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MONDAY, Aug. 18, 2003 (HealthDayNews) -- Children who are diagnosed with attention-deficit/hyperactivity disorder (ADHD) are more likely to use illicit drugs as adolescents.
This group is also more likely to start using at an earlier age, says a study appearing in the August issue of the Journal of Abnormal Psychology.
"The study confirms yet again that children with ADHD are indeed at risk for problems of greater substance abuse including cigarettes and alcohol," says Dr. Andrew Adesman, director of developmental and behavioral pediatrics at Schneider's Children's Hospital in New York City.
Oddly, though, these findings also have a silver lining. Recent studies have strongly suggested that Ritalin and other drugs not only improve symptoms of ADHD but also reduce the risk for substance abuse.
One study found that Ritalin actually reduced substance abuse by a factor of six. The current study "really speaks of the need for parents to intervene for their kids," Adesman says. "The treatment of ADHD with medication has both short-term benefits in terms of academics and attention, but also long-term benefits in terms of prevention or minimizing later risks of drug, cigarettes, and alcohol. With proper treatment, children do better socially and make more appropriate decisions."
ADHD is one of the most commonly diagnosed mental health disorders in children, affecting some 3 percent to 5 percent of school-age children. Children with ADHD are at risk for other behavior problems, including defiance and, eventually, more severe problems such as stealing and fighting.
These same conduct problems are also often linked to drug abuse. "This has led to lots of interest in whether ADHD is a risk factor for drug abuse if you don't have those [behavior] problems," says Brooke Molina, lead author of the study and associate professor of psychiatry and psychology at the University of Pittsburgh School of Medicine.
To try to tease out the different dimensions of the issue, Molina and her colleagues compared substance use and abuse between two groups of teenagers, the first consisting of 142 adolescents who had been diagnosed with ADHD and the second consisting of 100 controls without ADHD. All the participants were between 13 and 18 years old at the time of the study.
Inattention was assessed separately from impulsivity/hyperactivity.
In general, teenagers who had been diagnosed with ADHD in childhood were more likely to use and abuse alcohol and drugs by the time they were teenagers.
Within that group, however, those teens with both ADHD and behavioral problems were at the highest risk for substance abuse.
Also within this group, children with severe inattention (as opposed to hyperactivity/impulsivity) were most at risk to develop alcohol and marijuana problems and to become cigarette smokers by the time they reached adolescence.
However, the researchers were less sure about that finding than about the finding that children with more severe symptoms in general tended to be at greater risk.
"We do believe that severity is in general likely to be a risk factor," Molina says.
The study raises a number of questions. For one thing, Molina and her colleagues are not sure if the risk of drug abuse is a long-term one that translates into adult drug or alcohol abuse.
"Following these kids into adulthood is going to be key in determining longevity," Molina says. "The kids with persistent ADHD but no conduct problems were more likely to drink or be tobacco smokers. Is that more experimenting in teenage years that goes away, or does it persist and end up being something of concern?"
Also, researchers don't have a handle on why certain individuals with ADHD seem to be more vulnerable to drug abuse. "Not all kids with ADHD develop drug abuse, but we still don't know which kids are most likely to develop that problem," Molina says.
Then there is the issue of treatment. "The next hot-ticket item is going to be understanding the treatment ramifications for understanding drug abuse and that is still a wide open question," Molina concludes.
More information
For more on ADHD, visit the National Institute of Mental Health or Children and Adults with Attention-Deficit/Hyperactivity Disorder.
