Behavioral and Cognitive Behavioral and Cognitive Predictors of Adolescent Predictors of Adolescent

Substance Use in Children with Substance Use in Children with ADHDADHD

Jeffrey M. Halperin, Jeffrey H. Newcorn, Jeffrey M. Halperin, Jeffrey H. Newcorn, Nicole Thorn and Seth HartyNicole 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 ADHD and Risk for Adolescent Substance UseUse

Is it specific to ADHD or more closely Is it specific to ADHD or more closely linked to: linked to: The presence of early conduct disorder (CD)? The presence of early conduct disorder (CD)? The persistence of CD into adolescence? The persistence of CD into adolescence? The persistence of AD/HD into adolescence?The persistence of AD/HD into adolescence?

Is risk for substance use affected by level Is risk for substance use affected by level of cognitive function?of cognitive function?

Longitudinal Study of Urban Youth with Longitudinal Study of Urban Youth with ADHD: Baseline AssessmentADHD: Baseline Assessment

Initially recruited 1990 – 1997Initially recruited 1990 – 1997 Clinically-referred sampleClinically-referred sample Age at initial assessment 7 – 11 yearsAge at initial assessment 7 – 11 years Teacher ratings: IOWA ConnersTeacher ratings: IOWA Conners Parent ratings: CBCLParent ratings: CBCL Parent Interview: DISCParent Interview: DISC IQ: WISC-R/WISC-IIIIQ: WISC-R/WISC-III Academic Achievement: WRAT-R/WIATAcademic Achievement: WRAT-R/WIAT

Childhood Characteristics of Childhood Characteristics of Children with ADHDChildren with ADHD

AgeAge 8.998.99 1.301.30 9.489.48 1.161.16

FSIQFSIQ 91.8491.84 14.7214.72 96.0796.07 14.5014.50

T - I/OT - I/O 10.9910.99 3.123.12 11.0411.04 3.173.17

T – AGGT – AGG 8.158.15 4.684.68 7.777.77 4.744.74

P - EXTP - EXT 70.7070.70 10.0510.05 72.3472.34 9.919.91

P – INTP – INT 65.6665.66 10.4110.41 66.0966.09 11.0711.07

SESSES 3.793.79 1.411.41 3.333.33 1.291.29

Full Sample Presentation Sample

N = 169 N = 56

Mean SD Mean SD

Childhood Characteristics of Childhood Characteristics of Children with ADHDChildren with ADHD

Full Sample Presentation Sample

N = 169 N = 56

% Male% Male 87.687.6 88.088.0

% ODD% ODD 78.178.1 76.876.8

% CD% CD 31.431.4 32.132.1

% Anxiety% Anxiety 32.532.5 26.826.8

% Mood% Mood 13.013.0 10.710.7

Adolescent Sample CharacteristicsAdolescent Sample Characteristics

AgeAge 18.418.4 1.11.1 19.119.1 1.61.6 < .01< .01

FSIQFSIQ 93.593.5 14.514.5 94.494.4 14.714.7 > .10> .10

ReadingReading 89.589.5 20.320.3 98.298.2 15.415.4 < .05< .05

ADHD Controls

Mean SD Mean SD p

(N = 56) (N = 56)

Adolescent Assessment Adolescent Assessment InstrumentsInstruments

Kiddie SADS PLKiddie SADS PL ADHDADHD Conduct DisorderConduct Disorder Alcohol abuse and dependenceAlcohol abuse and dependence Substance abuse and dependenceSubstance abuse and dependence

Rutger’s Alcohol and Drug Use Questionnaire (Labouvie Rutger’s Alcohol and Drug Use Questionnaire (Labouvie et al. 1997)et al. 1997)

Aggression, Antisocial Behavior and Drug Use Summary Aggression, Antisocial Behavior and Drug Use Summary Scale (Kalmar & Halperin)Scale (Kalmar & Halperin) Aggression: r = .90Aggression: r = .90 Antisocial Behavior: r = .83Antisocial Behavior: r = .83 Substance Use: r = .93Substance Use: r = .93

Drug Use Summary ScaleDrug Use Summary Scale

1 2 3 4 5 6 7 8 9

absent infreq. freq. minor/ freq. major persistent

minor infreq. major very serious

Substance Use Diagnoses in Substance Use Diagnoses in ADHD and Control AdolescentsADHD and Control Adolescents

0

5

10

15

20

25

A-Abuse* A-Dep D-Abuse D-Dep

ADHD (N=56)

Controls (N=56)

*p = .067

Per

cent

Dimensional Assessment of Aggression, Dimensional Assessment of Aggression, Antisocial Behavior and Substance Use in Antisocial Behavior and Substance Use in

ADHD and Control GroupsADHD and Control Groups

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Aggression* AntisocialBehavior

SubstanceUse

ADHD (N=56)

Controls (N=56)

*p < .05

ADHD and Risk for Adolescent Substance ADHD and Risk for Adolescent Substance UseUse

Is it specific to ADHD or more closely Is it specific to ADHD or more closely linked to: linked to: The presence of early conduct disorder (CD)? The presence of early conduct disorder (CD)? The persistence of CD into adolescence? The persistence of CD into adolescence? The persistence of AD/HD into adolescence?The persistence of AD/HD into adolescence?

Is risk for substance use affected by level Is risk for substance use affected by level of cognitive function?of cognitive function?

Substance Use Diagnoses in Controls and Substance Use Diagnoses in Controls and ADHD as a function of Childhood CDADHD as a function of Childhood CD

0

5

10

15

20

25

30

35

40

A-Abuse A-Dep* D-Abuse D-Dep

ADHD/CD+ (N=18)

ADHD/CD- (N=38)

Controls (N=56)

*p = .08

Per

cent

Dimensional Assessment of Aggression, Antisocial Dimensional Assessment of Aggression, Antisocial Behavior and Substance Use in Controls and Behavior and Substance Use in Controls and

ADHD with and without Childhood CDADHD with and without Childhood CD

0

1

2

3

4

5

6

Aggression AntisocialBehavior

SubstanceUse

ADHD/CD+ (N=18)

ADHD/CD- (N=38)

Controls (N=56)

*Differs from ADHD/CD+, p < .05

**

* **

ADHD and Risk for Adolescent Substance ADHD and Risk for Adolescent Substance UseUse

Is it specific to ADHD or more closely Is it specific to ADHD or more closely linked to: linked to: The presence of early conduct disorder (CD)? The presence of early conduct disorder (CD)? The persistence of CD into adolescence? The persistence of CD into adolescence? The persistence of AD/HD into adolescence?The persistence of AD/HD into adolescence?

Is risk for substance use affected by level Is risk for substance use affected by level of cognitive function?of cognitive function?

Substance Use Diagnoses in Controls and Substance Use Diagnoses in Controls and ADHD as a function of Adolescent CDADHD as a function of Adolescent CD

0

5

10

15

20

25

30

35

40

45

50

A-Abuse A-Dep* D-Abuse D-Dep**

ADHD/CD+ (N=13)

ADHD/CD- (N=43)

Controls (N=56)

*p = .10; **p< .01

Per

cent

Dimensional Assessment of Aggression, Antisocial Dimensional Assessment of Aggression, Antisocial Behavior and Substance Use in Controls and Behavior and Substance Use in Controls and

ADHD with and without Adolescent CDADHD with and without Adolescent CD

0

1

2

3

4

5

6

7

Aggression AntisocialBehavior

SubstanceUse

ADHD/CD+ (N=13)

ADHD/CD- (N=43)

Controls (N=56)

*Differs from ADHD/CD+, p < .05 **Differs from other two groups, p < .05

* ** * **

Substance Use Diagnoses in Controls and Substance Use Diagnoses in Controls and ADHD as a function of Childhood and ADHD as a function of Childhood and

Adolescent CDAdolescent CD

0

5

10

15

20

25

30

35

40

45

50

A-Abuse* A-Dep* D-Abuse D-Dep**

CCD-/ACD- (N=32)

CCD-/ACD+ (N=11)

CCD+/ACD- (N=6)

CCD+/ACD+ (N=7)

Controls (N=56)

*p < .01; **p< .05

Per

cent

Dimensional Assessment and Substance Use as a Dimensional Assessment and Substance Use as a Function of Childhood and Adolescent CD*Function of Childhood and Adolescent CD*

0

1

2

3

4

5

6

CCD-/ACD- CCD+/ACD- CCD-/ACD+ CCD+/ACD+ Controls

*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 ADHD and Risk for Adolescent Substance UseUse

Is it specific to ADHD or more closely Is it specific to ADHD or more closely linked to: linked to: The presence of early conduct disorder (CD)? The presence of early conduct disorder (CD)? The persistence of CD into adolescence? The persistence of CD into adolescence? The persistence of AD/HD into adolescence?The persistence of AD/HD into adolescence?

Is risk for substance use affected by level Is risk for substance use affected by level of cognitive function?of cognitive function?

Substance Use Diagnoses in Controls and Substance Use Diagnoses in Controls and ADHD as a function of Adolescent ADHDADHD as a function of Adolescent ADHD

0

5

10

15

20

25

30

A-Abuse* A-Dep D-Abuse D-Dep

ADHD/F+ (N=41)

ADHD/F- (N=15)

Controls (N=56)

*p = .01

Per

cent

Dimensional Assessment of Aggression, Antisocial Dimensional Assessment of Aggression, Antisocial Behavior and Substance Use in Controls and Behavior and Substance Use in Controls and ADHD with and without Adolescent ADHD*ADHD with and without Adolescent ADHD*

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Aggression Antisocial SubstanceUse

ADHD/F+ (N=41)

ADHD/F- (N=15)

Controls (N=56)

* all p > .10

Proportion of Children with a Substance Use Proportion of Children with a Substance Use Diagnosis in AdolescenceDiagnosis in Adolescence

0

10

20

30

40

50

60

70

No CD(N=32)

CD-C (N=18)

CD-F (N=13)

ADHD-F(N=41)

ADHD-F/No CD

Controls(N=56)

*

**

*p < .10; **p < .05 relative to controls

ADHD and Risk for Adolescent Substance ADHD and Risk for Adolescent Substance UseUse

Is it specific to ADHD or more closely Is it specific to ADHD or more closely linked to: linked to: The presence of early conduct disorder (CD)? The presence of early conduct disorder (CD)? The persistence of CD into adolescence? The persistence of CD into adolescence? The persistence of AD/HD into adolescence?The persistence of AD/HD into adolescence?

Is risk for substance use affected by level Is risk for substance use affected by level of cognitive function?of cognitive function?

Drug Use Summary Ratings as a Function of Drug Use Summary Ratings as a Function of Childhood IQ and Academic Achievement in Childhood IQ and Academic Achievement in

Young Adolescents (N=32; mean age = 15.8 yrs.)*Young Adolescents (N=32; mean age = 15.8 yrs.)*

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1

VIQ PIQ Reading Arithmetic

r

*From Harty et al, In Press; all p > .10

Drug Use Summary Ratings as a Function of Drug Use Summary Ratings as a Function of Childhood CD and IQ/Academic Achievement in Childhood CD and IQ/Academic Achievement in

Young Adolescents (mean age = 15.8 yrs)Young Adolescents (mean age = 15.8 yrs) ^̂

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1

VIQ PIQ Reading Arithmetic

No CD

CD

r

^From Harty et al, In Press; * p < .10; ** p < .05; ***p < .01

********

*

Drug Use Summary Ratings as a Function of Drug Use Summary Ratings as a Function of Childhood IQ and Academic Achievement in Older Childhood IQ and Academic Achievement in Older

Adolescents (N=56, mean age = 18.4 yrs.)Adolescents (N=56, mean age = 18.4 yrs.)

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1

Aggression Antisocial Substance

FSIQ

Reading

r

all p > .10

Drug Use Summary Ratings as a Function of Drug Use Summary Ratings as a Function of Childhood CD and IQ/Academic Achievement in Childhood CD and IQ/Academic Achievement in

Older Adolescents (mean age = 18.4 yrs)Older Adolescents (mean age = 18.4 yrs)

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1

Agg Anti Sub Agg Anti Sub

No CD (N=38)

CD (N=18)

r

* p < .01; ** p < .05

***

FSIQ Reading

Summary and Conclusions ISummary and Conclusions I

Relative to controls, adolescents who had ADHD Relative to controls, adolescents who had ADHD in childhood are more likely to encounter in childhood are more likely to encounter alcohol, but not drug use problems;alcohol, but not drug use problems;

Among children with ADHD, conduct disorder in Among children with ADHD, conduct disorder in childhood or adolescence is associated with childhood or adolescence is associated with increased drug use problems;increased drug use problems;

The persistence of ADHD into adolescence The persistence of ADHD into adolescence appears linked to increased alcohol, but not drug appears linked to increased alcohol, but not drug use;use;

Summary and Conclusions IISummary and Conclusions II

High cognitive function is associated with early High cognitive function is associated with early onset of substance use among youth with CD. onset of substance use among youth with CD. However, it may not portend more severe However, it may not portend more severe difficulties in later adolescence;difficulties in later adolescence;

Whereas low cognitive function appears to be Whereas low cognitive function appears to be associated with increased adolescent associated with increased adolescent aggression and antisocial behavior, this does aggression and antisocial behavior, this does not appear to be the case for substance use;not appear to be the case for substance use;

Childhood ADHD in the absence of CD is Childhood ADHD in the absence of CD is notnot associated with elevated substance use associated with elevated substance use problems.problems.