# Presentation: 517103

## 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

## 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?

## 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

## Childhood Characteristics of Children with ADHD

| Age | 8.99 | 1.30 | 9.48 | 1.16 |
| --- | --- | --- | --- | --- |
| FSIQ | 91.84 | 14.72 | 96.07 | 14.50 |
| T - I/O | 10.99 | 3.12 | 11.04 | 3.17 |
| T – AGG | 8.15 | 4.68 | 7.77 | 4.74 |
| P - EXT | 70.70 | 10.05 | 72.34 | 9.91 |
| P – INT | 65.66 | 10.41 | 66.09 | 11.07 |
| SES | 3.79 | 1.41 | 3.33 | 1.29 |

- Full Sample            Presentation Sample

- N = 169                                     N = 56

- Mean                  SD                     Mean                 SD

## Childhood Characteristics of Children with ADHD

- Full Sample          Presentation Sample

- N = 169                                     N = 56

| % Male | 87.6 | 88.0 |
| --- | --- | --- |
| % ODD | 78.1 | 76.8 |
| % CD | 31.4 | 32.1 |
| % Anxiety | 32.5 | 26.8 |
| % Mood | 13.0 | 10.7 |

## Adolescent Sample Characteristics

| Age | 18.4 | 1.1 | 19.1 | 1.6 | < .01 |
| --- | --- | --- | --- | --- | --- |
| FSIQ | 93.5 | 14.5 | 94.4 | 14.7 | > .10 |
| Reading | 89.5 | 20.3 | 98.2 | 15.4 | < .05 |

- ADHD                      Controls

- Mean          SD            Mean          SD                 p

- (N = 56)                                (N = 56)

## Adolescent Assessment Instruments

- Kiddie SADS PL
- ADHD
- Conduct Disorder
- Alcohol abuse and dependence
- Substance abuse and dependence
- Rutger’s 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

## 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

## Substance Use Diagnoses in ADHD and Control Adolescents

- *p = .067

- Percent

## Dimensional Assessment of Aggression, Antisocial Behavior and Substance Use in ADHD and Control Groups

- *p < .05

## 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?

## Substance Use Diagnoses in Controls and ADHD as a function of Childhood CD

- *p = .08

- Percent

## Dimensional Assessment of Aggression, Antisocial Behavior and Substance Use in Controls and ADHD with and without Childhood CD

- *Differs from ADHD/CD+, p < .05

- *

- *

- *   *

- *

## 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?

## Substance Use Diagnoses in Controls and ADHD as a function of Adolescent CD

- *p = .10;  **p< .01

- Percent

## Dimensional Assessment of Aggression, Antisocial Behavior and Substance Use in Controls and ADHD with and without Adolescent CD

-   *Differs from ADHD/CD+, p < .05  **Differs from other two groups, p < .05

- *

- *

- *   *

- **

## Substance Use Diagnoses in Controls and ADHD as a function of Childhood and Adolescent CD

- *p < .01;  **p< .05

- Percent

## Dimensional Assessment and Substance Use as a Function of Childhood and Adolescent CD*

- *Main Effect for Childhood CD; p = .07                Main Effect for Adolescent CD; p = .01

- N=31             N=11            N=6               N=6               N=55

- **

- **

- ** Differs from CCD-/ACD-, p < .05

## 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?

## Substance Use Diagnoses in Controls and ADHD as a function of Adolescent ADHD

- *p = .01

- Percent

## Dimensional Assessment of Aggression, Antisocial Behavior and Substance Use in Controls and ADHD with and without Adolescent ADHD*

-   * all p > .10

## Proportion of Children with a Substance Use Diagnosis in Adolescence

- *

- **

- *p < .10; **p < .05 relative to controls

## 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?

## Drug Use Summary Ratings as a Function of Childhood IQ and Academic Achievement in Young Adolescents (N=32; mean age = 15.8 yrs.)*

- r

- *From Harty et al, In Press; all p > .10

## 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 < .10; ** p < .05; ***p < .01

- ***

- ***

- **

- *

## Drug Use Summary Ratings as a Function of Childhood IQ and Academic Achievement in Older Adolescents (N=56, mean age = 18.4 yrs.)

- r

- all p > .10

## Drug Use Summary Ratings as a Function of Childhood CD and IQ/Academic Achievement in Older Adolescents (mean age = 18.4 yrs)

- r

- * p < .01; ** p < .05

- *

- **

- FSIQ                                 Reading

## 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;

## 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.