Adolescent Substance Use in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD) (MTA) as a Function of Childhood ADHD, Random Assignment to Childhood Treatments, and Subsequent Medication

Abstract

Objectives To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n=436); to test whether (a) medication at follow-up, (b) cumulative psychostimulant treatment over time, or (c) both relate to substance use/SUD; to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n=261). Method Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used. Results The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8 year follow-up or earlier (M age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than non-ADHD samples, regardless of sex. Conclusions Medication for ADHD did not protect from, nor contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8 year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information—Multimodal Treatment Study of Children with Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388.

Differential Associations Between Alcohol Expectancies and Adolescent Alcohol Use as a Function of Childhood ADHD

“…For example, when frequency measures of drinking are considered in adolescence (beyond just use/ nonuse as refl ected in the studies considered by Lee et al, 2011), group differences emerge by late adolescence (Molina et al, , 2007. Similarly, in a large multisite sample of children with ADHD, repeated drinking or drunkenness in adolescence was elevated for the ADHD compared with the non-ADHD group (Molina et al, 2013). Thus, beginning in adolescence, there is an emerging vulnerability to later problematic alcohol use that warrants further research.…”

Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls

“…Children with ADHD are at risk of school failure, emotional difficulties, substance misuse, antisocial behaviour, and poor peer relationships in adolescence 8, 9, 10, 11, 12, 13, 14, and are more impaired in psychosocial, educational, and neuropsychological functioning as adults 15. ADHD affects both boys and girls in all areas of functioning, for example, academically, cognitively, psychosocially, and psychiatrically 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30.…”

“…ADHD affects both boys and girls in all areas of functioning, for example, academically, cognitively, psychosocially, and psychiatrically 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. Even though ADHD is associated with coexisting externalizing and internalizing disorders in both genders, girls with ADHD are significantly more likely to display internalizing disorders than boys with ADHD 25, 31, 32, 33.…”

Stimulant Treatment of ADHD and Cigarette Smoking: A Meta-Analysis

“…Only 1 study, the Multimodal Treatment Study for ADHD (MTA Study), employed random assignment to medication conditions or included a placebo comparison. At 8-year follow-up, no significant association was reported between ever receiving stimulant treatment and ND diagnosis 12 ; however, additional data provided by the author indicated that for youth who continued to take stimulant medication more than 50% of the time at follow-up, medication was associated with lower rates of daily smoking (OR = 0.51 [95% CI: 0.27-0.97]).…”

“…5,6 Youth with ADHD are 2 to 3 times more likely to smoke cigarettes than their peers without ADHD. [7][8][9][10][11][12] They also begin smoking earlier 7,13 and progress more quickly to regular use and dependence. 8 ADHD youth smokers are also at higher risk for drug and alcohol use disorders than youth with ADHD who do not smoke.…”