New studies confirm what has been suspected: children with attention deficit hyperactivity disorder (ADHD) are at risk for alcohol- as well as other substance-related problems as they grow older. Additional risk factors are parental alcoholism and stressful family experiences.
The results of the two studies are published in the April issue of Alcoholism: Clinical & Experimental Research.
“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,” explained Brooke Molina, associate professor of psychiatry and psychology at the University of Pittsburgh, and corresponding author for both studies.
In the first study, on “Age specificity,” Molina and her colleagues interviewed participants in the larger Pittsburgh ADHD Longitudinal Study. Children diagnosed with ADHD (n=364) were interviewed either as adolescents (11 to 17 years of age) or as young adults (18 to 28 years of age). Demographically and age-matched individuals without ADHD were also recruited as adolescents (n=120) or as adults (n=120) to serve as a comparison. Alcohol use was determined through questionnaires and interviews.
“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.”
“It appears that one of the reasons for the past inconsistencies in research is that the ADHD-alcohol relationship does not become solid until at least mid-adolescence,” observed Stephen Hinshaw, professor and chair of the department of psychology at UC Berkeley. “Later on, it may be that only a subset of kids with ADHD – namely, those with more aggressive or antisocial behavior patterns – are at risk by young adulthood.”
Molina says her findings support this theory. “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.” Molina also says, however, that researchers know little about the risk for alcoholism for children with ADHD beyond this age range. “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.”
In the second study, on “Life stress,” Molina and her colleagues interviewed 142 adolescents (133 males, 9 females) who had been diagnosed with childhood ADHD, as well as 100 demographically matched adolescents without childhood ADHD. All participants were asked about their drinking behavior and negative life events; in addition, parents reported their drinking histories.
“One of the reasons that children with ADHD might be at risk for alcohol problems is that alcoholism and ADHD tend to run together in families,” said Molina. “We found that parental alcoholism predicted heavy problem drinking among the teenagers, that the association was partly explained by higher rates of stress in these families, and these connections were stronger when the adolescent had ADHD in childhood. So, the bottom line is that when the child has ADHD and the parent has suffered from alcoholism, either currently or in the past, the child will have an increased risk for alcohol problems himself or herself.”
“In other words,” added Hinshaw, “when a youngster has ADHD, he or she is more likely to either provoke higher rates of drinking in parents, exacerbating overall stress levels; or be more confused and upset by parental drinking, then reverting to this pattern himself or herself.”
However, noted Molina, “we need to put these findings in perspective; it is important to recognize that not all children with ADHD will have problems with alcohol.”