ADHD, Conduct Disorder, Drugs, & Alcohol

ADHD, Conduct Disorder, Drugs, & Alcohol
New study sheds light on this alarming link

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It’s not difficult to find ADHD teens who participate in risky behavior that includes excessive alcohol, drug, and tobacco use. Throw in conduct disorder and lives can spin even further out of control.

Conduct disorder is an emotional/behavioral disorder that ( involves specific repetitive behaviors. “These behaviors fall into four main groupings: aggressive conduct that causes or threatens physical harm to other people or animals, nonaggressive conduct that causes property loss or damage, deceitfulness or theft, and serious violations of rules time and time again.”

A new study by The Cincinnati Children’s Hospital Medical Center and published in the journal Drug and Alcohol Dependence links ADHD with conduct disorder, drugs, and alcohol.

They study examined data on more than 2,500 teens between the ages of 12 and 15. The scientists found that a teen with both ADHD and conduct disorder was 3 to 5 times more likely to use drugs and alcohol, and begin use at an earlier age than a teen without either disorder.

If the teen had ADHD alone, they had an increased likelihood of tobacco use, but not alcohol use.

“Early onset of substance abuse is a significant public health concern,” says William Brinkman, MD, a pediatrician at Cincinnati Children’s Hospital Medical Center and the study’s lead author. “Adolescents who use substances before the mid-teen years are more likely to develop dependence on them than those who start later. This is why prevention is so important.”

What Causes ADHD?

What Causes ADHD?
After much research, the answer is…

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We’ve all heard that ADHD is caused by chemical imbalance. That’s really just a theory. ADHD may be related to a neurotransmitter called dopamine. After much research, it’s still impossible to determine if ADHD is caused by a malfunctioning or slow dopamine system.

How about genetics? Likely, but there’s no absolute certainty about a genetic link either because in some cases, no genetic link has been found.

Other research has indicated that smoking, the use of acetaminophen, or drinking during pregnancy, might be linked to ADHD in children.

The National Institute of Mental Health says:

“Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.”

Some studies have indicated that children with ADHD have reduced brain mass or delayed maturation of certain areas of the brain. Recent research published in the Proceedings of the National Academy of Sciences indicate that delayed brain maturation may be related to the underdevelopment of brain connections related to attention in ADHD children.

Let’s get to the heart of the matter. There is no certain cause of ADHD. It is likely to be caused by a variety of factors.

What do we do as parents, educators, and other concerned people if we don’t know the cause? One of the greatest conundrums in life is thinking that knowing the cause affects the outcome. As far as ADHD is concerned, knowing the cause won’t likely affect your outcomes; knowing that you smoked, used acetaminophen, were exposed to lead, or used alcohol during pregnancy will not change the fact that your child has ADHD.

You’ve got a variety of weapons against it in your arsenal ranging from medicine, to cognitive training, parental training, dietary change, behavioral training for your child, to exercise, and more.

No matter the cause, we know the brain can change and be changed through proper training. There is hope.

ADHD and Increased Risk for Substance Abuse

Fact or fiction?
Published in the December Journal of the American Academy of Child Adolescent Psychiatry
Research published in the December Journal of the American Academy of Child Adolescent Psychiatry reports that children with ADHD may be at significant risk for later substance abuse. This reflects previous research.

More than 600 children were followed over eight years. Those children diagnosed with ADHD at baseline average of 8.5 years), had significantly higher rates of substance regardless of their sex 6 to 8 years later compared with their age-matched peers who did not have ADHD.

“Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence,” write the investigators.

“We Need to Do Better…However, similar to managing high blood pressure or obesity, there are non-medical things we can do to decrease the risk of a bad outcome,” said Dr. Molina, one of the study’s authors.

“As researchers and practitioners, we need to do a better job of helping parents and schools address these risk factors that are so common for children with ADHD.

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Resources: Dr. Molina, one of the study’s authors.

ADHD and dropout rates

The July issue of the Journal of Psychiatric Research reports a study by the University of California, Davis. The researchers examined whether ADHD could be predictive of failure to graduate high school on time.

When the UC Davis scientists reviewed different types of ADHD, they found all of the types of ADHD are associated with a high dropout rate.

"The study found almost a third (33%) of students with ADHD, don’t graduate with their peers. That’s high compared with the national high school drop out rate of 15 percent. High school dropout rate really is a national crisis. We know that a third of kids nationally who start in ninth grade don’t graduate in four years," says  lead study author Dr. Joshua Breslau.

The researchers conducted structured diagnostic interviews with a US national sample of adults (18 and over). The interview process also correlated smoking and smokeless tobacco use. According to the National Institute of Health, nearly a 25% of high school students in the U.S. smoke cigarettes and another 8% use smokeless tobacco. The study found that students who use alcohol, smoke cigarettes and use other drugs are more at risk to drop out.

"There are really two main disorders, ADHD and conduct disorder, and there is an interlinking of smoking and drop out that is troubling…it really suggests that socioeconomic differences in health are already becoming established very early in life in adolescents…whether they smoke is probably the biggest indicator of their health in adulthood," said Breslau.

Intuitively, as parents and educators, we know this to be true. We have seen it in other families too. Intuitively we also know that we must do something as education and medicine alone fall far short.

Cognitive training, behavioral shaping, memory skills, and more must be instituted if we are to change the tide.

ADHD and Alcohol Abuse

Two new studies confirm that ADHD children are more at-risk for alcohol and substance abuse as they grow older. Parental alcoholism and stressful family environments are additional risks. Results of the two studies were published in Alcoholism: Clinical & Experimental Research [April 2007].

Brooke Molina, associate professor of psychiatry and psychology at the University of Pittsburgh, and co-author for both studies says that, “Children with ADHD are believed to be at risk for alcoholism because of their impulsivity and distractibility, as well as other problems that often accompany ADHD such as school failure and behavior problems.”

To determine alcohol use, Molina interviewed 364 participants in the larger Pittsburgh ADHD Longitudinal Study and compared it with demographically age matched adolescents and adults as a comparison. “We found that the children with ADHD were more likely than the comparison group to drink heavily and to have enough problems related to their drinking that they were diagnosed with alcohol abuse or dependence,” said Molina. “This means that their drinking caused problems such as fights with their parents or friends, a drop in their grades at school, or difficulty with controlling the amount of alcohol that they drank.”

Drinking problems began around age 15, said Molina. “The 15-to-17-year olds with childhood ADHD reported being drunk an average of 14 times in the previous year, versus only 1.8 times for 15-to-17-year olds in the study who did not have childhood ADHD. Whereas 14 percent of the 15-to-17-year olds with childhood ADHD were diagnosed with alcohol abuse or dependence, none of the 15-to-17-year olds without childhood ADHD were.”

The study indicates that the ADHD-alcohol connection seems to begin in adolescence when children have greater access to alcohol and other substances.

“For example, 42 percent of those children with ADHD who also had serious, persistent behavior problems [later] had alcohol abuse or dependence by the age of 18 to 25,” said Molina.

Molina indicates that little is known about alcohol dependence beyond this age range for ADHD persons. “Most young adults drink less after they settle into jobs and family life,” she said. “We will be following the young adults in the Pittsburgh study to see if this happens or not.”

Molina’s research also indicated that parental alcoholism predicted heavy problem drinking among teenagers in her study. The ADHD/family link may cause increased family stress beginning in early childhood due to lack of parental coping skills and behavioral conflicts. The parent may begin drinking in response to the increased family stress. No genetic proclivity is identified by this study, however, this seems like an essential next step. The study reflects an issue that affects families whether they have and ADHD member or not: if a parent suffers from alcoholism, the child will have an increased risk as well. What is interesting about the research is the fact that stressors like ADHD may drive some parents to drink as a coping mechanism. This, in turn, may begin a similar cycle for the ADHD child.

Bottom line, Molina says, “We need to put these findings in perspective; it is important to recognize that not all children with ADHD will have problems with alcohol.”