Department of Psychiatry, Ajou University School of Medicine and Graduate School of Medicine, Suwon, South Korea.
Department of Economics, Myongji University, Seoul, South Korea.
Drug Alcohol Depend. 2021 Feb 1;219:108490. doi: 10.1016/j.drugalcdep.2020.108490. Epub 2020 Dec 29.
Childhood attention deficit hyperactivity disorder (ADHD) is found to be a risk factor for substance use in adolescence, but literature has suggested that the observed influence of ADHD may be driven by the comorbid conduct disorder (CD) or oppositional defiance disorder (ODD). We examine whether childhood ADHD and CD influence lifetime use of substances, independent of other comorbid mental problems and familial risk factors.
A total of 712 sibling pairs from a nationally representative US longitudinal survey were followed from 1997 to 2015. The Behavior Problems Index (BPI) was used to measure mental disorders in children. The hyperactive, antisocial, headstrong, anxious/depressed subscales of the BPI for ADHD, CD, ODD, anxiety/depression of children were assessed by their biological mothers who were the primary caregiver. Lifetime substance use by age 18 was measured by self-reports. A within-family design was used to minimize confounding.
After controlling for mother fixed effects and comorbid mental disorders, symptoms of ADHD were not associated with lifetime substance use in adolescence except for regular smoking, while those of CD were positively and significantly associated with heightened risk for lifetime use of cannabis, regular smoking, cocaine, barbiturates, tranquilizers, hallucinogens, and inhalants in adolescence.
The results suggest that the association observed between childhood ADHD and substance use in adolescence may be driven by comorbid CD whose influences are robust to other mental disorders or unobserved familial factors.
儿童注意缺陷多动障碍（ADHD）被发现是青少年物质使用的一个风险因素，但文献表明，ADHD 的观察到的影响可能是由共患品行障碍（CD）或对立违抗性障碍（ODD）驱动的。我们研究了儿童 ADHD 和 CD 是否会影响物质的终身使用，而不考虑其他共患精神问题和家族风险因素。
对来自美国全国代表性纵向调查的共 712 对兄弟姐妹进行了随访，随访时间从 1997 年至 2015 年。使用行为问题指数（BPI）来衡量儿童的精神障碍。BPI 的多动、反社会、固执、焦虑/抑郁子量表用于评估 ADHD、CD、ODD 和儿童的焦虑/抑郁，由他们的主要照顾者即生物母亲进行评估。通过自我报告来衡量 18 岁前的终身物质使用情况。采用家庭内设计来最小化混杂因素。
在控制了母亲固定效应和共患精神障碍后，ADHD 的症状与青春期的终身物质使用无关，除了经常吸烟外，而 CD 的症状则与青春期终生使用大麻、经常吸烟、可卡因、巴比妥类药物、镇静剂、迷幻剂和吸入剂的风险显著升高有关。
结果表明，在儿童 ADHD 和青少年物质使用之间观察到的关联可能是由共患 CD 驱动的，而 CD 的影响对其他精神障碍或未观察到的家族因素是稳健的。
