Associations between ADHD and psychoactive substance use disorders. Findings from a longitudinal study of high-risk siblings of ADHD children

This article investigates the relationship between attention-deficit/hyperactivity disorder (ADHD) and psychoactive substance use disorders (PSUD) in siblings of ADHD and normal-control probands and addresses issues of psychiatric comorbidity and gender. Using DSM-III-R structured diagnostic interviews and blind raters, the authors conducted a 4-year follow-up of siblings. ADHD and male gender predicted higher rates and an earlier onset of PSUD after adjusting for high-risk status, other psychiatric disorders, and age. Risk was particularly high if the siblings had ADHD plus conduct disorder. This study's findings confirms the authors' prior report high-lighting the importance of drug and alcohol prevention and cessation programs aimed at ADHD youth and their siblings, particularly those with comorbid conduct disorder.     

Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders

We evaluated the association between attention deficit hyperactivity disorder (ADHD) and the age of onset of psychoactive substance use disorders (PSUD) in adults with ADHD. We hypothesized that ADHD and psychiatric comorbidity would be risk factors for early onset PSUD. We compared 120 referred adults having a clinical diagnosis of childhood-onset ADHD with 268 non-ADHD adults. All diagnoses were obtained using DSM-III-R based structured psychiatric interviews. We used group comparisons of age at onset and Cox proportional hazard models to examine the development of PSUD over time. ADHD was associated with earlier onset of PSUD independently of psychiatric comorbidity. Conduct and juvenile bipolar disorders conferred a significantly increased risk for early onset PSUD independently of ADHD. Psychiatric disorders commonly emerged before the onset of PSUD in both groups. Persistent ADHD with and without psychiatric comorbidity was associated with adolescent onset PSUD. In addition, comorbidity with conduct and juvenile bipolar disorders predicted very early onset PSUD in both ADHD and non-ADHD individuals. These findings confirm and extend previous findings documenting important associations between PSUD and psychiatric comorbidity including persistent ADHD.     

Parent training for attention-deficit hyperactivity disorder: its impact on parent functioning

This study examined changes in parent functioning resulting from parental participation in a behavioral parent training (PT) program specifically designed for school-aged children with attention-deficit hyperactivity disorder (ADHD). Relative to wait list controls, subjects who completed the nine-session PT program showed significant posttreatment gains in both child and parent functioning, which were maintained 2 months after treatment. In particular, there were PT-induced reductions in parenting stress and increases in parenting self-esteem, which accompanied parent-reported improvements in the overall severity of their child's ADHD symptoms. In addition to their statistical importance, these findings are discussed in terms of their clinical significance, utilizing methods developed by Jacobson and Truax (1991).     

Interaction between childhood temperament and parental discipline practices on behavioral adjustment in preadolescent sons of substance abuse and normal fathers

We conducted this study with a sample of sons of fathers having a Psychoactive Substance Use Disorder (PSUD+, n = 55) and sons of fathers who did not qualify for a PSUD (PSUD-, n = 97). Parental discipline practice from the child's perspective was investigated in relation to the child's difficult temperament to determine their association with sons' externalizing and internalizing behavior problems reported by mothers. PSUD+ status, difficult temperament in the boys, and their ratings of parental discipline practices accounted for a significant proportion of variance with respect to their externalizing behavior (11%), but only PSUD+ status had a main effect on internalizing behavior. However, the main finding of this study was that the interaction of parental discipline and difficult temperament in the child moderated both externalizing and internalizing behavior problems, accounting for an additional 5% of an explained variance. Thus, this study illustrates the importance of the conjoint influence of children's temperament characteristics and parental discipline practices on the children's adjustment. These results support the findings from previous studies showing that a difficult temperament disposition places the child at risk for maltreatment by parents and for development of a disruptive behavior disorder. Both outcomes have been found in many investigations to presage alcohol and drug abuse in adolescence. The findings also underscore the importance of both individual and contextual variables for understanding the development of psychopathology. In this regard, the results show the need for prevention and treatment to encompass strategies directed at disaggregating the basis of maladaptive family interaction patterns.     

Impacts d'un programme d'interventions multidimensionnel con?u pour les parents et leur enfant ayant un TDAH sur le stress parental et la relation parent–enfant.

The behaviours that characterize ADHD (Attention-Deficit/Hyperactivity Disorder) often lead to impairments in the parent–child relationship and contribute to increased stress amongst parents of children with the disorder. The main objective of this research is to evaluate the impact of a multimodal intervention program (Multi-Propulsions) on parental stress and on parent–child relationship as perceived by parents. The program combines: (1) a cognitive-behavioural program for ADHD children including physical activities in an adapted gymnasium; (2) a cognitive-behavioural parent training program; (3) joint activities with children and parents under the supervision of professionals. Sample contents 23 families with ADHD children aged between 6 and 12 years old from the ADHD clinic of the Rivière-des-Prairies Hospital in Montreal. Participants were randomly assigned to treatment or waiting group. Results highlight the efficiency of Multi-Propulsions program for diminishing parental stress, particularly stress associated with child's characteristics, and these therapeutic gains were maintained four months after the treatment. Furthermore, the results show an improvement in the quality of parent–child relationship. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Correction to Beaulieu and Sylvie Normandeau (2011).

Reports an error in "Prédicteurs des pratiques parentales: Cognitions sociales parentales et comportement des enfants TDAH" by Marie-Christine Beaulieu and Sylvie Normandeau (Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, Advanced Online Publication, Jul 25, 2011, np). There was an error in the English abstract. This error is corrected in the correction. (The following abstract of the original article appeared in record 2011-15455-001.) The purpose of this study was to examine the association between parental social cognitions (parental causal attributions, parental self-efficacy) and the behavioural characteristics of their child (ADHD subtypes, comorbidity, oppositional and anxiety/shy symptoms). Participants were 110 families with a child with ADHD (ADHD-I : n = 31, ADHD-H : n = 11, ADHD-C : n = 68). Multiple regressions show that parental self-efficacy is associated with more use of appropriate discipline, praise and incentives, positive verbal discipline, and less use of harsh and inconsistent discipline and physical punishment. Results also show that parental causal attributions for the child's misbehaviour to their own efforts are a predictor of positive verbal discipline whereas parents' causal attributions for the child's misbehaviour to the child's lack of efforts are a predictor of harsh and inconsistent discipline. Parents' perception of their child's oppositional symptom is a predictor of appropriate discipline and positive verbal discipline. Finally, children's comorbidity is a predictor of harsh and inconsistent discipline. The findings of this study highlight the importance of parental self-efficacy, because from all the variables studied, it shows the strongest association with positive and negative parenting practices. No association between ADHD subtype and parenting practices were observed. Implications of these results are explored in the discussion. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Does parental ADHD bias maternal reports of ADHD symptoms in children?

Within families, co-occurring attention-deficit/hyperactivity disorder (ADHD) in parents and children may be common. The authors evaluated the hypothesis that parental ADHD may lead to a reporting bias of ADHD symptoms in offspring. They combined 2 family case-controlled studies of ADHD using structured interviews. They compared rates of maternal reported ADHD symptoms among 3 groups of ADHD children: no parental ADHD (n=231), mother with ADHD (n=63), and father with ADHD (n=57). With the exception of 1 symptom, the rates of reporting between groups did not differ. There was no evidence that the discrepancy between maternal reports and self-reports of symptoms differed by parental ADHD. Results were similar across child gender or referral status. These results do not support the notion that parental ADHD affects maternal reports of offspring ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association Among Parental Substance Use Disorder, P300 Amplitude, and Neurobehavioral Disinhibition in Preteen Boys at High Risk for Substance Use Disorder.

The P300 amplitude of the event-related potential as a mediator of the association between parental substance use disorder (SUD) and child's neurobehavioral disinhibition was assessed. The P300 amplitude was recorded using an oddball task in sons of fathers having either lifetime SUD (n = 105) or no psychiatric disorder (n = 160). Neurobehavioral disinhibition was assessed using measures of affect regulation, behavior control, and executive cognitive function. Parental SUD and child's P300 amplitude accounted for, respectively, 16.6% and 16.8% of neurobehavioral disinhibition variance. Controlling for parental and child psychopathology, an association between parental SUD and child's P300 amplitude was not observed. It was concluded that the P300 amplitude does not mediate the association between parental SUD and child's neurobehavioral disinhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pre- and Postinjury Substance Misuse Among Veterans With Spinal Cord Injury.

Objective: To identify rates of substance misuse with onset before and after spinal cord injury (SCI) and to investigate whether patients with a history of substance misuse are more likely to report being intoxicated at the time of injury. Participants: One hundred twenty-four veterans with traumatic SCIs. Measures: Alcohol and nonalcohol psychoactive substance use disorder (PSUD) sections of the Structured Clinical Interview for DSM-III-R. Results: Forty (32%) had a lifetime PSUD. Of those, 55% recalled the onset of their PSUD occurring preinjury, 27.5% recalled the onset occurring postinjury, and 17.5% could not recall their age at onset. Compared with participants who reported postinjury onset of PSUD, those with reported preinjury onset were more likely to report intoxication at time of injury. No significant relation was found between intoxication at injury and presence of a lifetime PSUD. Conclusion: Intoxication at injury does not necessarily substantiate the existence of an underlying substance misuse problem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Good health according to the residents of the community

Although a role for family and parent factors in the development of behavioral problems in childhood is often acknowledged, the roles of specific parental characteristics in relation to specific child actions need further elucidation. We studied parental "Big Five" personality traits and psychiatric diagnoses in relation to their children's antisocial diagnoses and naturalistically observed antisocial behaviors, in boys with and without the diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD). First, regardless of comorbid antisocial diagnosis, boys with ADHD, more often than comparison boys, had mothers with a major depressive episode and/or marked anxiety symptoms in the past year, and fathers with a childhood history of ADHD. Second, compared to the nondiagnosed group, boys with comorbid ADHD + Oppositional Defiant or Conduct Disorder (ODD/CD) had fathers with lower Agreeableness, higher Neuroticism, and more likelihood of having Generalized Anxiety Disorder. Third, regarding linkages between parental characteristics and child externalizing behaviors, higher rates of child overt antisocial behaviors observed in a naturalistic summer program were associated primarily with maternal characteristics, including higher Neuroticism, lower Conscientiousness, presence of Major Depression, and absence of Generalized Anxiety Disorder. The association of maternal Neuroticism with child aggression was larger in the ADHD than in the comparison group. In contrast, higher rates of observed child covert antisocial behaviors were associated solely with paternal characteristics, including history of substance abuse and higher Openness. Results provide external validation in parent data for a distinction between overt and covert antisocial behaviors and support inclusion of parent personality traits in family studies. The interaction of maternal Neuroticism and child ADHD in predicting child aggression is interpreted in regard to a conceptualization of child by parent "fit."     

Correction to Stover et al. (2010).

Reports an error in "Agreement of parent and child reports of trauma exposure and symptoms in the early aftermath of a traumatic event" by Carla Smith Stover, Hilary Hahn, Jamie J. Y. Im and Steven Berkowitz (Psychological Trauma: Theory, Research, Practice, and Policy, 2010[Sep], Vol 2[3], 159-168). The article contained an incorrect DOI. The correct DOI is as follows: http://dx.doi.org/10.1037/a0019156. The online version has been corrected. (The following abstract of the original article appeared in record 2010-19144-001.) Exposure to violence and potentially traumatic events (PTEs) is a common experience among children and youth. The assessment of necessary intervention relies upon parental acknowledgment of exposure and recognition of their child's distress. Early interventions and treatment are most effective when parents are aware of the nature of the traumatic exposure, understand their child's symptomatic response, and are intimately involved in the treatment process. The present study investigated concordance between parents and exposed children on child trauma history, the subjective report of the impact of the traumas experienced, and presence of posttraumatic stress disorder (PTSD) symptoms. Agreement between parent and child report of traumas experienced was nonsignificant for serious accidents, separation from significant others, and physical assaults. Nonsignificant agreement was also found for avoidance and hyperarousal symptoms of PTSD. Correlations were not significant between parent and child report of the impact of traumas both at the time of the incident and at the time of the interview. Recommendations are suggested for helping parents improve their capacity to understand the potential impact of exposure on the child's psychological functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma exposure among children with oppositional defiant disorder and attention deficit–hyperactivity disorder.

Consecutive admissions to an outpatient child psychiatry clinic diagnosed with oppositional defiant disorder (ODD), attention deficit-hyperactivity disorder (ADHD), or adjustment disorder were assessed for trauma exposure by a structured clinical interview and parent report. Controlling for age, gender, severity of internalizing behavior problems, social competence, family psychopathology, and parent–child relationship quality (assessed by parent report), an ODD diagnosis, with or without comorbid ADHD, was associated with increased likelihood of prior victimization (but not nonvictimization) trauma. ADHD alone was not associated with an increased likelihood of a history of trauma exposure Traumatic victimization contributed uniquely to the prediction of ODD but not ADHD diagnoses. Children in psychiatric treatment who are diagnosed with ODD, but not those diagnosed solely with ADHD, may particularly require evaluation and care for posttraumatic sequelae. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Families of children with attention deficit hyperactivity disorder: a review

OBJECTIVES: 1) To review the evidence of attention deficit hyperactivity disorder (ADHD) and other conditions in family members (siblings and parents) of children with ADHD and determine the importance of genetic and environmental factors in this condition. 2) To describe the prospective 10-year follow-up of 65 families with ADHD children and 43 families of matched normal controls. 3) To review various studies that have looked at parent-child interactions with ADHD children on and off stimulant medication, and such interactions over time. The paper thus provides an overview of family pathology and functioning of families of ADHD children over time. METHOD: The paper outlines twin, sibling, family and adoption studies with regard to possible genetic and environmental factors in ADHD. It also presents data of a prospective 10-year follow-up of 65 families with ADHD children and 43 families of normal controls. This family study evaluated sociocultural factors, child rearing practices, health of family members and relationships, as well as the parental view of the child's functioning over time. RESULTS: A review of the literature suggests that ADHD has a strong genetic component, but that environmental factors also play an important role. Families of children with ADHD have more problems than families of normal controls, but these problems improve as the child with ADHD grows up and leaves home. Families of ADHD subjects can appreciate positive as well as negative changes in their children over time. Generally, family interactions with children with ADHD are problematic but improve when the child is on medication and when the child becomes an adult. CONCLUSIONS: This condition has strong genetic underpinnings; therefore, diagnosing and treating family members (parents and siblings) as well as the child with ADHD is important in improving parent-child interactions and better long-term outcome for the child and his or her family.     

Contribution of ADHD symptoms to substance problems and delinquency in conduct-disordered adolescents

We examined adolescents with conduct disorder (CD) and substance problems to determine if those with attention deficit hyperactivity disorder (ADHD) symptomatology had more severe delinquency and substance involvement. ADHD symptomatology was assessed in two ways: (1) by self-reports using the Diagnostic Interview Schedule for Children (DISC) and (2) by use of DISC plus reports of others (parents, program staff, and program teacher). We divided boys into three ADHD groups based on DISC: those who met criteria, those who reported at least eight current symptoms, and those who reported fewer than eight symptoms. We also divided the same boys into two groups: those with reports of ADHD by two or more sources and those without this multisource ADHD. Examining these definitions of ADHD revealed that boys with either self- or multisource ADHD had more CD symptoms, earlier age of CD onset, more substance dependence diagnoses, and more comorbid depression and anxiety.     

Parent and child reports of sleep problems associated with early-onset bipolar spectrum disorders.

Despite sleep problems being part of the diagnostic criteria for mood disorders, research on sleep difficulties related to early-onset bipolar spectrum disorders (EBSDs) is sparse. The authors examined the parent and child agreement, frequency, and severity of EBSD-related manic, depressive, and comorbid sleep problems. A sample of one hundred thirty-three 8- to 11-year-olds with EBSDs was assessed with parental and self-report measures of EBSD-related sleep problems. Dimensional and categorical measures indicated low agreement and high discrepancy between parent and child reports of EBSD sleep problems. Subsequent combination of parent-child data revealed the majority (96.2%) of children had moderate-to-severe sleep problems related to manic, depressive, or comorbid symptoms, either currently or during their worst mood period. More depression-related sleep problems than mania-related sleep problems were reported, especially initial insomnia. Over half the sample had sleep problems associated with current comorbidity, particularly separation anxiety disorder. These findings, their implications, and study limitations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrated services for treatment of schizophrenic substance abusers: demographics, symptoms, and substance abuse patterns

We have previously described a model of outpatient integrated treatment for patients with comorbid psychoactive substance use disorders and schizophrenia (PSUD/S)(1). Here we review relevant literature on comorbidity and outline the rationale for integrated services. Further, we describe results from 3 related studies: First, we document the approximate incidence of PSUD among a heterogeneous group of 602 schizophrenic inpatient admissions to our hospital. Second, we describe in greater detail the psychiatric symptoms and patterns of substance abuse among a subsample of 106 inpatients with PSUD/S, contrasting them with 112 patients with PSUD and mixed psychotic disorders, but who are not schizophrenic. Third, we present a prospective research project and describe a sample of 30 patients with PSUD/S, detailing demographic characteristics, psychiatric symptoms and substance abuse history. Attention is given to current issues in the differential diagnosis of patients with PSUD/S using standardized instruments.     

Interactions between early parenting and a polymorphism of the child's dopamine transporter gene in predicting future child conduct disorder symptoms.

Mounting evidence suggests that genetic risks for mental disorders often interact with the social environment, but most studies still ignore environmental moderation of genetic influences. The authors tested interactions between maternal parenting and the variable number tandem repeat (VNTR) polymorphism in the 3′ untranslated region of the dopamine transporter gene in the child to increase understanding of gene–environment interactions involving early parenting. Participants were part of a 9-year longitudinal study of 4- to 6-year-old children who met criteria for attention-deficit/hyperactivity disorder (ADHD) and demographically matched controls. Maternal parenting was observed during standard mother–child interactions in Wave 1. The child's conduct disorder (CD) symptoms 5–8 years later were measured using separate structured diagnostic interviews of the mother and youth. Controlling for ADHD symptoms and child disruptive behavior during the mother–child interaction, there was a significant inverse relation between levels of both positive and negative parenting at 4–6 years and the number of later CD symptoms, but primarily among children with 2 copies of the 9-repeat allele of the VNTR. The significant interaction with negative parenting was replicated in parent and youth reports of CD symptoms separately. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)