Attention deficit hyperactivity and oppositional defiant disorder symptoms in adolescence and risk of substance use disorders : A general population-based birth cohort study

• Published in: Acta Psychiatrica Scandinavica
• Main Authors: Mustonen, Antti, Rodriguez, Alina, Scott, James G., Vuori, Miika, Hurtig, Tuula, Halt, Anu Helmi, Miettunen, Jouko, Alakokkare, Anni Emilia, Niemelä, Solja
• Other Authors: Tampere University, Clinical Medicine, Seinäjoen keskussairaala VA
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2023
• Subjects: 3124 Neurology and psychiatry; Northern Finland
• Online Access: https://trepo.tuni.fi/handle/10024/150453; https://doi.org/10.1111/acps.13588

Background: Externalizing symptoms are associated with risk of future substance use disorder (SUD). Few longitudinal studies exist using general population-based samples which assess the spectrum of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms. Aims/Objectives: We aimed to study the associations between adolescent ADHD symptoms and subsequent SUD and additionally examine whether the risk of SUD is influenced by comorbid oppositional defiant disorder (ODD) symptoms. Methods: The Northern Finland Birth Cohort 1986 was linked to nationwide health care register data for incident SUD diagnoses until age 33 years (n = 6278, 49.5% male). ADHD/ODD-case status at age 16 years was defined using parent-rated ADHD indicated by Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire with 95% percentile cut-off. To assess the impact of ODD comorbidity on SUD risk, participants were categorized into four groups based on their ADHD/ODD case status. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to study associations between adolescent ADHD/ODD case statuses and subsequent SUD. Results: In all, 552 participants (8.8%) presented with ADHD case status at the age of 16 years, and 154/6278 (2.5%) were diagnosed with SUD during the follow-up. ADHD case status was associated with SUD during the follow-up (HR = 3.84, 95% CI 2.69–5.50). After adjustments for sex, family structure, and parental psychiatric disorder and early substance use the association with ADHD case status and SUD remained statistically significant (HR = 2.60, 95% CI 1.70–3.98). The risk of SUD remained elevated in individuals with ADHD case status irrespective of ODD symptoms. Conclusions: ADHD in adolescence was associated with incident SUD in those with and without symptoms of ODD. The association of ADHD and SUD persisted even after adjustment for a wide range of potential confounds. This emphasizes the need to identify preventative ...