Childhood trajectories of inattention, hyperactivity and oppositional behaviors and prediction of substance abuse/dependence: a 15-year longitudinal population-based study

Factors Associated With Cocaine Use at 17 and 20 Years Old: A Longitudinal Analysis of a Nationally Representative Cohort

PURPOSE

Despite growing concerns about trends in cocaine use, there is a shortage of longitudinal research that prospectively examines risk and protective factors associated with cocaine initiation and use in general youth populations. This study addresses this gap.

METHODS

Growing Up in Ireland is a nationally representative cohort. Individual, family, and socio-environmental exposures associated with incident past-year cocaine use at ages 17 (N = 5965) and 20 (n = 4549) were assessed with survey-weighted logistic regression using generalised estimating equations. Prevalent past-year cocaine use at 20 (N = 4679) was analysed using generalised estimating equations complemented by gradient-boosted decision trees and Shapley explanations.

RESULTS

221 (3.7%) self-reported cocaine use at 17 and 1072 (22.9%) at 20. Alcohol use at 14 or younger was associated with eight times the odds of cocaine use at 17 (aOR 8.0, 95% CI 1.7-37.3) and 19 times at 20 (aOR 19.2, 95% CI 8.6-43.2). Peer cannabis use was associated with 7 times the odds of cocaine use at 17 (aOR 7.3, 95% CI 2.9-18.3) and double at 20 (aOR 2.4, 95% CI 1.8-3.2). Growing up in a neighbourhood where substance use was common doubled the odds of cocaine use at 17 (aOR 2.4, 95% CI 1.3-4.4). Shapley explanations revealed individual-specific positive or negative impacts of exposures.

DISCUSSION

Cocaine use among 20-year-olds in Ireland is higher than reported internationally, and increases sharply between the ages of 17 and 20, suggesting a need for interventions targeting this age group. However, associations with early adolescent factors suggest that early interventions may also be important.

Associations of maternal peripregnancy cannabis use with behavioral and developmental outcomes in children with and without symptoms of autism spectrum disorder: Study to Explore Early Development

Some studies report increased prevalence of autism spectrum disorder (ASD) and associated symptoms with prenatal cannabis exposure. We examined whether associations of maternal cannabis use from 3 months preconception through delivery ("peripregnancy") with behavior and development in the offspring varied with the presence of ASD symptoms. Children ages 30-68 months with ASD symptoms (i.e., met study criteria for ASD or had ASD symptoms on standardized assessments or community ASD diagnosis, N = 2734) and without ASD symptoms (other developmental delay/disorders or general population sample, N = 3454) were evaluated with the Child Behavior Checklist and Mullen Scales of Early Learning. We examined cannabis use during three time periods: peripregnancy, pregnancy, and only preconception. Peripregnancy cannabis exposure was reported for 6.0% of children with and 4.6% of children without ASD symptoms. Preconception-only cannabis use (versus no use) was associated with more aggressive behavior, emotional reactivity, and sleep problems in children with ASD symptoms, but not in children without ASD symptoms. Cannabis use during pregnancy was associated with increased attention and sleep problems in children with ASD symptoms; these associations did not differ significantly by ASD symptoms. Peripregnancy cannabis use was not associated with child developmental abilities regardless of ASD symptoms. In summary, associations of peripregnancy cannabis use with some behavioral outcomes differed in children with and without ASD symptoms. With rising cannabis use among pregnant women, future studies that examine a range of developmental risks associated with timing and patterns of cannabis use prior to conception as well as during pregnancy could inform clinical guidance.

Exploring Health Informatics in the Battle against Drug Addiction: Digital Solutions for the Rising Concern

Drug addiction is a rising concern globally that has deeply attracted the attention of the healthcare sector. The United States is not an exception, and the drug addiction crisis there is even more serious, with 10% of adults having faced substance use disorder, while around 75% of this number has been reported as not having received any treatment. Surprisingly, there are annually over 70,000 deaths reported as being due to drug overdose. Researchers are continually searching for solutions, as the current strategies have been ineffective. Health informatics platforms like electronic health records, telemedicine, and the clinical decision support system have great potential in tracking the healthcare data of patients on an individual basis and provide precise medical support in a private space. Such technologies have been found to be useful in identifying the risk factors of drug addiction among people and mitigating them. Moreover, the platforms can be used to check prescriptions of addictive drugs such as opioids and caution healthcare providers. Programs such as the Prescription Drug Monitoring Program (PDMP) and the Drug and Alcohol Services Information Systems (DASIS) are already in action in the US, but the situation demands more in-depth studies in order to mitigate substance use disorders. Artificial intelligence (AI), when combined with health informatics, can aid in the analysis of large amounts of patient data and aid in classifying nature of addiction to assist in the provision of personalized care.

Association between ADHD symptoms and illicit stimulants use following 1 year among French university students of the i-Share cohort

PURPOSE

Although attention deficit hyperactivity disorder (ADHD) has been associated with illicit stimulants use, less is known about their prospective association in university students. We aimed to examine the association between ADHD symptoms at inclusion and illicit stimulants use following 1 year among university students.

METHODS

The i-Share cohort recruited French students from February 2013 to July 2020. The study included 4270 participants. The Adult ADHD Self-Report Scale (ASRS) was used to evaluate ADHD symptoms at inclusion. Illicit stimulants use was assessed at inclusion and 1 year after inclusion. Multivariable logistic regressions were conducted to assess the association between ADHD symptoms at inclusion and illicit stimulants use following 1 year.

RESULTS

High levels of ADHD symptoms at inclusion were associated with a greater probability of illicit stimulants use following 1 year (adjusted OR: 2.42 (1.51-3.8)). The adjusted odds ratio was 2.7 (1.08-7.84) among participants who had used illicit stimulant at least once (continuation) and 2.25 (1.04-4.37) among participants who had never used illicit stimulants at inclusion (initiation).

CONCLUSION

High levels of ADHD symptoms are a feature that may promote both initiation and continuation of illicit stimulants use among university students. Our findings suggest that university students with high levels of ADHD symptoms may benefit from screening to help identify those at risk of illicit stimulants use.

Effects of Stimulant Treatment on Changes in Brain Activation During Reward Notifications in Drug Naïve Youth With ADHD

BACKGROUND

Research examining the potential effects of stimulant exposure in childhood on subsequent development of substance use disorder (SUD) have focused on differences in the brain reward system as a function of risk.

METHODS

18 drug naïve children ages 7 to 12 years (11 High Risk [ADHD + ODD/CD]; 7 Low Risk [ADHD only]), underwent fMRI scans before and after treatment with mixed amphetamine salts, extended release (MAS-XR). We examined correlations between clinical ratings and fMRI activation at baseline and following treatment as a function of risk status.

RESULTS

High Risk children had higher activation than Low Risk children at baseline during both the Reward and Surprising Non-Reward conditions. Treatment produced strong differential effects on brain activation pertinent to group and reward outcome.

CONCLUSIONS

Findings support the hypothesized role of reward mechanisms in SUD risk, and suggest that stimulant treatment may have differential effects on reward processing in relation to SUD risk.

Adolescent Cannabis Use, Comorbid Attention-Deficit/Hyperactivity Disorder, and Other Internalizing and Externalizing Disorders

Cannabis use often co-occurs with attention-deficit/hyperactivity disorder and other internalizing and externalizing disorders. Treatment planning, including pharmacologic and psychosocial interventions, for these comorbid disorders require thorough diagnostic evaluation to determine the extent of social, emotional, and behavioral impairments, severity of substance use, and motivation for change. Improved understanding of these comorbid disorders will inform treatment planning that address current symptoms and behaviors and may also prevent the development of mental health and substance use disorders in early adulthood.

Joint Developmental Trajectories of Conduct Problems and Hyperactivity/Inattention: Antecedent Risk Markers for Group Membership

This study investigated joint trajectories of conduct problems and hyperactivity/inattention from age three to nine in a cohort of 7,507 children in Ireland (50.3% males; 84.9% Irish). The parent-reported Strengths and Difficulties Questionnaire was used to collect information on conduct problems (CP) and hyperactivity/inattention (HI). Information regarding risk markers was collected when participants were nine-months-old via parent report and standardised assessments. Using a person-centred approach (i.e., group-based multi trajectory modelling), six trajectories were identified: no CP/low HI, low-stable CP/HI, low-declining CP/stable HI, desisting co-occurring CP/HI, pure-increasing HI, and high chronic co-occurring CP/HI. Specific risk markers for group membership included: male sex; birth complications; perceived difficult temperament; lower primary caregiver age and education level, and higher stress level; prenatal exposure to smoking, and indicators of lower socioeconomic status. Primary caregiver-child bonding and having siblings were protective markers against membership in elevated groups. Results suggest support for both 'pure' HI and co-occurring trajectories of CP and HI emerging in toddlerhood. However, no support was found for a 'pure' CP trajectory, which may support the suggestion that children on a persistent CP trajectory will have coexisting HI. Intervention efforts may benefit from starting early in life and targeting multiple risk markers in families with fewer resources.

A mechanical task for measuring sign- and goal-tracking in humans: A proof-of-concept study

Cue-based associative learning (i.e., Pavlovian conditioning) is a foundational component of behavior in almost all forms of animal life and may provide insight into individual differences in addiction liability. Cues can take on incentive-motivational properties (i.e., incentive salience) through Pavlovian learning. Extensive testing with non-human animals (primarily rats) has demonstrated significant variation among individuals in the behaviors this type of learning evokes. So-named "sign-trackers" and "goal-trackers" have been examined in many studies of non-human animals, but this work in humans is still a nascent area of research. In the present proof-of-concept study, we used a Pavlovian conditioned approach task to investigate human sign- and goal-tracking in emerging adults. Conditioned behaviors that developed over the course of the task were directed toward the reward-cue and toward the reward location. Participants' eye-gaze and behavior during the task were submitted to a latent profile analysis, which revealed three groups defined as sign-trackers (n = 10), goal-trackers (n = 4), and intermediate responders (n = 36). Impulsivity was a significant predictor of the sign-tracking group relative to the goal-tracking group. The present study provides preliminary evidence that a simple procedure can produce learned Pavlovian conditioned approach behavior in humans. Though further investigation is required, findings provide a promising step toward the long-term goal of translating important insights gleaned from basic research into treatment strategies that can be applied to clinical populations.

Multi-Trajectories of Conduct Problems, Hyperactivity/Inattention, and Peer Problems Across Childhood: Results from the Growing Up in Scotland Birth Cohort

Using a person-centred approach, this study inspected multi-trajectories of conduct problems, hyperactivity/inattention and peer problems, and associated risk factors for group membership. The sample included 3,578 children (50.8% males) from a population birth cohort in Scotland (Growing Up in Scotland). The parental version of the Strengths and Difficulties Questionnaire (SDQ) was used when children were 4, 5, 6, 7, and 10 years old. Antecedent factors at the perinatal, child, and family levels were collected using parental reports, observation, and standardised assessments at 10, 24, and 36 months. A group-based multi-trajectory analysis was employed. Findings showed that a six-group model best fit the data. Identified groups included non-engagers, normative, decreasing externalising/low peer problems, low externalising/moderate peer problems, moderate externalising/increasing peer problems and multimorbid moderate-high chronic. Findings suggest multimorbidity between externalising behaviours and peer problems in the more elevated groups. Two common protective factors emerged across all groups: caregiver mental health and parent-infant attachment. Identified risk factors were specific to group membership. Risk factors for the most elevated group included single-parent status, social deprivation, previous neonatal intensive care unit admission, child sex, whilst children's expressive language was a protective factor. Taken together, findings contribute to the emerging literature modelling trajectories of externalising behaviours and peer problems simultaneously and have important practical implications for prevention of problems in childhood, by identifying targets at the perinatal, child, and family levels.

Multi-Trajectories of Conduct Problems, Hyperactivity/Inattention, and Peer Problems Across Childhood: Results from the Growing Up in Scotland Birth Cohort

Using a person-centred approach, this study inspected multi-trajectories of conduct problems, hyperactivity/inattention and peer problems, and associated risk factors for group membership. The sample included 3,578 children (50.8% males) from a population birth cohort in Scotland (Growing Up in Scotland). The parental version of the Strengths and Difficulties Questionnaire (SDQ) was used when children were 4, 5, 6, 7, and 10 years old. Antecedent factors at the perinatal, child, and family levels were collected using parental reports, observation, and standardised assessments at 10, 24, and 36 months. A group-based multi-trajectory analysis was employed. Findings showed that a six-group model best fit the data. Identified groups included non-engagers, normative, decreasing externalising/low peer problems, low externalising/moderate peer problems, moderate externalising/increasing peer problems and multimorbid moderate-high chronic. Findings suggest multimorbidity between externalising behaviours and peer problems in the more elevated groups. Two common protective factors emerged across all groups: caregiver mental health and parent-infant attachment. Identified risk factors were specific to group membership. Risk factors for the most elevated group included single-parent status, social deprivation, previous neonatal intensive care unit admission, child sex, whilst children's expressive language was a protective factor. Taken together, findings contribute to the emerging literature modelling trajectories of externalising behaviours and peer problems simultaneously and have important practical implications for prevention of problems in childhood, by identifying targets at the perinatal, child, and family levels.

Adolescent Cannabis Use, Comorbid Attention-Deficit/Hyperactivity Disorder, and Other Internalizing and Externalizing Disorders

Cannabis use often co-occurs with attention-deficit/hyperactivity disorder and other internalizing and externalizing disorders. Treatment planning, including pharmacologic and psychosocial interventions, for these comorbid disorders require thorough diagnostic evaluation to determine the extent of social, emotional, and behavioral impairments, severity of substance use, and motivation for change. Improved understanding of these comorbid disorders will inform treatment planning that address current symptoms and behaviors and may also prevent the development of mental health and substance use disorders in early adulthood.

Does cannabis use predict aggressive or violent behavior in psychiatric populations? A systematic review

Background: Despite an increase in information evaluating the therapeutic and adverse effects of cannabinoids, many potentially important clinical correlates, including violence or aggression, have not been adequately investigated.Objectives: In this systematic review, we examine the published evidence for the relationship between cannabis and aggression or violence in individuals with psychiatric disorders.Methods: Following PRISMA guidelines, articles in English were searched on PubMed, Google Scholar, MEDLINE, and PsycINFO from database inception to January 2022. Data for aggression and violence in people with psychiatric diagnoses were identified during the searches.Results: Of 391 papers identified within the initial search, 15 studies met inclusion criteria. Cross-sectional associations between cannabis use and aggression or violence in samples with post-traumatic stress disorder (PTSD) were found. Moreover, a longitudinal association between cannabis use and violence and aggression was observed in psychotic-spectrum disorders. However, the presence of uncontrolled confounding factors in the majority of included studies precludes any causal conclusions.Conclusion: Although cannabis use is associated with aggression or violence in individuals with PTSD or psychotic-spectrum disorders, causal conclusions cannot be drawn due to methodological limitations observed in the current literature. Well-controlled, longitudinal studies are needed to ascertain whether cannabis plays a causal role on subsequent violence or aggression in mental health disorders.

Explainable machine learning analysis reveals sex and gender differences in the phenotypic and neurobiological markers of Cannabis Use Disorder

Cannabis Use Disorder (CUD) has been linked to a complex set of neuro-behavioral risk factors. While many studies have revealed sex and gender differences, the relative importance of these risk factors by sex and gender has not been described. We used an "explainable" machine learning approach that combined decision trees [gradient tree boosting, XGBoost] with factor ranking tools [SHapley's Additive exPlanations (SHAP)] to investigate sex and gender differences in CUD. We confirmed that previously identified environmental, personality, mental health, neurocognitive, and brain factors highly contributed to the classification of cannabis use levels and diagnostic status. Risk factors with larger effect sizes in men included personality (high openness), mental health (high externalizing, high childhood conduct disorder, high fear somaticism), neurocognitive (impulsive delay discounting, slow working memory performance) and brain (low hippocampal volume) factors. Conversely, risk factors with larger effect sizes in women included environmental (low education level, low instrumental support) factors. In summary, environmental factors contributed more strongly to CUD in women, whereas individual factors had a larger importance in men.

ADHD misdiagnosis: Causes and mitigators

ADHD diagnoses increase discontinuously by a child's school starting age, with young-for-grade students having much higher ADHD diagnostic rates. Whether these higher rates reflect over-diagnosis or under-diagnosis remains unknown. To decompose this diagnostic discrepancy, we exploit differences in parent and teacher pre-diagnostic assessments within a regression discontinuity strategy based on school starting age. We show that being young-for-grade or male generates over-assessment of symptoms specifically from teacher assessment. However, under-assessments of the oldest students in a grade, especially the oldest females, account for a large part of the observed school starting age assessment gap. We argue that this difference by sex and higher school starting age effects in lower-income schools may exacerbate known gaps in educational attainment by gender and socioeconomic status. Importantly, we fail to find evidence that teachers who receive special education training make such errors.

Childhood Trajectories of Hyperactivity/Inattention Symptoms and Diurnal Cortisol in Middle Adolescence: Results from a UK Birth Cohort

OBJECTIVE

Children with attention-deficit/hyperactivity disorder (ADHD) show hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis. Whether the association between hyperactivity/inattention symptoms with HPA axis dysfunction holds in the general child population too is not clear.

METHOD

We assessed associations between longitudinal trajectories of hyperactivity/inattention symptoms during ages 4 to 13 years and basal cortisol profiles at age 15 in a British general population cohort.

RESULTS

Adolescents with persistently high levels of hyperactivity/inattention symptoms since childhood showed lower total morning cortisol and a smaller diurnal decline, even after adjusting for confounders. No associations were found between any of the symptom trajectories and cortisol awakening response, diurnal slope or daily output of cortisol.

CONCLUSION

This study provides evidence for hypocortisolism among adolescents with chronic hyperactivity/inattention symptoms in the general population.

Sensitization-based risk for substance abuse in vulnerable individuals with ADHD: Review and re-examination of evidence

Evidence of sensitization following stimulants administration in humans is just emerging, which prevents reaching more definitive conclusions in favor or against a purported protective role of stimulant treatments for ADHD for the development of substance use disorders. Existing evidence from both animal and human research suggest that stimulants produce neurophysiological changes in the brain reward system, some of which could be persistent. This could be relevant in choosing optimal treatments for young patients with ADHD who have additional clinical risk factors for substance abuse (e.g. conduct disorder (CD) and/or familial addictions). Here we stipulate that, while the majority of youth with ADHD greatly benefit from treatments with stimulants, there might be a subpopulation of individuals whose neurobiological profiles may confer risk for heightened vulnerability to the effects of stimulants on the responsiveness of the brain reward system. We propose that focused human research is needed to elucidate the unknown effects of prolonged stimulant exposure on the neurophysiology of the brain reward system in young patients with ADHD.

Attention deficit hyperactivity disorder symptoms and cannabis use after one year among students of the i-Share cohort

Background

Cannabis use in university students is associated with academic achievement failure and health issues. The objective of the study was to evaluate the association between attention deficit hyperactivity disorder (ADHD) symptoms and cannabis use after 1 year among students according to previous cannabis use.

Methods

Students in France were recruited from February 2013 to July 2020 in the i-Share cohort. 4,270 participants were included (2,135 who never used cannabis at inclusion and 2,135 who did). The Adult ADHD Self-Report Scale (ASRS) was used to assess ADHD symptoms at inclusion. Cannabis use frequency was evaluated 1 year after inclusion. Multinomial regressions were conducted to assess the association between inclusion ADHD symptoms and cannabis use after 1 year.

Results

Increase in ASRS scores was linked with a greater probability to use cannabis after 1 year and to have a higher cannabis use frequency (once a year—once a month adjusted odds ratio [OR]: 1.24 (1.15–1.34), more than once a month adjusted OR: 1.43 (1.27–1.61)). Among participants who never used cannabis at inclusion, this association disappeared (once a year—once a month adjusted OR: 1.15 (0.95–1.39), more than once a month adjusted OR: 1.16 (0.67–2)) but remained in participants who ever used cannabis at inclusion (once a year—once a month adjusted OR: 1.17 (1.06–1.29), more than once a month adjusted OR: 1.35 (1.18–1.55)).

Conclusions

High levels of ADHD symptoms in students could lead to continued cannabis use rather than new initiations.

The Relation Between Television Viewing Time and Reading Achievement in Elementary School Children: A Test of Substitution and Inhibition Hypotheses

Research has focused on the relations between television (TV) viewing time and children’s reading achievement. Two hypotheses have been proposed to explain this relation. The substitution hypothesis proposes that TV viewing distracts students from activities that are important for their learning. The inhibition hypothesis proposes that watching television inhibits important affective/cognitive skills. In this study, we test both hypotheses by estimating the relation between TV viewing time and reading achievement. We use the frequency of students’ leisure reading and the frequency of interactions between students and their parents as potential mediators to test the substitution hypothesis, whereas for the inhibition one, we use students’ intrinsic motivation to read and their level of inattention. Data come from the Québec Longitudinal Study of Child Development (QLSCD). Designed by the Institut de la statistique du Québec, QLSCD covers a wide range of themes. The QLSCD is representative of children in Québec and contains 2223 participants who were followed from 0 to 21 years old. The four structural models tested are built as follows: the TV viewing time at 6 years old predicts the four mediating variables at 8 years old, which in turn predicts reading achievement at 10 years old. In addition, we have tested models’ gender invariance. Results indicate that TV viewing time is not directly or indirectly associated with reading achievement. Specifically, it is not associated with the mediating variables of child-parent interactions, intrinsic motivation, and inattention. However, the frequency of leisure reading is negatively associated with the time spent watching TV. This association is very small (−0.07) and has no indirect effect on reading achievement. Finally, results do not vary according to the gender of the participants. Our results are in line with those of previous studies in the field and cast some doubts on the potential negative effects of TV viewing time on reading achievement.

Externalizing Risk Pathways for Adolescent Substance Use and Its Developmental Onset: A Canadian Birth Cohort Study: Trajectoires de comportements extériorisés et le risque pour l'initiation et l'usage de substances des adolescents : Une étude de cohorte de naissance canadienne

OBJECTIVE

Only a minority of drug and alcohol users develops a substance use disorder. Previous studies suggest that this differential vulnerability commonly reflects a developmental trajectory characterized by diverse externalizing behaviors. In this study, we examined the relation between child and adolescent externalizing behaviors and adolescent substance use in a prospectively followed Canadian birth cohort, accounting for the temporal sequence of a wide variety of contributing factors.

METHODS

Two hundred and forty-two adolescents followed since birth (date range: 1996 to 2012) were assessed on externalizing behavior (age 17 months to 16 years), alcohol and cannabis use at age 16, age of alcohol use onset, family history of substance use problems, family functioning (age 11 to 15), sensation seeking (age 16), prenatal substance exposure, socioeconomic status (age 1 to 9), and sex.

RESULTS

Age of alcohol use onset was predicted by a family history of substance use problems, externalizing traits from ages 6 to 10 and 11 to 16, sensation seeking at age 16, prenatal alcohol and tobacco exposure and family functioning at ages 11 to 15. High frequencies of alcohol and cannabis use at age 16 were both predicted by externalizing traits from ages 11 to 16, a family history of substance use problems and sensation seeking after controlling for other individual, environmental and familial variables. The association between familial substance use problems and substance use during adolescence was partially mediated by externalizing traits from age 11 to 16.

CONCLUSIONS

The present findings provide prospective evidence for a developmental risk pathway for adolescent substance use, potentially identifying those who could benefit from early interventions.

Hospital healthcare flows: A longitudinal clustering approach of acute coronary syndrome in women over 45 years

Acute coronary syndrome (ACS) in women is a growing public health issue and a death leading cause. We explored whether the hospital healthcare trajectory was characterizable using a longitudinal clustering approach in women with ACS. From the 2009-2014 French nationwide hospital database, we extracted spatio-temporal patterns in ACS patient trajectories, by replacing the spatiality by their hospitalization cause. We used these patterns to characterize hospital healthcare flows in a visualization tool. We clustered these trajectories with kmlShape to identify time gap and tariff profiles. ACS hospital healthcare flows have three key categories: Angina pectoris, Myocardial Infarction or Ischemia. Elderly flows were more complex. Time gap profiles showed that readmissions were closer together as time goes by. Tariff profiles were different according to age and initial event. Our approach might be applied to monitoring other chronic diseases. Further work is needed to integrate these results into a medical decision-making tool.

Concomitant Trajectories of Internalising, Externalising, and Peer Problems Across Childhood: a Person-centered Approach

This study investigated trajectories of concomitant internalising, externalising, and peer problems, and associated risk factors for group-membership, using a person-centered approach to better understand heterogeneity in subgroups identified. A cohort of 7,507 children in Ireland was followed from infancy to late childhood (50.3%, males; 84.9% Irish). The parent-version of the Strengths and Difficulties Questionnaire was used when children were 3, 5, 7 and 9 years of age. Information on antecedent risk factors was collected when children were 9 months. Group-based multi-trajectory modelling and multinomial logistic regression were used. Six subgroups of children with distinct profiles were identified, evidencing both homotypic and heterotypic comorbidity. No support of a ‘pure’ internalising, externalising or peer problems group was found in any identified trajectory group. Difficulties in one problem domain indicated the presence of difficulty in another problem domain for all children in elevated groups. Risk factors associated with group-membership were complex, with only three common factors across elevated groups: prenatal exposure to smoking, maternal education, and maternal stress. Specific risk factors for group-membership included low birth weight, sex, maternal age, maternal depression, family composition, social class, medical card status and quality of attachment. Despite some overlap in predictors, the combination of predictors specific to each group would suggest tailored programming. For children with the most acute problems, programming targets should include families with boys, born with low birth weight, exposed to smoking prenatally, with mothers who have lower levels of education, postnatal depression, increased stress and fewer financial resources.

Daily, but not occasional, cannabis use is selectively associated with more impulsive delay discounting and hyperactive ADHD symptoms in binge-drinking young adults

RATIONALE

There is increasing interest in and evidence for the negative impacts of cannabis use in cognitive performance and symptoms of attention-deficit/hyperactivity disorder (ADHD), with age of first cannabis use as a potential amplifier of these associations. However, the existing literature is inconsistent, which may be due to methodological limitations, including small sample sizes.

OBJECTIVE

To examine current cannabis use and age of first cannabis use in relation to neurocognitive task performance and ADHD symptoms in a large sample of binge-drinking young adults.

METHODS

Participants were young adults (N=730, M age=21.44, 52.6% female) assessed for current cannabis use, neurocognitive task performance, and ADHD symptoms. Three-group ANCOVAs compared individuals reporting frequent (daily/multiple times daily), occasional (weekly/monthly), or no cannabis use.

RESULTS

Covarying alcohol use, tobacco use, age, sex, income, and education, daily cannabis users exhibited significantly more impulsive delay discounting and hyperactive-impulsive ADHD symptoms compared to both other groups. However, cannabis use was not associated with inattentive ADHD symptoms, verbal intelligence, working memory, probability discounting, short-term verbal memory, or behavioral inhibition. Age of initiation of cannabis use exhibited neither main effects nor interactions in relation to any domains of cognitive performance or ADHD symptomatology.

CONCLUSIONS

The current findings provide support for a link between cannabis use in relation to immediate reward preference and symptoms of hyperactive-impulsive ADHD in young adults, but only among frequent users. No other neurocognitive domains exhibited associations with cannabis and age of first use was neither independently nor interactively associated with cognitive outcomes.

ASRS Questionnaire and Tobacco Use: Not Just a Cigarette. A Screening Study in an Italian Young Adult Sample

Young adults exhibit greater sensitivity than adults to nicotine reinforcement, and Attention Deficit Hyperactivity Disorder (ADHD) increases the risk for early-onset smoking. We investigated the correlation between ADHD Self-Report Scale (ASRS) scores and smoking, evaluated the prevalence of ADHD symptomatology (not diagnoses) in smokers and non-smokers and its comorbidity with benzodiazepine and gambling addictions. A total of 389 young adults from 14 schools in Northern Italy fill out a survey and the Adult ADHD Self-Report Scale (ASRS). A total of 15.2% of subjects tested positive at the ASRS, which correlated with smoking; moreover, smokers had twice the probability of testing positive at the ASRS. ADHD symptomatology, especially when comorbid with tobacco abuse, is an important condition to monitor because early nicotine exposure could be a gateway for other addictive behaviors.

Cannabis use, cognitive performance, and symptoms of attention deficit/hyperactivity disorder in community adults

There is some evidence that cannabis use is associated with lower cognitive performance and symptoms of attention-deficit/hyperactivity disorder (ADHD), but the existing literature is relatively inconsistent, potentially due to small samples in previous studies. Using a dimensional design, the current study examined cannabis use severity and age of first cannabis use in relation to neurocognitive performance and ADHD symptoms in a large sample of community adults (N = 1,008, Mage = 38.49, 56.0% female). Participants were assessed for cannabis involvement, neurocognitive performance, and ADHD symptoms. Dimensional relationships were investigated using multiple hierarchical regressions. Using a covariate model of age, income, sex, alcohol use, and tobacco use, severity of cannabis involvement was significantly associated with greater endorsement of both hyperactive-impulsive and inattentive ADHD symptoms but not with any other cognitive measures in the full sample. Exploratory analyses found greater cannabis use severity was associated with digit span forward and hyperactive ADHD symptoms in young adults (n = 371) and was associated with greater delay discounting, hyperactive, and impulsive ADHD symptoms in high-risk cannabis users (n = 161). Age of first cannabis use was not significantly associated with any neurocognitive variables or ADHD symptomatology in all analyses. The current findings provide evidence of a link between current cannabis misuse and both hyperactive and inattentive ADHD symptoms in general, and possible links to attention and impulsive delay discounting in subgroups of cannabis users, but no associations in other cognitive domains or implication of earlier initiation of cannabis use in relation to cognitive performance or ADHD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Longitudinal trajectory analysis of antipsychotic response in patients with schizophrenia: 6-week, randomised, open-label, multicentre clinical trial

BACKGROUND

Understanding the patterns of treatment response is critical for the treatment of patients with schizophrenia; one way to achieve this is through using a longitudinal dynamic process study design.

AIMS

This study aims to explore the response trajectory of antipsychotics and compare the treatment responses of seven different antipsychotics over 6 weeks in patients with schizoprenia (trial registration: Chinese Clinical Trials Registry Identifier: ChiCTR-TRC-10000934).

METHOD

Data were collected from a multicentre, randomised open-label clinical trial. Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and follow-up at weeks 2, 4 and 6. Trajectory groups were classified by the method of k-means cluster modelling for longitudinal data. Trajectory analyses were also employed for the seven antipsychotic groups.

RESULTS

The early treatment response trajectories were classified into a high-trajectory group of better responders and a low-trajectory group of worse responders. The results of trajectory analysis showed differences compared with the classification method characterised by a 50% reduction in PANSS scores at week 6. A total of 349 patients were inconsistently grouped by the two methods, with a significant difference in the composition ratio of treatment response groups using these two methods (χ2 = 43.37, P < 0.001). There was no differential contribution of high- and low trajectories to different drugs (χ2 = 12.52, P = 0.051); olanzapine and risperidone, which had a larger proportion in the >50% reduction at week 6, performed better than aripiprazole, quetiapine, ziprasidone and perphenazine.

CONCLUSIONS

The trajectory analysis of treatment response to schizophrenia revealed two distinct trajectories. Comparing the treatment responses to different antipsychotics through longitudinal analysis may offer a new perspective for evaluating antipsychotics.

mGlu5 receptor availability in youth at risk for addictions: effects of vulnerability traits and cannabis use

The excitatory neurotransmitter glutamate has been implicated in experience-dependent neuroplasticity and drug-seeking behaviors. Type 5 metabotropic glutamate (mGlu5) receptors might be particularly important. They are critically involved in synaptic plasticity and their availability has been reported to be lower in people with alcohol, tobacco, and cocaine use disorders. Since these reductions could reflect effects of drug use or pre-existing traits, we used positron emission tomography to measure mGlu5 receptor availability in young adults at elevated risk for addictions. Fifty-nine participants (age 18.5 ± 0.6) were recruited from a longitudinal study that has followed them since birth. Based on externalizing traits that predict future substance use problems, half were at low risk, half were at high risk. Cannabis use histories varied markedly and participants were divided into three subgroups: zero, low, and high use. Compared to low risk volunteers, those at elevated risk had lower [11C]ABP688 binding potential (BPND) values in the striatum, amygdala, insula, and orbitofrontal cortex (OFC). Cannabis use by risk group interactions were observed in the striatum and OFC. In these regions, low [11C]ABP688 BPND values were only seen in the high risk group that used high quantities of cannabis. When these high risk, high cannabis use individuals were compared to all other participants, [11C]ABP688 BPND values were lower in the striatum, OFC, and insula. Together, these results provide evidence that mGlu5 receptor availability is low in youth at elevated risk for addictions, particularly those who frequently use cannabis.

Attention-deficit/hyperactivity disorder and lifetime cannabis use: genetic overlap and causality

Attention-deficit/hyperactivity disorder (ADHD) is a severely impairing neurodevelopmental disorder with a prevalence of 5% in children and adolescents and of 2.5% in adults. Comorbid conditions in ADHD play a key role in symptom progression, disorder course and outcome. ADHD is associated with a significantly increased risk for substance use, abuse and dependence. ADHD and cannabis use are partly determined by genetic factors; the heritability of ADHD is estimated at 70-80% and of cannabis use initiation at 40-48%. In this study, we used summary statistics from the largest available meta-analyses of genome-wide association studies (GWAS) of ADHD (n = 53,293) and lifetime cannabis use (n = 32,330) to gain insights into the genetic overlap and causal relationship of these two traits. We estimated their genetic correlation to be r2 = 0.29 (P = 1.63 × 10-5) and identified four new genome-wide significant loci in a cross-trait analysis: two in a single variant association analysis (rs145108385, P = 3.30 × 10-8 and rs4259397, P = 4.52 × 10-8) and two in a gene-based association analysis (WDPCP, P = 9.67 × 10-7 and ZNF251, P = 1.62 × 10-6). Using a two-sample Mendelian randomization approach we found support that ADHD is causal for lifetime cannabis use, with an odds ratio of 7.9 for cannabis use in individuals with ADHD in comparison to individuals without ADHD (95% CI (3.72, 15.51), P = 5.88 × 10-5). These results substantiate the temporal relationship between ADHD and future cannabis use and reinforce the need to consider substance misuse in the context of ADHD in clinical interventions.

Trajectories of Overprotective Parenting and Hyperactivity-Impulsivity and Inattention Among Moderate-Late Preterm Children: A Population-Based Study

Parents of preterm children are more likely to adopt non-optimal parenting behaviors than parents of full-term (FT) children. However, there is a lack of studies on parents of children born moderate to late preterm (MLP; 32-36 gestational weeks). In this study, we aimed to examine: (1) the association between MLP birth status and the trajectory of parental overprotection throughout preschool years, and (2) the role of parental overprotection, MLP birth status, and their interaction in the prediction of the trajectories of hyperactivity-impulsivity and inattention throughout childhood. Data comes from a Canadian representative population-based cohort including 2028 FT, 100 MLP children, and their parents. Overprotective parenting was measured when children were 5, 17, and 29 months old. Hyperactivity-impulsivity and inattention symptoms were measured repeatedly from 4 to 8 years of age. Trajectories of parents' overprotectiveness and children's hyperactivity-impulsivity and inattention were modeled. MLP birth status was associated with an increase in parental overprotectiveness across the preschool period. MLP birth status and parental overprotection were both found to be associated with higher levels of hyperactivity-impulsivity symptoms across childhood. No interaction was found between birth status and parental overprotection. The results suggest that parents of MLP children become more overprotective across time compared to parents of FT children and that children born MLP and/or exposed to higher levels of parental overprotection demonstrated higher levels of hyperactivity-impulsivity symptoms across childhood.

Inattention in boys from low-income backgrounds predicts welfare receipt: a 30-year prospective study

BACKGROUND

Childhood disruptive behaviors are highly prevalent and associated with adverse long-term social and economic outcomes. Trajectories of welfare receipt in early adulthood and the association of childhood behaviors with high welfare receipt trajectories have not been examined.

METHODS

Boys (n = 1000) from low socioeconomic backgrounds were assessed by kindergarten teachers for inattention, hyperactivity, aggression, opposition, and prosociality, and prospectively followed up for 30 years. We used group-base trajectory modeling to estimate trajectories of welfare receipt from age 19-36 years using government tax return records, then examined the association between teacher-rated behaviors and trajectory group membership using mixed effects multinomial regression models.

RESULTS

Three trajectories of welfare receipt were identified: low (70.8%), declining (19.9%), and chronic (9.3%). The mean annual personal employment earnings (US$) for the three groups at age 35/36 years was $36 500 (s.d. = $24 000), $15 600 (s.d. = $16 275), and $1700 (s.d. = $4800), respectively. Relative to the low welfare receipt group, a unit increase in inattention (mean = 2.64; s.d. = 2.32, range = 0-8) at age 6 was associated with an increased risk of being in the chronic group (relative risk ratio; RRR = 1.16, 95% CI 1.03-1.31) and in the declining group (RRR = 1.13, 95% CI 1.03-1.23), after adjustment for child IQ and family adversity, and independent of other behaviors. Family adversity was more strongly associated with trajectories of welfare receipt than any behavior.

CONCLUSIONS

Boys from disadvantaged backgrounds exhibiting high inattention in kindergarten are at elevated risk of chronic welfare receipt during adulthood. Screening and support for inattentive behaviors beginning in kindergarten could have long-term social and economic benefits for individuals and society.

Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) in the United States in 2019

IMPORTANCE

To date, limited information is available on the characteristics of adolescents with e-cigarette, or vaping, product use-associated lung injury (EVALI).

OBJECTIVE

To inform public health and clinical practice by describing differences in demographics, substance use behaviors, and clinical characteristics of EVALI among adolescents compared with adults.

DESIGN, SETTING, AND PARTICIPANTS

Surveillance data reported to the Centers for Disease Control and Prevention during the 2019 EVALI outbreak were used to calculate adjusted prevalence ratios (aPRs) with 95% CIs and to test differences between 360 hospitalized or deceased adolescents vs 859 young adults and 936 adults with EVALI (N = 2155).

MAIN OUTCOMES AND MEASURES

Demographics, substance use behaviors, and clinical characteristics.

RESULTS

Included in this cross-sectional study were 360 hospitalized or deceased adolescents (age range, 13-17 years; 67.9% male) vs 859 young adults (age range, 18-24 years; 72.4% male) and 936 adults (age range, 25-49 years; 65.6% male) with EVALI. Adolescents diagnosed as having EVALI reported using any nicotine-containing (62.4%), any tetrahydrocannabinol (THC)-containing (81.7%), and both (50.8%) types of e-cigarette or vaping products. Informal sources for obtaining nicotine-containing and THC-containing e-cigarette or vaping products were more commonly reported by adolescents (50.5% for nicotine and 96.5% for THC) than young adults (19.8% for nicotine [aPR, 2.49; 95% CI, 1.78-3.46] and 86.9% for THC [aPR, 1.11; 95% CI, 1.05-1.18]) or adults (24.3% for nicotine [aPR, 2.06; 95% CI, 1.49-2.84] and 75.1% for THC [aPR, 1.29; 95% CI, 1.19-1.40]). Mental, emotional, or behavioral disorders were commonly reported; a history of attention-deficit/hyperactivity disorder was almost 4 times more likely among adolescents (18.1%) than adults (4.9%) (aPR, 3.74; 95% CI, 1.92-7.26). A history of asthma was more likely to be reported among adolescents (43.6%) than adults (28.3%) (aPR, 1.53; 95% CI, 1.14-2.05). Gastrointestinal and constitutional symptoms were more common in adolescents (90.9% and 97.3%, respectively) than adults (75.3% and 94.5%, respectively) (aPR, 1.20; 95% CI, 1.13-1.28 and aPR, 1.03; 95% CI, 1.00-1.06, respectively). Because of missing data, percentages may not be able to be calculated from data provided.

CONCLUSIONS AND RELEVANCE

Public health and clinical professionals should continue to provide information to adolescents about the association between EVALI and THC-containing e-cigarette or vaping product use, especially those products obtained through informal sources, and that the use of any e-cigarette or vaping product is unsafe. Compared with adults, it appears that adolescents with EVALI more frequently have a history of asthma and mental, emotional, or behavioral disorders, such as attention-deficit/hyperactivity disorder, and report nonspecific problems, including gastrointestinal and constitutional symptoms; therefore, obtaining a confidential substance use history that includes e-cigarette or vaping product use is recommended.

The Role of Parental Monitoring in Mediating the Link Between Adolescent ADHD Symptoms and Risk-Taking Behavior

Objective: ADHD in adolescents and low level of parental monitoring have been associated with increased risk-taking behavior. The present study examined whether parental knowledge of the child's whereabouts mediates the correlations between adolescent ADHD symptoms and risk-taking behavior. Method: Ninety-two adolescents and their parents completed questionnaires assessing perceptions of parents' monitoring, engagement in risk-taking behaviors, and ADHD symptoms. Results: Greater engagement in risk-taking behavior correlated with higher levels of ADHD symptoms and decreased parental monitoring. Mediation analysis revealed both direct effect of ADHD symptoms on risk-taking behavior and an indirect effect mediated by level of parental knowledge. Conclusion: These findings suggest that parental knowledge is negatively affected by the presence of ADHD symptoms, and may in turn lead to risk-taking behavior. The findings emphasize the need to target parenting and in particular parental knowledge of the child's whereabouts to reduce risk-taking behaviors among youth with ADHD.

Identifying Early Risk Factors for Addiction Later in Life: A Review of Prospective Longitudinal Studies

PURPOSE OF REVIEW

To review prospective longitudinal studies that have identified risk factors for the development of substance use disorders in adulthood from individual differences during childhood and adolescence.

RECENT FINDINGS

Risk factors during childhood and adolescence that have been consistently linked to increased risk for addiction include externalizing and internalizing symptoms, early substance use, and environmental influences, such as parental behavior and exposure to traumatic experiences.

SUMMARY

Since the etiology of substance use disorders is complex and likely is attributable to many causal pathways, systematic examination of the associations between risk factors will be necessary to understand the mixed findings in the existing literature, to determine which individuals should be targeted for prevention efforts, and to design interventions that address risk factors that are most likely to improve outcomes.

Genetic and environmental influences on attention-deficit/hyperactivity disorder symptoms in Chinese adolescents: a longitudinal twin study

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental disorder. However, no study has examined genetic and environmental influences in the longitudinal developmental course of ADHD symptoms in a non-Western population. This study investigated changes of genetic and environmental influences and their contributions to the stability and change of ADHD symptoms of hyperactivity/impulsivity and inattention in Chinese adolescent twins. A prospective sample of 602 twin pairs (48% male) self-reported both DSM-IV ADHD symptom subscales three times at the approximate age of 12, 13, and 15 years. Longitudinal multivariate genetic analyses through structural equation modelling examined genetic and environmental contributions to the developmental course of ADHD symptoms. From early (time 1 and 2) to middle adolescence (time 3), both symptoms showed modest and non-significant genetic influences that became substantial and significant, whereas shared environmental influences were substantial and significant and became modest and non-significant. The same genetic factors influenced ADHD symptoms throughout adolescence, while shared and non-shared environmental influences largely came from new emerging factors. In early adolescence, genetic factor contributed to the stability of inattention, whereas shared environmental factor contributed to the stability of hyperactivity/impulsivity. Genetic influences of ADHD tended to be smaller, whereas shared environmental influences tended to be larger in Chinese than in Western populations. Genetic factors played a large role in the stability of ADHD throughout adolescence, while shared and non-shared environment primarily contributed to its change. Findings highlight the importance of shared family, neighbourhood, and community experiences on child psychopathology in a collectivistic culture such as the Chinese society.

Attention Deficit Hyperactivity Disorder (ADHD) Subtypes, Co-Occurring Psychiatric Symptoms and Sexual Risk Behaviors among Adolescents Receiving Substance Abuse Treatment

Background: Adolescents entering substance abuse treatment report clustered psychiatric symptoms and sexual risk behaviors representing differential levels of impairment and risk for maladaptive health outcomes. Objectives: To examine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) subtypes among adolescents receiving outpatient substance abuse treatment; To document group differences in (a) past-year psychiatric symptom scores and (b) sexual risk behaviors by ADHD subtype and gender. Methods: Self-report data were collected via structured interviews from 394 adolescents (280 males, M = 16.33 years, SD = 1.15 years), enrolled in an HIV/STI risk reduction intervention for adolescents receiving outpatient substance abuse treatment. ADHD diagnostic subtypes and other past-year psychiatric symptoms were assessed using the Brief Michigan Version of the Composite Internal Diagnostic Interview (UM-CIDI). Adolescents provided self-report data on sexual risk behaviors. Results: Multivariate analyses of variance (MANOVAs) documented that Inattentive and Hyperactive-Impulsive ADHD subtypes were significantly associated with higher scores for all past-year psychiatric symptoms. The combined ADHD subtype was significantly associated with higher scores for all psychiatric symptoms except affective disorder. Girls reported significantly higher mean symptoms than boys for alcohol abuse and dependence, anxiety, and affective disorder symptoms. Sexual risk behavior scores were not associated with ADHD status, but girls reported consistently higher scores for multiple risk behavior outcomes. Several psychiatric disorder symptoms were significant covariates of multiple sexual risk behaviors. Conclusion/Importance: Brief screenings for ADHD, other psychiatric disorders and sexual risk behaviors can provide data for tailoring substance abuse services to improve adolescent health outcomes for high-risk subgroups.

Analysis of substance use and its outcomes by machine learning: II. Derivation and prediction of the trajectory of substance use severity

BACKGROUND

This longitudinal study explored the utility of machine learning (ML) methodology in predicting the trajectory of severity of substance use from childhood to thirty years of age using a set of psychological and health characteristics.

DESIGN

Boys (N = 494) and girls (N = 206) were recruited using a high-risk paradigm at 10-12 years of age and followed up at 12-14, 16, 19, 22, 25 and 30 years of age.

MEASUREMENTS

At each visit, the subjects were administered a comprehensive battery to measure psychological makeup, health status, substance use and psychiatric disorder, and their overall harmfulness of substance consumption was quantified according to the multidimensional criteria (physical, dependence, and social) developed by Nutt et al. (2007). Next, high- and low- substance use severity trajectories were derived differentially associated with probability of segueing to substance use disorder (SUD). ML methodology was employed to predict trajectory membership.

FINDINGS

The high-severity trajectory group had a higher probability of leading to SUD than the low-severity trajectory (89.0% vs 32.4%; odds ratio = 16.88, p < 0.0001). Thirty psychological and health status items at each of the six visits predict membership in the high- or low-severity trajectory, with 71% accuracy at 10-12 years of age, increasing to 93% at 22 years of age.

CONCLUSION

These findings demonstrate the applicability of the machine learning methodology for detecting membership in a substance use trajectory with high probability of culminating in SUD, potentially informing primary and secondary prevention.

Early childhood child care and disruptive behavior problems during adolescence: a 17-year population-based propensity score study

BACKGROUND

Child-care services during early childhood provide opportunities for social interactions that may facilitate children's learning of acceptable social behaviors. Furthermore, they may reduce exposure to family adversity for some children. The aim of this study was to determine whether intensity of exposure to child-care services prior to age 5 years has a beneficial effect on disruptive behavior problems during adolescence, and whether the effect is more pronounced for children from low socioeconomic families.

METHODS

N = 1,588 participants from the Québec Longitudinal Study of Child Development were assessed 14 times from 5 months to 17 years. Intensity of child-care exposure was measured from 5 months to 5 years of age. Main outcomes were self-reported physical aggression and opposition from age 12 to 17 years. Family socioeconomic status (SES) was measured at 5 months. Factors explaining differences in child-care use were controlled using propensity score weights (PSW).

RESULTS

Children exposed to moderate-intensity child-care services (part-time child-care services before 1½ years and full time afterward) reported lower levels of physical aggression (d = -.11, p = .056) and opposition (d = -.14, p = .029) during adolescence compared to children exposed to low-intensity child-care services. A significant child care by SES interaction (p = .017) for physical aggression indicated that the moderate-intensity child-care effect was specific to children from low SES families (d = -.36, p = .002). No interaction with socioeconomic status was found for opposition.

CONCLUSIONS

Moderate-intensity child-care services from infancy to school entry may prevent disruptive behavior during adolescence, especially for disadvantaged children.

Risk of Alcohol Abuse in Humans with Attention-deficit/Hyperactivity Disorder Symptoms

The relationship between attention-deficit/hyperactivity disorder (ADHD) and the risk of alcohol abuse is widely studied. Even though this topic has been of interest for several years, it is heavily debated. We studied various papers and conducted a systematic review using PubMed as the main source of data collection. We found that several studies put forward the concept of a positive association between alcohol abuse and ADHD symptoms, but a minority of them also showed opposing and contradictory results. We discovered that this inconsistency observed in studies could be a result of a biased approach in studies and a subjective attempt in interpretations. These biases could be studied in terms of sample size involved in the analysis, age at which studies are conducted among other statistical parameters. We believe that the deviations in the outcomes prove that the studies may be incomplete and that a standardized method of interpretation is required. Therefore, this paper recommends the need for further research to explore the connection between alcohol abuse in patients showing ADHD symptoms.

Association Between Childhood Behaviors and Adult Employment Earnings in Canada

Importance

Specifying the association between childhood behaviors and adult earnings can inform the development of screening tools and preventive interventions to enhance social integration and economic participation.

Objective

To test the association between behaviors at age 6 years and employment earnings at age 33 to 35 years.

Design, Setting, and Participants

This study obtained data from the Quebec Longitudinal Study of Kindergarten Children, a population-based sample of boys and girls (n = 3020) born in 1980 or 1981 in Quebec, Canada, and followed up from January 1, 1985, to December 31, 2015. The data included behavioral ratings by kindergarten teachers when the children were aged 5 or 6 years and 2013 to 2015 government tax returns of those same participants at age 33 to 35 years. Data were analyzed from September 2017 to December 2018.

Main Outcomes and Measures

Mixed-effects linear regression models were used to test the associations between teacher-rated inattention, hyperactivity, aggression, opposition, anxiety, and prosociality at age 6 years and reported annual earnings on income tax returns at age 33 to 35 years. Participant IQ and family adversity were adjusted for in the analysis.

Results

The study included 2850 participants, with a mean (SD) age of 35.9 (0.29) years, of whom 1470 (51.6%) were male and 2740 (96.2%) were white. The mean (SD) personal earnings at follow-up were US $33 300 ($27 500) for men and $19 400 ($15 200) for women. A 1-unit increase in inattention score at age 6 years (males mean [SD], 2.47 [2.42] vs females mean [SD], 1.67 [2.07]) was associated with a decrease in annual earnings of $1271.49 (95% CI, -1908.67 to -634.30) for male participants and $924.25 (95% CI, -1424.44 to -425.46) for female participants. A combined aggression-opposition score (males mean [SD] 2.22 [2.52] vs females mean [SD], 1.05 [1.73]) was associated with a reduction in earnings of $699.83 (95% CI, -1262.49 to -137.17) for males only, albeit with an effect size roughly half that of inattention. A 1-unit increase in prosociality score (males mean [SD], 6.12 [4.30] vs females mean [SD], 7.90 [4.56]) was associated with an increase in earnings of $476.75 (95% CI, 181.53-771.96) for male participants only. A 1-SD reduction in inattention score at age 6 years would theoretically restore $3077 in annual earnings for male participants and $1915 for female participants.

Conclusions and Relevance

In this large population-based sample of kindergarten children, behavioral ratings at 5-6 years were associated with employment earnings 3 decades later, independent of a person's IQ and family background. Inattention and aggression-opposition were associated with lower annual employment earnings, and prosociality with higher earnings but only among male participants; inattention was the only behavioral predictor of income among girls. Early monitoring and support for children demonstrating high inattention and for boys exhibiting high aggression-opposition and low prosocial behaviors could have long-term advantages for those individuals and society.

Adult attention-deficit/hyperactivity disorder, risky substance use and substance use disorders: a follow-up study among young men

We investigated whether adult attention-deficit/hyperactivity disorder (ADHD) predicts risky substance use and substance use disorders (SUDs), and its impact on the course of these problematic substance use patterns. Our sample included 4975 Swiss men (mean age 20 ± 1.2 years) who participated in the baseline and 15-month follow-up assessments of the Cohort Study on Substance Use Risk Factors. We examined: (1) the contribution of ADHD, as assessed at baseline, on the risky use of alcohol, nicotine and cannabis, and their corresponding use disorders (AUD, NUD, CUD) at follow-up; and (2) the association between ADHD and the course of outcomes (i.e., absence, initiation, maturing out, persistence) over 15 months. All analyses were adjusted for socio-demographics and co-morbidity. Men with ADHD were more likely to exhibit persistent risky alcohol and nicotine use, and to mature out of risky cannabis use. ADHD at baseline was positively linked to AUD and negatively to CUD at follow-up, but not to NUD. For all SUDs, ADHD had a positive association with use persistence and maturing out. Comparing these two trajectories revealed that early age of alcohol use initiation distinguished between persistence and maturing out of AUD, while the course of NUD and CUD was related to ADHD symptoms and SUD severity at baseline. Already in their early twenties, men with ADHD are especially likely to exhibit persistent problematic substance use patterns. Substance-specific prevention strategies, particularly implemented before early adulthood, may be crucial to reducing the development and persistence of pathological patterns in such individuals.

Early life predictors of attention deficit/hyperactivity disorder symptomatology profiles from early through middle childhood

This study used repeated measures data to identify developmental profiles of elevated risk for ADHD (i.e., six or more inattentive and/or hyperactive-impulsive symptoms), with an interest in the age at which ADHD risk first emerged. Risk factors that were measured across the first 3 years of life were used to predict profile membership. Participants included 1,173 children who were drawn from the Family Life Project, an ongoing longitudinal study of children's development in low-income, nonmetropolitan communities. Four heuristic profiles of ADHD risk were identified. Approximately two thirds of children never exhibited elevated risk for ADHD. The remaining children were characterized by early childhood onset and persistent risk (5%), early childhood limited risk (10%), and middle childhood onset risk (19%). Pregnancy and delivery complications and harsh-intrusive caregiving behaviors operated as general risk for all ADHD profiles. Parental history of ADHD was uniquely predictive of early onset and persistent ADHD risk, and low primary caregiver education was uniquely predictive of early childhood limited ADHD risk. Results are discussed with respect to how changes to the age of onset criterion for ADHD in DSM5 may affect etiological research and the need for developmental models of ADHD that inform ADHD symptom persistence and desistance.

Moderation of parenting by inhibitory control in the prediction of the common and unique variance of hyperactivity-impulsivity and inattention

This study examined whether the interaction between parenting and inhibitory control predicts hyperactivity-impulsivity and inattention in 195 children. Observation data of positive parenting were collected at 4 years, and mother reports of coercive parenting at 5 years, inhibitory control at 6 years, and hyperactivity-impulsivity/inattention at 7 years were obtained. The common and unique variance of hyperactivity-impulsivity and inattention symptoms were examined as outcomes using a bifactor model. Results indicated that positive parenting practices predicted lower levels of hyperactivity-impulsivity/inattention behaviors at age 7 only when children's inhibitory control was high. These results support the vantage sensitivity model, which posits that some individuals show an increased sensitivity to positive experiences exclusively, and support the appropriateness of a targeted prevention approach in early childhood.

Cross-domain correlates of cannabis use disorder severity among young adults

BACKGROUND

Correlates of cannabis use and dependence among young adults have been widely studied. However, it is not known which factors are most strongly associated with severity of cannabis use dependence (CUD) severity. Identification of the salient correlates of CUD severity will be of increasing clinical significance as use becomes more socially normative.

METHODS

This study used a data-driven, hypothesis-free approach to examine the most robust correlates of CUD severity among a sample of 76 young adults (ages 18 to 25 years) who used cannabis at least weekly. Seventy-one candidate variables were examined for association with CUD severity. These included demographic variables, self-reported and psychodiagnostic assessments of mood and anxiety, self-reported measures of personality, cannabis and other substance use characteristics, and objective and subjective measures of cognition.

RESULTS

Of the 71 candidate variables considered, 27 were associated with CUD severity on a univariate level at a p-value ≤.20. Correlates of CUD severity in the multivariable model using stepwise selection were: more frequent cannabis use in the past 90 days, greater expectancies that cannabis causes cognitive and behavioral impairment, greater self-reported metacognitive deficits, greater anxiety, and lower reaction time variability on a test of sustained attention. Internal validation tests support high prediction accuracy of all variables in the multivariable model, except for lower reaction time variability.

CONCLUSIONS

Cannabis use frequency, beliefs about use, perceived cognitive abilities, and anxiety are robustly associated with CUD severity in young adult, regular cannabis users, and may be important in guiding prevention and treatment efforts.

Mediating pathways from childhood ADHD to adolescent tobacco and marijuana problems: roles of peer impairment, internalizing, adolescent ADHD symptoms, and gender

BACKGROUND

We examined whether increased risk for adolescent tobacco and marijuana problems associated with childhood ADHD is explained by key intermediary influences during adolescence and differs by gender.

METHODS

Longitudinal structural equation models examined mediating effects on problems with both substances (or each substance separately) through age-14 peer impairment, internalizing, and adolescent ADHD symptoms in two twin samples, prospectively assessed since age 11 (N = 2,164). Whether these mediators contributed beyond mediating effects of early-adolescent substance use was also considered. Twin difference analyses further illuminated which mediators might be potentially causal.

RESULTS

Direct effects of childhood ADHD on age-17 tobacco and marijuana problems (i.e., independent of included mediators) as well as effects of adolescent ADHD symptoms were significant only for females. By contrast, mediation by peer impairment, evident particularly for marijuana, was relatively stronger for males than females. Depression and anxiety were not prospectively associated with age-17 substance problems when earlier substance problems were considered. Consistent with causal influence of early substance use on later problems, monozygotic twins with more severe tobacco or marijuana problems at age 14 than their co-twins were also more likely to have substance problems later in adolescence.

CONCLUSIONS

Mediation through peer impairment, continued presence of ADHD symptoms, and early substance use may alter development so that childhood ADHD indirectly contributes to problems with tobacco and marijuana. Targeting gender-sensitive interventions prior to mid-adolescence, before these patterns become established, is essential.

Correlates of nicotine dependence in men with childhood attention-deficit/hyperactivity disorder: a 33-year follow-up

Identify correlates of nicotine dependence [lifetime (l) and ongoing (o)] in adults with attention-deficit/hyperactivity disorder (ADHD) in childhood. We conducted a 33-year prospective follow-up of boys (mean age 8) with combined type ADHD (n = 135/207, 65% original sample). Correlates of nicotine dependence in adulthood were selected from characteristics obtained in childhood and adolescence. Among selected childhood features, only immature behavior was significantly related to nicotine dependence (OR_(o) = 0.29, p = 0.02), indexing decreased risk. In contrast, several adolescent variables significantly correlated (p < 0.01) with nicotine dependence at mean age 41, including alcohol substance use disorder (SUD, OR_(l) = 4.97), non-alcohol SUD (OR_(o) = 4.33/OR_(l) = 10.93), parental antisocial personality disorder (OR_(l) = 4.42), parental SUD (OR_(l) = 3.58), dropped out of school (OR_(l) = 2.29), impulsivity (OR_(o) = 1.53/OR_(l) = 1.59), hyperactivity (OR_(o) = 1.38), and number of antisocial behaviors (OR_(o) = 1.10/OR_(l) = 1.14). Results highlight the role of adolescent psychopathology in the development of nicotine dependence, motivating prospective longitudinal efforts to better define the developmental trajectories of risk and protection.

Shyness Trajectories across the First Four Decades Predict Mental Health Outcomes

Although childhood shyness is presumed to predict mental health problems in adulthood, no prospective studies have examined these outcomes beyond emerging adulthood. As well, existing studies have been limited by retrospective and cross-sectional designs and/or have examined shyness as a dichotomous construct. The present prospective longitudinal study (N = 160; 55 males, 105 females) examined shyness trajectories from childhood to the fourth decade of life and mental health outcomes. Shyness was assessed using parent- and self-rated measures from childhood to adulthood, once every decade at ages 8, 12-16, 22-26, and 30-35. At age 30-35, participants completed a structured psychiatric interview and an experimental task examining attentional biases to facial emotions. We found 3 trajectories of shyness, including a low-stable trajectory (59.4%), an increasing shy trajectory from adolescence to adulthood (23.1%), and a decreasing shy trajectory from childhood to adulthood (17.5%). Relative to the low-stable trajectory, the increasing, but not the decreasing, trajectory was at higher risk for clinical social anxiety, mood, and substance-use disorders and was hypervigilant to angry faces. We found that the development of emotional problems in adulthood among the increasing shy trajectory might be explained in part by adverse peer and social influences during adolescence. Our findings suggest different pathways for early and later developing shyness and that not all shy children grow up to have psychiatric and emotional problems, nor do they all continue to be shy.

Associations between childhood ADHD, gender, and adolescent alcohol and marijuana involvement: A causally informative design

BACKGROUND

We report whether the etiology underlying associations of childhood ADHD with adolescent alcohol and marijuana involvement is consistent with causal relationships or shared predispositions, and whether it differs by gender.

METHODS

In three population-based twin samples (N = 3762; 64% monozygotic), including one oversampling females with ADHD, regressions were conducted with childhood inattentive or hyperactive-impulsive symptoms predicting alcohol and marijuana outcomes by age 17. To determine whether ADHD effects were consistent with causality, twin difference analyses divided effects into those shared between twins in the pair and those differing within pairs.

RESULTS

Adolescents with more severe childhood ADHD were more likely to initiate alcohol and marijuana use earlier, escalate to frequent or heavy use, and develop symptoms. While risks were similar across genders, females with more hyperactivity-impulsivity had higher alcohol consumption and progressed further toward daily marijuana use than did males. Monozygotic twins with more severe ADHD than their co-twins did not differ significantly on alcohol or marijuana outcomes, however, suggesting a non-causal relationship. When co-occurring use of other substances and conduct/oppositional defiant disorders were considered, hyperactivity-impulsivity remained significantly associated with both substances, as did inattention with marijuana, but not alcohol.

CONCLUSIONS

Childhood ADHD predicts when alcohol and marijuana use are initiated and how quickly use escalates. Shared familial environment and genetics, rather than causal influences, primarily account for these associations. Stronger relationships between hyperactivity-impulsivity and heavy drinking/frequent marijuana use among adolescent females than males, as well as the greater salience of inattention for marijuana, merit further investigation.

Universelle Prävention kindlicher Verhaltensstörungen durch Elterntrainings

Zusammenfassung. Theoretischer Hintergrund: Die Prävalenzrate kindlicher psychischer Störungen beträgt ca. 20 % und ist durch psychotherapeutische Interventionen alleine nicht zu reduzieren. Universelle präventive Interventionen sind daher dringend notwendig, allerdings ist unklar, ob solche Maßnahmen auch langfristig wirksam sind. Fragestellung: Ziel der vorliegenden Studie ist die Überprüfung der 10-Jahres-Wirksamkeit des Triple P-Elterntrainingsprogramms als universelle Präventionsmaßnahme aus Mütter-, Väter- und Jugendlichensicht. Methode: Zum Prä-Zeitpunkt wurden N = 477 Familien über Kindertagesstätten in Braunschweig rekrutiert und zufällig der Kontrollgruppe (KG) oder dem Triple P-Elterntraining (TP) zugewiesen. 77 % der Familien nahmen das TP-Angebot an (T+), 23 % lehnten eine Teilnahme ab (T–). Die 10-Jahres-Wirksamkeit konnte mit einer multimethodalen diagnostischen Batterie an N=361 Familien überprüft werden (Rücklauf: 76 %). Ergebnisse: Die „Intention to Treat“- Auswertung (Vergleich TP vs. KG) erbrachten keine bedeutsamen Unterschiede. Eine differentielle Analyse der T+, T- und KG-Gruppen ergab aus Sicht der T+ Mütter im Vergleich zur KG eine Reduktion des kindlichen Problemverhaltens (CBCL) und eine Steigerung ihrer Partnerschaftszufriedenheit auf niedrigem Effektstärke-Niveau. In Bezug auf die CBCL-Auffälligkeitsraten zeigten sich im Vergleich zu Prä nach 10 Jahren bei der T+ Gruppe mit 5 % die geringsten, bei der T- Gruppe die stärksten Zuwächse (33 %). Entgegen der Erwartung ließen sich aus Sicht der Mütter keine Effekte hinsichtlich des elterlichen Erziehungsverhaltens nachweisen. Bei den T+ Vätern hingegen zeigte sich eine Verbesserung ihres Erziehungsverhaltens. Aus Jugendlichensicht ergaben sich keine bedeutsamen Effekte. Schlussfolgerungen: Die Ergebnisse unterstützen – allerdings nur aus Sicht der T+ Mütter – die langfristige Wirksamkeit des Triple P-Gruppenprogramms als universelle Maßnahme zur Prävention kindlicher Verhaltensprobleme. Zukünftig sollte der Ablehnenden-Gruppe T- mehr Aufmerksamkeit gewidmet werden, da diese Familien noch ungünstigere Ergebnisse als die Kontrollgruppe aufwiesen.