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October 1998

Familial Risk Analysis of the Association Between Attention-Deficit/Hyperactivity Disorder and Psychoactive Substance Use Disorders

Author Affiliations

From the Pediatric Psychopharmacology Unit, Massachusetts General Hospital (Drs Milberger, Faraone, Biederman, and Wilens, and Ms Chu); the Harvard Institute of Psychiatric Epidemiology and Genetics (Dr Faraone); Harvard Medical School (Drs Milberger, Faraone, Biederman, and Wilens); and Massachusetts Mental Health Center (Dr Faraone), Boston.

Arch Pediatr Adolesc Med. 1998;152(10):945-951. doi:10.1001/archpedi.152.10.945

Objective  To test hypotheses about patterns of familial association between attention-deficit/hyperactivity disorder (ADHD) and psychoactive substance use disorders (PSUDs) by using the family study method.

Design  The first-degree relatives of clinically referred children and adolescents with ADHD (131 probands, 413 relatives) and healthy control probands (106 probands, 323 relatives) were assessed by blind raters.

Results  After stratifying the probands with ADHD and the control probands into those with PSUD (group 1 and group 3, respectively) and those without PSUD (group 2 and group 4, respectively), familial risk analyses revealed the following: (1) the risk for ADHD was not significantly different between relatives of group 2 and group 1 probands (19.6% vs 18.0%; P=.88), but these 2 risks were significantly greater than the risk to relatives of group 3 probands (1.0%; P=.01 and P=.02, respectively) and group 4 probands (7.0%; P=.001 and P=.01, respectively); (2) there were no significant differences in the risk for PSUD between relatives of group 1 (47.5%) and group 3 probands (39.7%; P=.40), but these risks were greater than the risk to relatives of group 2 (30.0%; P=.32) and group 4 probands (20.9%; P<.001); and (3) there was no evidence for nonrandom mating.

Conclusions  These findings are consistent with the hypothesis that ADHD and PSUD are transmitted independently in families. Because the probands were young adolescents, many have not lived through the age at risk for PSUD. Thus, the hypothesis stating that ADHD and PSUD represent variable expressions of a common underlying risk factor cannot be ruled out.