Guest Lecture- Andrea Howard Flashcards
What does Andrea Howard study?
the development of substance use disorder in Children with ADHD
What are some impairments associated with ADHD?
Social and academic impairments. Symptoms and impairments often continue beyond adolescence.
How is ADHD treated?
with stimulant medication
How has ADHD prognosis been studied so far? (childhood to adolescence)
Childhood ADHD diagnosis : Established in childhood
Adjusted for various characteristics (sex), SES, comorbid disorders (especially conduct). ——–> By Late adolescence/early adulthood: Higher risk for dropping out, delinquent behaviour, getting fired, fewer close friends, more sexual partners, heavier substance use and dependence, early pregnancy, depression and anxiety
The MTA study: Method
Multimodal treatment study of ADHD. ADHD in children and their improvement, Psychologist and psychiatrists (CA and US), 14 month randomized clinical trial of treatment strategies for ADHD (Behaviour therapy, Assessed and differed to care) Random assignment and follow ups
Does stimulant medication combined with intensive
behavior therapy outperform
medication alone? (research question for MTA)
Not really. ADHD symptoms improved, Anyone who received medication improved significantly
Does childhood ADHD increase risk for adult substance use? What is the developmental course of risk?
Study follows individuals from 2 years to 16 years of age
ADHD vs non ADHD using substance relatively heavily in adulthood. Expected ADHD to progress quicker. Starting sooner and progressing faster.
What was the key question?
How much does atypical early involvement with substance use matter?
How did they measure substance use?
Measured substance use (self-report) scale of 0-3 (never- weekly). Drinking, marijuana, smoking, other illicit drugs (past year).
How did they measure early Atypical use?
Alcohol and smoking (age 15), marijuana and illicit drugs (16). Criterion A was trying a substance once before the age of 15 (alcohol, smoking) and 16/17 (drugs). Criterion B was heavy drinking, smoking more than once, marijuana more than once and heavy drugs any use before 17. Any A + B = early and atypical heavy use
What was the conclusion?
yes childhood ADHD increases risk for young adult use of marijuana (therapeutic) and cigarettes (stimulant/dopaminergic). No difference in heavy drinking or illicit drug use.
What is the impact of depressive symptoms on substance use in adolescence and adulthood? (other reasons explaining continuing and heavy use into adulthood)
Comorbidity. Time varying effects: period of unusually elevated symptoms predict shifts to high-risk trajectories of use.
Average effects: Some children with ADHD develop depressive symptoms and sometimes depressive disorders in adolescence, Symptoms might enhance teens’ ADHD related vulnerabilities to continuing substance use
What were the results?
Marijuana in Adolescence - time varying depressive symptoms. Higher changes of using marijuana at 17 and have expressed depressive symptoms 18% (compared to not expressing depressive symptoms - 14%). Being more depressed on average more likely to use marijuana.
Marijuana in Adulthood- average depressive symptoms in adolescence predict marijuana use in adults. (higher in adolescence = high use in adulthood). Adolescent depression predicts heavier use if no childhood ADHD history.
more results
In adolescence being more depressed on average= a little more likely to use marijuana.. About the same for ADHD and LNCG
In adulthood, average adolescent depression predicts heavier use if no childhood ADHD history.. ADHD are using at high rates regardless of adolescent depression
Current/future directions for the MTA
How are perceptions of peer substance use related to your own substance use?
Does a pattern of continued stimulant medication use to protect against later substance use?
How are changes in delinquent behavior related to changes in substance use involvement through adolescence?
What role do academic and vocational difficulties in adulthood
