Pathways from ADHD to early drug use

J Am Acad Child Adolesc Psychiatry. 1999 Nov;38(11):1347-54. doi: 10.1097/00004583-199911000-00008.


Objective: This study tests whether attention-deficit hyperactivity disorder (ADHD) increases the risk of early drug use.

Method: A community-based sample of 412 low birth weight and 305 normal birth weight children and their mothers initially were assessed when the children were 6 years old with a follow-up assessment at age 11.

Results: The relationship of ADHD with drug use varied by level of externalizing problems. Regardless of ADHD status, children with a low level of externalizing problems had a low risk of drug use, and those with the highest level of externalizing problems had a high risk. At the middle level of externalizing problems, ADHD increased the incidence of drug use to the magnitude observed at the high level of externalizing problems, and children with ADHD were at significantly higher risk than those without ADHD (odds ratio = 2.1, p = .03). Findings were similar for low and normal birth weight children. Low parent monitoring and high peer drug use signaled increased risk of drug use for children, independent of ADHD status. Psychostimulant treatment for ADHD was unrelated to risk of drug use.

Conclusions: Risk for early drug use in children with ADHD depends on level of associated externalizing problems. Parent monitoring and peer drug use appear to be potential targets for drug prevention for children with ADHD, as well as children in general.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / complications*
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Child
  • Conduct Disorder / complications
  • Conduct Disorder / psychology*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Male
  • Risk Assessment
  • Substance-Related Disorders / etiology*
  • Substance-Related Disorders / psychology