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CORK Bibliography: Attention Deficit/Hyperactivity Disorder

34 citations. XXXX to present

Prepared: March 2008

Aharonovich, E.; Garawi, F.; Bisaga, A.; Brooks, D.; Raby, WN; Rubin, E. et al. Concurrent cannabis use during treatment for comorbid ADHD and cocaine dependence: Effects on outcome. American Journal of Drug and Alcohol Abuse 32(4): 629-635, 2006. (10 refs.)

Cannabis is the most widely used illicit substance in the United States with especially high prevalence of use among those with psychiatric disorders. Few studies have examined the relationship between concurrent cannabis use and treatment outcome among patients receiving treatment for comorbid substance abuse and psychiatric disorders. This study investigated the effects of cannabis use on treatment retention and abstinence from cocaine among cocaine dependent patients with Attention Deficit Hyperactivity Disorder (ADHD). Cocaine dependent patients diagnosed with current ADHD (DSM-IV, N = 92) aged 25 to 51 participated in a randomized clinical trial of methylphenidate for treatment of ADHD and cocaine dependence in an outpatient setting. The majority of patients (69%) used cannabis during treatment. Results suggest that moderate/intermittent cannabis users had greater retention rates compared to abstainers and consistent users (p = .02). This study is the first to examine concurrent cannabis use in cocaine dependent patients diagnosed with ADHD.

Barnow S; Schuckit M; Smith T; Spitzer C; Freyberger HJ. Attention problems among children with a positive family history of alcohol abuse or dependence and controls: Prevalence and course for the period from preteen to early teen years. European Addiction Research 13(1): 1-5, 2007. (59 refs.)

This longitudinal study investigated the scope and course of attention problems over a period of time from preteen (ages 7-12 years) to early teen years (ages 13-17 years). We compared symptoms in subjects with and without a family history (FH) of alcohol abuse or dependence from among families without evidence of antisocial personality disorder. Evaluations of attention problems for the offspring were based on the Child Behavior Checklist and a validated semistructured interview carried out with the mother. The findings indicate no higher risk for attention problems and attention-deficit hyperactivity disorder (ADHD)-like symptoms in the children of families with an alcohol use disorder. Regarding the course of problems, the ADHD symptom count tended to decrease over time, especially for children without a FH of alcohol abuse or dependence. Further research will be needed to determine whether results can be replicated with families from different social strata and including subjects with the antisocial personality disorder.

Biederman J Petty CR Wilens TE Fraire MG Purcell CA Mick E et al. Familial risk analyses of attention deficit hyperactivity disorder and substance use disorders. American Journal of Psychiatry 165(1): 107-115, 2008. (37 refs.)

Objective: A robust and bidirectional comorbidity between attention deficit hyperactivity disorder (ADHD) and psychoactive substance use disorder (alcohol or drug abuse or dependence) has been consistently reported in the extant literature. Method: First-degree relatives from a large group of pediatrically and psychiatrically referred boys with (112 probands, 385 relatives) and without (105 probands, 358 relatives) ADHD were comprehensively assessed by blind raters with structured diagnostic interviews, Familial risk analysis examined the risks in first-degree relatives for ADHD, psychoactive substance use disorder, alcohol dependence, and drug dependence after stratifying probands by the presence and absence of these disorders. Results: ADHD in the proband was consistently associated with a significant risk for ADHD in relatives. Drug dependence in probands increased the risk for drug dependence in relatives irrespective of ADHD status, whereas alcohol dependence in relatives was predicted only by ADHD probands with comorbid alcohol dependence. in addition, ADHD in the proband predicted drug dependence in relatives, and drug dependence in comparison probands increased the risk for ADHD in relatives. Both alcohol dependence and drug dependence bred true in families without evidence for a common risk between these disorders. Conclusions: Patterns of familial risk analysis suggest that the association between ADHD and drug dependence is most consistent with the hypothesis of variable expressivity of a common risk between these disorders, whereas the association between ADHD and alcohol dependence is most consistent with the hypothesis of independent transmission of these disorders. Findings also suggest specificity for the transmission of alcohol and drug dependence.

Biederman J; Spencer TJ; Wilens TE; Prince JB; Faraone SV. Treatment of ADHD with stimulant medications: Response to Nissen perspective in The New England Journal of Medicine. (editorial). Journal of the American Academy of Child and Adolescent Psychiatry 45(10): 1147-1150, 2006

This editorial is a response to an article in the New England Journal of Medicine (SE Nissen, ADHD drugs and cardiovascular risk, 354(14): 1445-1448, 2006) written by a consultant to the Food and Drug and Administration (FDA) Committee that recommended a "black-box" warning describing the cardiovascular risks associated with stimulant drugs used to treat attention deficit-hyperactivity disorder (ADHD).

Brooks DJ; Vosburg SK; Evans SM; Levin FR. Assessment of cognitive functioning of methadone-maintenance patients: Impact of adult ADHD and current cocaine dependence. Journal of Addictive Diseases 25(4): 15-25, 2006. (48 refs.)

The purpose of this study was to determine if methadone-maintained patients (MMP) with cocaine dependence (CD) and/or adult Attention Deficit Hyperactivity Disorder (ADHD) exhibited compounded cognitive dysfunction associated with their poly-substance use and/or co-morbid psychiatric diagnoses. The sample consisted of 79 MNIP (59% male, 51 % Caucasian), maintained on methadone doses ranging from 40-130 mg/day, who were placed into one of four diagnostic categories: (1) a control group (no ADHD, no CD) (n = 24), (2) CD alone (n = 18),(3) ADHD alone (n = 18), and (4) ADHD + CD (n = 19). The California Computerized Assessment Package (CalCAP((R))) was administered to assess cognitive functioning requiring focused and sustained attention in a standardized fashion. There were no group differences on Simple Reaction tasks. Compared to the control group, the ADHD + CD group was slower and less accurate on 33% of the Choice Reaction (CR) tasks. Specifically, individuals in the ADHD + CD group and the ADHD alone group performed significantly worse on tasks measuring attention and psychomotor responding. These tasks are associated with broader cognitive skills in working memory, language discrimination and flexibility of cognitive sets that may have implications for treatment outcome. Diagnostic services capable of identifying cognitive deficits among MMP with ADHD and/or CD are needed to maximize the likelihood of treatment success and to serve as ail indicator for the efficacy of therapeutic approaches.

Clarke AR; Barry RJ; McCarthy R; Selikowitz M; Johnstone SJ. Effects of stimulant medications on the EEG of girls with Attention-Deficit/Hyperactivity Disorder. Clinical Neurophysiology 118(12): 2700-2708, 2007. (56 refs.)

Objective: Stimulant medications are the most commonly used treatments for Attention-Deficit/Hyperactivity Disorder (AD/HD) in North America and Australia, although it is still not entirely known how these medications work. This study investigated the effects of stimulant medications on the EEG of girls with AD/HD. Methods: An initial EEG was recorded during an eyes-closed resting condition. Data from 19 electrode sites were Fourier transformed to provide absolute and relative power estimates for the delta, theta, alpha and beta bands. The data were then averaged into 9 regions and an analysis of both global and regional differences was performed. Subjects were placed on a six-month trial of a stimulant and a second EEG was recorded at the end of the trial. Results: The unmedicated girls had significantly greater total power, absolute delta and theta, more relative theta especially in the frontal regions, and reduced frontal relative delta and beta activity compared with controls. Medication resulted in normalisation of theta power, but after medication, increased relative beta was also apparent in the AD/HD group. Conclusions: These results indicate that stimulant medications result in a normalisation of slow wave activity in the EEG. In line with published research on the effects of arousal on the EEG, these results suggest that stimulant medications may have their therapeutic effect by improving the EEG substrate of processing deficits in these children. However, this requires further testing during active processing tasks. Significance: This is the first study to investigate the effect of stimulant medications on the EEG of girls with AD/HD.

Faraone SV; Biederman J; Wilens TE; Adamson J. A naturalistic study of the effects of pharmacotherapy on substance use disorders among ADHD adults. Psychological Medicine 37(12): 1743-1752, 2007. (33 refs.)

Background. Studies of adults with attention deficit hyperactivity disorder (ADHD) show an elevated prevalence of substance use disorders (SUDs) and the substance abuse literature shows that ADHD is elevated in substance users. Some researchers postulate that stimulant treatment of ADHD increases the risk for SUD in ADHD patients but follow-up studies suggest treatment protects patients from subsequent SUDS. This report uses retrospective data to assess the impact of prior ADHD pharmacotherapy on SUDS in 206 ADHD adults (n = 79 late-onset ADHD, n = 127 full ADHD) grouped by lifetime history of ADHD treatment (no treatment, past treatment, current and past treatment). Method. Structured Clinical Interview for DSM-IV (SCID) data were used to establish abuse and dependence, and Drug Use Screening Inventory (DUSI) responses were used to establish prevalence of use, preference for cigarettes, alcohol and drugs of abuse, complications from use, and motivation for use (get high, change mood, sleep better). Results. No differences were found in the prevalence of cigarette smoking, alcohol or drug abuse or dependence, as well as no significant differences in 1-month prevalence of any use or use more than 20 times. No differences were found in complications of drug or alcohol use across groups. Subjects with current treatment rated getting high as a motivating factor significantly more frequently than subjects in the past treatment group; this result lost significance when we included ADHD diagnostic category. Conclusions. Our results are consistent across substances and ADHD diagnoses, and support the hypothesis that pharmacotherapy does not cause subsequent SUDS.

Faraone SV; Wilens TE; Petty C; Antshel K; Spencer T; Biederman J. Substance use among ADHD adults: Implications of late onset and subthreshold diagnoses. American Journal on Addictions 16(Supplement 1): 24-34, 2007. (42 refs.)

Diagnosing ADHD in adults is difficult when the diagnostician cannot establish an onset prior to the DSM-IV criterion of age seven or if the number of symptoms does not achieve the DSM threshold for diagnosis. These diagnostic issues are an even larger concern for clinicians faced with adults with substance use disorders (SUD). The present study compared four groups of adults: full ADHD subjects who met all DSM-IV criteria for childhood onset ADHD, late onset ADHD subjects who met all criteria except the age at onset criterion, subthreshold ADHD subjects who did not meet full symptom criteria, and non-ADHD subjects who did not meet any of the above criteria. Diagnoses were by the Structured Clinical Interview for DSM-IV, and the Drug Use Severity Index (DUSI) was used for self-report of substance use. Cigarette and marijuana use was significantly greater in all ADHD groups relative to non-ADHD controls. Although usage rates of other drugs failed to reach significance, the ADHD groups were more likely to have used each drug (except alcohol) compared with the non-ADHD group. The late onset and full ADHD groups were more likely to have endorsed ever having a problem due to use of cigarettes, alcohol, or marijuana and reported more trouble resisting use of drugs or alcohol. The full ADHD group was more likely than the other groups to have reported "getting high" as their reason for using their preferred drug. Adults with ADHD have elevated rates of substance use and related impairment. Data about late onset ADHD provides further support for the idea that the DSM-IV age at onset criterion is too stringent. In contrast, subthreshold ADHD seems to be a milder form of the disorder, or perhaps a heterogeneous group of true ADHD cases and false positives.

Fuemmeler BF; Kollins SH; McClernon FJ. Attention deficit hyperactivity disorder symptoms predict nicotine dependence and progression to regular smoking from adolescence to young adulthood. Journal of Pediatric Psychology 32(10): 1203-1213, 2007. (36 refs.)

Objective To examine the association between retrospectively reported attention deficit hyperactivity disorder (ADHD) symptoms and progression to smoking and the association with nicotine dependence. Methods Study sample consisted of a nationally representative cohort of U. S. adolescents (n = 13,494). Logistic regression was used to examine ADHD symptoms from both the inattentive (IN) and hyperactive-impulsive (HI) domains and smoking trajectories. Linear regression was used to examine nicotine dependence. Results HI symptoms were associated with progression from nonsmoking to regular smoking (OR = 1.14, 95% CI = 1.07-1.21), and with progression from experimentation to regular smoking (OR = 1.16, 95% CI = 1.08-1.26). In and HI symptoms were associated with nicotine dependence among current smokers (IN: beta = 0.17, SE = 0.03, p< 0.0001; HI: beta = 0.10, SE = 0.04., p<. 001). Conclusions These results have important implications for the development of prevention and treatment modalities.

Hazell P. Does the treatment of mental disorders in childhood lead to a healthier adulthood? (editorial). Current Opinion in Psychiatry 20(4): 315-318, 2007. (28 refs.)

Purpose of review To review mechanisms by which intervention for childhood mental disorders may exert an influence on mental health and wellbeing in adulthood, the challenges to demonstrating long-term benefit of harm from such intervention,existing evidence of long-term benefit, and strategies for improving the long-term benefit of treatment. Recent findings Intervention may improve long-term outcome through the promotion of protective interpersonal relationships, by enhancing scholastic and later occupational functioning, by arresting the progression of disorder, and by improving general health. Challenges to demonstrating benefits of harms in the long term include variability in the natural course of childhood mental disorders, heterotypic outcomes, and the influence of other variables over time on long-term functioning. Examples of demonstrated benefit include the lowering of risk for substance abuse seen with psychostimulant treatment for attention-devicit/hyperactivity disorder, improved outcomes for autism since the introduction of early interventions to address language impairment, and reduced mortality in anorexia nervosa. Summary There are feasible enduring benefits of treatment for childhood mental disorders. Treatment of complex problems may have a greater long-term impact than in conditions that follow a benign natural course. Success requires more assertive approaches to treatment than are traditionally employed by child and adolescent mental health services.

Herpertz-Dahlmann B. Long-term effects of methylphenidate on neural networks associated with executive attention in children with ADHD: Results from a longitudinal functional MRI study. Journal of the American Academy of Child and Adolescent Psychiatry 46(12): 1633-1641, 2007. (46 refs.)

Objective: Little is known about the long-term effects of stimulants on the functional organization of the developing brain. Nonacute effects of stimulants on neural activity related to three aspects of attention (alerting, reorienting, and executive control) were examined in children with attention-deficit/hyperactivity disorder (ADHD) using a longitudinal functional magnetic resonance imaging approach. Method: Nine boys with ADHD were scanned while drug naive (t1) and after 1 year of methylphenidate treatment (t2). Eleven matched controls were also investigated twice. ADHD children stopped medication 1 week before t2. Results: Although all of the children showed stable alerting and reorienting performance from t1 to t2, normal controls significantly improved their executive control performance at t2, whereas children with ADHD did not. Neurally, controls showed a larger increase in neural activity from t1 to t2 in regions critical to task performance (i.e., in the temporoparietal junction during reorienting of attention and in the anterior cingulate cortex during executive control) compared to the patient group. However, only children with ADHD showed a decrease in neural activity in the insula and putamen during reorienting, indicating a reduction in compensatory brain activation over time. Conclusions: These data suggest that 1 year of MPH treatment may be beneficial, albeit insufficient, to show enduring normalization of neural correlates of attention.

Kaloyanides KB; McCabe SE; Cranford JA; Teter CJ. Prevalence of illicit use and abuse of prescription stimulants, alcohol, and other drugs among college students: Relationship with age at initiation of prescription stimulants. Pharmacotherapy 27(5): 666-674, 2007. (20 refs.)

Study Objective. To examine associations between age at initiation of prescription stimulants and illicit use and abuse of prescription stimulants, alcohol, and other drugs among college students in the United States. Design. Web-based survey of college students. Setting. A large (full-time undergraduate population > 20,000) university. Intervention. A Web-based survey was sent to a random sample of 5389 undergraduate college students plus an additional 1530 undergraduate college students of various ethnic backgrounds over a 2-month period. Measurements and Main Results. Alcohol abuse was assessed by including a modified version of the Cut Down, Annoyance, Guilt, Eye-opener (CAGE) instrument. Drug use-related problems were assessed with a slightly modified version of the Drug Abuse Screening Test, short form (DAST-10). The final sample consisted of 4580 undergraduate students (66% response rate). For the analyses, five subgroups were created based on age at initiation of prescription stimulant use: no prescription stimulant use, grades kindergarten (K)-4, grades 5-8, grades 9-12, and college. Undergraduate students to whom stimulants were prescribed in grades K-4 reported similar rates of alcohol and other drug use compared with that of the group that had no prescription stimulant use. For example, students who started prescription stimulants in grades K-4 were no more likely to report coingestion of alcohol and illicit prescription stimulants (odds ratio [OR] 1.4, 95% confidence interval [CI] 0.2-11.5, NS] than the group that had no prescription stimulant use. However, undergraduate students whose prescription stimulant use began in college had significantly higher rates of alcohol and other drug use. For example, students who started a prescription stimulant in college were almost 4 times as likely (OR 3.7, 95% CI 1.9-7.1, p < 0.001) to report at least three positive indicators of drug abuse on the DAST-10 compared with the group that had no prescription stimulant use. Conclusions. In concordance with results of previous research, these results indicate that initiation of prescription stimulants during childhood is not associated with increased future use of alcohol and other drugs.

Kim J-W; Park CS; Hwang J-W; Shin M-S; Hong K-E; Cho S-C et al. Clinical and genetic characteristics of Korean male alcoholics with and without attention deficit hyperactivity disorder. Alcohol and Alcoholism 41(4): 407-411, 2006. (49 refs.)

Aims: To examine the clinical and genetic characteristics of Korean male alcoholics with and without attention deficit hyperactivity disorder (ADHD). Methods: The present study included 85 male alcoholics who were diagnosed as having DSM-IV alcohol dependence. A total of 28 (32.9%) alcoholics were diagnosed as having DSM-IV ADHD with ongoing symptoms in adulthood. For the evaluation of their psychiatric conditions, the alcohol dependence scale (ADS), Beck depression inventory (BDI), Beck anxiety inventory (BAI), Barratt impulsiveness scale (BIS), brief anger-aggression questionnaire (BAQ), overt aggression scale (OAS), codependence test, and obsessive compulsive drinking scale (OCDS) were administered. The genotype frequencies of the dopamine type 2 receptor gene (DRD2), aldehyde dehydrogenase type 2 gene (ALDH2), functional polymorphism in the regulatory region of the serotonin transporter gene (5-HTTLPR), and catechol-O-methyltransferase gene (COMT) polymorphisms were examined. Results: Compared with alcoholics without ADHD, the mean ages for the onset of pathological drinking and alcohol withdrawal hallucinations were significantly earlier in alcoholics with ADHD. There was also a significant difference in the history of antisocial behaviour between the two groups. Compared with alcoholics without ADHD, the mean scores of the ADS, BDI, BAI, OAS, and OCDS were significantly higher in alcoholics with ADHD. With regard to the codependence test results, the mean scores of the interpersonal problem, low self-esteem and anxiety/fear subscales, and the mean total score of the codependence test were significantly higher in alcoholics with ADHD when compared with those without ADHD. There were no significant differences in the genotype frequencies of the DRD2, ALDH2, 5-HTTLPR, and COMT polymorphisms between alcoholics with and without ADHD. Conclusions: The results of this study suggest that the comorbidity of alcohol dependence and ADHD in this Korean sample forms a distinct clinical phenotype that shows an increased severity of alcohol-related symptoms and behavioural/emotional problems and that ADHD is associated with an increased risk for the early onset of alcohol dependence in Korean male alcoholics.

Knight M. Stimulant-drug therapy for attention-deficit disorder (with or without hyperactivity) and sudden cardiac death. (editorial). Pediatrics 119(1): 154-155, 2007. (6 refs.)

Kollins SH. Abuse liability of medications used to treat attention-deficit/hyperactivity disorder (ADHD). American Journal on Addictions 16(Supplement 1): 35-44, 2007. (58 refs.)

The use of psychostimulants to treat attention-deficit/hyperactivity disorder (ADHD) has been controversial for a number of reasons. In an effort to clarify the extent to which the psychostimulant methylphenidate has abuse potential, the existing published evidence has been reviewed and is summarized here, with an emphasis on delineating a number of related but independent issues that are often confused. The existing evidence reviewed is pertinent to three questions: Does stimulant drug use increase the risk for substance abuse later in life? Do ADHD medications have the potential for abuse? and What is the distinction between drug abuse and misuse/diversion with respect to ADHD medication?

Kollins S. Subjective effects of methylphenidate. IN: Earleywine M, ed. Mind-Altering Drugs: The Science of Subjective Experience. New York: Oxford University Press, 2005. pp. 275-304. (121 refs.)

Methylphenidate (Ritalin) is among the most widely prescribed psychoactive agents. This chapter review sthe the reseach and theory on the subjective effects. It begins with a review of the history of the use of methylphenidate, and recent trends of use. It then examines the type of information about the subjective effects that can provide insights into abuse potential for abuse, and reviews human subject studies. It also examines the subjective effects of those with Attention Deficit/Hyperactivity Disorder. The chapter concludes with an overview of potential mechanisms that may account for the subjective effects and the basis for differences between those with ADHD and controls.

Levin FR; Adamson JJ; Antshel KM; Biederman J; Faraone SV; Kollins SH. ADHD and substance abuse update. (editorial). American Journal on Addictions 16(Supplement 1): 1-4, 2007. (0 refs.)

Levin FR; Bisaga A; Raby W; Aharonovich E; Rubin E; Mariani J et al. Effects of major depressive disorder and attention-deficit/hyperactivity disorder on the outcome of treatment for cocaine dependence. Journal of Substance Abuse Treatment 34(1): 80-89, 2008. (56 refs.)

Co-occurring psychiatric disorders have been associated with poor prognosis among substance-dependent patients, but few studies have examined this association among patients with cocaine dependence (CD). We compared baseline characteristics and treatment outcome between cocaine-dependent patients with major depressive disorder (MDD; n = 66), those with attention-deficit/hyperactivity disorder (ADHD; n = 53), and those with CD without comorbid disorders (CD alone; n = 48) who had been randomized to the placebo arms of clinical trials with venlafaxine, methylphenidate, and gabapentin, respectively. The three groups differed significantly in racial makeup, with more Caucasians and Hispanics among patients With MDD and those with ADHD but more African Americans among those with CD alone. The groups did not differ significantly in treatment retention, with retention rates ranging from 42% to 47%; neither did they differ in the rates of achieving 2 consecutive weeks of urinalysis-confirmed abstinence, with rates ranging from 40% to 50%. Using logistic regression for repeated measures with general estimating equations, modeling the likelihood of a cocaine-positive week over time in treatment, we found the diagnostic group to interact with the baseline level of cocaine use and time. Among cocaine-dependent patients who achieved abstinence at baseline, those with MDD and those with ADHD had better outcome over time as compared with patients with CD alone. However, among patients with cocaine-positive urine specimens at baseline, those with MDD and those with ADHD were associated with poor outcome as compared with patients with CD alone. The findings suggest that diagnosis and treatment of co-occurring disorders such as depression and ADHD may be important components of treatment planning for CD and that the baseline level of cocaine use should be included as a covariate in studies evaluating the impact of such treatment.

Levin FR; Evans SM; Brooks DJ; Garawi F. Treatment of cocaine dependent treatment seekers with adult ADHD: Double-blind comparison of methylphenidate and placebo. Drug and Alcohol Dependence 87(1): 20-29, 2007. (56 refs.)

The purpose of this double-blind 14-week trial was to compare the efficacy of sustained-release methylphenidate (MPH) to placebo (PBO) in treating adult attention deficit hyperactivity disorder (ADHD) symptoms in current cocaine dependent (CD) treatment seekers. The randomized sample consisted of 106 participants who were predominately male (83%) and 60% Caucasian, 14% Hispanic, 20% African-American and 6% other. All participants met DSM-IV criteria for ADHD and CD. There were no significant demographic differences between the two treatment groups. All participants received weekly individual cognitive behavioral therapy. There was no difference in retention rate based on treatment group (p = .91). The majority of the PBO group and the MPH group reported > 30% improvement in their ADHD symptoms (55% versus 47%), with no significant difference between the two groups (p = .44). Using a combined outcome measure (> 30% reduction in ADHD symptoms and CGI < 3), the response rates were similar for both groups (28% PBO versus 30% MPH; p = .83). Longitudinal analyses of the urine toxicology data using generalized estimating equations, revealed a decrease in the probability of cocaine positive urine samples during the trial for the MPH group compared to the PBO group (p = .001). Further analysis suggested that for the MPH group, ADHD treatment responders, based on a semi structured clinical interview, were more likely to have a reduction in cocaine use compared to the non-ADHD responders. Although sustained-release MPH did not show superiority over PBO in treating ADHD symptoms, this trial provides some evidence that improvement in ADHD symptoms (clinician rated) among those patients receiving MPH, but not placebo, was associated with a reduction in cocaine use.

Luty J; Sarkhel A; O'Gara C; Umoh O. Prevalence of childhood attention deficit hyperactivity disorder in opiate-dependent adults. International Journal of Psychiatry in Clinical Practice 11(2): 157-162, 2007. (43 refs.)

Background. There is a clear association between childhood attention deficit hyperactivity disorder and substance use disorders in adulthood. Symptoms of attention deficit disorder may also persist into adulthood. The study aimed to determine the prevalence of childhood ADHD in a sample of treatment seeking opiate-dependent adults. Methods. Treatment-seeking opiate-dependent subjects completed the Utah adult ADHD screening test and the self-report early delinquency scale. Results. A total of 15% were "likely'' and 49 were "highly likely'' to have suffered ADHD in childhood. The averages scores for the delinquency scales were over 6 times those reported from population norms. Conclusion. Symptoms of childhood ADHD is common in adults with opiate dependence. The residual symptoms in adults should be investigated as may be amenable to newer treatments for adult attention deficit disorder.

Mariani JJ; Levin FR. Treatment strategies for co-occurring ADHD and substance use disorders. (review). American Journal on Addictions 16(Supplement 1): 45-56, 2007. (106 refs.)

Attention-deficit hyperactivity disorder (ADHD) is a common co-occurring mental disorder among patients with substance use disorders (SUD). Clinicians must be cognizant of the complicated nature of diagnosis and treatment of ADHD when comorbid with SUD. Pharmacotherapy remains the mainstay of treatment for ADHD, although complementary psychotherapeutic approaches have been developed. Psychostimulant medications are the most commonly used medications to treat ADHD, but many clinicians are reluctant to prescribe stimulants to patients with SUD. Recommendations for treatment planning and clinical management for patients with co-occurring ADHD and SUD are discussed.

Marshal MP; Molina BSG; Pelham WE; Cheong J. Attention-deficit hyperactivity disorder moderates the life stress pathway to alcohol problems in children of alcoholics. Alcoholism: Clinical and Experimental Research 31(4): 564-574, 2007. (69 refs.)

Background: Parent alcoholism is a well-established risk factor for the development of pathological alcohol involvement in youth, and life stress is considered to be one of the central mechanisms of the parent alcoholism effect; however, little is known about the moderators of the life stress pathway. Attention-deficit hyperactivity disorder (ADHD) has also been shown to predict pathological alcohol involvement, however, little is known about whether or not ADHD interacts with parent alcoholism to increase offspring risk. The goals of this study were to examine stressful life events as mediators of the relationship between parent alcoholism and adolescent pathological alcohol involvement, and to examine whether or not this mediated pathway was stronger for adolescents with ADHD than for adolescents without ADHD. Method: Participants were 142 adolescents with a childhood ADHD diagnosis (probands) and 100 demographically matched control adolescents without childhood ADHD. Probands, controls, and at least 1 parent were interviewed about drinking behavior; probands and controls were interviewed about negative life events. Results: A moderated mediation paradigm was used to test the hypotheses using ordinary least squares regression. Results showed that the relationships between parent alcoholism and 2 of the stress variables ("family" stress and "peer" stress) were significant for probands only, and that stress in the probands mediated the parent alcoholism effect on offspring alcohol involvement. Conclusions: These results provide preliminary support for the hypothesis that offspring characteristics might moderate the life stress pathway to alcoholism, and indicate that ADHD may serve to facilitate the transmission of pathological alcohol use from parent to child.

Mayes R; Rafalovich A. Suffer the restless children: The evolution of ADHD and paediatric stimulant use, 1900-80. History of Psychiatry 18(4): 435-457, 2007. (78 refs.)

This article traces the historical evolution of Attention Deficit/Hyperactivity Disorder (ADHD) and the controversial use of stimulants as a treatment for children diagnosed with the disorder in North America. While the children in question have exhibited similar behaviour over the last century, the diagnostic labels used to identify them have changed due largely to cultural, medical and scientific changes and discoveries. For decades, children's treatment with psychotropic drugs was sufficiently controversial that pharmaceutical companies would not finance research in the area. The only substantial source of research funding for paediatric psychopharmacology in the USA from the 1950s to the 1970s was the National Institute of Mental Health (NIMH). In 1970, the first in a long-running series of controversies erupted over children's treatment with stimulants.

McClernon FJ; Fuemmeler BF; Kollins SH; Kail ME; Ashley-Koch AE. Interactions between genotype and retrospective ADHD symptoms predict lifetime smoking risk in a sample of young adults. Nicotine & Tobacco Research 10(1): 117-127, 2008. (83 refs.)

Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with an increased risk of smoking, and genetic studies have identified similar candidate genes associated with both ADHD and smoking phenotypes. This paper addresses the question of whether ADHD symptoms interact with candidate gene variation to predict smoking risk. Participants were a subsample of individuals from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of adolescents followed from 1995 to 2002. The sample analyzed included a subset from Add Health of 1,900 unrelated individuals with genotype data. Multiple logistic regression was used to examine relationships between self-reported ADHD symptoms, genotype, and lifetime history of regular smoking. Polymorphisms in the DRD2 gene and, among females, the MAOA gene interacted with retrospective reports of ADHD symptoms in contributing to risk for smoking. Trends were observed for interactions between the DRD4 gene and, among males, the MAOA gene and ADHD symptoms to predict smoking risk. No main effect for any of these polymorphisms was observed. We observed neither main effects nor interactions with CYP2A6, DAT, and SLC6A4 genes. These findings suggest that genotypes associated with catecholamine neurotransmission interact with ADHD symptoms to contribute to smoking risk.

Monuteaux MC; Wilens TE; Biederman J. Does social class predict substance problems in young adults with ADHD? American Journal on Addictions 16(5): 403-409, 2007. (44 refs.)

The relationship between social class and substance use problems is unclear. We aimed to clarify this association in a sample of young adult males with and without attention deficit/hyperactivity disorder ( ADHD). We included 69 ADHD and 78 control subjects. Substance use problems were measured with the Drug Use Screening Inventory -Revised ( DUSI). Among ADHD subjects, we found a U-shaped association, with elevated risk for substance-related problems at both ends of the SES spectrum. No significant association was found in controls. These findings indicate that substance use risk in ADHD subjects is especially vulnerable to social class.

Neuman RJ; Lobos E; Reich W; Henderson CA; Sun LW; Todd RD. Prenatal smoking exposure and dopaminergic genotypes interact to cause a severe ADHD subtype. Biological Psychiatry 61(12): 1320-1328, 2007. (63 refs.)

Background: In utero exposure to smoking and alcohol are common risk factors that have been associated with attention-deficit/hyperactivity disorder (ADHD) in human beings and animal models. Furthermore, molecular studies have focused on the association between ADHD and DNA polymorphisms in dopamine pathway-related genes. We examined the joint effects of genetic and prenatal substance exposures on DSM-IV and population-defined subtypes of ADHD. Methods: Logistic regression was used to assess the relationship between ADHD subtypes, DAT1 and DRD4 polymorphisms, and prenatal substance exposures in a birth-record sample of male and female twin pairs, aged 7-19 years. Results: Interactions between prenatal exposure to smoking and variations in the DAT1 and DRD4 loci were observed in children with either the DSM-IV or population-defined ADHD combined subtypes. The odds of a diagnosis of DSM-IV combined subtype was 2.9 times greater in twins who had inherited the DAT1 440 allele and who were exposed, than in unexposed twins without the risk allele. The OR was 2.6 in the population-defined subtype. Odds ratios for the DRD4 seven-repeat allele were 3.0 (2.8) in the population-defined (DSM-IV) combined ADHD subtypes. The OR for exposed children with both alleles was 9.0 (95% confidence interval = 2.0-41.5) for the population-defined combined subtypes. Conclusions: Results indicate that smoking during pregnancy is associated with specific subtypes of ADHD in genetically susceptible children.

Ohlmeier MD; Peters K; Kordon A; Seifert J; Wildt BT; Wiese B et al. Nicotine and alcohol dependence in patients with comorbid attention-deficit/hyperactivity disorder (ADHD). Alcohol and Alcoholism 42(6): 539-543, 2007. (38 refs.)

Aims: Several studies have shown that attention-deficit/hyperactivity disorder (ADHD) represents a significant risk factor for the onset and development of an addiction. Thirty-five per cent of adult ADHD patients are known to be addicted to alcohol. Many ADHD patients also have an increased nicotine consumption, which typically, leads to an improvement of attention, ability to concentrate and control of impulses. There may be pathophysiological connections here. On the other hand, it can also be assumed that there is a high prevalence of addicted patients with undiagnosed ADHD. Methods: Ninety-one adult alcohol-dependent patients were examined for ADHD in this study, using the Wender Utah Rating Scale (WURS-k), Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom check-list for ADHD and the Conners Adult ADHD Rating Scales (CAARS, Long Version). The patients were divided into diagnostic sub-groups according to DSM-IV (inattentive type, impulsive type, combined type). Nicotine consumption was investigated using the Fagerstrm Test of Nicotine Dependence (FTND) and then graded as minimal, average or high nicotine dependence. Results: There were 20.9% (WURS-k) or 23.1% (DSM-IV diagnostic criteria) of the patients addicted to alcohol, who showed evidence of ADHD in childhood. With the help of CAARS, it could be demonstrated that 33.3% of the patients who fulfilled the diagnostic criteria of ADHD, according to DSM-IV, had persisting ADHD in adulthood. The FTND showed a statistically significant difference in nicotine dependence between alcohol-dependent patients with and without ADHD in childhood. Patients numbering 76.2% with ADHD, demonstrated an average to high level of nicotine dependence compared to 45.7% of those patients without ADHD. Furthermore, the number of patients not addicted to nicotine (19%) was significantly lower than among those without ADHD (36.6%) (P = 0.029). Conclusions: The results of this investigation reveal that a large number of ADHD patients suffer from alcohol dependence, and an even greater number from excessive nicotine dependence. The outcome indicates that there are most likely pathophysiological connections with alcohol and nicotine dependence, and that this substance abuse is probably a form of self-medication. The results clearly underline the great importance of early and adequate diagnosis and therapy of ADHD, in order to prevent exacerbation of addictive illness.

Poulin C. From attention-deficit/hyperactivity disorder to medical stimulant use to the diversion of prescribed stimulants to non-medical stimulant use: Connecting the dots. Addiction 102(5): 740-751, 2007. (40 refs.)

Aims To describe the connections among the likelihood of attention deficit/hyperactivity disorder (ADHD), medical and non-medical methylphenidate and amphetamine use and the diversion of prescribed methylphenidate in the general adolescent population. Design Cross-sectional self-reported anonymous data from the 2002 Student Drug Use Survey in the Atlantic Provinces. Setting: The Atlantic provinces of Canada. Participants: A total of 12,990 students participated. Measurements The outcomes were a positive ADHD screening test, medical and non-medical use of methylphenidate, medical and non-medical use of amphetamine and the giving and selling of methylphenidate medication by students with a prescription. The Ontario Child Health Study Hyperactivity Scale was used to screen for ADHD. Findings The prevalence of a positive ADHD screening test was 6% with no significant gender difference. The prevalence of medical and non-medical methylphenidate use and medical and non-medical amphetamine use was 2.0%, 6.6%, 1.2% and 8.7%, respectively. A positive ADHD screening test was independently predictive of these four patterns of use. About 26% of students with prescribed methylphenidate gave or sold some of their medication. Students in a class where at least one student had given or sold some of their prescribed pills had a 1.52-fold increased risk of non-medical methylphenidate use than their counterparts in classes where no giving or selling had taken place. Conclusions: Connections were demonstrated at the population level between ADHD, medical methylphenidate use, the diversion of prescribed methylphenidate and the non-medical use of methylphenidate. The appropriate assessment and management of ADHD are essential to minimize both the risk of diversion and of substance use associated with unrecognized or untreated ADHD.

Szobot CM; Rohde LA; Bukstein O; Molina BSG; Martins C; Ruaro P et al. Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community-based case-control study. Addiction 102(7): 1122-1130, 2007. (58 refs.)

Aims: This study aims at evaluating the association between attention-deficit/hyperactivity disorder (ADHD) and illicit substance use disorders (SUD) (marijuana, cocaine and inhalants), controlling for the association with conduct disorder (CD), in a community-based sample of adolescents. Design Case-control, community-based study. Setting A delimited geographical area in the South of Brazil, served by four public health clinics. Participants: A total of 968 male adolescents (15-20 years of age) were screened for SUD in their households. Of the subjects who were screened positive, we selected 61 cases with illicit SUD. For each case we selected, from the group which was screened negative, three controls without illicit or alcohol SUD, matched by age and proximity with the case's household. Measurements: The screening instrument was the Alcohol Smoking and Substance Screening Test (ASSIST). SUD diagnoses were assessed by the drug section of the Mini International Neuropsychiatry Interview (MINI). Other psychiatric diagnoses were based on semistructured (Schedule for Affective Disorders and Schizophrenia for School-Age Children-epidemiological version; MINI) and clinical interviews. Findings Adolescents with ADHD presented a significantly higher odds ratio (OR) for illicit SUD than youths without ADHD, even after adjusting for potential confounders (CD, ethnicity, religion and estimated IQ) (OR = 9.12; 95% CI = 2.84 -29.31, P < 0.01). Conclusions: Our results suggest an association between ADHD and illicit SUD in Brazilian adolescents that is not mediated by CD. These findings are potentially important from a prevention perspective because treatments are available for ADHD.

West SL; Mulsow M; Arredondo R. An examination of the psychometric properties of the attention deficit scales for adults with outpatient substance abusers. American Journal of Drug and Alcohol Abuse 33(5): 755-764, 2007. (26 refs.)

A growing body of research has established a high co-morbidity in the rates of attention deficit/hyperactivity disorder (ADHD) and substance abuse. The co-occurrence of these two conditions and the negative impact of untreated ADHD on the course and treatment of substance abuse highlights the need for ADHD assessment in individuals seeking substance abuse treatment. In this article, we investigated the clinical utility of the Attention Deficit Scales for Adults (ADSA) in a sample of substance abusers in an outpatient treatment program by assessing its sensitivity, specificity, positive and negative predictive values, and likelihood ratios at two potential cut-off levels ( 161 and 181) using a DSM-IV based ADHD diagnosis as the criterion. The ADSA had strong reliability (Cronbach's alpha.93; Guttman split-half.92) and correlated well with DSM-IV diagnostic criteria. Sensitivity and specificity of the device were relatively strong at both cut-off levels, as were the positive and negative predictive values.

Wilens TE Adamson J Sgambati S Whitley J Santry A Monuteaux MC et al. Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD. American Journal on Addictions 16(Supplement 1): 14-23, 2007. (63 refs.)

Studies report increased rates of cigarette and substance use in youths with Attention-Deficit/Hyperactivity Disorder (ADHD), though the mechanism of risk remains unclear. The present study tests the hypothesis that ADHD individuals "self-medicate" with cigarettes and substances of abuse. As part of five- and ten-year case-control longitudinal family studies of ADHD, responses to the Drug Use Screening Inventory (DUSI) were examined for evidence of self-medication. DUSI data from 90 ADHD probands and 96 control probands were obtained. Thirty-six percent of subjects reported self-medication, 25% used to get high, and 39% had unknown motivation. No significant differences were found between ADHD and controls in motivation. ADHD symptoms did not differ between self-medicators and subjects using to get high. DUSI problem scores were higher in ADHD (versus controls), those using to get high (versus self-medicators), and subjects using alcohol (versus other substances). More than one-third of adolescents and young adults endorsed using cigarettes and substances for self medication. Studies clarifying the role of self-medication in substance use disorders are necessary.

Wilens TE; Adler LA; Adams J; Sgambati S; Rotrosen J; Sawtelle R et al. Misuse and diversion of stimulants prescribed for ADHD: A systematic review of the literature. (review). Journal of the American Academy of Child and Adolescent Psychiatry 47(1): 21-31, 2008. (56 refs.)

Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-cleficit/hyperactivity disorder (ADHD) and non-ADHD individuals. Method: We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search. Results: We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, "get high," or to experiment. Conclusions: The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants.

Wilson JJ. ADHD and substance use disorders: Developmental aspects and the impact of stimulant treatment. American Journal on Addictionssss 16(Supplement 1): 5-13, 2007. (74 refs.)

Adolescents and adults with substance use disorders often demonstrate symptoms of inattention, impulsivity, and hyperactivity. These core symptoms of ADHD may contribute to the development of substance use disorders by promoting antisocial behavior and substance use; conversely, substance use itself can adversely affect these symptoms. Common deficits in self-regulatory processes could underlie the developmental progression of these disorders, deficits further worsened by ongoing substance use. Some investigators have questioned whether stimulant treatment itself could promote substance abuse, while others have argued that such treatment reduces substance abuse. With an increased awareness of the phenomenon of adult ADHD and its relevance to substance-abusing persons, there is an increased awareness of the potential benefit of ADHD treatment on substance abuse treatment outcome. Consideration of an individual's developmental relationship between attention deficit/hyperactivity symptoms and substance use can inform treatment planning among patients seeking substance abuse treatment.

Winterstein AG; Gerhard T; Shuster J; Johnson M; Zito JM; Saidi A. Cardiac safety of central nervous system stimulants in children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics 120(6): E1494-E1501, 2007. (33 refs.)

OBJECTIVES. Case reports have raised concerns about the risk of cardiac events associated with central nervous system stimulants for the treatment of attention-deficit/hyperactivity disorder. PATIENTS AND METHODS. This was a retrospective cohort study that used 10 years ( July 1994 to June 2004) of Florida Medicaid claims data cross-linked to Vital Statistics Death Registry data. The cohort was composed of all youth 3 to 20 years old who were newly diagnosed with attention-deficit/hyperactivity disorder. Each month of follow-up was classified according to stimulant claims ( methylphenidate, amphetamines, and pemoline) as current use ( active stimulant claim), former use ( time after periods of current use), or nonuse ( time preceding the first stimulant claim, including follow-up of youth who were never exposed to stimulants). The study's end points were ( 1) cardiac death, ( 2) first hospital admission for cardiac causes or ( 3) first emergency department visit for cardiac causes. Risks were compared with time-dependent Cox regression analysis adjusting for various cardiac risk factors. RESULTS. During 124 932 person-years of observation ( n = 55 383), 73 youth died, 5 because of cardiac causes. No cardiac death occurred during 42 612 person-years of stimulant use. Hospital admissions for cardiac cause occurred for 27 children ( 8 during stimulant use, 11 during 35 671 person-years of former use, and 8 during 46 649 person-years of nonuse); and 1091 children visited the emergency department for cardiac causes ( 8.7 per 1000 person-years). Current stimulant use was associated with a 20% increase in the hazard for emergency department visits when compared with nonuse. No increased risk was found for periods of former use when compared with nonuse. CONCLUSIONS. Incidence rates of cardiac events requiring hospitalization were small and similar to national background rates. Stimulants were associated with an increase in cardiac emergency department visits. More evidence is needed that addresses the long-term risk/benefit of the various treatment options and the effect of other cardiac risk factors and comedications.