Children with ADHD at Risk for Alcohol Problems

Children with attention deficit hyperactivity disorder (ADHD) are at risk for alcohol abuse or dependence -- as well as other substance-related problems -- as they grow older, new research confirms. Two University of Pittsburgh-led studies show that ADHD is, indeed, a risk factor for alcohol problems, with parental alcoholism and stressful experiences in the family playing an important role.

Results 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, Ph.D., associate professor of psychiatry and psychology at the University of Pittsburgh, and corresponding author for both studies. "Our studies show that adolescents with ADHD were much more likely to use alcohol than their peers without ADHD."

In the first of the two studies on age specificity, Dr. Molina and her colleagues interviewed participants in the larger Pittsburgh ADHD Longitudinal Study. Researchers interviewed 364 children diagnosed with ADHD 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 also were recruited 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 Dr. 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 Dr. 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 peers in the study who did not have childhood ADHD. Whereas 14 percent of that age group with childhood ADHD were diagnosed with alcohol abuse or dependence, none of the 15-to-17-year-olds without childhood ADHD had alcohol problems."

Researchers note that 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. 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.

Dr. Molina said 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." Dr. Molina also said, however, that researchers know little about the risk for alcoholism for young adults (18 to 25) 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 this group in the Pittsburgh study to see if this happens or not."

In the second study, on "life stress," Dr. 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 Dr. 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. 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."

"However," noted Dr. 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."

The study was principally funded by the National Institute on Alcohol Abuse and Alcoholism.

Co-authors of the study include William E. Pelham and Elizabeth M. Gnagy of the departments of psychology and pediatrics at The State University of New York at Buffalo; Amanda L. Thompson of the department of psychology at the University of Pittsburgh; and Michael P. Marshal of the department of psychiatry at the University of Pittsburgh School of Medicine.