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ADHD at 6, Alcoholic at 16?
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Study Shows Kids with ADHD Risk Alcohol Abuse as Teens
Daniel J. DeNoon
Reviewed By Louise Chang, MD
The study looked at 364 children with ADHD -- attention deficit hyperactivity disorder -- enrolled in the Pittsburgh ADHD Longitudinal Study.
Psychologist Brooke S.G. Molina, PhD, and colleagues interviewed the kids and their parents at the beginning of the study and again, eight years later, during adolescence (ages 11 to 17) or young adulthood (ages 18-25). They also interviewed 120 adolescents and 120 young adults never diagnosed with ADHD.
"We found that children with ADHD are more likely to report heavy drinking in their teen years, and more problems from drinking, than non-ADHD teens," Molina tells WebMD. "In the United States, 5% of teens have this problem. We found that in their late teen years, 14% of children with ADHD had these drinking problems."
On average, teens without ADHD said they'd been drunk two times in the past year. Teens with ADHD said they'd been drunk 15 times in the past year.
Before age 15, kids with ADHD didn't abuse alcohol any more than did other kids.
When they reached young adulthood, the ADHD group did not, on average, drink more alcohol than did other young adults. But that may be because young adults, exploring their independence as well as their limits, tend to drink a lot. Molina notes that 18% of young Americans actually meet the criteria for alcohol use disorder.
Even so, some of the ADHD group -- those with persistent ADHD problems -- seemed to be drinking even more than other young adults did.
"A fair number of those adults eventually settle down. They get a family and job and bills to pay," Molina says. "Our question, as we continue this study, is whether those diagnosed with ADHD in childhood will have a harder time managing those transitions as adults."
Molina and colleagues -- including William E. Pelham, PhD, director of the Center for Children and Families at the University at Buffalo -- report their findings in the April issue of Alcoholism: Clinical and Experimental Research.
Does ADHD Treatment Cut Alcoholism Risk?
Adolescent medicine specialist Cheryl Kodjo, MD, treats ADHD teens at the University of Rochester Medical Center in New York, where she is assistant professor of pediatrics. Kodjo says kids with undiagnosed, untreated ADHD certainly are at increased risk of drug and alcohol abuse.
"These kids don't fit in well with their peers and are not doing well in school," Kodjo tells WebMD. "They recognize they are not like other kids and may self-medicate with substances."
Kodjo says the crucial question is whether treating childhood ADHD cuts kids' risk of later alcohol and drug abuse.
"People who have ADHD have more of a tendency to be impulsive. If they are treated, theoretically the medications should control that, giving them a chance to think things through and be more organized," Kodjo tells WebMD. "The kids I work with who have ADHD have done pretty well as teens."
Molina says it's difficult to separate out the effects of ADHD treatment. That's because treatments vary, as does the severity of a child's ADHD. Some studies show that early ADHD treatment protects kids from later substance abuse -- but some don't, she says.
The Pittsburgh ADHD Longitudinal Study group is looking at the issue and expects to report new findings this summer, Molina says.
Meanwhile, Molina advises parents to remain involved as their ADHD kids reach adolescence.
"What we now know is that two-thirds of kids with ADHD will still have ADHD in adolescence -- and even more of them may be suffering academically," she says. "Parents and teachers cannot back off because academic performance does play a role in risk for alcohol abuse. So one thing must be to keep them on a good track in school."
That is more easily said than done. But Molina insists that it's worth it.
"When ADHD teens complain that they need more independence, the message to give them is yes, you do need to learn to become independent -- and we will manage that change with you," she says. "It is important for parents, pediatricians, and teachers to monitor not only ADHD symptoms but how well a child is doing in school and how well a child is doing socially."
Parents should also keep an eye on their own drinking. In a separate study, Molina and colleagues find that when their parents' alcohol use creates a stressful family situation, kids with ADHD are particularly likely to self-medicate with alcohol.
SOURCES: Molina, B.S.G. Alcoholism: Clinical and Experimental Research, April 2007; vol 31, manuscript received ahead of print. Marshal, M.P. Alcoholism: Clinical and Experimental Research, April 2007; vol 31, manuscript received ahead of print. Brooke Molina, PhD, associate professor of psychiatry and psychology, University of Pittsburgh. Cheryl Kodjo, MD, assistant professor of pediatrics and adolescent medicine specialist, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, N.Y.
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