Given the clinical and public health significance of substance disorders and the need to identify their early risk factors, we examined the association of childhood attention-deficit/hyperactivity disorder (ADHD) with substance use (e.g., nicotine, alcohol) and abuse/dependence outcomes (nicotine, alcohol, marijuana, cocaine, other). To strengthen a potential causal inference, we meta-analyzed longitudinal studies that prospectively followed children with and without ADHD into adolescence or adulthood. Children with ADHD were significantly more likely to have ever used nicotine and other substances, but not alcohol. Children with ADHD were also more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine, and other substances (i.e., unspecified). Sex, age, race, publication year, sample source, and version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose ADHD did not significantly moderate the associations with substance outcomes that yielded heterogeneous effect sizes. These findings suggest that children with ADHD are significantly more likely to develop substance use disorders than children without ADHD and that this increased risk is robust to demographic and methodological differences that varied across the studies. Finally, few studies addressed ADHD and comorbid disruptive behavior disorders (DBD), thus preventing a formal meta-analytic review. However, we qualitatively summarize the results of these studies and conclude that comorbid DBD complicates inferences about the specificity of ADHD effects on substance use outcomes.

In younger children, the CT and IT may be stable enough to segregate groups for research, but they seem too unstable for use in the clinical assessment of individual children. Children rarely remain in the HT classification over time; rather, they sometimes desist from ADHD but mostly shift to CT in later years. Using continuous ratings of hyperactivity-impulsivity symptoms as a diagnostic qualifier should be considered as an alternative to classifying nominal subtypes of ADHD in DSM-V.

The misuse of stimulant medication among college students is a prevalent and growing problem. The purpose of this review and meta-analysis is to summarize the current research on rates and demographic and psychosocial correlates of stimulant medication misuse among college students, to provide methodological guidance and other ideas for future research, and to provide some preliminary suggestions for preventing and reducing misuse on college campuses. Random-effects meta-analysis found that the rate of stimulant medication misuse among college students was estimated at 17 % (95 % CI [0.13, 0.23], p < .001) and identified several psychological variables that differentiated misusers and nonusers, including symptoms of attention-deficit/hyperactivity disorder, problems associated with alcohol use, and marijuana use. A qualitative review of the literature also revealed that Greek organization membership, academic performance, and other substance use were associated with misuse. Students are misusing primarily for academic reasons, and the most common source for obtaining stimulant medication is peers with prescriptions. Interpretation of findings is complicated by the lack of a standard misuse definition as well as validated tools for measuring stimulant misuse. The relation between stimulant medication misuse and extra curricular participation, academic outcomes, depression, and eating disorders requires further investigation, as do the reasons why students divert or misuse and whether policies on college campuses contribute to the high rates of misuse among students. Future research should also work to develop and implement effective prevention strategies for reducing the diversion and misuse of stimulant medication on college campuses.

These findings support the validity of the DSM-IV diagnosis of ADHD in younger children by demonstrating that the symptoms and associated impairment are likely to persist well into elementary school.

The predictive validity of symptom criteria for different subtypes of ADHD among children who were impaired in at least one setting in early childhood was examined. Academic achievement was assessed seven times over 8 years in 125 children who met symptom criteria for ADHD at 4-6 years of age and in 130 demographically-matched non-referred comparison children. When intelligence and other confounds were controlled, children who met modified criteria for the predominantly inattentive subtype of ADHD in wave 1 had lower reading, spelling, and mathematics scores over time than both comparison children and children who met modified criteria for the other subtypes of ADHD. In some analyses, children who met modified criteria for the combined type had somewhat lower mathematics scores than comparison children. The robust academic deficits relative to intelligence in the inattentive group in this age range suggest either that inattention results in academic underachievement or that some children in the inattentive group have learning disabilities that cause secondary symptoms of inattention. Unexpectedly, wave 1 internalizing (anxiety and depression) symptoms independently predicted deficits in academic achievement controlling ADHD, intelligence, and other predictors. KeywordsADHD; Academic achievement; learning disabilities; anxiety; depression; longitudinal outcomes One of the serious difficulties faced by youth who meet criteria for attention-deficit/ hyperactivity disorder (ADHD) is poor academic achievement (DeShazo Barry, Lyman, & Grofer Klinger, 2002;DuPaul, McGoey, Eckert, & Vanbrakle, 2001;Faraone et al., 1993;Frick et al., 1991;Lonigan et al., 1999;McGee, Williams, Share, Anderson, & Silva, 1986;Rapport, Scanlan, & Denney, 1999;Zentall, Smith, Lee, & Wieczorek, 1994). Although academic difficulties are one of the primary justifications for treating ADHD, much remains to be learned about the nature of the academic deficits of children with ADHD. Four issues are particularly important in considering the current data base regarding the academic deficits of children and adolescent with ADHD.Address all correspondence to Greta Massetti, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341; (770) 488-1349; Fax (770) NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptFirst, because children who meet criteria for ADHD have lower intelligence scores than the population mean on average (August & Garfinkel, 1990;Faraone et al., 1993;Frazier, Demaree, & Youngstrom, 2004;Szatmari, Offord, Siegel, Finlayson, & Tuff, 1990), and because intelligence is highly correlated with standardized measures of reading and mathematics (Vanderwood, McGrew, Flanagan, & Keith, 2001), it is necessary to take intelligence into account when studying the academic achievement of children with ADHD. Similarly, because children with ADHD tend to exhibit more symptoms of psychopathology than children without ADHD, and these other forms of psychopathology may be associated with aca...