Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse
Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse
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DOI：
10.1001/archpsyc.64.10.1145
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发表时间：
2007-10-01
影响因子：
--
通讯作者：
Iacono, William G.
中科院分区：
文献类型：
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作者：
Elkins, Irene J.;McGue, Matt;Iacono, William G.
背景：注意力缺陷/多动障碍(ADHD)是外化行为的早期表现，可能会识别出以后滥用药物的高危儿童。目的：确定ADHD与药物滥用之间是否存在预期的关系，以及这种关系是否取决于ADHD的亚型(多动/冲动或注意力不集中)、CD或性别。设计、环境和参与者：通过Logistic回归分析，研究ADHD和CD的维度和分类测量与随后的烟草、酒精、来自明尼苏达州双胞胎家庭研究的11岁双胞胎(760名女性和752名男性双胞胎)在14岁和18岁之前开始使用非法药物和药物使用障碍。主要观察指标：对青少年和他们的母亲进行结构化访谈，了解药物使用情况并做出诊断。结果：对于男孩和女孩，多动/冲动预测开始所有类型的药物使用、尼古丁依赖和大麻滥用/依赖(对于所有人，P，05)，即使在2个时间点控制CD。相比之下，当控制了多动/冲动和CD时，注意力不集中和物质结果之间的关系消失了，可能的例外是尼古丁依赖。ADHD的明确诊断只对烟草和非法药物的使用有显著预测作用(调整后的优势比分别为2.01和2.82)。在11至14岁诊断为CD是18岁之前物质障碍的有力预测因子(所有优势比，>；4.27)。结论：即使考虑到较晚出现的CD的生长，多动/冲动也能预测以后的物质问题，而注意力不集中本身带来的风险较小。即使是ADHD或CD的一个单一症状也会增加风险。在之前的研究中，未能一致地观察ADHD与药物使用和滥用结果之间的关系，可能是因为依赖不太敏感的分类诊断。
Context: Attention- deficit/ hyperactivity disorder ( ADHD), an early manifestation of externalizing behavior, may identify children at high risk for later substance abuse. However, the ADHD - substance abuse relationship often disappears when co- occurring conduct disorder ( CD) is considered.Objective: To determine whether there is a prospective relationship between ADHD and the initiation of substance use and disorders, and whether this relationship depends on the ADHD subtype ( hyperactive/ impulsive or inattentive), CD, or sex.Design, Setting, and Participants: Dimensional and categorical measures of ADHD and CD were examined via logistic regression analyses in relation to subsequent initiation of tobacco, alcohol, and illicit drug use by 14 years of age and onset of substance use disorders by 18 years of age in a population- based sample of 11- yearold twins ( 760 female and 752 male twins) from the Minnesota Twin Family Study.Main Outcome Measures: Structured interviews were administered to adolescents and their mothers regarding substance use and to generate diagnoses.Results: For boys and girls, hyperactivity/ impulsivity predicted initiation of all types of substance use, nicotine dependence, and cannabis abuse/ dependence ( for all, P ,. 05), even when controlling for CD at 2 time points. By contrast, relationships between inattention and substance outcomes disappeared when hyperactivity/ impulsivity and CD were controlled for, with the possible exception of nicotine dependence. A categorical diagnosis of ADHD significantly predicted tobacco and illicit drug use only ( adjusted odds ratios, 2.01 and 2.82, respectively). A diagnosis of CD between 11 and 14 years of age was a powerful predictor of substance disorders by 18 years of age ( all odds ratios, > 4.27).Conclusions: Hyperactivity/ impulsivity predicts later substance problems, even after growth in later- emerging CD is considered, whereas inattention alone poses less risk. Even a single symptom of ADHD or CD is associated with increased risk. Failure in previous research to consistently observe relationships between ADHD and substance use and abuse outcomes could be due to reliance on less- sensitive categorical diagnoses.