Review
Childhood Attention-Deficit/Hyperactivity Disorder and Future Substance Use Disorders: Comparative Meta-Analyses

An earlier version of this meta-analytic review was presented at the Annual Meeting of the American Academy of Child and Adolescent Psychiatry; Chicago; October 2008.
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Objective

In recent years cohort studies have examined childhood attention-deficit/hyperactivity disorder (ADHD) as a risk factor for substance use disorders (SUDs) in adolescence and young adulthood. The long-term risk is estimated for development of alcohol, cannabis, combined alcohol and psychoactive SUDs, combined SUDs (nonalcohol), and nicotine use disorders in children with ADHD.

Method

MEDLINE, CINHAL, PsycINFO, and EMBASE were searched through October 2009; reference lists of included studies were hand-searched. Prospective cohort studies were included if they compared children with ADHD to children without, identified cases using standardized criteria by mean age of 12 years, followed participants until adolescence (nicotine use) or young adulthood (psychoactive substance use disorder, with and without alcohol, alcohol use disorder, cannabis use disorder), and reported SUD outcomes. Two independent reviewers examined articles and extracted and cross-checked data. Effects were summarized as pooled odds ratios (ORs) in a random effects model.

Results

Thirteen studies were included. Only two of five meta-analyses, for alcohol use disorder (N = 3,184) and for nicotine use (N = 2,067), estimated ORs showing stability when evaluated by sensitivity analyses. Childhood ADHD was associated with alcohol use disorder by young adulthood (OR = 1.35, 95% confidence interval = 1.11-1.64) and with nicotine use by middle adolescence (OR = 2.36, 95% confidence interval = 1.71-3.27). The association with drug use disorder, nonalcohol (N = 593), was highly influenced by a single study.

Conclusions

Childhood ADHD is associated with alcohol and drug use disorders in adulthood and with nicotine use in adolescence.

Section snippets

Method

The literature search identified all published reports of prospective longitudinal cohorts of school-age children diagnosed with ADHD followed until age 18 years or beyond, which examined risk of SUDs compared with nonclinical children.

Search Results

The search yielded 1,319 references. Of these, 90 studies were reviewed in detail and assessed for internal validity. Sixty were irrelevant for our review, 15 were graded as good, 10 as fair, and 5 as poor. Of the 30 relevant articles, 15 reported results included in other articles (Figure 1). Thirteen were deemed suitable for inclusion in the meta-analysis of any of the five outcomes of interest. These studies are presented in Table 1.1, 3, 5, 12, 13, 14, 17, 19, 24, 25, 26, 27, 28

Alcohol Use Disorder

Ten studies

Discussion

The present review is the first meta-analysis quantifying risk for development of SUDs for young children diagnosed with ADHD. Substance use remains a serious concern and an important target of prevention and early intervention for childhood ADHD. The meta-analyses reported in this review confirm that children with ADHD are at risk for developing alcohol use disorder (OR = 1.35, 95% CI = 1.11-1.64) by early adulthood and for self-reported nicotine use by middle adolescence (OR = 2.36, 95% CI =

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    Search strategy designed by Elizabeth Uleryk, Library Director, Hospital for Sick Children, Toronto, Ontario, Canada. Statistical consultation was provided by Joseph Beyene, Ph.D., Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Assistance with supervision of abstract review and grading of internal validity was provided by Jennifer Crosbie, Ph.D., Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.

    This article represents original work and the first author has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Disclosures: Dr. Charach has received salary support through a New Investigator Fellowship Award from the Ontario Mental Health Foundation, with funding from the Ontario Ministry of Health and Long Term Care. She has received research support through the McMaster University Evidence-Based Practice Center, sponsored by the U.S. Agency for Healthcare Research and Quality. She has also received research support from the Hospital for Sick Children Department of Psychiatry Endowment Fund and the Canadian Institutes of Health Research. Ms. Yeung, Mr. Climans, and Ms. Lillie report no biomedical financial interests or potential conflicts of interest.

    This article is discussed in an editorial by Dr. Timothy E. Wilens on page 6.

    This article can be used to obtain continuing medical education (CME) category 1 credit at jaacap.org.

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