Elsevier

The Journal of Pediatrics

Volume 153, Issue 3, September 2008, Pages 414-419.e1
The Journal of Pediatrics

Original article
Cigarette Smoking Associated with Attention Deficit Hyperactivity Disorder

https://doi.org/10.1016/j.jpeds.2008.04.030Get rights and content

Objective

To evaluate the association between attention deficit hyperactivity disorder (ADHD) and severity of physical dependence on nicotine in a controlled study of adolescents and young adults with ADHD.

Study design

In controlled longitudinal family studies of ADHD, we examined self-reports on the modified Fagerström Tolerance Questionnaire (mFTQ) for degrees of physical dependence on nicotine.

Results

We obtained mFTQ data from 80 ADHD probands and 86 control probands (mean age, 19.2 years). The smokers with ADHD had significantly higher scores on the mFTQ, indicative of more severe physical dependence on nicotine. Similarly, in current smokers, a positive linear relationship was found between mFTQ score and both inattentive and hyperactive ADHD symptoms. Environmental factors, such as current parental smoking, peer smoking, and living with a smoker, all increased the risk for smoking in those with ADHD compared with controls.

Conclusion

Male and female smokers with ADHD manifest more severe physical dependence on smoking compared with controls. Important environmental factors appear to add to the risk of smoking associated with ADHD.

Section snippets

Subjects

The subjects were derived from 2 previous longitudinal case-control family studies of ADHD.16, 17 A 3-stage ascertainment procedure was used to select subjects: referral, telephone screening, and structured interview.18 Because this study had started before publication of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), our baseline assessment used DSM third edition revised (DSM-IIIR)-based structured interviews, supplemented

Results

We assessed a total of 341 subjects and obtained mFTQ data from 80 ADHD probands and 86 control probands between age 15 and 25 years. There were no significant differences between ADHD and control subjects in terms of age (19.3 ± 2.7 vs 19.2 ± 2.8 years; P = .73), SES status (2.0 ± 1.2 vs 1.7 ± 0.8; P = .27), or sex ratio (43% males vs 38% males; P = .59). The ADHD cohort comprised 70 (out of 80) subjects who reported receiving pharmacotherapy for ADHD in their lifetime (duration, 8.6 ± 4.1

Discussion

Our findings support our hypotheses and replicate previous work demonstrating that ADHD is a risk factor for earlier onset and higher rates of cigarette smoking. Our data extend previous findings by illustrating an association between ADHD and more severe cigarette smoking. We also found important relationships among ADHD symptoms, environmental factors, and the risk for smoking.

These findings support our hypotheses and replicate previous work demonstrating that ADHD is a major risk factor for

References (33)

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Supported in part by the National Institute on Drug Abuse (grants R01 DA14419, DA016264, and 5U10DA015831).

Potential conflict of interest information is available at www.jpeds.com.

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