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 FSIQ T - I/O T – AGG P - EXT P – INT SES Full Sample Presentation Sample N = 169 N = 56 Mean SD

Childhood Characteristics of Children with ADHD Full Sample Presentation Sample N = 169 N = 56 % Male % ODD % CD % Anxiety % Mood

Adolescent Sample Characteristics Age <.01 FSIQ >.10 Reading <.05 ADHD Controls Mean SD Mean SD p (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 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.