Review: childhood ADHD increases the risk of nicotine use in adolescence and alcohol use in young adulthood

Abstract

QUESTION Question: Does childhood attention-defi cit/hyperactivity disorder (ADHD) increase the risk of substance use disorders (SUDs) in adolescence and young adulthood? Outcomes: Persistent substance use, abuse or dependence meeting DSM-IV TR (Diagnostic and Statistical Manual, Fourth Edition, Text Revision) criteria for SUDs. Single substance categories included alcohol, cannabis, cigarettes, tobacco or nicotine; other outcomes included any psychoactive SUD (excluding nicotine) or drug use disorder (DUD; excluding alcohol and nicotine). METHODS Design: Systematic review with meta-analysis. Data sources: MEDLINE, CINHAL, PsycINFO and EMBASE were searched from the database inception to October 2009. Additional articles were identifi ed by hand search of reference lists. Study selection and analysis: Inclusion criteria were English language prospective cohort studies comparing substance use in primary school children (≤12 years) with and without ADHD (DSM-III, DSM-III-R, DSM-IV criteria or DSM-II hyperkinetic disorder) and following participants to a mean age of 18 years or older. Inclusion criteria for nicotine use were extended to include adolescents aged 14–16 years because of the few eligible studies. A single reviewer selected studies and assessed internal validity with a second reviewer appraising a random sample. Studies of historical cohorts or those retrospectively applying diagnoses were excluded. Included studies measured outcomes using reliable measurements. Random effects meta-analyses were performed using all studies which provided suffi cient data to calculate ORs and 95% CIs or unadjusted ORs and CIs where direct calculation was not possible. Heterogeneity was quantifi ed using I 2 and the Cochran Q test.