Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD.

Children diagnosed with attention-deficit hyperactivity disorder (ADHD; n=142) were prospectively monitored into adolescence (13-18 years old) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD (n=100). Probands reported higher levels of alcohol, tobacco, and illicit drug use than did controls. Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses. Within probands, severity of childhood inattention symptoms predicted multiple substance use outcomes; childhood oppositional defiant disorder/conduct disorder (ODD/CD) symptoms predicted illicit drug use and CD symptoms. Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls. Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concurrent and longitudinal effects of ethnic identity and experiences of discrimination on psychosocial adjustment of Navajo adolescents.

In this study, we examined concurrent and longitudinal relations among Navajo adolescents' ethnic identity, experiences of discrimination, and psychosocial outcomes (i.e., self-esteem, substance use, and social functioning). At Time 1, 137 Navajo adolescents (67 male, 70 female), primarily in Grades 9 and 10, completed a written survey assessing ethnic identity, discrimination experiences, and a range of internalizing and externalizing behaviors. Two years later, 92 participants completed the same survey again. Ethnic and cultural identification was assessed via the Multiethnic Ethnic Identity Measure (MEIM; Phinney, 1992) and the Orthogonal Cultural Identification Scale (OCIS; Oetting & Beauvais, 1990). At Time 1, MEIM Affirmation and Belonging, MEIM Exploration, and OCIS White American identification all demonstrated strong, positive associations with adaptive functioning for male and female adolescents, whereas discrimination experiences were linked to lower self-esteem and social functioning for male adolescents. By Time 2, fewer significant concurrent associations between ethnic identity and psychosocial functioning scores remained, and discrimination experiences emerged as the most consistent correlate of poorer psychosocial functioning for male adolescents. Controlling for Time 1 psychosocial functioning, relatively few direct effects of ethnic and cultural identification variables predicted psychosocial functioning longitudinally, but discrimination experiences demonstrated strong and consistent longitudinal links with boys' substance use. Finally, interaction effects assessing the moderating influence of ethnic and cultural identification on negative links between discrimination and psychosocial functioning suggested that embeddedness in and connection to Navajo culture and, in some cases, connection to White American culture, served as a buffer to the negative effects of discrimination experiences. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Military-Style Residential Treatment for Disruptive Adolescents: Effective for Some Girls, All Girls, When, and Why?

The authors evaluated the effectiveness of military-style residential treatment for adolescents with conduct, academic, and substance use problems. They compared 171 boys and 81 girls (ages 16-18 years) referred to a 22-week boot camp administered by the Wisconsin National Guard. At referral, girls showed equal levels of conduct problems as boys, but higher levels of comorbid internalizing symptoms. Completion rates were similar across genders; however, most (84%) girls with histories of abuse withdrew from treatment. At 6-month follow-up, program graduates showed improved social-emotional functioning, greater frequency of school completion and employment, and lower frequency of substance use problems and arrest than controls. Outcomes were independent of gender. Results suggest military-style treatment can be effective for both genders, but treatment effectiveness is reduced considerably for girls with histories of maltreatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactive effects of attention deficit hyperactivity disorder and conduct disorder on early adolescent substance use.

This study examined the interactive effects of attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) diagnosis on early adolescent substance use in a cross-sectional study of 202 middle school students. ADHD diagnosis alone did not suggest increased risk for substance use, but more adolescents with both ADHD and CD reported use of tobacco, alcohol, marijuana, and other drugs than did adolescents with either disorder alone. Dimensionally scored impulsivity-hyperactivity symptoms, not symptoms of inattention, appeared to account for the association with ADHD. Results illustrate the need to continue examination of the role of ADHD in the development of substance use and later abuse, especially as it relates to the onset of conduct problems in adolescence that mark liability for early onset substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial Variables Associated With Adolescent Gambling.

The authors empirically examined the relations between several psychosocial variables associated with adolescent problem gambling. Participants were 2,336 students in Grades 7-13, and all completed a questionnaire regarding gambling activities, gambling severity, perceived social support, drug and alcohol dependence, and various social, emotional, and behavioral problems. With respect to gambling severity, 4.9% of adolescents met the criteria for pathological gambling, and 8.0% were found to be at risk. Psychosocial difficulties associated with problem gambling include poor perceived familial and peer social support, substance use problems, conduct problems, family problems, and parental involvement in gambling and substance use. A set of predictor variables that may lead to problem gambling includes having family problems, having conduct problems, being addicted to drugs or alcohol, and being male. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies, drinking motives, and stressful life events among middle adolescents: Associations with emotional and behavioral problems and with academic functioning.

A sample of 733 middle adolescents was used to study interrelations among coping strategies, drinking motives, stressful life events (major, daily positive, and daily negative), emotional and behavioral problems, and academic functioning. A main-effects (vs. stress-buffering) model was supported. Some predictors (e.g., task-oriented coping, major stressful events) were general in their predictive relations to the outcome variables, whereas others were highly specific (e.g., emotion-focused coping predicting depressed affect). Overall, the predictors accounted for 22-53% of the variance in regression equations. Positive daily events predicted higher levels of alcohol use, alcohol problems, and delinquent activity, as well as higher academic performance and lower levels of depressed affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conduct disorder with and without mania in a referred sample of ADHD children

OBJECTIVE: To test the hypothesis that dysphoric and non-dysphoric types of CD could be distinguished from one another in their patterns of familiality, adversity, and comorbidity. METHODS: We examined 140 ADHD and 120 normal controls at baseline and 4 years later using assessments from multiple domains. We compared ADHD subgroups with and without conduct (CD) and bipolar (BPD) disorders on psychiatric outcomes at a 4-year follow-up, familial psychopathology and psychosocial functioning. RESULTS: We found that ADHD children with both disorders had higher familial and personal risk for mood disorders than those with CD only, who had a higher personal risk for antisocial personality disorder. Among ADHD probands, having both CD and BPD was associated with poorer functioning and an increased risk for psychiatric hospitalization. DISCUSSION: Although preliminary, our findings suggest that the distinction between dysphoric and non-dysphoric CD may be clinically meaningful. If confirmed, our findings could have important diagnostic and therapeutic implications for the management of antisocial youth.     

Association between hyperactivity and executive cognitive functioning in childhood and substance use in early adolescence

OBJECTIVE: To determine whether deficient executive cognitive functioning (ECF) in association with high behavioral activity level comprise components of the liability to substance abuse. METHOD: A high-risk (HR) group having fathers with a lifetime DSM-III-R diagnosis of a psychoactive substance use disorder was compared with a low-average-risk (LAR) group whose fathers had neither psychoactive substance use disorder nor another adult Axis I psychiatric disorder. ECF and behavioral activity were measured using neuropsychological tests, activity monitor, diagnostic interview, and informant ratings when the subjects were 10 to 12 years of age. Alcohol, tobacco, and cannabis use were measured at 2-year follow-up. RESULTS: At baseline, the HR group had a significantly higher behavioral activity level and exhibited poorer performance on ECF tests than the LAR group. By early adolescence, HR subjects had a higher lifetime rate of tobacco and cannabis use and earlier age at onset of cannabis use. ECF capacity, but not behavioral activity level, predicted tobacco and cannabis use, total number of drugs ever tried, and severity of drug involvement. ECF accounted for additional variance beyond the effects of conduct problems on these outcomes. CONCLUSION: Whereas behavioral activity and ECF capacity in late childhood distinguishes HR from LAR youth, childhood ECF capacity is the more salient predictor of drug use in early adolescence.     

Attention-deficit/hyperactivity disorder and conduct disorder symptomatology in adolescents with alcohol use disorder.

This study tested the hypothesis that attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) comorbidity is associated with substance use and deviance severity in 395 adolescents with alcohol use disorder. Thirty percent of the adolescents had high ADHD symptom counts, and 73% had 3 or more CD symptoms. ADHD-CD was associated with nonalcohol substance use disorder, drinking levels, and CD severity, but in general substance use was not uniquely elevated or problematic among the comorbid cases. In general, CD and CD severity were more important. The findings did not differ between boys and girls, revealing that in a treatment sample of adolescents, ADHD-CD comorbidity may need to be assessed and treated, but it is not broadly indicative of severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol dependence and domestic violence as sequelae of abuse and conduct disorder in childhood

OBJECTIVES: To examine in the Navajo population: (1) the importance of childhood abuse as a risk factor for conduct disorder; (2) the importance of each form of abuse and conduct disorder as risk factors for alcohol dependence; and (3) the relative importance of each form of abuse, conduct disorder, and alcohol dependence as risk factors for being a perpetrator and/or victim of domestic violence. METHOD: The study is based on a case-control design. Cases (204 men and 148 women) between the ages of 21 and 65 were interviewed in alcohol treatment program and matched to community controls. There were two groups of controls: alcohol dependent (374 men, 60 women) and nonalcohol dependent (157 men, 143 women). When adjusted for stratification by age, community of residence, and sex, the combined control groups comprise a representative sample of the Navajo male and female population 21-65 years of age. RESULTS: The prevalence of physical and sexual abuse before age 15 is within limits observed in other populations. Each form of abuse is a risk factor for conduct disorder. Along with conduct disorder, physical abuse is a risk factor for alcohol dependence. Physical abuse and alcohol dependence are independent risk factors for being involved in domestic violence as both perpetrator and victim. There appears to have been no secular trend in the incidence of childhood abuse over the past several generations, but there is suggestive evidence that domestic violence has become more common. CONCLUSIONS: Physical abuse is a significant risk factor for alcohol dependence as well as for domestic violence independent of the effects of alcohol abuse. The effects of sexual abuse with regard to both domestic violence and alcohol dependence do not appear to be significant.     

Social role functioning by adolescents with psychiatric disorders

OBJECTIVE: To identify aspects of social role functioning that are impaired in adolescents with specific psychiatric disorders in order to improve the psychiatric taxonomy and clinical knowledge base. METHOD: Adolescents in four urban public schools were screened for mental health problems. Structured psychiatric interviews (National Institute of Mental Health Diagnostic Interview Schedule for Children Version 2.2) with 288 adolescents and their mothers were used to identify youths with psychiatric disorders, and 10 aspects of social role functioning were assessed. Aspects of social role functioning that discriminated between youths with and without psychiatric disorders and between those with emotional disorders and those with disruptive disorders were identified for boys and for girls. RESULTS: Boys with any type of disorder and all youths with disruptive disorders had significant, consistent impairment in academic performance and several other areas of functioning. Youths with emotional disorders, especially girls, demonstrated impairment in social activity participation and peer acceptance, but girls with disorders were not as consistently different from those without as were the boys with emotional disorders. CONCLUSIONS: Role functioning differs in important ways between youths with and without psychiatric disorders and between girls and boys with disorders. The results underscore the importance of investigating observable aspects of role behavior in order to improve the timely detection and effective management of psychiatric disorders in youth.     

US double-blind, controlled trials of omeprazole and amoxycillin for treatment of Helicobacter pylori

OBJECTIVE: To identify environmental and psychosocial factors associated with receiving special education services. DESIGN: The 1992 Minnesota Student Survey, an anonymous, self-report survey. SETTING: Minnesota public schools. PARTICIPANTS: A total of 121848 adolescents in the 6th, 9th, and 12th grades. MAIN OUTCOME MEASURES: Emotional status and potential environmental risk factors including family structure, family substance use problems, family violence, and sexual abuse were compared between adolescents reporting a history of having been in classes for learning problems and a grade- and race-matched comparison group of adolescents who had never been in classes for learning problems. Comparisons were conducted separately for male and female respondents. RESULTS: Compared with adolescents who had never been in classes for learning problems, a significantly greater proportion of male and female students who had been in special education classes lived in single-parent and nontraditional households, indicated that a family member had an alcohol or other drug problem, had witnessed or experienced physical abuse, and reported a history of sexual abuse and poor emotional health. Most of these associations remained significant when simultaneously controlling for the other factors in logistic regression. Significant factors showed modest odds ratios in the multivariate analyses (<1.6), except for the emotional status variable. Students with a history of receiving special education services had from 6 to 14 times the odds of reporting poor emotional health. This association was strongest among the youngest adolescents. CONCLUSION: Several environmental stressors and psychosocial factors, most notably poor emotional health, are associated with a history of special class placement for learning problems.     

Evaluation of a voluntary military-style residential treatment program for youths with conduct problems: 6- and 36-month outcomes.

The authors investigated the socioemotional and behavioral outcomes of adolescents referred to voluntary military-style residential treatment. Adolescents (N = 232) with conduct problems were classified into three groups: adolescents who completed treatment, adolescents who withdrew from treatment, and wait list controls. Six months after treatment, boys and girls who completed military-style residential treatment showed fewer externalizing problems, greater adaptive skills, and better behavioral outcomes (e.g., high school completion, employment, lower recidivism) than comparison youths. Results were not maintained at 36-month follow-up. Adolescents who enlisted in the military after treatment showed better outcomes at 36-month follow-up than youths who returned home after treatment. Results indicate that the benefits of treatment might be tangible but short-lived for adolescents who return to their communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of change in adolescents involved in alcohol and drug treatment.

This study examined differences between statistical and clinically significant change. All participants were adolescent "drinkers" who were classified into 2 groups: those recruited from alcohol or drug treatment programs and with a diagnosis of current alcohol abuse or dependence, or those with no such diagnostic history, and no history of substance abuse treatment. The results showed statistically significant change in clinical participants from baseline to 1 yr on the 1 psychosocial adjustment and 3 drinking pattern measures. Additional analyses of clinically significant change greatly enhanced understanding of the level of functioning and degree of change in the clinical participants. The findings illustrate that use of such an approach increases the value of analyses of outcome data to the consumer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Levels of adult alcohol consumption induced by interactions with child confederates exhibiting normal versus externalizing behaviors.

Investigated levels of distress and alcohol consumption in Ss interacting with problematic vs nonproblematic child confederates. Social drinkers were randomly assigned to interact with boys trained to enact behaviors characteristic of either normal or attention-deficit disorder/conduct disorder (ADD/CD) children. Mood data were collected before and after the interaction. Ss engaged in ad lib beer consumption for 20 min, while anticipating another interaction with the same boy. Children in the ADD/CD role produced comparably distressed moods for both male and female Ss. However, only men drank to higher blood-alcohol levels in the ADD/CD vs. normal child condition. Results suggest that higher rates of drinking observed in fathers of ADD/CD children may be partly a function of their particular response to the distress associated with interactions with such children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure to interparental violence in childhood and psychosocial adjustment in young adulthood

OBJECTIVE: To study the relationships between retrospective reports of exposure to interparental violence in childhood and rates of psychosocial adjustment problems in young adulthood in a birth cohort of New Zealand subjects. METHOD: Data were gathered during the course of an 18 year longitudinal study of a birth cohort of 1,265 New Zealand children. At age 18 retrospective reports of exposure to interparental violence were obtained. At this time the cohort was also assessed on measures of psychosocial adjustment including mental health problems, substance abuse behaviors, and criminal offending. RESULTS: Young people reporting high levels of exposure to interparental violence had elevated rates of adjustment problems at age 18. These problems included mental health problems, substance abuse behaviors and criminal offending. Analyses using multiple logistic regression showed that much of this elevated risk was explained by social and contextual factors associated with exposure to interparental violence. However, even after adjustment for confounding factors, exposure to father initiated violence was associated with increased risks of anxiety, conduct disorder and property crime, while exposure to mother initiated violence was associated only with increased risks of later alcohol abuse/dependence. CONCLUSION: Children exposed to high levels of interparental violence are an at risk population for psychosocial adjustment problems in young adulthood. Much of the elevated risk of these children arises from the social context within which interparental violence occurs. Nonetheless, exposure to interparental violence, and particularly father initiated violence, may be associated with later increased risks of anxiety, conduct disorder, problems with alcohol, and criminal offending.     

Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome

Most delinquent youths have conduct disorder (CD), often with comorbid substance use disorder (SUD), attention-deficit/hyperactivity disorder (ADHD) and depression. Some youths' conduct problems later abate, while those of others persist into adult antisocial personality disorder. Earlier CD onset and ADHD reportedly predict persisting antisocial problems, but predictors of persisting SUD are poorly understood. Males aged 13-19 years (n = 89), most referred by criminal justice and social service agencies, received residential treatment for comorbid CD and SUD. They had diagnostic assessments for SUD at intake and for CD, ADHD, and depression (as well as drug-use assessments) at intake and 6, 12 and 24 months later. At intake nearly all had DSM-III-R substance dependence (usually on alcohol and marijuana) and CD with considerable violence and criminality. The 2-year follow-ups revealed improvements in criminality, CD, depression and ADHD, but substance use remained largely unchanged. Various aspects of conduct, crime and substance outcomes at 2 years were predicted by intake measures of intensity of substance involvement, and by CD severity and onset age, but not by severity of either ADHD or depression, nor by treatment duration. Earlier CD onset, more severe CD and more drug dependence predicted worse outcomes, supporting the validity of these diagnoses in adolescents.     

A comparative study of the long term psychosocial functioning of childhood acute lymphoblastic leukemia survivors treated by intrathecal methotrexate with or without cranial radiation

BACKGROUND: Although previous research has delineated medical, cognitive, and neuropsychologic late effects of central nervous system (CNS) prophylaxis for childhood acute lymphoblastic leukemia (ALL), it has been difficult to draw conclusions about the long term psychosocial sequelae of these treatments due to methodologic problems that led to inconclusive results in past studies. In the current study, the authors examined the long term psychosocial functioning of childhood ALL survivors who had been treated on a Phase III clinical protocol (Cancer and Leukemia Group B [CALGB] 7611) between 1976 and 1979, in which they were randomized to receive either 2400 centigray of cranial radiation (CRT) with intrathecal methotrexate (IT-MTX) or intermediate dose systemic methotrexate (IV-MTX) with IT-MTX. METHODS: One hundred ten survivors of childhood ALL (mean age, 20.8 years) treated on CALGB 7611 who were age 14 years or older and disease free for at least 1 year were studied a mean of 14.7 years after their entry on CALGB 7611. In a telephone interview, a psychosocial assessment battery was administered to the patients, consisting of measures that assessed psychologic, sexual, social, and vocational functioning as well as any delayed physical effects. RESULTS: Survivors who had received CRT + IT-MTX had significantly poorer academic achievement (P = 0.0001), poorer self-images with regard to their bodies (P = 0.001), and greater psychologic distress (P = 0.005). CONCLUSIONS: Cranial radiation used to treat children with ALL has significant long term sequelae in terms of poorer academic achievement and psychosocial functioning. These data add weight to the conclusion that CRT prophylaxis should only be used to treat children who are at high risk of CNS relapse.     

Couples- versus individual-based therapy for alcohol and drug abuse: Effects on children's psychosocial functioning.

The study compared the effect of couples-based vs individual-based therapy for men who entered outpatient substance abuse treatment on the psychosocial functioning of children in their homes. Men were randomly assigned to (1) behavioral couples therapy (BCT), (2) individual-based treatment (IBT) or (3) couples-based psychoeducational attention control treatment (PACT). For both children of alcohol (N=71) and drug-abusing men (N=64), parents' ratings of children's psychosocial functioning was higher for children whose fathers participated in BCT at posttreatment and at 6- and 12-mo follow-up than for children whose fathers participated in IBT or PACT. BCT resulted in greater improvements in parents' dyadic adjustment and fathers' substance use. Thus, couples-based intervention that addresses both issues may have greater benefits for children in these homes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: Individuals with symptoms of attention-deficit/hyperactivity disorder are uniquely at risk.

Most prior literature examining the relations among attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use and abuse suggests that CD fully accounts for the ADHD-substance abuse relation. This study sought to test an alternate theory that individuals with symptoms of both ADHD and CD are at a special risk for substance abuse. Relations between childhood ADHD and CD symptoms, and young adult tobacco, alcohol, marijuana, and hard drug use and dependence symptoms, were examined in a sample of 481 young adults. ADHD and CD symptoms interacted to predict marijuana dependence symptoms and hard drug use and dependence symptoms, such that individuals with high levels of both ADHD and CD had the highest levels of these outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)