Age of Methylphenidate Treatment Initiation in Children With ADHD and Later Substance Abuse: Prospective Follow-Up Into Adulthood

• Published in: The American journal of psychiatry Vol. 165; no. 5; pp. 604 - 609
• Main Authors: Mannuzza, Salvatore, Klein, Rachel G., Truong, Nhan L., Moulton, John L., Roizen, Erica R., Howell, Kathryn H., Castellanos, Francisco X.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Association 01.05.2008
• Subjects: Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; Age Factors; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention deficit hyperactivity disorder; Behavior; Biological and medical sciences; Central Nervous System Stimulants - therapeutic use; Child; Children & youth; Drug abuse; Drug therapy; Follow-Up Studies; Humans; Hyperactivity; Incidence; Male; Medical sciences; Methylphenidate - therapeutic use; Miscellaneous; Neuropharmacology; Observer Variation; Parents; Parents & parenting; Pharmacology. Drug treatments; Prevalence; Prospective Studies; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Substance-Related Disorders - epidemiology; Surveys and Questionnaires; United States; North America; America; Human; Social environment; CNS stimulant; Psychotropic; Mental health; Pharmacotherapy; Male; Substance abuse; Treatment; School age; Follow up study; Piperidine derivatives; Adolescent; Young adult; Risk factor; Attention disorder with hyperactivity; Child; Age; Methylphenidate; Public health
• ISSN: 0002-953X; 1535-7228; 1535-7228
• DOI: 10.1176/appi.ajp.2008.07091465

Objective: Animal studies have shown that age at stimulant exposure is positively related to later drug sensitivity. The purpose of this study was to examine whether age at initiation of stimulant treatment in children with attention deficit hyperactivity disorder (ADHD) is related to the subsequent development of substance use disorders. Method: The authors conducted a prospective longitudinal study of 176 methylphenidate-treated Caucasian male children (ages 6 to 12) with ADHD but without conduct disorder. The participants were followed up at late adolescence (mean age=18.4 years; retention rate=94%) and adulthood (mean age=25.3; retention rate=85%). One hundred seventy-eight comparison subjects also were included. All subjects were diagnosed by blinded clinicians. The Cox proportional hazards model included the following childhood predictor variables: age at initiation of methylphenidate treatment, total cumulative dose of methylphenidate, treatment duration, IQ, severity of hyperactivity, socioeconomic status, and lifetime parental psychopathology. Separate models tested for the following four lifetime outcomes: any substance use disorder, alcohol use disorder, non-alcohol substance use disorder, and stimulant use disorder. Other outcomes included antisocial personality, mood, and anxiety disorders. Results: There was a significant positive relationship between age at treatment initiation and non-alcohol substance use disorder. None of the predictor variables accounted for this association. Post hoc analyses showed that the development of antisocial personality disorder explained the relationship between age at first methylphenidate treatment and later substance use disorder. Even when controlling for substance use disorder, age at stimulant treatment initiation was significantly and positively related to the later development of antisocial personality disorder. Age at first methylphenidate treatment was unrelated to mood and anxiety disorders. Conclusions: Early age at initiation of methylphenidate treatment in children with ADHD does not increase the risk for negative outcomes and may have beneficial long-term effects.