Journal Article Review by Madison Goodpasture
Abnormal Psychology - 2230
December 9, 2015

Attention-deficit/hyperactivity disorder (ADHD) is a mental condition that affects ~5-10% of children with symptoms such as inattentiveness, impulsiveness, and hyperactivity. While both children and adults can have ADHD, it is typically diagnosed in children around the age of seven. Along with inattention, hyperactivity, and impulsiveness, ADHD is also thought to lead to other behavioral issues including substances use/abuse and addiction. Since ADHD can continue through adolescence and into adulthood, it is important to learn if this disorder puts individuals at risk substance use. The object of one study conducted by Brooke S.G. Molina and William E. Pelham, Jr. was to clarify the magnitude of risk for early substance use and SUD in clinic-referred children with ADHD compared to children without ADHD. Their results were published in the Journal of Abnormal Psychology, 2003, Vol.112, No.3, in their paper titled, “Childhood Predictors of Adolescent Substance use in a Longitudinal Study of Children with ADHD”. The research was performed by two distinguished psychologists, Dr. Molina and her mentor, Dr. Pelham, both of whom have significant experience in studying ADHD in children. The article reference section was lengthy and covered numerous topics of children behavior specific to ADHA issues. The authors themselves had several other publications included in the References.

The longitudinal study followed two sets of children: one set of 142 clinical-referred children with ADHD and one set of 100 demographically similar children that did not have ADHD. Initial participant ages ranged between 5 and 17. After five years, the participants were contacted for the study where 56.5% agreed to participate. The study procedure was obtained through separate office interviews of the children and their parents using a structured paper and pencil questionnaire. The results were scored for level of use, lifetime use, and age of first use for alcohol, tobacco, marijuana, and illicit drugs. According to the study, ADHD children appeared to have more statistical risk for substance use for illicit drugs, and problems with alcohol, cigarettes, and marijuana use in their adolescence than non-ADHD children. Severe attention problems were found to be a predictor for drinking alcohol and smoking marijuana or cigarettes.

The article indicated that most studies on children and the influence of substance use are based on family, environment, influence, school, peer groups, income status, etc. and the first use predictors of substance use. They also pointed to the many studies of ADHD children and the long term course of ADHD into and through adulthood but the apparent lack of information if ADHD and conduct disorders can influence child substance use and maybe later abuse or dependency.

The article is a description of the study the authors conducted to compare drug use between teenagers diagnosed with ADHD in childhood with children without ADHD. Anti-social behaviors were also considered for influencing substance use. The authors open the article with both the issue of ADHD and the problem of substance use in school age children. They present the question of whether ADHD may be a viable precursor to substance use and substance us disorder (SUD). The authors identify the need for this type of research by citing previous studies that attempted to link ADHD and substance use and the problems with those results. Using these studies, they identify apparent discrepancies in the findings based on the average age of the groups and the manner in which the substance use was assessed. They also highlight the existence of previous studies that focus primarily on the long-term course of ADHD or on studies of adolescent substance use without the influence of ADHD. By referencing previous study discrepancies and the virtual lack of other research, the authors seemingly justify the need for their study.

Prior to presenting their findings, the authors appropriately and succinctly identify what the research intended to accomplish. Not only were they intending to establish the magnitude of risk for children with ADAD to substance use but they also were interested in testing whether severity of behavior disorders were viable predictors of early substance use. It seemed they also spent a lot of time trying to justify the need for this study by citing the problems with previous research or the lack thereof. That may be good article writing or a subtle way to justify additional research funding. After two pages of explanation, the authors finally get to their study methodology.

The article describes how the study was conducted and the details of their study group. The authors used a longitudinal study approach of five years with the ADHD Probands group and the non-ADHD control group. The participant numbers were limited to 142 probands and 100 controls. After year five of the study, only 56.5% of the eligible children and parents agreed to re-participate. The authors attempted to explain this was not statistically significant. The demographic of the study participants was also limited to one specific area of Pittsburg. This makes one wonder if geographical and environmental forces were ignored as a viable influence on children and substance use. For example, is it well known that the population in the southern United States has a higher percentage of cigarette smokers than other parts of the country. Parental and peer examples are strong influences for recruiting young smokers regardless of ADHD diagnosis. The authors went into significant detail on their study methodology and how the measures were extracted. After choosing the Probands from clinically diagnosed records, office-based interviews with children and parents, along with limited teacher behavior observations, provided responses for the study. Although significant confidentiality was built into the interviews, the authors seemed to be satisfied that an interview method would provide truthful responses especially from adolescents when it comes to using alcohol, cigarettes, marijuana, or illicit drugs. Regarding illicit drugs, the study also lumped the use of prescription medication into the illicit or street drug category. While inhalants are the typical teenagers choice for getting high, stealing prescriptions drugs from mommy and daddy is also a viable issue that maybe should be considered separately since it involves two crimes.

The authors’ use of detailed tables and graphs coupled with the written description was helpful in deciphering the results. The detail in the statistical presentation however, would be confusing to someone reading the article that did not have a background in basic mathematical statistics. These readers would have to rely on the study abstract or summary for results of the study and then one would have to assume it was correct. The authors eventually interpreted their results to suggest an increase in the risk for elevated use and abuse of alcohol and heavy drugs and the earlier use of tobacco and other drugs by the teenage years. They also emphasized the findings for the inattention dimension of ADHD as a predictor for later substance use, more so than antisocial behaviors. From this, the authors interpret the association of inattention as a better predictor of substance use.

At the conclusion of the article, the authors address the potential limitations of the study and the potential bias involved. They also identify two issues with the study: 1) the age range of the participants, and 2) the limited number of girls in the sample. They do pledge to continue monitoring these participants into adulthood for substance use and potential abuse issues.

In summary, the article adequately described the study and results using detailed written and visual techniques. The writing was very detailed and used abnormal psychology references and techniques indicating that the authors were knowledgeable in the subject matter. Since the article was published in the Journal of Abnormal Psychology, it is apparent that this is the target audience for the article. As mentioned earlier, readers without a background in statistics and psychology may find it a difficult read. The information was found to be interesting in the understanding of the potential relationship of ADHD/CD and potential substance use influences since most ADHD patients are treated with medication. This makes the authors case for further study reasonable. But while this and other studies try to determine the relationship between ADHD and substance use/abuse, one cannot forget the importance of parental influence and monitoring, strong school oversight, proper peer persuasion, and higher individual participation in productive activities are adequate predictors of substance use in children regardless of diagnosis.