The Effects of Childhood ADHD Symptoms on Early-onset Substance Use: A Swedish Twin Study
- 1.1k Downloads
Research has documented that children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of substance use problems. Few studies, however, have focused on early-onset substance use. This study therefore investigated how the two symptom dimensions of ADHD (hyperactivity/impulsivity and inattention) are associated with early-onset substance use, the role of persistent ADHD for the association, and to what extent the association is influenced by genetic and environmental factors. Twins (1,480 pairs) in the Swedish Twin Study of Child and Adolescent Development were followed from childhood to adolescence. ADHD symptoms were measured at age 8–9 and age 13–14 via parent-report, whereas substance use was assessed at age 13–14 via self-report. Results revealed that hyperactive/impulsive symptoms predicted early-onset “sometimes” tobacco use (adjusted odds ratios, 1.12, for one symptom count), controlling for inattentive symptoms and conduct problem behaviors. There is no independent effect of inattentive symptoms on early-onset substance use. Children with persistent hyperactivity/impulsivity (defined as scoring above the 75th percentile at both time points) had a pronounced risk of both early-onset tobacco and alcohol use (adjusted odds ratios from 1.86 to 3.35, compared to the reference group). The associations between hyperactivity/impulsivity and early-onset substance use were primarily influenced by genetic factors. Our results indicated that hyperactivity/impulsivity, but not inattention, is an important early predictor for early-onset substance use, and a shared genetic susceptibility is suggested to explain this association.
KeywordsADHD Conduct problem behaviors Early-onset substance use Twins Genetics
This research was supported by grants from the Swedish Council for Working Life and Social Research and from the Swedish Research Council. Henrik Larsson was supported by grants from the Swedish Research Council (2010–3184), Swedish brain foundation and Karolinska Institutet center of Neurodevelopmental Disorders.
- Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
- Baker, J. H., Maes, H. H., Larsson, H., Lichtenstein, P., & Kendler, K. S. (2011). Sex differences and developmental stability in genetic and environmental influences on psychoactive substance consumption from early adolescence to young adulthood. Psychological Medicine, 1–10. doi: S003329171000259X[pii]10.1017/S003329171000259X.
- Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford Press.Google Scholar
- Bussing, R., Mason, D. M., Bell, L., Porter, P., & Garvan, C. (2010). Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 49(6), 595–605. doi: 10.1016/j.jaac.2010.03.006.PubMedGoogle Scholar
- ESPAD (2004). Alcohol and other drug use among students in 35 European countries. The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group at the Council of Europe, Stockholm.Google Scholar
- Fisher, S. L., Bucholz, K. K., Reich, W., Fox, L., Kuperman, S., Kramer, J., et al. (2006). Teenagers are right–parents do not know much: an analysis of adolescent-parent agreement on reports of adolescent substance use, abuse, and dependence. Alcoholism, Clinical and Experimental Research, 30(10), 1699–1710. doi: 10.1111/j.1530-0277.2006.00205.x.PubMedCrossRefGoogle Scholar
- HBSC (2004). Young people’s health in context: international report from the HBSC 2001/02 survey, (Health Policy for Children and Adolescents, No.4). WHO Regional Office for Europe, Copenhagen.Google Scholar
- Kendler, K. S., Jacobson, K. C., Prescott, C. A., & Neale, M. C. (2003). Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins. The American Journal of Psychiatry, 160(4), 687–695.PubMedCrossRefGoogle Scholar
- Kendler, K. S., Schmitt, E., Aggen, S. H., & Prescott, C. A. (2008). Genetic and environmental influences on alcohol, caffeine, cannabis, and nicotine use from early adolescence to middle adulthood. Archives of General Psychiatry, 65(6), 674–682. doi: 10.1001/archpsyc.65.6.674.PubMedCrossRefGoogle Scholar
- Larsson, J. O., Larsson, H., & Lichtenstein, P. (2004). Genetic and environmental contributions to stability and change of ADHD symptoms between 8 and 13 years of age: a longitudinal twin study. Journal of the American Academy of Child and Adolescent Psychiatry, 43(10), 1267–1275.PubMedCrossRefGoogle Scholar
- Larsson, H., Dilshad, R., Lichtenstein, P., & Barker, E. D. (2011). Developmental trajectories of DSM-IV symptoms of attention-deficit/hyperactivity disorder: genetic effects, family risk and associated psychopathology. Journal of Child Psychology and Psychiatry, 52(9), 954–963. doi: 10.1111/j.1469-7610.2011.02379.x.PubMedCrossRefGoogle Scholar
- Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clinical Psychology Review, 31(3), 328–341. doi: 10.1016/j.cpr.2011.01.006.PubMedCrossRefGoogle Scholar
- Macleod, J., Oakes, R., Copello, A., Crome, I., Egger, M., Hickman, M., et al. (2004). Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet, 363(9421), 1579–1588. doi: 10.1016/S0140-6736(04)16200-4.PubMedCrossRefGoogle Scholar
- McGue, M., Iacono, W. G., Legrand, L. N., Malone, S., & Elkins, I. (2001). Origins and consequences of age at first drink. I. Associations with substance-use disorders, disinhibitory behavior and psychopathology, and P3 amplitude. Alcoholism: Clinical and Experimental Research, 25(8), 1156–1165.CrossRefGoogle Scholar
- Monuteaux, M. C., Faraone, S. V., Hammerness, P., Wilens, T. E., Fraire, M., & Biederman, J. (2008). The familial association between cigarette smoking and ADHD: a study of clinically referred girls with and without ADHD, and their families. Nicotine & Tobacco Research, 10(10), 1549–1558.CrossRefGoogle Scholar
- Neale, M. C., Boker, S. M., Xie, G., & Maes, H. H. (2003). Mx: Statistical modeling (6th ed.). Richmond: Department of Psychiatry.Google Scholar
- Plomin, R., Defries, J. C., McClearn, G. E., & McGuffin, P. (2008). Behavioral genetics (5th ed.). New York: Worth.Google Scholar
- Socialstyrelsen. (2002). ADHD hos barn och vuxna [In Swedish]. Stockholm: Socialstyrelsen.Google Scholar
- van Lier, P. A., van der Ende, J., Koot, H. M., & Verhulst, F. C. (2007). Which better predicts conduct problems? The relationship of trajectories of conduct problems with ODD and ADHD symptoms from childhood into adolescence. Journal of Child Psychology and Psychiatry, 48(6), 601–608. doi: 10.1111/j.1469-7610.2006.01724.x.PubMedCrossRefGoogle Scholar