ADHD in Childhood Ups Risk of Smoking

People who reported symptoms of attention-deficit hyperactivity disorder in childhood have a greater risk of becoming cigarette smokers later in life.

While the researchers who reported these findings looked only at self-reported symptoms and not a clinical diagnosis of attention-deficit hyperactivity disorder (ADHD), the study could help in fine-tuning smoking prevention programs.

“This gives us some additional insight into the kinds of things that place people at risk for smoking, and that is all of these [ADHD] symptoms,” said study author Scott H. Kollins, an assistant professor of psychiatry at Duke University Medical Center. “The far-reaching implications are that this can provide additional ways of identifying kids who are at risk of smoking earlier who can be targeted for specialized intervention.”

The findings appear in the October issue of the Archives of General Psychiatry.

ADHD is one of the most commonly diagnosed mental health disorders in children, affecting up to 5 percent of school-age children. Children with ADHD are at risk for other behavioral problems, including defiance, and, eventually, more severe problems like stealing and fighting.

These same conduct problems are also often linked to drug abuse and, indeed, an earlier study found that children diagnosed with ADHD were more likely to use illicit drugs as adolescents and to start using at an earlier age.

Other studies have also shown an association between ADHD and smoking, and some research has suggested that inattentiveness might be at the root of the risk. Adults with ADHD also report more difficulty quitting smoking than individuals in the general population.

“We do know that people who have a clinical diagnosis of ADHD smoke more than those who don’t,” Kollins said.

Kollins and his colleagues wanted to see if there was a relationship between symptoms of ADHD and smoking.

To that end, they looked at data on 13,852 individuals who had participated in the National Longitudinal Study of Adolescent Health and who had provided information on ADHD symptoms such as inattentiveness and impulsivity, as well as on their smoking status.

“These people were asked when they were 22 or 23 years of age to think back between the ages of 5 and 12 and tell us how much they exhibited these symptoms,” Kollins explained.

Each reported symptom of ADHD increased the likelihood of regular smoking. Participants who reported ADHD symptoms also started smoking earlier, and smoked more cigarettes than individuals who did not report such symptoms.

At this time, it’s not clear if the relationship is a causal one. “We certainly don’t want to say that ADHD symptoms cause people to smoke,” Kollins said.

The working hypothesis is that “people who are diagnosed with ADHD may experience the effects of nicotine and nicotine withdrawal in a way that’s a little bit different from those who aren’t diagnosed or who don’t have many symptoms,” Kollins said. “There may be a difference in how they respond to nicotine or how they experience withdrawal. It’s interesting, and it needs more research.”

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