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Childhood trajectories of inattention, hyperactivity and oppositional behaviors and prediction of substance abuse/dependence: a 15-year longitudinal population-based study

Abstract

Numerous prospective studies have shown that children diagnosed with attention deficit/hyperactivity disorder (ADHD) are at higher risk of long-term substance abuse/dependence. However, there are three important limits to these studies: (a) most did not differentiate the role of hyperactivity and inattention; (b) most did not control for associated behavioral problems; and (c) most did not consider females. Our aim was to clarify the unique and interactive contributions of childhood inattention and hyperactivity symptoms to early adulthood substance abuse/dependence. Behavioral problems of 1803 participants (814 males) in a population-based longitudinal study were assessed yearly between 6 and 12 years by mothers and teachers. The prevalence of substance abuse/dependence at age 21 years was 30.7% for nicotine, 13.4% for alcohol, 9.1% for cannabis and 2.0% for cocaine. The significant predictors of nicotine dependence were inattention (odds ratio (OR): 2.25; 95% confidence interval (CI): 1.63–3.11) and opposition (OR: 1.65; 95%: 1.20–2.28). Only opposition contributed to the prediction of cannabis dependence (OR: 2.33; 95% CI: 1.40–3.87) and cocaine dependence (OR: 2.97; 95% CI: 1.06–8.57). The best behavioral predictor of alcohol abuse/dependence (opposition) was only marginally significant (OR: 1.38; 95% CI: 0.98–1.95). Frequent oppositional behaviors during elementary school were clearly the most pervasive predictors of substance abuse/dependence in early adulthood. The association of childhood ADHD with substance abuse/dependence is largely attributable to its association with opposition problems during childhood. However, inattention remained an important predictor of nicotine dependence, in line with genetic and molecular commonalities between the two phenotypes suggested in the literature.

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Acknowledgements

This study was supported by grants from the Fonds québecois de la Recherche sur la Société et la Culture; grants from the Social Sciences and Humanities Research Council of Canada; grants from the Canadian Institutes of Health Research (National Health Research and Development Program/Canadian Institutes of Health Research); grant SES-9911370 from the US National Science Foundation; grant RO1 MH65611-01A2 from the US National Institute of Mental Health; and a grant from the National Consortium on Violence Research (supported by grant SBR-9513040 from the National Science Foundation). Dr Pingault received a Government of Canada Post-doctoral Research Fellowship (PDRF) and a post-doctoral fellowship from the Research Unit on Children's Psychosocial Maladjustment via a grant from the Fonds de la recherche et de la Santé du Québec (no. 16031) attributed to Dr Côté.

Additional Contributions

We thank the participants, their families and their teachers for their long-term commitment to this project; Qian Xu and Charles-Edouard Giguère for statistical expertise; Hélène Beaumont, the many research assistants and the Research Unit on Children's Psychosocial Maladjustment staff for their assistance in data collection and administration of the project.

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Correspondence to S M Côté or R E Tremblay.

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Pingault, JB., Côté, S., Galéra, C. et al. Childhood trajectories of inattention, hyperactivity and oppositional behaviors and prediction of substance abuse/dependence: a 15-year longitudinal population-based study. Mol Psychiatry 18, 806–812 (2013). https://doi.org/10.1038/mp.2012.87

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Keywords

  • alcohol
  • cannabis
  • hyperactivity
  • inattention
  • nicotine
  • opposition

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