Psychotic Symptoms in Attention-Deficit/Hyperactivity Disorder: An Analysis of the MTA Database

Objective: To assess the prevalence of psychotic symptoms among youths (14-25 years of age) with a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) combined type. Method: Participants in the Multimodal Treatment Study of Children with ADHD (MTA) and a local normative comparison group (LNCG) were systematically assessed 6, 8, 10, 12, 14, and 16 years after the original enrollment at a mean age of 8.5 years. Trained research assistants administered a psychosis screener, and positive screens were referred to study clinicians to confirm or exclude psychosis. Possible associations between screening positive and alcohol or substance use were assessed. Results: Data were available from 509 MTA participants (88% of original MTA sample; mean age 25.1 years) and 276 LNCG participants (96% of original sample; mean age 24.6 years) at year 16. Twenty-six MTA participants (5%; 95% CI 3-7) and 11 LNCG participants (4%; 95% CI 2-6) screened positive for at least 1 psychotic symptom (p = .60). Most psychotic symptoms were transient. The prevalence of clinician-confirmed psychotic symptoms was 1.1% (95% CI 0.2-2.1) in the MTA group and 0.7% (0-1.7) in the LNCG (p = .72). Greater cannabis use was reported by those who screened positive (p < .05) and were confirmed positive (p < .01). Conclusion: There was no evidence that ADHD increased the risk for psychotic symptoms. In the ADHD and normative comparison groups, more frequent cannabis use was associated with a greater likelihood of experiencing psychotic symptoms, thus supporting the recommendation that youth should not use cannabis

Paths to postsecondary education enrollment among adolescents with and without childhood attention‐deficit/hyperactivity disorder (ADHD): A longitudinal analysis of symptom and academic trajectories

We examined developmental trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms, standardized achievement, and school performance for adolescents with and without ADHD who did and did not enroll in postsecondary education (PSE; N = 749; 79% boys; 63% White, 17% non-Hispanic Black, 10% Hispanic, and 10% other ethnicities). In a multisite study (recruitment based in New York, North Carolina, Pennsylvania, California, and Quebec), participants were originally enrolled between 1994 and 1998 at ages 7 to 9.9 and followed up through 2012 (Mage = 25 at final follow-up). Adolescents who eventually enrolled in PSE had less severe symptoms, but differences were modest and trajectories were similar over time. For all adolescents, standardized achievement trajectories declined up to two thirds of a standard deviation from ages 9 to 17. By the end of high school, the average GPA of adolescents with ADHD was three quarters of a point higher for those who eventually enrolled in PSE compared to those who did not. Overall, school performance mattered more than academic achievement for understanding eventual enrollment of adolescents with ADHD

Childhood Factors Affecting Persistence and Desistence of Attention-Deficit/Hyperactivity Disorder Symptoms in Adulthood: Results From the MTA

Objective: To determine childhood factors that predict attention-deficit/hyperactivity disorder (ADHD) persistence and desistence in adulthood. Method: Regression analyses were used to determine associations between childhood factors and adult ADHD symptom persistence in 453 participants (mean age, 25 years) from the Multimodal Treatment Study of Children with ADHD (MTA). Childhood IQ, total number of comorbidities, child-perceived parenting practices, child-perceived parent-child relationships, parental mental health problems, marital problems of parents, household income levels, and parental education were assessed at a mean age of 8 years in all participants. Adult ADHD persistence was defined using . DSM-5 symptom counts either with or without impairment, as well as mean ADHD symptom scores on the Conners' Adult ADHD Rating Scale (CAARS). Age, sex, MTA site, and childhood ADHD symptoms were covaried. Results: The most important childhood predictors of adult ADHD symptom persistence were initial ADHD symptom severity (odds ratio [OR] = 1.89, standard error [SE] = 0.28, . p = .025), comorbidities (OR = 1.19, SE = 0.07, . p = .018), and parental mental health problems (OR = 1.30, SE = 0.09, . p = .003). Childhood IQ, socioeconomic status, parental education, and parent-child relationships showed no associations with adult ADHD symptom persistence. Conclusion: Initial ADHD symptom severity, parental mental health, and childhood comorbidity affect persistence of ADHD symptoms into adulthood. Addressing these areas early may assist in reducing adult ADHD persistence and functioning problems

Progression of impairment in adolescents with attention-deficit/hyperactivity disorder through the transition out of high school: Contributions of parent involvement and college attendance

Long-term, prospective follow-up studies of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) show that symptoms tend to decline with age, but impairments in daily life functioning often persist into adulthood. We examined the developmental progression of impairments before and after the transition out of high school in relation to parent involvement during adolescence, parent support during adulthood, and college attendance, using 8 waves of data from the prospective 16-year follow-up of the Multimodal Treatment of ADHD (MTA) Study. Participants were 548 proband children diagnosed with DSM-IV ADHD Combined Type and 258 age- and sex-matched comparison children (Local Normative Comparison Group; LNCG) randomly sampled from probands' schools. Impairment was assessed consistently by parent report from childhood through adulthood. Results showed that impairment worsens over time both before and after the transition to adulthood for those with ADHD histories, in contrast to non-ADHD peers, whose impairments remained stably low over time. However, impairment stabilized after leaving high school for young adults with ADHD histories who attended college. Involved parenting in adolescence was associated with less impairment overall. Attending college was associated with a stable post-high school trajectory of impairment regardless of parents' involvement during adolescence, but young adults with histories of involved parenting and who attended college were the least impaired overall

Adult substance use as a function of growth in peer use across adolescence and young adulthood in the context of ADHD: Findings from the MTA

Peer substance use strongly predicts adolescent and young adult substance use, but its role in ADHD-related risk for substance use, especially in adulthood, is unclear. In a sample with (n = 516) and without (n = 249) childhood ADHD from the Multimodal Treatment Study of ADHD, we compared associations between change over time in peer substance use and personal substance use (alcohol, cigarettes, marijuana, illicit drugs) from age 14–26 by ADHD status. Developmentally typical peer substance use trajectories across adolescence and young adulthood coincided with similar changes in personal use – but less so for those with ADHD histories. Concurrent associations between peer and personal use in adolescence and young adulthood were weaker for those with ADHD histories than without for commonly used substances (alcohol, marijuana). Prospectively, escalating peer use during adolescence forecasted adulthood declines for commonly used substances, yet persistently high substance use at age 25, regardless of ADHD history. In the reverse direction, growth in adolescent substance use predicted developmentally normative young adult declines in peer use – but for the ADHD group, adolescent heavy drinking predicted increases in young adult peer use. Findings suggest that individuals with ADHD may have difficulty emulating their peers' developmentally normative declines in substance use, highlighting the importance of social factors when treating young adults affected by ADHD and substance abuse

Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study

Background: Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. Methods: Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. Results: In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups. Conclusions: Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels

Early substance use in the pathway from childhood attention-deficit/ hyperactivity disorder (ADHD) to Young Adult Substance Use: Evidence of statistical mediation and substance specificity

This study tested whether early and developmentally atypical substance use mediates risk for adult substance use among children with attention-deficit/hyperactivity disorder (ADHD), and whether that risk is substance-specific. Participants were children with ADHD previously enrolled in a randomized controlled trial (RCT), and a demographically similar non-ADHD group, assessed at 2 through 16 years after the original RCT baseline. Self-reports of heavy drinking, marijuana use, daily smoking, and other illicit drug use were collected at follow-ups to establish atypically early and frequent use. Models estimated statistically mediated effects of childhood ADHD on adult substance use via early substance involvement, with planned comparisons to evaluate substance specificity. Results supported the mediation hypothesis, showing that childhood ADHD was associated with more frequent adult substance use via early substance involvement for marijuana, cigarettes, illicit drugs, and to a lesser extent, alcohol. Mediation was not escalated by comorbid childhood conduct disorder or oppositional defiant disorder except for early use of nonmarijuana illicit drugs. Substance-specificity in the mediational pathway was largely absent except for cigarette use, where ADHD-related early smoking most strongly predicted adult daily smoking. Findings from this study provide new evidence that atypically early substance use associated with childhood ADHD signals important cross-drug vulnerability by early adulthood, but cigarette use at a young age is especially associated with increased risk for habitual (daily) smoking specifically. Efforts to prevent, delay, or reduce substance experimentation should occur early and focus on factors relevant to multiple drugs of abuse in this at-risk population

Corrigendum: Cigarette smoking progression among young adults diagnosed with ADHD in Childhood: A 16-year longitudinal study of children with and without ADHD (Nicotine and Tobacco Research (2018) DOI: 10.1093/ntr/nty045)

Corrections have been made throughout the article to clarify how daily smoking during the 12- through 16-year assessments was defined in the original report. In this corrigendum, daily smoking during these assessments was defined by participant's responding either (a) once a day or more in response to In the past year, how often did you smoke cigarettes? or (b) responding yes to Are you currently a daily smoker? The authors repeated their analyses and this updated definition of daily smoking did not change findings in terms of statistical significance for Aims 1, 2, or 3 with one exception. In Aim 2, the initiation age (linear) by childhood ADHD status interaction was significant in this correction (p=.025), indicating that progression to daily smoking was faster for LNCG participants who initiated smoking at an older age than ADHD participants. For instance, mean latency was 5.61 years (SD=3.28) for ADHD participants and 5.29 (SD=3.22) for LNCG participants who initiated at 17 year-old or younger, but 2.14 (SD=2.26) for ADHD participants and 1.20 (SD=1.23) for LNCG participants who initiated at 18 years-old and older. This re-analysis did not impact the main findings from this study. This corrigendum includes updated values in the main article and supplemental material based on how we operationalize daily smoking status between 12- through 16-year assessments. The authors also clarify that for the 2- through 10-year assessments, participants were coded as daily smokers if they smoked at least one cigarette per day in response to During the past month, how many cigarettes have you smoked on an average day? The authors also clarify in this correction that weekly smoking in Aim 1 analysis was defined as those who responded once a week or more in response to In the past year, how often did you smoke cigarettes? These two clarifications did not require any re-analysis