Dr. Timothy Wilkens followed 500 children with ADHD for ten years, and found they were one and a half times more likely to abuse drugs or alcohol, and had more than double the risk of smoking cigarettes than others without the disorder.

"Since anywhere from six to nine percent of the children in this country have ADHD, the notion that they are at increased risk for substance abuse becomes a very important educational piece, and prevention and early intervention component of their treatment," said Dr. Wilkens, a foremost expert in addiction.

Having ADHD was a greater risk factor for substance abuse than having problems in cognitive processes and learning, or having a family history of substance abuse.

"It is not the cognitive style or attentional component that seems to be driving the substance use," Dr. Wilkens explained. "It seems to be the dysregulation of mood or affect and the behavior that seems to be driving it."

This study appears in Current Opinion in Psychiatry.

Thought by addiction specialists to be similar in both ‘desirable’ effects and negative side-effects to such substances of abuse as cocaine, psychostimulants like methylphenidate (Ritalin) are typically used to control the inattention and hyperactivity of children with ADHD.

Considered a psychiatric disorder, ADHD is believed to have a neurobiological basis which accounts for its classic symptoms of distractibility, poor concentration, inattention, impulsivity and excessive energy—all of which are especially notable, disabling and disruptive in a classroom setting. Consequently, teachers have by default become the primary gatekeepers of diagnosis and eventual treatment with medication for most children who receive this diagnosis.

The use of psychostimulants with American children has dramatically risen in recent years. Between 1991 and 2005, for example, there was a 700% increase in the number of such prescriptions given to children diagnosed with ADHD in the United States. Given what is already known about long-term psychostimulant use this raises significant issues and concern.

Research has long established that psychostimulants cause cardiovascular changes such as elevated blood pressure and heart rate, both of which lead to significant health consequences in adulthood. Prolonged psychostimulant use–as is typical in childhood ADHD—naturally exposes children to a prolonged risk of future cardiovascular complications. Additionally, there are indications that psychostimulants reduce growth rates both during and for some time after their use.

A recent study, conducted by Todd Elder at Michigan State University has comprehensively addressed all of these concerns about the treatment of ADHD in children. He has found that perhaps 20% or 900,000 U.S. children who are treated for ADHD may be misdiagnosed and given inappropriate medical treatment. The growing concern about long-term effects of psychostimulant use makes this is an alarming discovery. In effect, this study shows that almost one million children in the U.S. may be receiving inappropriately prescribed psychostimulant medication.

Well-known in the field of addiction as abusable and addictive, psychostimulants pose a serious health risk for many teens and adults who use them illicitly. The eventual consequences for children who typically use them over prolonged periods (years) is not yet fully understood. Misdiagnosed children who use them without medical necessity also present concern for health professionals and parents since the effects of prolonged psychostimulant use in childhood without the neurobiological presence of ADHD are not yet known.

Elder cites the perceptions of teachers and the specifics of classroom dynamics in early childhood. He finds that children misdiagnosed with ADHD are actually normal children who are simply younger and naturally more immature intellectually and emotionally than their older classmates. When compared with their chronological age mates, these misdiagnosed children do not have inappropriate behavior or poor attention. It is only when younger children are compared to more mature classmates that the bar is raised for their performance and they fail to perform as well as older children.

The age differences examined in this research seem slight numerically, but a year (and even lesser) age difference is significant in early childhood development. Children who enter kindergarten when just meeting the age of eligibility are 60% more vulnerable to receiving an ADHD diagnosis than classmates who are some months or even a year older when entering the same class. Elder’s research found that children who entered school one year later were less likely (5.4 percentage points) to be diagnosed with the disorder. In short, it appears that when compared to others in the class who may be up to a full year older, the younger children are apt to be mislabeled as dysfunctional. Even more alarmingly, these youngsters are then likely to be considered in need of stimulants to make them appear more like older classmates.
Elder’s research shows that children who are at the younger end of school eligibility age perform better and are considered normal children throughout elementary and middle school years when given another year to mature before entering school. The ‘failed’ performance and stigma of psychiatric diagnosis for these younger and misdiagnosed children are psychologically and emotionally costly. Additionally, the monetary costs to parents and government supported healthcare that finance the treatment of misdiagnosed children are dramatic. It is estimated that Medicaid spends $320-500 million per year to fund psychostimulant treatment for misdiagnosed children.
 

Dr. David Brook and his colleagues began their work in 1975 when participants were 14 to 16 years of age, and followed them until they were in their thirties, identifying those young people diagnosed with ADHD, conduct disorders and substance abuse. Their problems tended to appear in that order, with ADHD in childhood, conduct disorder in adolescence, and substance abuse in young adulthood.

"For pediatricians, because ADHD develops earlier than conduct disorder, ADHD may be an important diagnostic cue for later conduct disorder and ultimately substance abuse disorder," according to the study published in the Archives of Pediatric and Adolescent Medicine.
 

Because of these negative consequences, it’s important to identify predictors of substance use disorders.
Researchers have previously identified attention-deficit/hyperactivity disorder (ADHD) as being associated with the development of substance use disorders, and Brook and his colleagues wanted to see if there was a similar link between conduct disorders and later substance use disorders.

The researchers looked at 485 people who were initially recruited from upstate New York in 1975 and followed up with them to a mean age of 37 years. Participants were assessed at 14 years and 16 years, and then again between the ages of 27 and 37. They evaluated the existence of ADHD and conduct disorders using the Diagnostic Interview Schedule for Children, and substance use disorders were identified with the University of Michigan’s Composite International Diagnostic Interview.

Those with ADHD in adolescence were 1.9 times more likely to develop a substance use disorder, and those with conduct disorder in adolescence were 3.5 times more likely to develop a substance use disorder. The authors write that clinicians should pay attention to ADHD in adolescents when it progresses to conduct disorder, as conduct disorder is a big indicator of later substance use disorders.

The researchers conclude that because ADHD usually develops earlier than conduct disorders, ADHD may be an important cue for eventual conduct disorder and perhaps later substance use disorders. They add that further research about this developmental pattern is needed.

Source: Medscape Today, Laurie Barclay, MD, Conduct Disorder in Adolescence Predicts Substance Use Disorders in Adulthood, October 11, 2010

In this study, 2,057 mothers answered questionnaires annually that concerned sleep duration and hyperactivity of their children. This data was collected on the children from birth to five years of age.

A research team from the Université de Montréal, its affiliated Hôpital du Sacré-Cœur de Montréal and Sainte Justine University Hospital Research Center, as well as the Université Laval and the French National Institute for Health and Medical Research (INSERM), analyzed the data.

“Hyperactivity problems may interfere with night-time sleep," said senior author Jacques Montplaisir, a professor in the Université de Montréal Department of Psychiatry and director of the Sleep Disorders Center at Hôpital du Sacré-Cœur de Montréal, in Science Daily. "We found that children who didn’t sleep long were generally hyperactive boys who lived under adverse family conditions."

According to this research team, boys – more than girls – with mothers of a low education, insufficient family income and who were comforted outside the bed or got into bed with mom after awakening at night were considered to be at more risk of having both short sleep duration and high hyperactivity.

"Short or fragmented sleep leads to sleepiness, which could manifest as hyperactivity in boys," explained Dr. Montplaisir. "However, the risk of abbreviated sleep in highly hyperactive children is stronger than the risk of hyperactivity among kids with short sleep duration."
 

Med Page Today issued a report focusing on this new research from the University of Cincinnati in Ohio. According to Jennifer Setlik, MD, calls to poison centers regarding the use of ADHD drugs jumped 76 percent between 1998 and 2005.

“The sharp increase, out of proportion to other poison center calls and general poison center use, suggests a rising problem with abuse, teen abuse, and particularly teen ADHD stimulant medication abuse," the researchers said in Med Page Today. "It may be that abuse is rising, or it may be that increased calls are a result of the escalating severity, perhaps reflecting the shift toward amphetamine use."

Part of the increase is blamed on the belief that these drugs are safe to use for anything and at any time because they are prescribed by a physician. Teens will often use these medications to relieve pain and anxiety, to aid sleep and to help them concentrate.

According to researchers, amphetamine exposure rates rose faster than amphetamine sales. Within the ADHD category, amphetamine/dextroamphetamine-related calls experienced a 476 percent increase over the study period. By comparison, prescriptions jumped 133 percent for persons age 13 to 19 years old.

Of those teens that made the calls to the poison centers, 42 percent experienced moderate or major effects. Some eventually experienced death. Researchers did highlight that previous studies had shown prescribing stimulants for ADHD did not lead to drug abuse or addiction. This study suggests other research ignored important variables and that this is a major problem that must be addressed immediately.