Early substance use in the pathway from childhood attention-deficit/hyperactivity disorder (ADHD) to young adult substance use: Evidence of statistical mediation and substance specificity.
Early substance use in the pathway from childhood attention-deficit/hyperactivity disorder (ADHD) to young adult substance use: Evidence of statistical mediation and substance specificity.
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DOI：
10.1037/adb0000542
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发表时间：
2020-03
影响因子：
3.4
通讯作者：
Molina, Brooke S G
中科院分区：
文献类型：
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作者：
Howard, Andrea L;Kennedy, Traci M;Mitchell, John T;Sibley, Margaret H;Hinshaw, Stephen P;Arnold, L Eugene;Roy, Arunima;Stehli, Annamarie;Swanson, James M;Molina, Brooke S G
这项研究测试了早期和发育中的非典型物质使用是否介导ADHD儿童成人物质使用的风险，以及这种风险是否是物质特异性的。参与者是以前参加过随机对照试验（RCT）的ADHD儿童，以及人口统计学上相似的非ADHD组，在原始RCT基线后2至16年进行评估。在随访时收集了大量饮酒、大麻使用、每日吸烟和其他非法药物使用的自我报告，以确定早期和频繁使用的危险性。模型估计统计介导的影响，儿童多动症成人物质使用通过早期的物质参与，有计划的比较，以评估物质的特异性。结果支持中介假说，表明儿童多动症与更频繁的成人物质使用通过早期物质使用大麻，香烟，非法药物，并在较小程度上，酒精。除了早期使用非大麻非法药物外，共病儿童行为障碍或对立违抗性障碍不会使调解升级。物质特异性的介导途径基本上是不存在的，除了香烟的使用，其中ADHD相关的早期吸烟最强烈地预测成人每日吸烟。这项研究的结果提供了新的证据，表明与儿童多动症相关的早期药物使用表明成年早期的重要交叉药物脆弱性，但年轻时吸烟尤其与习惯性（每日）吸烟的风险增加有关。预防、延迟或减少药物试验的努力应及早进行，并应关注与这一高危人群中多种药物滥用相关的因素。
This study tested whether early and developmentally atypical substance use mediates risk for adult substance use among children with ADHD, and whether that risk is substance-specific. Participants were children with ADHD previously enrolled in a randomized controlled trial (RCT), and a demographically similar nonADHD group, assessed at 2 through 16 years after the original RCT baseline. Self-reports of heavy drinking, marijuana use, daily smoking, and other illicit drug use were collected at follow-ups to establish atypically early and frequent use. Models estimated statistically mediated effects of childhood ADHD on adult substance use via early substance involvement, with planned comparisons to evaluate substance specificity. Results supported the mediation hypothesis, showing that childhood ADHD was associated with more frequent adult substance use via early substance use for marijuana, cigarettes, illicit drugs, and to a lesser extent, alcohol. Mediation was not escalated by comorbid childhood conduct disorder or oppositional defiant disorder except for early use of non-marijuana illicit drugs. Substance-specificity in the mediational pathway was largely absent except for cigarette use, where ADHD-related early smoking most strongly predicted adult daily smoking. Findings from this study provide new evidence that atypically-early substance use associated with childhood ADHD signals important cross-drug vulnerability by early adulthood, but cigarette use at a young age is especially associated with increased risk for habitual (daily) smoking specifically. Efforts to prevent, delay, or reduce substance experimentation should occur early and focus on factors relevant to multiple drugs of abuse in this at-risk population.