Gender Differences in Associations Between Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 55; no. 3; pp. 227 - 234.e4
• Main Authors: Ottosen, Cæcilie, Petersen, Liselotte, Larsen, Janne Tidselbak, Dalsgaard, Søren
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016; Elsevier BV
• Subjects: ADHD; Adolescent; Alcohol abuse; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - psychology; Attention deficit hyperactivity disorder; Autism; Autism Spectrum Disorders; Autistic children; Bipolar disorder; Cannabis; Child; Child, Preschool; Children; Cohort analysis; Cohort Studies; Comorbidity; Conduct disorder; Denmark - epidemiology; Depression; Drug abuse; Female; Females; gender; Gender differences; Humans; Hyperactivity; Male; Males; Mental depression; Mental disorders; Pediatrics; Prospective Studies; Psychiatric/Mental Health; Psychiatry; Risk assessment; Risk Factors; Schizophrenia; Sex differences; Sex Factors; Socioeconomic factors; Socioeconomic status; Substance abuse; Substance use disorder; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Denmark; ADHD; gender; substance abuse; alcohol abuse
• ISSN: 0890-8567; 1527-5418; 1527-5418
• DOI: 10.1016/j.jaac.2015.12.010

To examine gender differences in the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD), and to explore the impact of comorbid psychiatric conditions. This was a cohort study of all children born in Denmark in 1990 to 2003 (n = 729,560). By record linkage across nationwide registers, we merged data on birth characteristics, socioeconomic status, familial psychiatric history, and diagnoses of ADHD (N = 19,645), comorbidities, and SUD. Hazard ratios (HR) with 95% CIs were estimated by Cox regression and adjusted for a range of variables. ADHD increased the risk of alcohol abuse (HRfemales = 1.72 [95% CI = 1.42–2.08], HRmales = 1.57 [1.37–1.79]), cannabis abuse (HRfemales = 2.72 [2.12–3.47], HRmales = 2.24 [1.86–2.70]), and other illicit substance abuse (HRfemales = 2.05 [1.54–2.73], HRmales = 2.42 [1.98–2.96]), compared to individuals without ADHD. In the overall estimates, no gender differences were found. Among individuals with ADHD without comorbidities, females had a higher SUD risk than males, as did females with ADHD and conduct disorder (CD). Comorbid CD, depression, bipolar disorder, and schizophrenia further increased the risk of SUD in ADHD, compared to non-ADHD. Autism spectrum disorder in males with ADHD lowered the SUD risk. ADHD increased the risk of all SUD outcomes. Individuals with ADHD without comorbidities were also at increased risk, and some comorbid disorders further increased the risk. Females and males with ADHD had comparable risks of SUD, although females had higher risk of some SUDs than males. Females with ADHD may be perceived as less impaired than males, but they are at equally increased risk of SUD.