated levels of IMP, and heavier drinking were less likely to demonstrate a normative decline in depression. Adolescents with higher levels of AS and anxiety were more likely to show a faster rate of increase in alcohol use.

CONCLUSIONS

These results highlight the importance of examining personality traits in studying the associations between alcohol use and psychological symptoms.

Anxiety Psychopathology and Alcohol Use among Adolescents: A Critical Review of the Empirical Literature and Recommendations for Future Research

Adolescent alcohol use is a critical public health concern; accordingly, a considerable body of work exists identifying developmentally salient risk and protective factors. One area receiving increasing attention among adults is the linkage between specific constellations of anxiety psychopathology and alcohol use problems. Relatively less is known about such linkages among adolescents, despite the onset of both anxiety-type problems and alcohol use during this developmental period. The current review presents a detailed summary and analysis of the empirical literature focused on specific forms of anxiety psychopathology as they relate to alcohol use among adolescents, and provides a number of specific recommendations for future work with an emphasis on the utility of experimental psychopathology techniques for clarifying basic questions and forwarding this body of work.

Hopelessness and Excessive Drinking among Aboriginal Adolescents: The Mediating Roles of Depressive Symptoms and Drinking to Cope

Canadian Aboriginal youth show high rates of excessive drinking, hopelessness, and depressive symptoms. We propose that Aboriginal adolescents with higher levels of hopelessness are more susceptible to depressive symptoms, which in turn predispose them to drinking to cope-which ultimately puts them at risk for excessive drinking. Adolescent drinkers (n = 551; 52% boys; mean age = 15.9 years) from 10 Canadian schools completed a survey consisting of the substance use risk profile scale (hopelessness), the brief symptom inventory (depressive symptoms), the drinking motives questionnaire-revised (drinking to cope), and quantity, frequency, and binge measures of excessive drinking. Structural equation modeling demonstrated the excellent fit of a model linking hopelessness to excessive drinking indirectly via depressive symptoms and drinking to cope. Bootstrapping indicated that this indirect effect was significant. Both depressive symptoms and drinking to cope should be intervention targets to prevent/decrease excessive drinking among Aboriginal youth high in hopelessness.

Associations between first use of substances and change in internalizing symptoms among girls: differences by symptom trajectory and substance use type

This study examined how girls' initial use of alcohol, cigarettes, and marijuana related to changes in depressive, generalized anxiety, and social anxiety symptoms, and whether these changes varied based on which internalizing symptom trajectories the girls were on. Data came from the Pittsburgh Girls Study, a community-based study of girls assessed at ages 5 to 8 and followed for 6 years. Growth mixture modeling was used to identify trajectory groups. The results indicated that for girls on a "high depressive symptom" trajectory, initial use of marijuana was related to further increases in depressive symptoms. Initial uses of alcohol and cigarettes were associated with overall increases in depressive symptoms, and the initial use of cigarettes was associated with an overall increase in generalized anxiety symptoms. Initial use of all substances was related to change in social anxiety, but the direction of change varied by trajectory group and substance. Links between initial use and internalizing symptoms depended on the type of substance, type of internalizing symptom, and trajectory group.

Substance use and common child mental health problems: examining longitudinal associations in a British sample

AIMS

To examine the longitudinal associations in both directions between mental health and substance use in adolescence.

DESIGN

Three-year longitudinal cohort.

SETTING

Britain (nationally representative sample).

PARTICIPANTS

3607 youths aged 11-16 years at baseline.

MEASUREMENTS

Externalizing and internalizing mental health problems were measured using brief questionnaires (parent-reported Strengths and Difficulties Questionnaire) and diagnostic interviews, including clinician-rated diagnoses of mental disorder. Substance use was measured by youth self-report, and included regular smoking, frequent alcohol consumption, regular cannabis use and ever taking other illicit drugs.

FINDINGS

Externalizing (specifically behavioural) problems at baseline independently predicted all forms of substance use, with a particularly strong effect on smoking. In all cases this association showed a dose-response relationship. In contrast, although internalizing problems had a strong univariable association with smoking, this disappeared after adjusting for comorbid externalizing problems. There was little or no evidence that baseline substance use predicted mental health at follow-up.

CONCLUSIONS

Externalizing problems predict adolescent substance use, and adjusting for comorbid externalizing problems is vital when investigating the effects of internalizing problems. A dose-response effect of externalizing problems is seen across the full range. Programmes seeking to prevent adolescent substance use by reducing externalizing problems may therefore wish to consider population-wide interventions rather than targeting individuals only at the negative extreme.

Adolescents, adults and rewards: comparing motivational neurocircuitry recruitment using fMRI

BACKGROUND

Adolescent risk-taking, including behaviors resulting in injury or death, has been attributed in part to maturational differences in mesolimbic incentive-motivational neurocircuitry, including ostensible oversensitivity of the nucleus accumbens (NAcc) to rewards.

METHODOLOGY/PRINCIPAL FINDINGS

To test whether adolescents showed increased NAcc activation by cues for rewards, or by delivery of rewards, we scanned 24 adolescents (age 12-17) and 24 adults age (22-42) with functional magnetic resonance imaging while they performed a monetary incentive delay (MID) task. The MID task was configured to temporally disentangle potential reward or potential loss anticipation-related brain signal from reward or loss notification-related signal. Subjects saw cues signaling opportunities to win or avoid losing $0, $.50, or $5 for responding quickly to a subsequent target. Subjects then viewed feedback of their trial success after a variable interval from cue presentation of between 6 to 17 s. Adolescents showed reduced NAcc recruitment by reward-predictive cues compared to adult controls in a linear contrast with non-incentive cues, and in a volume-of-interest analysis of signal change in the NAcc. In contrast, adolescents showed little difference in striatal and frontocortical responsiveness to reward deliveries compared to adults.

CONCLUSIONS/SIGNIFICANCE

In light of divergent developmental difference findings between neuroimaging incentive paradigms (as well as at different stages within the same task), these data suggest that maturational differences in incentive-motivational neurocircuitry: 1) may be sensitive to nuances of incentive tasks or stimuli, such as behavioral or learning contingencies, and 2) may be specific to the component of the instrumental behavior (such as anticipation versus notification).