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Kelley M, Sibley MH, Coxe SJ, Basu H, Margherio SM, Evans SW, Wang FL. High vs. Low Intensity Behavior Therapy Delivered to Adolescents with ADHD: Potential Adverse Long-Term Effects on Substance Use Outcomes. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01254-1. [PMID: 39400649 DOI: 10.1007/s10802-024-01254-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2024] [Indexed: 10/15/2024]
Abstract
Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. Little is known about the impact of psychosocial ADHD treatment on substance use. Based on existing theory, both therapeutic (i.e., through reducing symptoms and impairments) and iatrogenic effects (i.e., through improved social functioning) of psychosocial treatment for ADHD on adolescent substance use initiation are plausible. A primarily ethnic/racial minority sample (~ 95% Latinx or Black) of rising ninth grade students with ADHD (n = 106) were randomly assigned to receive high intensity (i.e., Summer Treatment Program-Adolescent, parent training, and school consultation) or lower intensity (parent training, organization skills training, and school consultation) intervention the summer before entering high school. Participants were followed four-years post-baseline and substance use was documented. Analyses tested treatment effects on substance use initiation (alcohol and/or marijuana) and mediators of main effects. After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. Clinicians delivering psychosocial treatment to adolescents with ADHD should monitor for potential iatrogenic effects.
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Affiliation(s)
| | - Margaret H Sibley
- University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA.
| | | | - Hana Basu
- University of Washington, Seattle, WA, USA
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Hinshaw SP, Porter PA, Ahmad SI. Developmental psychopathology turns 50: Applying core principles to longitudinal investigation of ADHD in girls and efforts to reduce stigma and discrimination. Dev Psychopathol 2024:1-15. [PMID: 39188249 DOI: 10.1017/s0954579424000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
The seminal contributions of Dante Cicchetti to the field/paradigm/metaparadigm of developmental psychopathology (DP) - and its continuing ascendance as a guiding force for multidisciplinary investigation of normative and atypical development - are legion. Our aim is to illustrate a number of DP's core principles in the context of (a) prospective longitudinal research on children (particularly girls) with attention-deficit hyperactivity disorder and (b) theoretical and empirical work dedicated to alleviating the stigma and discrimination toward those experiencing mental health, substance use, and neurodevelopmental challenges. We feature (i) the mutual interplay of perspectives on normative and non-normative development, (ii) reciprocal and transactional processes, and the constructs of equifinaliy and multifinality; (iii) continuities and discontinuities in developmental processes and outcomes, with particular focus on heterotypic continuity; (iv) the inseparability of heritable and environmental risk; (v) multiple levels of analysis, and (vi) the benefits of qualitative perspectives. We highlight that interventions promoting recovery, along with the multi-level facilitation of protective factors/strengths, lie at the heart of both DP and anti-stigma efforts. The ongoing youth mental-health crisis provides a sobering counterpoint to the gains of the DP enterprise over the past half century.
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Affiliation(s)
- Stephen P Hinshaw
- University of California, Berkeley, CA, USA
- University of California, San Francisco, CA, USA
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Brancati GE, Magnesa A, Acierno D, Carli M, De Rosa U, Froli A, Gemignani S, Ventura L, Weiss F, Perugi G. Current nonstimulant medications for adults with attention-deficit/hyperactivity disorder. Expert Rev Neurother 2024; 24:743-759. [PMID: 38915262 DOI: 10.1080/14737175.2024.2370346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/16/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Stimulants, including methylphenidate and amphetamines, are the first-line pharmacological treatment of ADHD in adults. However, in patients who do not respond or poorly tolerate stimulants, non-stimulant medications are usually recommended. AREAS COVERED The authors provide a narrative review of the literature on non-stimulant treatments for adult ADHD, including controlled and observational clinical studies conducted on adult samples. Atomoxetine has been extensively studied and showed significant efficacy in treating adult ADHD. Issues related to dosing, treatment duration, safety, and use in the case of psychiatric comorbidity are summarized. Among other compounds indicated for ADHD in adults, antidepressants sharing at least a noradrenergic or dopaminergic component, including tricyclic compounds, bupropion, and viloxazine, have shown demonstratable efficacy. Evidence is also available for antihypertensives, particularly guanfacine, as well as memantine, metadoxine, and mood stabilizers, while negative findings have emerged for galantamine, antipsychotics, and cannabinoids. EXPERT OPINION While according to clinical guidelines, atomoxetine may serve as the only second-line option in adults with ADHD, several other nonstimulant compounds may be effectively used in order to personalize treatment based on comorbid conditions and ADHD features. Nevertheless, further research is needed to identify and test more personalized treatment strategies for adults with ADHD.
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Affiliation(s)
- Giulio Emilio Brancati
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Anna Magnesa
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Donatella Acierno
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Marco Carli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Ugo De Rosa
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Alessandro Froli
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Samuele Gemignani
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lisa Ventura
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Francesco Weiss
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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Ghetti CM, Hjelmbrekke S, Morken K, Dahl T, Stige B. Steering the energy with music: hermeneutic phenomenological study of user perspectives of music and music therapy for co-occurring ADHD and substance use problems. Subst Abuse Treat Prev Policy 2024; 19:10. [PMID: 38263064 PMCID: PMC10807156 DOI: 10.1186/s13011-024-00594-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND User perspectives and involvement are crucial for improving substance use treatment service provision. First-hand accounts provide rich perspectives on how users experience change within therapeutic approaches like music therapy. People with substance use problems have a higher incidence of experiencing challenges with impulsivity, hyperactivity and inattention. Such challenges can negatively affect social functioning and outcomes of substance use treatment. Music therapy can offer people a means to regulate emotions and facilitate social relationships. There is a lack of research on user perspectives of music therapy in substance use treatment, and we could identify no studies that explore user perspectives of music therapy for adults with substance use problems and co-occurring impulsivity, hyperactivity and inattention. METHODS The aim of this phenomenological study was to center the voices of people living with co-occurring attention deficit hyperactivity disorder (ADHD) and substance use disorder (SUD) to understand how they experience music and music therapy in their process of recovery. We used a hermeneutic phenomenological approach to qualitative analysis of transcripts from in-depth interviews with 8 adult service users from a Norwegian substance use treatment facility. RESULTS Our main finding was that music and music therapy enabled experiences of motivation and mastery that ultimately afforded social belonging. The participants demonstrated detailed and nuanced understanding of how they use music to steer the energy and restlessness that are characteristic of ADHD, to change mood, and to shift negative thought patterns. These forms of music-centered regulation served as pre-requisites for more active and gratifying participation in social communities. For several participants, musicking offered a means of establishing drug-free identity and fellowship. The motivation and mastery experienced during musicking lowered the threshold for social engagement, and served as an incentive for continuing substance use treatment for some participants. CONCLUSIONS The nuanced descriptions from our participants illustrate the importance of motivation, and how music therapy can contribute to motivation in substance use treatment. In particular, the context surrounding musicking, adaptations from the music therapist, and social affordances of such musicking contributed to pleasure, mastery, participation, development of identity and social belonging, which in interaction generated motivation.
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Affiliation(s)
- Claire M Ghetti
- GAMUT-The Grieg Academy Music Therapy Research Centre, The Grieg Academy-Department of Music, University of Bergen, 5020, Bergen, Postbox 7805, Norway.
| | - Steinar Hjelmbrekke
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Katharina Morken
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Therese Dahl
- Albatrossen Aftercare Center (The Albatrossen Foundation), Bergen, Norway
| | - Brynjulf Stige
- GAMUT-The Grieg Academy Music Therapy Research Centre, The Grieg Academy-Department of Music, University of Bergen, 5020, Bergen, Postbox 7805, Norway
- Polyfon Knowledge Cluster for Music Therapy, Bergen, Norway
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Molina BSG, Kennedy TM, Howard AL, Swanson JM, Arnold LE, Mitchell JT, Stehli A, Kennedy EH, Epstein JN, Hechtman LT, Hinshaw SP, Vitiello B. Association Between Stimulant Treatment and Substance Use Through Adolescence Into Early Adulthood. JAMA Psychiatry 2023; 80:933-941. [PMID: 37405756 PMCID: PMC10323757 DOI: 10.1001/jamapsychiatry.2023.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 07/06/2023]
Abstract
Importance Possible associations between stimulant treatment of attention-deficit/hyperactivity disorder (ADHD) and subsequent substance use remain debated and clinically relevant. Objective To assess the association of stimulant treatment of ADHD with subsequent substance use using the Multimodal Treatment Study of ADHD (MTA), which provides a unique opportunity to test this association while addressing methodologic complexities (principally, multiple dynamic confounding variables). Design, Setting, and Participants MTA was a multisite study initiated at 6 sites in the US and 1 in Canada as a 14-month randomized clinical trial of medication and behavior therapy for ADHD but transitioned to a longitudinal observational study. Participants were recruited between 1994 and 1996. Multi-informant assessments included comprehensively assessed demographic, clinical (including substance use), and treatment (including stimulant treatment) variables. Children aged 7 to 9 years with rigorously diagnosed DSM-IV combined-type ADHD were repeatedly assessed until a mean age of 25 years. Analysis took place between April 2018 and February 2023. Exposure Stimulant treatment of ADHD was measured prospectively from baseline for 16 years (10 assessments) initially using parent report followed by young adult report. Main Outcomes and Measures Frequency of heavy drinking, marijuana use, daily cigarette smoking, and other substance use were confidentially self-reported with a standardized substance use questionnaire. Results A total of 579 children (mean [SD] age at baseline, 8.5 [0.8] years; 465 [80%] male) were analyzed. Generalized multilevel linear models showed no evidence that current (B [SE] range, -0.62 [0.55] to 0.34 [0.47]) or prior stimulant treatment (B [SE] range, -0.06 [0.26] to 0.70 [0.37]) or their interaction (B [SE] range, -0.49 [0.70] to 0.86 [0.68]) were associated with substance use after adjusting for developmental trends in substance use and age. Marginal structural models adjusting for dynamic confounding by demographic, clinical, and familial factors revealed no evidence that more years of stimulant treatment (B [SE] range, -0.003 [0.01] to 0.04 [0.02]) or continuous, uninterrupted stimulant treatment (B [SE] range, -0.25 [0.33] to -0.03 [0.10]) were associated with adulthood substance use. Findings were the same for substance use disorder as outcome. Conclusions and Relevance This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD. These findings do not appear to result from other factors that might drive treatment over time and findings held even after considering opposing age-related trends in stimulant treatment and substance use.
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Affiliation(s)
- Brooke S. G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrea L. Howard
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - James M. Swanson
- Department of Pediatrics, University of California, Irvine, Irvine
| | - L. Eugene Arnold
- Department of Psychiatry & Behavioral Health, Ohio State University, Columbus
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Annamarie Stehli
- Department of Pediatrics, University of California, Irvine, Irvine
| | - Edward H. Kennedy
- Department of Statistics & Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital, Montreal, Quebec, Canada
| | | | - Benedetto Vitiello
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Cannabis use in Attention - Deficit/Hyperactivity Disorder (ADHD): A scoping review. J Psychiatr Res 2023; 157:239-256. [PMID: 36508935 DOI: 10.1016/j.jpsychires.2022.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Treatments for Adult ADHD include stimulants, two non-stimulant medications, as well as cognitive-behavioral therapy (CBT). These pharmacological agents are often associated with side effects, contributing to poor treatment adherence. Patients with ADHD have regularly stated that cannabis has helped improve their ADHD symptoms; however, scientific literature describing the effects of cannabis on symptoms of ADHD is scarce. METHODS We systematically searched MEDLINE, EMBASE, EMCARE, PsycINFO, Web of Science, Cochrane Library, and Clinicaltrials.gov. The searches included all publications in English up to June 27, 2022. We included both experimental and observational studies that assessed the effect of cannabis on ADHD symptomatology and neuropsychiatric outcomes. To synthesize our current understanding of the potential effects of cannabis use on ADHD symptoms and pathophysiology, and the effects of ADHD on cannabis use, data was extracted from each study regarding the characteristics of its population, methods used to assess both cannabis consumption and ADHD symptoms, and key findings. RESULTS Our scoping review included a total of 39 studies. Only one study employed a randomized and placebo-controlled design to directly measure the effect of cannabis on ADHD, and no significant effect was observed for the study's primary outcome, the QbTest (Est = -0.17, 95% CI -0.40 to 0.07, p = 0.16). Most of the literature consists of cross-sectional studies that evaluate the association between ADHD severity and cannabis use. 15 studies addressed the neuropsychiatric effects of cannabis on ADHD by employing either a battery of neuropsychiatric tests or neuroimaging. The concentration and amount of THC and CBD used were not well measured in most of the studies. Although some studies indicated that cannabis improved ADHD symptoms, most studies indicated it worsened or had no effect on ADHD symptoms. CONCLUSIONS Given the current evidence, cannabis is not recommended for people with ADHD. Limitations of the literature include the absence of objective measurements for cannabis exposure and ADHD symptoms, heterogenous definitions, oversampling, and small sample sizes.
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Silver NA, Kierstead EC, Briggs J, Schillo B. Charming e-cigarette users with distorted science: a survey examining social media platform use, nicotine-related misinformation and attitudes towards the tobacco industry. BMJ Open 2022; 12:e057027. [PMID: 35649587 PMCID: PMC9160585 DOI: 10.1136/bmjopen-2021-057027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/15/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the role of social media in promoting recall and belief of distorted science about nicotine and COVID-19 and whether recall and belief predict tobacco industry beliefs. DESIGN Young adults aged 18-34 years (N=1225) were surveyed cross-sectionally via online Qualtrics panel. The survey assessed recall and belief in three claims about nicotine and COVID-19 and three about nicotine in general followed by assessments of industry beliefs and use of social media. Ordinal logistic regression with robust standard errors controlling for gender, race/ethnicity, education, current e-cigarette use and age was used to examine relationships between variables. RESULTS Twitter use was associated with higher odds of recall (OR=1.21, 95% CI=1.01 to 1.44) and belief (OR=1.26, 95% CI=1.04 to 1.52) in COVID-19-specific distorted science. YouTube use was associated with higher odds of believing COVID-19-specific distorted science (OR=1.32, 95% CI=1.09 to 1.60). Reddit use was associated with lower odds of believing COVID-19-specific distorted science (OR=0.72, 95% CI=0.59 to 0.88). Recall (OR=1.26, 95% CI=1.07 to 1.47) and belief (OR=1.28, 95% CI=1.09 to 1.50) in distorted science about nicotine in general as well as belief in distorted science specific to COVID-19 (OR=1.61, 95% CI=1.34 to 1.95) were associated with more positive beliefs about the tobacco industry. Belief in distorted science about nicotine in general was also associated with more negative beliefs about the tobacco industry (OR=1.18, 95% CI=1.02 to 1.35). CONCLUSIONS Use of social media platforms may help to both spread and dispel distorted science about nicotine. Addressing distorted science about nicotine is important, as it appears to be associated with more favourable views of the tobacco industry which may erode public support for effective regulation.
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Affiliation(s)
- Nathan A Silver
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Elexis C Kierstead
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Jodie Briggs
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Barbara Schillo
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
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Stueber A, Cuttler C. Self-Reported Effects of Cannabis on ADHD Symptoms, ADHD Medication Side Effects, and ADHD-Related Executive Dysfunction. J Atten Disord 2022; 26:942-955. [PMID: 34632827 DOI: 10.1177/10870547211050949] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE People with ADHD are more likely to use cannabis but little is known about the effects of cannabis on ADHD symptoms, ADHD medication side effects, or ADHD-related executive dysfunction. METHOD Students (n = 1,738) completed an online survey containing measures of ADHD symptoms, cannabis use, perceived effects of cannabis on ADHD symptoms and medication side effects, as well as executive dysfunction. RESULTS Participants with ADHD who have used cannabis reported that cannabis has acute beneficial effects on many symptoms of ADHD (e.g., hyperactivity, impulsivity). Further, they perceived cannabis to improve most of their medication side effects (e.g., irritability, anxiety). Finally, cannabis use frequency was a significant moderator of the associations between symptom severity and executive dysfunction. CONCLUSION Results suggest people with ADHD may be using cannabis to self-medicate for many of their symptoms and medication side effects and that more frequent use may mitigate ADHD-related executive dysfunction.
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Ginapp CM, Macdonald-Gagnon G, Angarita GA, Bold KW, Potenza MN. The lived experiences of adults with attention-deficit/hyperactivity disorder: A rapid review of qualitative evidence. Front Psychiatry 2022; 13:949321. [PMID: 36032220 PMCID: PMC9403235 DOI: 10.3389/fpsyt.2022.949321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common condition that frequently persists into adulthood, although research and diagnostic criteria are focused on how the condition presents in children. We aimed to review qualitative research on lived experiences of adults with ADHD to characterize potential ADHD symptomatology in adulthood and provide perspectives on how needs might be better met. We searched three databases for qualitative studies on ADHD. Studies (n = 35) in English that included data on the lived experiences of adults with ADHD were included. These studies covered experiences of receiving a diagnosis as an adult, symptomatology of adult ADHD, skills used to adapt to these symptoms, relationships between ADHD and substance use, patients' self-perceptions, and participants' experiences interacting with society. Many of the ADHD symptoms reported in these studies had overlap with other psychiatric conditions and may contribute to misdiagnosis and delays in diagnosis. Understanding symptomatology of ADHD in adults may inform future diagnostic criteria and guide interventions to improve quality of life.
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Affiliation(s)
- Callie M Ginapp
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | | | - Gustavo A Angarita
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Connecticut Mental Health Center, New Haven, CT, United States
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.,Connecticut Mental Health Center, New Haven, CT, United States.,Connecticut Council on Problem Gambling, Wethersfield, CT, United States.,Child Study Center, Yale School of Medicine, New Haven, CT, United States.,Department of Neuroscience, Yale University, New Haven, CT, United States.,Wu Tsai Institute, Yale University, New Haven, CT, United States
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Mitchell JT, Sibley MH, Hinshaw SP, Kennedy TM, Chronis-Tuscano A, Arnold LE, Swanson JM, Hechtman LT, Molina BS, Caye A, Tamm L, Owens EB, Roy A, Weisner TS, Murray DW, Jensen PS. A Qualitative Analysis of Contextual Factors Relevant to Suspected Late-Onset ADHD. J Atten Disord 2021; 25:724-735. [PMID: 30929549 PMCID: PMC9678489 DOI: 10.1177/1087054719837743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Recent studies suggest attention-deficit/hyperactivity disorder (ADHD) may emerge post-childhood. We integrate qualitative methods to systematically characterize contextual factors that may (a) delay identification of ADHD in childhood and (b) inform why ADHD symptoms emerge post-childhood. Method: Suspected late-onset ADHD cases from the local normative comparison group of the Multimodal Treatment Study of ADHD completed a qualitative interview (14 young adults and 7 caregivers). Interviews were qualitatively analyzed. Results: We identified five themes. Three themes may attenuate or delay identification of childhood ADHD: external factors (e.g., supportive adults), internal factors (e.g., strong intellectual functioning), and other factors (e.g., dismissive attitudes toward ADHD). Two themes may accompany an increase in ADHD symptoms post-childhood: external factors (e.g., increased external demands) and internal factors (e.g., perceived stress). Conclusion: Clinicians should probe these factors in suspected late-onset cases to address (a) whether, how, and to what extent ADHD was attenuated in childhood and (b) why symptoms emerge post-childhood.
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Affiliation(s)
- John T. Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Margaret H. Sibley
- Department of Psychiatry and Behavioral Health, Florida International University
| | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley
- Department of Psychiatry, University of California, San Francisco
| | | | | | - L. Eugene Arnold
- Department of Psychiatry & Behavioral Health, Ohio State University
| | | | - Lily T. Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital
| | - Brooke S.G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh
| | - Arthur Caye
- Department of Psychiatry, Federal University of Rio Grande do Sul
| | - Leanne Tamm
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center & University of Cincinnati College of Medicine
| | | | - Arunima Roy
- Division of Molecular Psychiatry, University Hospital Würzburg
| | - Thomas S. Weisner
- Departments of Anthropology and Psychiatry, University of California, Los Angeles
| | - Desiree W. Murray
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill
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Neurodevelopmental Effects of Cannabis Use in Adolescents and Emerging Adults with ADHD: A Systematic Review. Harv Rev Psychiatry 2021; 29:251-261. [PMID: 34138796 PMCID: PMC9129887 DOI: 10.1097/hrp.0000000000000303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Systematically review the scientific literature to characterize the effects of cannabis use on brain structure, function, and neurodevelopmental outcomes in adolescents and young adults with ADHD. METHOD Systematic review following PRISMA guidelines utilizing PubMed, Embase, PsycINFO, and Cochrane CENTRAL trials register from inception until 1 January 2020. Articles that examined the impact of cannabis use on youth with ADHD were included. RESULTS Eleven studies were identified that compared outcomes for individuals with ADHD who used cannabis or synthetic cannabinoids against those with ADHD who did not. Seven of these studies used neuroimaging techniques, including fMRI, structural MRI, and SPECT. Differential regions of activation were identified, including the right hippocampus and cerebellar vermis, and bilateral temporal lobes. Morphological differences were identified in the right precentral and postcentral gyri, left nucleus accumbens, right superior frontal and postcentral gyri. No study identified any additive or ADHD × cannabis use interaction on neuropsychological tasks of executive function. Two studies found adverse differential impacts of early-onset cannabis use in this population. CONCLUSION A dearth of evidence is available on the impact of cannabis use on the developing brain and functioning for individuals with ADHD, despite the elevated risk for substance use in this population. The limited, potentially underpowered evidence does not support the hypothesis that cannabis use has a deleterious impact on neuropsychological tasks in transitional age youth with ADHD. Larger and longer-term studies are needed, however, to better inform clinicians and patients as to the impacts of cannabis use in youth with ADHD.
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Stevens AK, Gunn RL, Jackson KM, Borsari B, Metrik J. Examining motivational pathways from adult attention-deficit/hyperactivity disorder symptoms to cannabis use: Results from a prospective study of veterans. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 35:16-28. [PMID: 32881541 DOI: 10.1037/adb0000682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: Attention-deficit/hyperactivity disorder (ADHD) is linked prospectively to cannabis; however, no study has examined mechanisms underlying this comorbidity. We examined 5 cannabis motives (i.e., coping with negative affect, sleep, social anxiety, perceived low risk of cannabis, and altered perception) as mediators of the prospective ADHD-cannabis relation. Method: Veterans reporting lifetime cannabis use (N = 361; 93% male; 80% White) completed three semiannual assessments. Prospective mediation models using structural equation modeling analyzed the indirect effects of baseline ADHD symptoms on 12-month cannabis use and problems via each motive at 6 months. Zero-inflated negative binomial models were employed for both manifest outcomes and ADHD symptoms and motives were each modeled as 1-factor latent variables. Results: Sleep motives was a robust mediator for cannabis use frequency in single mediator models and was marginally significant when examined simultaneously with other motives after accounting for baseline cannabis use, demographics, other substance use, and other psychopathology. Coping with negative affect was the only significant mediator of ADHD symptoms and subsequent cannabis problem severity. Conclusion: Among veterans with ADHD symptoms, sleep disturbance is a salient motive for cannabis use, whereas coping with negative affect is a proximal predictor of cannabis problems. Findings support addressing sleep disturbance in adults with ADHD symptoms and converge with extant literature demonstrating robust associations between coping motives and substance use problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Howard AL, Kennedy TM, Mitchell JT, Sibley MH, Hinshaw SP, Eugene BL, Roy A, Stehli A, Swanson JM, Molina BSG. Early substance use in the pathway from childhood attention-deficit/hyperactivity disorder (ADHD) to young adult substance use: Evidence of statistical mediation and substance specificity. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:281-292. [PMID: 31886682 PMCID: PMC9812258 DOI: 10.1037/adb0000542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study tested whether early and developmentally atypical substance use mediates risk for adult substance use among children with attention-deficit/hyperactivity disorder (ADHD), and whether that risk is substance-specific. Participants were children with ADHD previously enrolled in a randomized controlled trial (RCT), and a demographically similar non-ADHD group, assessed at 2 through 16 years after the original RCT baseline. Self-reports of heavy drinking, marijuana use, daily smoking, and other illicit drug use were collected at follow-ups to establish atypically early and frequent use. Models estimated statistically mediated effects of childhood ADHD on adult substance use via early substance involvement, with planned comparisons to evaluate substance specificity. Results supported the mediation hypothesis, showing that childhood ADHD was associated with more frequent adult substance use via early substance involvement for marijuana, cigarettes, illicit drugs, and to a lesser extent, alcohol. Mediation was not escalated by comorbid childhood conduct disorder or oppositional defiant disorder except for early use of nonmarijuana illicit drugs. Substance-specificity in the mediational pathway was largely absent except for cigarette use, where ADHD-related early smoking most strongly predicted adult daily smoking. Findings from this study provide new evidence that atypically early substance use associated with childhood ADHD signals important cross-drug vulnerability by early adulthood, but cigarette use at a young age is especially associated with increased risk for habitual (daily) smoking specifically. Efforts to prevent, delay, or reduce substance experimentation should occur early and focus on factors relevant to multiple drugs of abuse in this at-risk population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Walther CAP, Pedersen SL, Gnagy E, Pelham WE, Molina BSG. Specificity of expectancies prospectively predicting alcohol and marijuana use in adulthood in the Pittsburgh ADHD longitudinal study. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:117-127. [PMID: 30640503 PMCID: PMC6405311 DOI: 10.1037/adb0000439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol and marijuana use expectancies are presumed to be drug-specific, but prospective study of this assumption is lacking. In addition, these associations may operate differently for adults with attention-deficit/hyperactivity disorder (ADHD) histories, as expectancies have been found to be less associated with alcohol and marijuana use among this population. The first aim of the present study was to investigate whether associations between alcohol and marijuana expectancies and substance use were specific to the substances they assess. The second aim was to determine whether these associations differed as a function of ADHD history. Participants (N = 491; 281 ADHD, 210 non-ADHD) were young adults followed longitudinally between ages 21 to 23 and 29 as part of the Pittsburgh ADHD Longitudinal Study (PALS). Autoregressive models were estimated separately for positive and negative expectancies for frequency of alcohol and marijuana use and compared between ADHD groups. Although there were exceptions, results generally support the specificity of associations between outcome expectancies and respective substance use both concurrently and prospectively, but this specificity was primarily present for those without a history of ADHD. These findings suggest that young adults perceive and respond distinctly to the effects of alcohol and marijuana, but a history of ADHD may interfere with this process. These findings also extend our prior cross-sectional findings that expectancies are less associated with alcohol and marijuana use for individuals with ADHD histories. Additional research examining implicit cognitions is needed to further examine risk for substance use among those with ADHD histories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Elizabeth Gnagy
- Center for Children and Families, Florida International University
| | - William E Pelham
- Center for Children and Families and Department of Psychology, Florida International University
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Mitchell JT, LeGrand S, Hightow-Weidman LB, McKellar MS, Kashuba AD, Cottrell M, McLaurin T, Satapathy G, McClernon FJ. Smartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial. JMIR Mhealth Uhealth 2018; 6:e10456. [PMID: 30201601 PMCID: PMC6231728 DOI: 10.2196/10456] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/07/2018] [Accepted: 06/16/2018] [Indexed: 11/28/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) provides a strong preventative benefit to individuals at risk for HIV. While PrEP adherence is highly correlated with its efficacy, adherence rates are variable both across and within persons. Objective The objective of this study was to develop and pilot-test a smartphone-based intervention, known as mSMART, that targets PrEP adherence. mSMART provides contingency management in the form of monetary incentives for daily PrEP adherence based on a real-time adherence assessment using a camera-based medication event-monitoring tool as well as medication reminders, PrEP education, individualized behavioral strategies to address PrEP adherence barriers, and medication adherence feedback. Methods This was a 4-week open-label, phase I trial in a community sample of young men who have sex with men already on PrEP (N=10). Results Although adherence composite scores corresponding to PrEP biomarkers indicated that 90% (9/10) of the sample already had an acceptable baseline adherence in the protective range, by the end of the 4-week period, the scores improved for 30% (3/10) of the sample—adherence did not worsen for any participants. Participants reported mean PrEP adherence rates of 91% via daily entries in mSMART. At the end of the 4-week period, participants indicated acceptable ratings of satisfaction, usability, and willingness to recommend mSMART to others. There were no technical difficulties associated with smartphone compatibility, user misunderstandings about mSMART features that interfered with daily use, or study attrition. Conclusions This study is the first to apply contingency management to PrEP adherence. Findings indicated that mSMART is feasible and acceptable. Such an adherence intervention administered via a user-friendly smartphone app can allow for widespread dissemination. Future efficacy trials are needed. Trial Registration ClinicalTrials.gov NCT02895893; https://clinicaltrials.gov/ct2/show/NCT02895893 (Accessed by Webcite at http://www.webcitation.org/72JskjDJq)
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Affiliation(s)
- John T Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.,Duke Center for Addiction Science and Technology, Durham, NC, United States
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research at Duke University, Duke Global Health Institute, Durham, NC, United States
| | - Lisa B Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mehri S McKellar
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, United States
| | - Angela Dm Kashuba
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mackenzie Cottrell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tony McLaurin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
| | - Goutam Satapathy
- Intelligent Automation Incorporated, Rockville, NC, United States
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States.,Duke Center for Addiction Science and Technology, Durham, NC, United States
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Swanson JM, Wigal T, Jensen P, Mitchell JT, Weisner TS, Murray DW, Arnold LE, Hechtman L, Molina BSG, Owens E, Belendiuk K, Howard AL, Wigal S, Sorenson P, Stehli A. The Qualitative Interview Study of Persistent and Nonpersistent Substance Use in the MTA: Sample Characteristics, Frequent Use, and Reasons for Use. J Atten Disord 2018; 22:21S-37S. [PMID: 29090967 PMCID: PMC6746244 DOI: 10.1177/1087054717714058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate participants' perceptions about frequent use and reasons for substance use (SU) in the qualitative interview study, an add-on to the multimodal treatment study of ADHD (MTA). METHOD Using the longitudinal MTA database, 39 ADHD cases and 19 peers with Persistent SU, and 86 ADHD cases and 39 peers without Persistent SU were identified and recruited. In adulthood, an open-ended interview was administered, and SU excerpts were indexed and classified to create subtopics (frequent use and reasons for use of alcohol, marijuana, and other drugs). RESULTS For marijuana, the Persistent compared with Nonpersistent SU group had a significantly higher percentage of participants describing frequent use and giving reasons for use, and the ADHD group compared with the group of peers had a significantly higher percentage giving "stability" as a reason for use. CONCLUSION Motivations for persistent marijuana use may differ for adults with and without a history of ADHD.
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Affiliation(s)
| | | | - Peter Jensen
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA,Reach Institute, New York, NY, USA
| | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Thomas S. Weisner
- Departments of Psychiatry & Anthropology, UCLA, Los Angeles, CA, USA
| | - Desiree W. Murray
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA,Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - L. Eugene Arnold
- Department of Psychiatry, Ohio State University, Columbus, OH, USA
| | - Lily Hechtman
- Division of Child Psychiatry, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Brooke S. G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Owens
- Institute of Human Development and Department of Psychology, University of California, Berkeley, CA, USA
| | - Katherine Belendiuk
- Department of Real World Data Science, Genentech, South San Francisco, CA, USA
| | | | | | - Page Sorenson
- University of California, San Francisco, Research Development Office
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Jensen PS, Weisner T, Hinshaw SP. Introduction: Just Say No? New Insights About Change Versus Constancy in Substance Use Behavioral Decisions in Youth With and Without ADHD. J Atten Disord 2018; 22:3S-9S. [PMID: 29633895 PMCID: PMC6718161 DOI: 10.1177/1087054718763729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite enormous social-psychological and economic consequences of substance abuse in youth and young adults, too little is known about effective interventions among substance users, both with and without ADHD. This special issue reports on four linked investigations that employed a novel research strategy when the Multimodal Treatment Children with ADHD Study (MTA) participants were between ages 21.7 and 27.3 years old (14-16 years after initial assessments). Using combination of in-depth qualitative narrative interviews and quantitative analyses ("mixed methods") of 183 participants from four to six original MTA sites, investigators sought to obtain a more complete understanding of factors contributing to youths' substance use (SU) initiation, maintenance, and desistence, (both among youth with ADHD and control participants). The articles in this special issue illuminate important new insights about possible influences contributing to SU, particularly persistent use/abuse. Findings also illustrate the benefits of mixed-methods studies, not only to better understand the linkages between ADHD and SU, but also to understand other areas of child/adult psychopathology.
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Affiliation(s)
- Peter S. Jensen
- University of Arkansas for Medical Sciences, Little Rock, USA
- The REACH Institute, New York, NY, USA
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Jensen PS, Yuki K, Murray D, Mitchell JT, Weisner T, Hinshaw S, Molina B, Swanson J, Arnold LE, Hechtman L, Wells K. Turning Points in the Lives of Youth of With/Without ADHD: Are They Linked to Changes in Substance Use? J Atten Disord 2018; 22:38S-48S. [PMID: 28423975 PMCID: PMC5623613 DOI: 10.1177/1087054717700977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examines the behavior beliefs, social supports, and turning points in individuals with/without ADHD related to their substance use/abuse (SU/A) decisions. METHOD The coded interviews from 60 participants with/without ADHD were compared for their SU/A decisions and precipitants with these decisions among abstainers, persisters, and desisters. RESULTS ADHD participants reported fewer social advantages to avoid SU/A than non-ADHD participants. Desisters and persisters reported more social advantages of using drugs than abstainers. Persisters reported both more negative and positive psychological/physiological effects of SU/A. ADHD participants reported fewer positive role models in their lives. Non-ADHD patients reported more positive turning points than ADHD participants, regardless of SU/A status. CONCLUSION ADHD individuals face challenges in making healthy decisions about SU/A due to lack of positive role models. Reinforcing accurate behavioral beliefs may be important to change behaviors in individuals with SU/A or to prevent SU/A initiation in ADHD individuals.
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Affiliation(s)
- Peter S Jensen
- 1 University of Arkansas for Medical Science, Little Rock, USA
| | - Kumi Yuki
- 2 Reach Institute, New York, NY, USA
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Molina BS, Howard AL, Swanson JM, Stehli A, Mitchell JT, Kennedy TM, Epstein JN, Arnold LE, Hechtman L, Vitiello B, Hoza B. Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study. J Child Psychol Psychiatry 2018; 59:692-702. [PMID: 29315559 PMCID: PMC5985671 DOI: 10.1111/jcpp.12855] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. METHODS Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. RESULTS In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups. CONCLUSIONS Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels.
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Affiliation(s)
- Brooke S.G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh
| | | | | | | | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Lily Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital
| | | | - Betsy Hoza
- Department of Psychological Science, University of Vermont
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Howard AL, Pritchard TR. Heavy Drinking in University Students With and Without Attention-Deficit/Hyperactivity Disorder: Contributions of Drinking Motives and Protective Behavioral Strategies. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2017; 11:1178221817723318. [PMID: 28814878 PMCID: PMC5546638 DOI: 10.1177/1178221817723318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
This study examined rates of heavy drinking and alcohol problems in relation to drinking motives and protective behavioral strategies in university students with a documented current diagnosis of attention-deficit/hyperactivity disorder (ADHD; n = 31) compared with students with no history of ADHD (n = 146). Participants completed a Web-based questionnaire, and logistic regression models tested interactions between ADHD/comparison group membership and motives and protective strategies. Group differences in rates of heavy drinking and alcohol problems were not statistically significant, but medium-sized risk ratios showed that students without ADHD reported heavy drinking at a rate 1.44 times higher than students with ADHD and met screening criteria for problematic alcohol use at a rate of 1.54 times higher than students with ADHD. Other key findings were, first, that drinking to enhance positive affect (e.g., drinking because it is exciting), but not to cope with negative affect (e.g., drinking to forget your worries), predicted both heavy drinking and alcohol problems. Second, only protective behavioral strategies that emphasize alcohol avoidance predicted both heavy drinking and alcohol problems. Contrary to expectations, we found no ADHD-related moderation of effects of motives or protective strategies on our alcohol outcomes. Results of this study are limited by the small sample of students with ADHD but highlight tentative similarities and differences in effects of motives and strategies on drinking behaviors and alcohol problems reported by students with and without ADHD.
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Affiliation(s)
- Andrea L Howard
- Department of Psychology, Carleton University, Ottawa, ON, Canada
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