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Prospective relationships of ADHD symptoms with developing substance use in a population-derived sample

  • E. Sihvola (a1) (a2), R. J. Rose (a3), D. M. Dick (a4), T. Korhonen (a1), L. Pulkkinen (a5), A. Raevuori (a1), M. Marttunen (a6) (a7) and J. Kaprio (a1) (a6) (a8)...



Clinically ascertained reports suggest that boys and girls with attention deficit hyperactivity disorder (ADHD) may differ from each other in their vulnerability to substance use problems.


A total of 1545 Finnish adolescents were assessed for DSM-IV-based ADHD symptoms by their parents and classroom teachers using standardized rating scales at age 11–12 years. At age 14, substance use disorders and psychiatric co-morbidity were assessed with the Semi-Structured Assessment for the Genetics of Alcoholism, providing DSM-III-R/DSM-IV diagnoses for Axis I disorders. At age 17.5, substance use was assessed by multi-item questionnaire.


Although baseline ADHD symptoms were less common among females, they were more predictive of adverse substance use outcomes once conduct disorder and previous substance use were controlled for. Only in females were baseline ADHD symptoms significant predictors of alcohol abuse and dependence and illicit drug use at age 14. At the age of 17.5, parents' reports of inattentiveness and hyperactivity were significant predictors for frequent alcohol use in both sexes, but they were more predictive of frequent alcohol and illicit drug use in girls. Impulsivity in teachers' ratings predicted frequent alcohol use and illicit drug use in boys. Parental reports of inattentiveness in their 11-/12-year-old daughters were a consistent predictor for illicit drug use across adolescence.


Inattentiveness and hyperactivity may be more predictive of alcohol use disorders and maladaptive patterns of alcohol and illicit drug use among girls than boys. The importance of these behavioural symptoms should be assessed further in the community, as they could jeopardize adolescents' successful transitioning into adult roles.


Corresponding author

*Address for correspondence: E. Sihvola, M.D., Department of Public Health (5th floor), Mannerheimintie 172, PO Box 41 00014, University of Helsinki, Finland. (Email:


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APA (1987). Diagnostic and Statistical Manual of Mental Health Disorders, 3rd edn, Revised (DSM-III-R). American Psychiatric Association: Washington, DC.
APA (1994). Diagnostic and Statistical Manual of Mental Health Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.
Arnold, LE (1996). Sex differences in ADHD: conference summary. Journal of Abnormal Child Psychology 24, 555569.
Banbury, MM, Wellington, B (1989). Designing and using peer nomination forms. Gifted Child Quarterly 33, 161164.
Barkley, RA, Brown, TE (2008). Unrecognized attention deficit/hyperactivity disorder in adults presenting with other psychiatric disorders. CNS Spectrums 13, 977984.
Barman, SK, Pulkkinen, L, Kaprio, J, Rose, RJ (2004). Inattentiveness, parental smoking and adolescent smoking initiation. Addiction 99, 10491061.
Biederman, J, Faraone, SV (2004). The Massachusetts General Hospital Studies on gender influences on attention-deficit/hyperactivity disorder in youth and in relatives. Psychiatric Clinics of North America 27, 225232.
Biederman, J, Mick, E, Faraone, SV, Braaten, E, Doyle, A, Spencer, T, Wilens, T, Frazier, E, Johnson, MA (2002). Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. American Journal of Psychiatry 159, 3642.
Biederman, J, Monuteaux, MC, Mick, E, Spencer, T, Wilens, TE, Klein, KL, Price, JE, Faraone, SV (2006). Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biological Psychiatry 60, 10981105.
Biederman, J, Wilens, T, Mick, E, Milberger, S, Spencer, TJ, Faraone, SV (1995). Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD); effects of ADHD and psychiatric comorbidity. American Journal of Psychiatry 152, 16521658.
Brook, D, Brook, JS, Zhang, C, Koppel, J (2010). The association between attention deficit hyperactivity disorder in adolescence and substance use disorders in adulthood. Archives of Pediatrics and Adolescent Medicine 164, 930934.
Buzholz, KK, Cadoret, R, Cloninger, CR, Dinwiddie, SH, Hesselbrock, VM, Nurnberger, Jr. JI, Reich, T, Schmidt, I, Schuckit, MA (1994). A new, semi-structured psychiatric interview for use in genetic linkage studies: a report on the reliability of the SSAGA. Journal of Studies on Alcohol 55, 149158.
Dick, DM, Viken, RJ, Kaprio, J, Pulkkinen, L, Rose, RJ (2005). Understanding the covariation among childhood externalizing symptoms: genetic and environmental influences on conduct disorder, attention deficit hyperactivity disorder, and oppositional defiant disorder symptoms. Journal of Abnormal Child Psychology 33, 219229.
Disney, ER, Elkins, IJ, McGue, M, Iacono, WG (1999). Effects of ADHD, conduct disorder, and gender on substance use and abuse in adolescence. American Journal of Psychiatry 156, 15151521.
Edenberg, HJ (2002). The collaborative study on the genetics of Alcoholism: an update. Alcohol Research & Health 26, 214218.
Elkins, EJ, McGue, M, Iacono, WG (2007). Prospective effects of attention-deficit/hyperactivity disorder and conduct disorder and substance use and abuse. Archives of General Psychiatry 64, 11451152.
Faraone, SV, Wilens, TE (2007). Effect of stimulant medications for attention-deficit hyperactivity disorder on later substance use and the potential for stimulant misuse, abuse and diversion. Journal of Clinical Psychiatry 68 (Suppl. 11), 1522.
Gau, SF, Chong, MY, Yang, P, Yen, CF, Liang, KY, Cheng, ATA (2007). Psychiatric and psychosocial predictors of substance use disorders among adolescents: longitudinal study. British Journal of Psychiatry 190, 4248.
Gaub, M, Carlson, CL (1997). Gender difference in ADHD: a meta-analysis and critical review. Journal of American Academy of Child and Adolescent Psychiatry 36, 10361045.
Isomaki, H, Kukkonen, P (1993). Peer nomination as a measure of children's social behavior [Masters thesis]. Department of Psychology, University of Jyvaskyla, Finland.
Kaprio, J, Pulkkinen, , Rose, RJ (2002). Genetic and environmental factors in health-related behaviors: studies on Finnish twins and twin families. Twin Research 5, 366371.
Kessler, R, Green, J, Adler, L, Barkley, R, Chatterji, S, Faraone, S, Finkelman, M, Greenhill, L, Gruber, M, Jewell, M, Russo, L, Sampson, N, Van Brunt, D (2010). Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. Archives of General Psychiatry 67, 11681178.
Kollins, SH (2008). A qualitative review of issues arising in the use of psycho-stimulant medications in patients with ADHD and co-morbid substance use disorders. Current Medical Research and Opinion 24, 13451352.
Korhonen, T, Huizink, A, Dick, D, Pulkkinen, L, Rose, RJ, Kaprio, J (2008). Role of individual, peer and family factors in the use of cannabis and other illicit drugs. A longitudinal analysis among Finnish adolescent twins. Drug and Alcohol Dependence 97, 3343.
Lahey, BB, Pelham, WE, Chronis, A, Massetti, G, Kipp, H, Ehrhardt, A, Lee, S (2006). Predictive validity of ICD-10 hyperkinetic disorder relative to DSM-IV attention-deficit/hyperactivity disorder among young children. Journal of Child Psychology and Psychiatry 47, 472479.
Leeuwen, AP, Creemers, HE, Verhulst, FC, Ormel, J, Huizink, AC (2010). Are adolescents gambling with cannabis use? A longitudinal study if impulsivity measures and adolescent substance use: the TRAILS study. Journal of studies on Alcohol and Drugs 72, 7078.
Lynskey, M, Fergusson, D (1995). Childhood conduct problems, attention deficit behaviors and adolescent alcohol, tobacco, and illicit drug use. Journal of Abnormal Psychology 23, 281302.
Mannuzza, S, Klein, RG, Truong, NL, Moulton, JL, Roizen, ER, Howell, KH, Castellanos, FX (2008). Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: prospective follow-up into adulthood. American Journal of Psychiatry 165, 604609.
Pulkkinen, L, Kaprio, J, Rose, RJ (1999). Peers, teachers and parents as assessors of the behavioural and emotional problems of twins and their adjustment: the Multidimensional Peer Nomination Inventory. Twin Research 2, 274285.
Pulkkinen, L, Vaalamo, I, Hietala, R, Kaprio, J, Rose, RJ (2003). Peer reports of adaptive behavior in twins and singletons: is twinship a risk or an advantage? Twin Research 6, 106118.
Rose, RJ, Dick, DM, Viken, RJ, Kaprio, J (2001). Drinking or abstaining at age of 14? A genetic epidemiological study. Alcoholism: Clinical and Experimental Research 25, 15941604.
Rose, RJ, Dick, DM, Viken, RJ, Pulkkinen, L, Kaprio, J (2004). Genetic and environmental effects on conduct disorder and alcohol dependence symptoms and their covariation at age 14. Alcoholism: Clinical and Experimental Research 28, 15411548.
Seppä, K, Sillanaukee, P, Koivula, T (1990). The efficiency of a questionnaire in detecting heavy drinkers. British Journal of Addiction 12, 16391645.
Wilens, TE (2007). The nature of the relationship between attention-deficit hyperactivity disorders and substance use. Journal of Clinical Psychiatry 68 (Suppl. 11), 68.
Wilens, TE, Adamson, J, Monuteaux, MC, Faraone, SV, Schillinger, M, Westerberg, D, Biederman, J (2008). Impact of prior stimulant treatment for attention-deficit/hyperactivity disorder in the subsequent risk for cigarette smoking, alcohol and drug use disorders in adolescent girls. Archives of Pediatrics and Adolescent Medicine 162, 916921.
Wilens, TE, Biederman, J (1993). Psychopathology in preadolescent children at high risk for substance abuse: a review of the literature. Harvard Review of Psychiatry 1, 207218.
Wilens, TE, Biederman, J, Spencer, T, Frances, R (1994). Comorbidity of attention/deficit hyperactivity and psychoactive substance use disorders. Hospital & Community Psychiatry 45, 421–423, 435.
Williams, RL (2000). A note on robust variance estimation for cluster-correlated data. Biometrics 56, 645646.


Prospective relationships of ADHD symptoms with developing substance use in a population-derived sample

  • E. Sihvola (a1) (a2), R. J. Rose (a3), D. M. Dick (a4), T. Korhonen (a1), L. Pulkkinen (a5), A. Raevuori (a1), M. Marttunen (a6) (a7) and J. Kaprio (a1) (a6) (a8)...


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