Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common child and adolescent disorder that is associated with negative outcomes (e.g., emotional and behavioral problems, substance use) and is often comorbid with Conduct Problems (CP). Research findings are mixed as to whether youth with ADHD alone or comorbid ADHD/CP suffer from low self-esteem. Research has also shown links between low self-esteem and ADHD (alone and with CP) with substance use; yet, no research has examined the links between self-esteem and substance use in adolescents with ADHD and CP. The current study examined the relation between ADHD with and without comorbid CP and self-esteem, and whether self-esteem moderated the relation between ADHD and ADHD/CP with substance use among adolescents. We hypothesized that adolescents with comorbid ADHD/CP would experience lower self-esteem than adolescents with ADHD alone or with neither disorder and that self-esteem would moderate the association between ADHD, CP, and substance use. Participants were 62 adolescents who completed the laboratory-based study with a parent. Results suggested that adolescents with comorbid ADHD and CP had significantly lower self-esteem than adolescents with ADHD alone or neither disorder. Self-esteem was not significantly different for adolescents with ADHD alone versus those in the control group. There was one marginally significant interaction between ADHD and self-esteem predicting substance use, such that individuals with comorbid ADHD/CP who also had low self-esteem tended to use more substances. Results have implications for treatments that target adolescents with ADHD and comorbid CP, as these adolescents are at risk for many deleterious outcomes.
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References
Ambrosini PJ (2000) Historical development and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS). J Am Acad Child Adolesc Psychiatry 39:49–58
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR). American Psychiatric Association, Washington, DC
Barber S, Grubbs L, Cottrell B (2005) Self-perception in children with attention-deficit/hyperactivity disorder. J Pediatr Nurs 20:235–245
Barkley RA (2006) Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment, 3rd edn. Guilford, New York
Barkley RA, Fischer M, Edelbrock CS, Smallish L (1990) The adolescent outcome of hyperactive children diagnosed by research criteria: I. an 8-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 29:546–557
Barry CT, Frick PJ, Killian AL (2003) The relation of narcissism and self-esteem to conduct problems in children: a preliminary investigation. J Clin Child Adolesc 32:139–152
Baumeister RF, Smart L, Boden JM (1996) Relation of threatened egotism to violence and aggression: the dark side of high self-esteem. Psychol Rev 103:5–33
Beck AT (1967) Depression. Hoeber, New York
Biederman J, Newcorn J, Sprich S (1991) Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatry 148:564–577
Chassin L, Presson CC, Sherman SJ, Edwards DA (1991) Four pathways to young-adult smoking status: adolescent social-psychological antecedents in a midwestern community sample. Health Psychol 10:409–418
Dalton MA, Sargent JD, Beach ML, Bernhardt AM, Stevens M (1999) Positive and negative outcome expectations of smoking: implications for prevention. Prev Med 29:460–465
Edbom T, Lichtenstein P, Granlund M, Larsson J (2006) Long-term relationships between symptoms of attention deficit hyperactivity disorder and self-esteem in a prospective longitudinal study of twins. Acta Paediatr 95:650–657
Edwards JR (1995) Alternatives to difference scores as dependent variables in the study of congruence in organizational research. Organ Behav and Hum Decis 64:307–324
Ek U, Westerlund J, Holmberg K, Fernell E (2008) Self-esteem in children with attention and/or learning deficits: the importance of gender. Acta Paediatr 97:1125–1130
Flory K, Lynam DR (2003) The relation between attention deficit hyperactivity disorder and substance abuse: what role does conduct disorder play? Clin Child Fam Psych 6:1–16
Glendinning A (2002) Self-esteem and smoking in youth-muddying the waters? J Adolesc 25:415–425
Gresham FM, MacMillan DL, Bocian KM, Ward SL, Forness SR (1998) Comorbidity of hyperactivity-impulsivity-inattention and conduct problems: risk factors in social, affective, and academic domains. J Abnorm Child Psychol 26:393–406
Guindon MH (2010) Self-esteem across the lifespan. Taylor and Francis, New York
Ha C, Petersen N, Sharp C (2008) Narcissism, self-esteem, and conduct problems: evidence from a British community sample of 7–11 year olds. Eur Child Adolesc Psychiatry 17:406–413
Harter S (1985) Manual for self-perception profile for children. University of Denver, Denver, CO
Harter S (1988) Manual for the self-perception profile for adolescents. University of Denver, Denver, CO
Harter S (2006) The development of self-esteem. In: Kernis MH (ed) Self-esteem issues and answers: a sourcebook of current perspectives. Taylor and Francis, New York, pp 144–150
Harty SC, Miller CJ, Newcorn JH, Halperin JM (2009) Adolescents with childhood ADHD and comorbid disruptive behavior disorders: aggression, anger, and hostility. Child Psychiatry Hum Dev 40:85–97
Hoza B, Pelham WE, Milich R, Pillow D, McBride K (1993) The self-perceptions and attributions of attention deficit hyperactivity disordered and nonreferred boys. J Abnorm Child Psych 21:271–286
Hoza B, Pelham WE, Dobbs J, Owens JS, Pillow DR (2002) Do boys with attention- deficit/hyperactivity disorder have positive illusory self-concepts? J Abnorm Psychol 111:268–278
Hoza B, Gerdes AC, Hinshaw SP, Pelham WE, Molina BSG, Abikoff HB et al (2004) Self- perceptions of competence in children with ADHD and comparison children. J Consult Clin Psychol 72:382–391
Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P et al (1997) Schedule for affective disorders and schizophrenia for school-age children- present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988
Kernis MH, Whisenhunt CR, Waschull SB, Greenier KD, Berry AJ, Herlocker CE et al (1998) Multiple facets of self-esteem and their relations to depressive symptoms. Pers Soc Psychol B 24:657–668
Kollins SH, McClernon FJ, Fuemmeler BF (2005) Association between smoking and attention- deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Arch Gen Psychiatry 62:1142–1147
Kovacs M (1985) The children’s depression inventory (CDI). Psychopharmacol Bull 21:995–998
Kuhne M, Schachar R, Tannock R (1997) Impact of comorbid oppositional of conduct problems on attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 36:1715–1725
Leventhal AM, Schmitz JM (2006) The role of drug use outcome expectancies in substance abuse risk: an interactional-transformational model. Addict Behav 31:2038–2062
Mayhew KP, Flay BR, Mott JA (2000) Stages in the development of adolescent smoking. Drug Alcohol Depen 59:S61–S81
McClernon FJ, Kollins SH (2008) ADHD and smoking: from genes to brain to behavior. Ann NY Acad Sci 1141:131–147
Milberger S, Biederman J, Faraone SV, Chen L, Jones J (1997) Further evidence of an association between attention-deficit/hyperactivity disorder and cigarette smoking: findings from a high-risk sample of siblings. Am J Addiction 6:205–217
Molina BSG, Pelham WE (2003) Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. J Abnorm Psychol 112:497–507
Molina BSG, Pelham WE, Gnagy EM, Thompson AL, Marshal MP (2007) Attention- deficit/hyperactivity disorder risk for heavy drinking and alcohol use disorder is age specific. Alcohol Clin Exp Pes 31:643–654
Mruk CR (1995) Self-esteem: research, theory, and practice. Springer, New York
Mruk CR (2006) Defining self-esteem: an often overlooked issue with crucial implications. In: Kernis MH (ed) Self-esteem issues and answers: a sourcebook of current perspectives. Taylor and Francis, New York, pp 10–17
Murray DM, O’Connell CM, Schmid LA, Perry CL (1987) The validity of smoking self-reports by adolescents: a reexamination of the bogus pipeline procedure. Addict Behav 12:7–15
Orth U, Robins RW, Meier LL (2009) Disentangling the effects of low self-esteem and stressful events on depression: findings from three longitudinal studies. J Pers Soc Psychol 97:307–321
Owens JS, Goldfine ME, Evangelista NM, Hoza B, Kaiser NM (2007) A critical review of self- perceptions and the positive illusory bias in children with ADHD. Clin Child Fam Psych 10:335–351
Saylor CF, Finch AJ, Spirito A, Bennett B (1984) The children’s depression inventory: a systematic evaluation of psychometric properties. J Consult Clin Psych 52:955–967
Snow PC, Bruce DD (2003) Cigarette smoking in teenage girls: exploring the role of peer reputations, self-concept and coping. Health Educ Res 18:439–452
Taylor E, Chadwick O, Heptinstall E, Danckaerts M (1996) Hyperactivity and conduct problems as risk factors for adolescent development. J Am Acad Child Psy 35:1213–1226
Treuting JJ, Hinshaw SP (2001) Depression and self-esteem in boys with attention- deficit/hyperactivity disorder: associations with comorbid aggression and explanatory attributional mechanisms. J Abnorm Child Psych 29:23–39
Tyas S, Pederson LL (1998) Psychosocial factors related to adolescent smoking: a critical review of the literature. Tob Control 7:409–420
Wilkinson D, Abraham C (2004) Constructing an integrated model of the antecedents of adolescent smoking. Brit J Health Psych 9:315–333
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Glass, K., Flory, K., Martin, A. et al. ADHD and comorbid conduct problems among adolescents: associations with self-esteem and substance use. ADHD Atten Def Hyp Disord 3, 29–39 (2011). https://doi.org/10.1007/s12402-010-0042-y
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DOI: https://doi.org/10.1007/s12402-010-0042-y