Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is prospectively linked to substance use and disorder. Depression emerging in adolescence is an understudied risk factor that may explain some of this risk. In the present study, we considered mediating and moderating roles of adolescent depression in explaining this association by using longitudinal data from the prospective 16-year follow-up of the Multimodal Treatment Study of ADHD (MTA). Participants were 547 children diagnosed with DSM-IV ADHD Combined Type, and 258 age- and sex-matched comparison children. In adolescence, depressive symptoms did not exacerbate effects of childhood ADHD on any substance use. For both groups, time-varying and average depressive symptoms were associated with more frequent use of all substances. Prospectively, we found no evidence of depression mediation to adult substance use. However, adolescent depression moderated the association between childhood ADHD and adult marijuana use. Although adults without ADHD histories used marijuana more frequently if they had elevated depressive symptoms in adolescence, marijuana use by adults with ADHD histories was independent of their adolescent depression. In adulthood, depression diagnoses and ADHD persistence continued to operate as independent, additive correlates of substance use risk. Our findings suggest a circumscribed role for depression in substance use risk that adds to, but does not alter or explain, ADHD-related risk.
Similar content being viewed by others
Notes
Defined as one standard deviation above average depressive symptoms (.24) in adolescence. Odds ratio associated with the largest mediated effect in Table 1 = e(.15*.24)/[1 + e(.15*.24)] = 1.037 (i.e., odds are 3.7% higher).
References
Aiken, L. S. & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Sage Publications.
Anastopoulos, A. D., Smith, T. F., Garrett, M. E., Morrissey-Kane, E., Schatz, N. K., Sommer, J. L., Kollins, S. H., & Ashley-Koch, A. (2011). Self-regulation of emotion, functional impairment, and comorbidity among children with AD/HD. Journal of Attention Disorders, 15(7), 583–592.
Arnold, L. E., Abikoff, H. B., Cantwell, D. P., Conners, C. K., Elliott, G., Greenhill, L. L., …, Wells, K. C. (1997). National Institute of Mental Health collaborative multimodal treatment study of children with ADHD (the MTA). Design challenges and choices. Archives of General Psychiatry, 54(9), 865–70.
Blackman, G. L., Ostrander, R., & Herman, K. C. (2005). Children with ADHD and depression: A Multisource, Multimethod Assessment of Clinical, Social, and Academic Functioning. Journal of Attention Disorders, 8(4), 195–207.
Breyer, J. L., Lee, S., Winters, K., August, G., & Realmuto, G. (2014). A Longitudinal Study of Childhood ADHD and Substance Dependence Disorders in Early Adulthood. Psychology of Addictive Behaviors, 28(1), 238–246.
Buckner, J. D., Zvolensky, M. J., Crosby, R. D., Wonderlich, S. A., Ecker, A. H., & Richter, A. (2015). Antecedents and consequences of cannabis use among racially diverse cannabis users: An analysis from ecological momentary assessment. Drug and Alcohol Dependence, 147, 20–25.
Center for Behavioral Health Statistics and Quality (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15–4927, NSDUH Series H-50). Retrieved from samhsa.gov/data.
Chan, Y. F., Dennis, M. L., & Funk, R. R. (2008). Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment. Journal of Substance Abuse Treatment, 34(1), 14–24.
Chassin, L., Colder, C., Hussong, A., & Sher, K. J. (2013). Substance use and substance use disorders. In D. Cicchetti & D. J. Cohen (Eds.), Developmental Psychopathology (3rd ed.). Hoboken: Wiley.
Chronis-Tuscano, A., Molina, B. S., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 67(10), 1044–1051.
Claude, D., & Firestone, P. (1995). The development of ADHD boys: A 12-year follow-up. Canadian Journal of Behavioural Science, 27(2), 226–249.
Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah: Lawrence Erlbaum.
Conners, C. K., Erhardt, D., & Sparrow, E. (1999). Conners' adult ADHD rating scales (CAARS) technical manual. North Tonawanda: Multi-Health Systems, Inc.
Cooper, M. L., Frone, M. R., Russell, M., & Mudar, P. (1995). Drinking to regulate positive and negative emotions: A motivational model of alcohol use. Journal of Personality and Social Psychology, 69(5), 990–1005.
Cooper, R. E., Williams, E., Seegobin, S., Tye, C., Kuntsi, J., & Asherson, P. (2017). Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. European Neuropsychopharmacology, 27(8), 795–808.
Curran, P. J., & Bauer, D. J. (2011). The disaggregation of within-person and between-person effects in longitudinal models of change. Annual Review of Psychology, 62, 583–619.
De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858–900.
Enders, C. K. (2010). Applied missing data analysis. New York: Guilford Press.
Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Compton, W.…, Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on alcohol and related conditions. Archives of General Psychiatry, 61(8), 807–16.
Groenman, A. P., Janssen, T. W. P., & Oosterlaan, J. (2017). Childhood psychiatric disorders as risk factor for subsequent substance abuse: A meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 56(7), 556–569.
Harty, S. C., Gnagy, E. M., Pelham, W. E., Jr., & Molina, B. S. G. (2017). Anger-irritability as a mediator of attention deficit hyperactivity disorder risk for adolescent alcohol use and the contribution of coping skills. Journal of Child Psychology and Psychiatry, 58(5), 555–563.
Hechtman, L., Swanson, J. M., Sibley, M. H., Stehli, A., Owens, E. B., Mitchell, J. T., … & Nichols, J. Q. (2016). Functional adult outcomes 16 years after childhood diagnosis of attention-deficit/hyperactivity disorder: MTA results. Journal of the American Academy of Child & Adolescent Psychiatry, 55(11), 945–952.
Henry, B., Feehan, M., McGee, R., Stanton, W., Moffitt, T. E., & Silva, P. (1993). The importance of conduct problems and depressive symptoms in predicting adolescent substance use. Journal of Abnormal Child Psychology, 21, 469–480.
Hinshaw, S. P., Owens, E. B., Sami, N., & Fargeon, S. (2006). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: Evidence for continuing cross-domain impairment. Journal of Consulting and Clinical Psychology, 74(3), 489–499.
Howard, A. L., Molina, B. S. G., Swanson, J. M., Hinshaw, S. P., Belendiuk, K. A., Harty, S. C., … Wigal, T. (2015). Developmental progression to early adult binge drinking and marijuana use from worsening versus stable trajectories of adolescent attention deficit/hyperactivity disorder and delinquency. Addiction, 110, 784–795.
Hoza, B. (2007). Peer functioning in children with ADHD. Ambulatory Pediatrics, 7(1), 01–06.
Humphreys, K. L., Katz, S. J., Lee, S. S., Hammen, C., Brennan, P. A., & Najman, J. M. (2013). The association of ADHD and depression: Mediation by peer problems and parent-child difficulties in two complementary samples. Journal of Abnorm Psychology, 122(3), 854–867.
Hussong, A. M., Jones, D. J., Stein, G. L., Baucom, D. H., & Boeding, S. (2011). An internalizing pathway to alcohol use and disorder. Psychology of Addictive Behaviors, 25, 390–404.
Hussong, A. M., Ennett, S. T., Cox, M. J., & Haroon, M. (2017). A systematic review of the unique prospective association of negative affect symptoms and adolescent substance use controlling for externalizing symptoms. Psychology of Addictive Behaviors, 31, 137–147.
Judd, L. L., & Akiskal, H. S. (2000). Delineating the longitudinal structure of depressive illness: Beyond clinical subtypes and duration thresholds. Pharmacopsychiatry, 33, 3–7.
Kandel, D. B., Johnson, J. G., Bird, H. R., Canino, G., Goodman, S. H., Lahey, B. B., …, Schwab-Stone, M. (1997). Psychiatric disorders associated with substance use among children and adolescents: Findings from the methods for the epidemiology of child and adolescent mental disorders (MECA) study. Journal of Abnormal Child Psychology, 25(2), 121–32.
Katz, E. C., Fromme, K., & D’Amico, E. J. (2000). Effects of outcome expectancies and personality on young adults' illicit drug use, heavy drinking, and risky sexual behavior. Cognitive Therapy and Research, 24(1), 1–22.
King, S. M., Iacono, W. G., & McGue, M. (2004). Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction, 99, 1548–1559.
Kovacs, M. (1992). The Children’s depression, inventory (CDI). Psychopharmacology Bulletin, 21, 995–998.
Lev-Ran, S., Roerecke, M., Le Foll, B., George, T. P., McKenzie, K., & Rehm, J. (2014). The association between cannabis use and depression: A systematic review and meta-analysis of longitudinal studies. Psychological Medicine, 44(4), 797–810.
Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M. (1998). Adult psychiatric status of hyperactive boys grown up. The American Journal of Psychiatry, 155(4), 493–498.
Marmorstein, N. R. (2013). Associations between dispositions to rash action and internalizing and externalizing symptoms in children. Journal of Clinical Child and Adolescent Psychology, 42(1), 131–138.
Marmorstein, N. R., White, H. R., Loeber, R., & Stouthamer-Loeber, M. (2010). Anxiety as a predictor of age at first use of substances and progression to substance use problems among boys. Journal of Abnormal Child Psychology, 38, 211–224.
Mehta, P. D., & West, S. G. (2000). Putting the individual back into individual growth curves. Psychological Methods, 5(1), 23–43.
Meinzer, M. C., Pettit, J. W., & Viswesvaran, C. (2014). The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: A meta-analytic review. Clinical Psychology Review, 34(8), 595–607.
Meinzer, M. C., Pettit, J. W., Waxmonsky, J. G., Gnagy, E., Molina, B. S., & Pelham, W. E. (2016). Does childhood attention-deficit/hyperactivity disorder (ADHD) predict levels of depressive symptoms during emerging adulthood? Journal of Abnormal Child Psychology, 44(4), 1–11.
Mitchell, J. T., Sweitzer, M. M., Tunno, A. M., Kollins, S. H., & McClernon, F. J. (2016). "I use weed for my ADHD": A qualitative analysis of online forum discussions on Cannabis use and ADHD. PLoS One, 11(5), e0156614.
Mitchell, J. T., McIntyre, E. M., English, J. S., Dennis, M. F., Beckham, J. C., & Kollins, S. H. A (2017). Pilot trial of mindfulness meditation training for ADHD in adulthood: Impact on Core symptoms, executive functioning, and emotion dysregulation. Journal of Attention Disorders, 21(13), 1105–1120.
Mitchell, J. T., Howard, A. L., Belendiuk, K. A., Kennedy, T. M., Stehli, A., Swanson, J. M., Hechtman, L., …, Molina, B. S. G. (2019). Cigarette smoking progression among young adults diagnosed with ADHD in childhood: A 16-year longitudinal study of children with and without ADHD. Nicotine & Tobacco Research, 21(5), 638-647.
Molina, B. S. G., & Pelham, W. E. (2003). Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Journal of Abnorm Psychology, 112(3), 497–507.
Molina, B. S. G., & Pelham, W. E., Jr. (2014). Attention-deficit/hyperactivity disorder and risk of substance use disorder: Developmental considerations, potential pathways, and opportunities for research. Annual Review of Clinical Psychology, 10, 607–639.
Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., … & MTA Cooperative Group. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 484–500.
Molina, B., Hinshaw, S. P., Arnold, L. E., Swanson, J. M., Pelham, W. E., Hechtman, L., et al. (2013). Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. Journal of the American Academy of Child and Adolescent Psychiatry, 52(3), 250–263.
Molina, B. S. G., Howard, A. L., Swanson, J. M., Stehli, A., Mitchell, J. T., Kennedy, T. M., et al. (2018). Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: Findings from the MTA longitudinal study. Journal of Child Psychology and Psychiatry, 29, 546–511.
MTA Cooperative Group (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1073-1086.
Ostrander, R., & Herman, K. C. (2006). Potential cognitive, parenting, and developmental mediators of the relationship between ADHD and depression. Journal of Consulting and Clinical Psychology, 74(1), 89–98.
Preacher, K. J., & Selig, J. P. (2012). Advantages of Monte Carlo confidence intervals for indirect effects. Communication Methods and Measures, 6(2), 77–98.
Roy, A., Oldehinkel, A. J., & Hartman, C. A. (2017). Cognitive functioning in adolescents with self-reported ADHD and depression: Results from a population-based study. Journal of Abnormal Child Psychology, 45(1), 69–81.
Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.
Sibley, M. H., Altszuler, A. R., Ross, J. M., Sanchez, F., Pelham, W. E., Jr., & Gnagy, E. M. (2014). A parent-teen collaborative treatment model for academically impaired high school students with ADHD. Cognitive and Behavioral Practice, 21, 32–42.
Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A., …, Pelham, W.E. (2017). Defining ADHD symptom persistence in adulthood: Optimizing sensitivity and specificity. Journal of Child Psychology and Psychiatry, 58(6), 655–662.
Swanson, J. M. (1992). School-based assessments and interventions for ADD students. Irvine: KC Publications.
Swanson, J. M., Arnold, L. E., Molina, B. S. G., Sibley, M. H., Hechtman, L. T., Hinshaw, S. P., … & Kraemer, H.C. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: Symptom persistence, source discrepancy, and height suppression. Journal of Child Psychology and Psychiatry, 58(6), 663–678.
Tarter, R. E., Kirisci, L., Feske, U., & Vanyukov, M. (2007). Modeling the pathways linking childhood hyperactivity and substance use disorder in young adulthood. Psychology of Addictive Behaviors, 21(2), 266–271.
Truter, I., Regnart, J., & Meyer, A. (2017). Critical exploration of co-occurring attention-deficit/hyperactivity disorder, mood disorder and substance use disorder. Expert Review of Pharmacoeconomics & Outcomes Research, 17(3), 275–282.
Vitulano, L., Fite, P. J., Hopko, D. R., Lochman, J., Wells, K., & Asif, I. (2014). Evaluation of underlying mechanisms in the link between childhood ADHD symptoms and risk for early initiation of substance use. Psychology of Addictive Behaviors, 28(3), 816–827.
Wang, F. L., Pedersen, S. L., Joseph, H., Gnagy, E. M., Curran, P., Pelham, W. E., & Molina, B. S. G. (2019). Role of ADHD in the co-occurrence between heavy alcohol use and depression trajectories in adulthood. Alcoholism: Clinical and Experimental Research, 43(2), 342–352.
Warden, D., Riggs, P. D., Min, S. J., Mikulich-Gilbertson, S. K., Tamm, L., Trello-Rishel, K., & Winhusen, T. (2012). Major depression and treatment response in adolescents with ADHD and substance use disorder. Drug and Alcohol Dependence, 120(1–3), 214–219.
Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., et al. (2011). Does ADHD predict substance use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 50(6), 543–553.
Yoshimasu, K., Barbaresi, W. J., Colligan, R. C., Voigt, R. G., Weaver, A. L., & Katusic, S. K. (2016). Mediating and Moderating Role of Depression, Conduct Disorder or Attention-Deficit/Hyperactivity Disorder in Developing Adolescent Substance Use Disorders: A Population-Based Study. PLoS One, 11(6), e0157488.
Acknowledgements
Collaborators formerly at NIMH: Benedetto Vitiello, (University of Turin); Joanne B. Severe; Peter S. Jensen (currently University of Arkansas); L. Eugene Arnold (currently Ohio State University); Kimberly Hoagwood, (currently Columbia); early-phase NIMH contributors: John Richters; Donald Vereen. Site PIs/Co-Is: University of California, Berkeley/San Francisco: Stephen P. Hinshaw (Berkeley), Glen R. Elliott (San Francisco); Duke University: Karen C. Wells; Jeffery N. Epstein (currently Cincinnati Children’s Hospital); Desiree W. Murray (currently UNC Chapel Hill); early-phase Duke contributors: C. Keith Conners; John March; University of California, Irvine: James Swanson, Timothy Wigal; UCLA contributor: Dennis P. Cantwell; NYU School of Medicine: Howard B. Abikoff; Montréal Children’s Hospital/McGill University: Lily Hechtman; NY State Psychiatric Institute/ Columbia University/Mount Sinai Medical Center: Laurence L. Greenhill; Jeffrey H. Newcorn; University of Pittsburgh: Brooke Molina; Betsy Hoza (University of Vermont); William E. Pelham (currently Florida International University). Follow-up statistical collaborators: Robert D. Gibbons (University of Illinois, Chicago); Sue Marcus (Mt. Sinai College of Medicine); Kwan Hur (University of Illinois, Chicago). Original study statistical/design consultant: Helena C. Kraemer (Stanford University). Collaborators from US Department of Education, Thomas Hanley and Karen Stern.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
J.T.M. consulted with Avanir. L.E.A. received research funding from Forest, Lilly, Noven, Roche/Genentech, Shire, Supernus, and YoungLiving (as well as NIH and Autism Speaks), and consulted with Pfizer, Tris Pharma, and Waypoint, and been on advisory boards for Arbor, Ironshore, Otsuka, Pfizer, Roche/Genentech, Seaside Therapeutics, and Shire. J.M.S. acknowledges research support, advisory board/ speaker’s bureau and/or consulting for Alza, Richwood, Shire, Celgene, Novartis, Celltech, Gliatech, Cephalon, Watson, CIBA, UCB, Janssen, McNeil, Noven, NLS, Medice, and Lilly. J.N.E. received consulting fees from American Academy of Pediatrics and American Board of Pediatrics, received royalties from Multi-Health Systems, Optimal Medicine, and IXICO, and received research support from Akili Interactive Labs. A.R. was supported by an Alexander von Humboldt fellowship in 2017-2018. The other remaining authors have declared that they have no competing or potential conflicts of interest.
Ethical Approval
The Multimodal Treatment Study of Children with ADHD (MTA) was a National Institute of Mental Health (NIMH) cooperative agreement randomized clinical trial with the observational phase funded by NIMH and the National Institute on Drug Abuse (NIDA) to the following: University of California–Berkeley*: U01MH50461, N01MH12009, N01DA-8-5550; Duke University*: U01MH50477, N01MH12012, N01DA-8-5554; University of California, Irvine*: U01MH50440, N01MH12011, N01DA-8-5551; Research Foundation for Mental Hygiene (New York State Psychiatric Institute*/Columbia University): U01 MH50454, N01 MH12007, N01DA-8- 5552; Long Island–Jewish Medical Center*: U01 MH50453; New York University: N01MH 12,004, N01DA-8-5549; University of Pittsburgh*: U01 MH50467, N01MH 12,010, N01DA-8-5553; McGill University N01MH12008, N01DA-8-5548. A data analysis grant awarded to the University of Pittsburgh (DA039881) followed. IRB ethics approvals for primary data collection at the RCT and observational phases were obtained from all above sites marked with an asterisk* as well as at Mount Sinai Medical Center and Montréal Children’s Hospital. The opinions and assertions contained in this report are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Health and Human Services, the National Institutes of Health or the National Institute of Mental Health.
Informed consent
Informed consent (parental permission and child assent) was obtained from all participating families prior to completing study procedures. Once they reached age 18, participants provided their own informed consent. All participating study sites (see Author note for a detailed list) obtained IRB ethics approval. Secondary data analysis procedures were approved by the Carleton University Research Ethics Board.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 224 kb)
Rights and permissions
About this article
Cite this article
Howard, A.L., Kennedy, T.M., Macdonald, E.P. et al. Depression and ADHD-Related Risk for Substance Use in Adolescence and Early Adulthood: Concurrent and Prospective Associations in the MTA. J Abnorm Child Psychol 47, 1903–1916 (2019). https://doi.org/10.1007/s10802-019-00573-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-019-00573-y