Behavioral and Cognitive Predictors of Adolescent Substance Use in Children with ADHD

1
Behavioral and Cognitive Predictors of Adolescent
Substance Use in Children with ADHD

• Jeffrey M. Halperin, Jeffrey H. Newcorn, Nicole
  Thorn and Seth Harty

Queens College and The Graduate Center, CUNY
and The Mount Sinai School of Medicine
Supported by NIMH grant RO1 MH060698
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ADHD and Risk for Adolescent Substance Use

• Is it specific to ADHD or more closely linked to
  
• The presence of early conduct disorder (CD)?
• The persistence of CD into adolescence?
• The persistence of AD/HD into adolescence?
• Is risk for substance use affected by level of
  cognitive function?

3
Longitudinal Study of Urban Youth with ADHD
Baseline Assessment

• Initially recruited 1990 1997
• Clinically-referred sample
• Age at initial assessment 7 11 years
• Teacher ratings IOWA Conners
• Parent ratings CBCL
• Parent Interview DISC
• IQ WISC-R/WISC-III
• Academic Achievement WRAT-R/WIAT

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Childhood Characteristics of Children with ADHD
Full Sample Presentation Sample
N 169 N 56
Mean SD Mean
SD
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Childhood Characteristics of Children with ADHD
Full Sample Presentation Sample
N 169 N 56
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Adolescent Sample Characteristics
ADHD Controls
(N 56) (N 56)
Mean SD Mean SD
p
7
Adolescent Assessment Instruments

• Kiddie SADS PL
• ADHD
• Conduct Disorder
• Alcohol abuse and dependence
• Substance abuse and dependence
• Rutgers Alcohol and Drug Use Questionnaire
  (Labouvie et al. 1997)
• Aggression, Antisocial Behavior and Drug Use
  Summary Scale (Kalmar Halperin)
• Aggression r .90
• Antisocial Behavior r .83
• Substance Use r .93

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Drug Use Summary Scale
1 2 3 4
5 6 7 8
9
absent infreq.
freq. minor/ freq. major
persistent minor
infreq. major
very serious
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Substance Use Diagnoses in ADHD and Control
Adolescents
Percent
p .067
10
Dimensional Assessment of Aggression, Antisocial
Behavior and Substance Use in ADHD and Control
Groups
p lt .05
11
ADHD and Risk for Adolescent Substance Use

• Is it specific to ADHD or more closely linked to
  
• The presence of early conduct disorder (CD)?
• The persistence of CD into adolescence?
• The persistence of AD/HD into adolescence?
• Is risk for substance use affected by level of
  cognitive function?

12
Substance Use Diagnoses in Controls and ADHD as a
function of Childhood CD
Percent
p .08
13
Dimensional Assessment of Aggression, Antisocial
Behavior and Substance Use in Controls and ADHD
with and without Childhood CD




Differs from ADHD/CD, p lt .05
14
ADHD and Risk for Adolescent Substance Use

• Is it specific to ADHD or more closely linked to
  
• The presence of early conduct disorder (CD)?
• The persistence of CD into adolescence?
• The persistence of AD/HD into adolescence?
• Is risk for substance use affected by level of
  cognitive function?

15
Substance Use Diagnoses in Controls and ADHD as a
function of Adolescent CD
Percent
p .10 plt .01
16
Dimensional Assessment of Aggression, Antisocial
Behavior and Substance Use in Controls and ADHD
with and without Adolescent CD




Differs from ADHD/CD, p lt .05 Differs from
other two groups, p lt .05
17
Substance Use Diagnoses in Controls and ADHD as a
function of Childhood and Adolescent CD
Percent
p lt .01 plt .05
18
Dimensional Assessment and Substance Use as a
Function of Childhood and Adolescent CD


N31 N11 N6
N6 N55
Main Effect for Childhood CD p .07
Main Effect for Adolescent CD p .01
Differs from CCD-/ACD-, p lt .05
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ADHD and Risk for Adolescent Substance Use

• Is it specific to ADHD or more closely linked to
  
• The presence of early conduct disorder (CD)?
• The persistence of CD into adolescence?
• The persistence of AD/HD into adolescence?
• Is risk for substance use affected by level of
  cognitive function?

20
Substance Use Diagnoses in Controls and ADHD as a
function of Adolescent ADHD
Percent
p .01
21
Dimensional Assessment of Aggression, Antisocial
Behavior and Substance Use in Controls and ADHD
with and without Adolescent ADHD
all p gt .10
22
Proportion of Children with a Substance Use
Diagnosis in Adolescence


p lt .10 p lt .05 relative to controls
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ADHD and Risk for Adolescent Substance Use

• Is it specific to ADHD or more closely linked to
  
• The presence of early conduct disorder (CD)?
• The persistence of CD into adolescence?
• The persistence of AD/HD into adolescence?
• Is risk for substance use affected by level of
  cognitive function?

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Drug Use Summary Ratings as a Function of
Childhood IQ and Academic Achievement in Young
Adolescents (N32 mean age 15.8 yrs.)
r
From Harty et al, In Press all p gt .10
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Drug Use Summary Ratings as a Function of
Childhood CD and IQ/Academic Achievement in Young
Adolescents (mean age 15.8 yrs)



r

From Harty et al, In Press p lt .10 p lt
.05 p lt .01
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Drug Use Summary Ratings as a Function of
Childhood IQ and Academic Achievement in Older
Adolescents (N56, mean age 18.4 yrs.)
r
all p gt .10
27
Drug Use Summary Ratings as a Function of
Childhood CD and IQ/Academic Achievement in Older
Adolescents (mean age 18.4 yrs)
r


FSIQ Reading

p lt .01 p lt .05
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Summary and Conclusions I

• Relative to controls, adolescents who had ADHD in
  childhood are more likely to encounter alcohol,
  but not drug use problems
• Among children with ADHD, conduct disorder in
  childhood or adolescence is associated with
  increased drug use problems
• The persistence of ADHD into adolescence appears
  linked to increased alcohol, but not drug use

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Summary and Conclusions II

• High cognitive function is associated with early
  onset of substance use among youth with CD.
  However, it may not portend more severe
  difficulties in later adolescence
• Whereas low cognitive function appears to be
  associated with increased adolescent aggression
  and antisocial behavior, this does not appear to
  be the case for substance use
• Childhood ADHD in the absence of CD is not
  associated with elevated substance use problems.