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Certain Behaviors in ADHD May Increase Risk of Early Drug Use


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Dec. 22, 1999 (Atlanta) -- In children with certain external behavior problems, attention deficit hyperactivity disorder (ADHD) increases the risk of early drug use, according to a report in November's Journal of the AmericanAcademy of Child and Adolescent Psychiatry. Experts say the findings have important implications for prevention and early intervention.

In this study, researchers assessed over 700 children at ages 6 and 11 for psychiatric disorders and behavior problems. Data were collected using objective testing as well as reports from mothers and teachers. Additionally, reports from children were used to assess use of tobacco, alcohol, marijuana, or inhalants by themselves and their peers.

The data showed that 19% of all the children had used drugs by age 11. Most had used tobacco and alcohol; a small number had used both.

In regard to ADHD, the researchers found a definite correlation between the disorder and externalizing behavior problems including aggressiveness and other disruptive behaviors. Regardless of ADHD status, externalizing problems have been consistently associated with early drug use. In children with ADHD, drug use increased significantly with increases in externalizing behavior problems. The highest risk for early drug use was found in ADHD children with moderate levels of externalizing problems.

In addition, children with ADHD had a twofold increase in early drug use when parental monitoring was minimal and a sixfold increase when peer drug use was heavy. They found no evidence that the medications used to treat ADHD increased the risk of early drug use.

"We need to target kids with behavior problems both with and without ADHD," says Howard Chilcoat, ScD, lead author of the study and a psychiatric epidemiologist at Henry Ford Health Sciences Center in Detroit. "These kids are at high risk for early drug use, and interventions should begin in elementary school. It's also important for parents to monitor where their kids are and who they're with." Psychiatrists stress the importance of the parent-child relationship in this regard.

"We need to focus on strengthening the parent-child relationship rather than controlling children's lives," says Robert Begtrup, a child psychiatrist and associate clinical professor of psychiatry at Vanderbilt University, "because kids use this relationship as an internal reference. And when peer behavior strays too far from this point of reference, kids often make appropriate adjustments."

"From an early age, kids with ADHD need to be educated so they can learn how to manage their impulsivity," says James Parker, MD, medical director of the JBS Mental Health Authority and associate clinical professor of psychiatry at University of Alabama at Birmingham. "And then they're more able to resist the influence of peers. But drug therapy alone can't do this." Parker says behavioral therapy for ADHD families is an important supplement to ADHD drug therapy.

The study was supported with grants from the National Institute on Drug Abuse and the National Institute of Mental Health.

  • Researchers have found a correlation between ADHD and externalizing behavior problems, which in turn increases the risk of early drug use.
  • Regardless of ADHD status, all kids with externalizing behavior problems should be targeted for intervention programs.
  • Parents should closely monitor where their children are and who they are with in order to lower the likelihood of risky behavior.

 

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