Smoking Risks for Female Adolescents with ADHD in Childhood

Children with more severe symptoms of attention deficit hyperactivity disorder (ADHD) are more likely to smoke cigarettes by age 17 and to start smoking at an earlier age, researchers reported in AJP in Advance.¹

According to the report, nicotine is the substance most consistently linked with ADHD.²  This is a persistent problem and raises the question of the nature of the link between smoking and ADHD. There is also the issue of smoking and female adolescents, because the majority of prospective clinical samples of children with ADHD in studies that investigate substance use include mostly or exclusively males.³

This study examined a total of 3762 individuals (52% females) at baseline. That sample included 1,881 like-sex twin pairs, 64% of them monozygotic and the remainder dizygotic. One group was assessed at age 17, and 2 groups were assessed at age 11 and followed to age 17. Assessments for all groups overlapped at age 17. Age 17 data were available for 92.5% of the combined sample.

Adolescents who had more severe ADHD symptoms as children were more likely to initiate smoking and to start smoking younger without significant gender moderation. Comparing female with male smoking adolescents, ADHD was associated with faster progression to daily smoking. Of note, the researchers observed a 27% increase in female adolescents (19% in males) in the odds of progressing one level toward daily smoking for each inattentive symptom, or 45% for each symptom of hyperactivity-impulsivity (24% in males).

In contrast, for hyperactivity impulsivity no monozygotic-within-pair estimates were significant (except for cigarettes smoked per day by females).

The investigators also commented that it is critical to prevent nicotine exposure among adolescent females because they may be more susceptible to the substance’s neurotoxic effects.

References

1. Elkins IJ, Saunders GRB, Malone SM, et al. Increased risk of smoking in female adolescents who had childhood ADHD [published online August 25, 2017]. Am J Psychiatry. doi:10.1176/appi.ajp.2017.17010009
2. Nigg JT. Attention-deficit/hyperactivity disorder and adverse healthy outcomes. Clin Psychol Rev. 2013;33:215-228.
3. Lee SS, Humphreyss KL, Flory K, et al. Prospective association of  childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. [published online January 20,2011]. Clin Psychol Rev. doi:10.1016/j.cpr.2011.01.006 .