Childhood ADHD and Adulthood Alcohol Problems: The Role of Emotional Impulsivity

These findings are important, as CDC rank alcohol-attributable mortality as the third leading cause of preventable death in the United States.

According to CDC, attention deficit hyperactivity disorder (ADHD) is one of the most prevalent developmental disorders, and approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD in 2011. The average age of ADHD diagnosis is 7 years of age, and boys are more likely than girls (13% vs. 6%) to receive the diagnosis. In the present study, average age at diagnosis of ADHD was 9.40 years (SD=2.27), with a range of 5 to 16 years of age. Also, 90% of participants were between 5 and 12 years of age.

Investigators affiliated with the University of Pittsburgh, University of Houston-Clear Lake, Chatham University in Pittsburgh, and Florida International University, showed that elevated levels of emotional impulsivity among children diagnosed with ADHD are associated with an increased risk for alcohol problems such as alcohol use disorder (AUD) in adulthood. Their findings from a longitudinal study of individuals with (n=170; 88 male) and without (n=119; 89 male) childhood ADHD [an average of 15.25 years (SD=2.5) from childhood into adulthood] were reported in the journal Addiction, which is published by the Society for the Study of Addiction.

“The current study examines associations between childhood ADHD, five components of impulsivity (lack of planning, lack of perseverance, negative urgency, positive urgency, and sensation seeking) and alcohol problems in adulthood,” researchers wrote in their publication.

Researchers used a modified version of the Young Adult Alcohol Problems Screening Test (YAAPST) to assess alcohol problems in adulthood among participants with [29.02 years of age (SD=3.39)] and without [28.15 years of age (SD=3.32)] childhood ADHD. With regard to impulsivity, they used the UPPs-P impulsive behavior scale. Investigators included the following covariates in their analyses: gender, age at adult assessment, race, frequency of alcohol use, and conduct disorder diagnosis (assessed at the same time as childhood ADHD).

Findings indicate that childhood ADHD significantly predicted a higher number of alcohol problems in adulthood, as well as higher levels of 4 out of 5 impulsivity facets in adulthood. More specifically, childhood ADHD did not predict sensation-seeking behavior, but it did significantly predict lack of planning, lack of perseverance, negative urgency, and positive urgency.

The association between ADHD and number of alcohol problems in adulthood was mediated significantly by both negative and positive urgency, was mediated marginally by lack of perseverance, and was not mediated significantly by lack of planning.

These findings are important, as CDC rank alcohol-attributable mortality as the third leading cause of preventable death in the United States. And, on average, almost 70% of substance use disorders involve alcohol only (ie, alcohol use disorders).

“The current study addresses several existing gaps in the literature,” and “is the first to demonstrate that impulsive tendencies, in the context of strong positive or negative mood, are related significantly to alcohol problems in adulthood for individuals who had ADHD in childhood,” the authors concluded.

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Pedersen SL, Walther CA, Harty Sc, et al. The indirect effects of childhood attention deficit hyperactivity disorder on alcohol problems in adulthood through unique facets of impulsivity. Addiction. 2016;111(9):1582-1589.