CoChat
Sign Up
Cited by 67Attention Deficit Hyperactivity DisorderAutism Spectrum Disorder ResearchPrenatal Substance Exposure Effects

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

Open access
Ottosen, Cæcilie, Petersen, Liselotte, Larsen, Janne Tidselbak, Dalsgaard, Søren·2016·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2015.12.010
Open this paper in CoChat — free accountOpen PDF

Abstract

OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.

Integrity signals

Registry

Crossref · 10.1016/j.jaac.2015.12.010

Cites

59 of 59 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 14 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Earlier onset of treatment seems to be a protective factor.

    “and earlier onset of treatment seems to be a protective factor.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [6] Steinhausen, 2014, Substance use disorders in association with attention-deficit/hyperactivity disorder, co-morbid mental disorders, and medication in a nationwide sample, Eur Neuropsychopharmacol source
    • cites [7] Dalsgaard, 2014, ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood—a naturalistic long-term follow-up study, Addict Behav source

      The available passages, including those labelled Abstract (no page given), contain bibliographic information and keywords but no findings about when treatment began. Searches for earlier treatment onset, age at initiation, and a protective effect found no passage addressing the claim. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
  • Premisecitation

    Stimulant treatment of ADHD may reduce the risk of developing SUD.

    “Stimulant treatment of ADHD may also reduce the risk of developing SUD”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [7] Dalsgaard, 2014, ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood—a naturalistic long-term follow-up study, Addict Behav source

      The available passages identify the study and list substance use disorder as a keyword, but provide no results about whether stimulant treatment reduces its risk. Further searches for a reduced risk or protective effect returned only bibliographic material, so the claim cannot be verified from our copy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
    • cites [52] Groenman, 2013, Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder, Br J Psychiatry source
  • Findingown data

    In females with ADHD, the risk of alcohol abuse was increased compared to females without ADHD (HR 1.72, 95% CI 1.42-2.08).

    “ADHD increased the risk of alcohol abuse (HR females ¼ 1.72 [95% CI ¼ 1.42-2.08]”
    Quote in the paperSubstantial claim
  • Findingown data

    Comorbid ODD/CD in individuals with ADHD further increased the risk of all 3 types of SUD (p<.005).

    “Having comorbid ODD/CD or schizophrenia resulted in a higher risk of all 3 types of SUD, in both females and males (p < .005).”
    Quote in the paperSubstantial claim
  • Findingown data

    Females with ADHD without any of 10 comorbid psychiatric disorders had increased risk of other illicit substance abuse (HR 4.79) compared to female controls without these disorders.

    “and other illicit substances (HR ¼ 4.79 and 4.10) abuse”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 7
  • The quote only partly states this claim. 5
  • May combine two claims. 10

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Diagnostic and treatment practices in Denmark are conservative compared to those of many other countries.

    “and diagnostic and treatment practices in Denmark are conservative compared to those of many other countries.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [55] Dalsgaard, 2012, Relative standards in ADHD diagnoses: the role of specialist behavior, Econ Lett source
    • cites [56] Dalsgaard, 2014, Common Danish standards in prescribing medication for children and adolescents with ADHD, Eur Child Adolesc Psychiatry source
    • cites [57] Dalsgaard, 2013, J Child Adolesc Psychopharmacol source

      The Discussion (page unavailable) reports lower ADHD-medication prevalence in Denmark than in many other Western countries and says only authorized specialists can initiate ADHD treatment for youth. This supports a narrower claim about ADHD medication, but the paper does not establish that Danish diagnostic practices, or treatment practices generally, are more conservative. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • The quote only partly states this claim.

    Findingown data

    Comorbid depression further increased the risk of SUD in individuals with ADHD compared to non-ADHD.

    “Comorbid depression also added significantly to the risk of cannabis abuse in females and males with ADHD, compared to ADHD alone (p < .05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Males with ADHD and ASD had an increased risk of cannabis abuse only when compared to individuals without these psychiatric disorders, not an increased risk of alcohol or other illicit substance abuse.

    “In fact, males with ADHD and ASD had an increased risk of cannabis abuse only when compared to individuals without these psychiatric disorders, not an increased risk of alcohol or other illicit substance abuse.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Comorbid bipolar disorder further increased the risk of SUD in individuals with ADHD compared to non-ADHD.

    “In females, comorbid bipolar disorder further increased the risk of alcohol, cannabis, and other illicit substance abuse (all p < .005).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Adjusting for effect of comorbid disorders in individuals with ADHD had much stronger effects, and HRs were significantly lowered (model 3).

    “However, adjusting for the effect of comorbid disorders in the individuals with ADHD had much stronger effects, and HRs were significantly lowered (model 3).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In a nationwide cohort of all children born in Denmark 1990 to 2003, the gender difference in crude hazard ratio for other illicit substances is statistically significant (p = .016).

    “Gender difference | - | - | p ¼ .016 | p ¼ .033 | p ¼ .067 | p ¼ .305”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In a nationwide cohort of all children born in Denmark 1990 to 2003, the gender difference in fully adjusted (Model 3) hazard ratio for other illicit substances is not statistically significant (p = .305).

    “Gender difference | - | - | p ¼ .016 | p ¼ .033 | p ¼ .067 | p ¼ .305”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    In a nationwide cohort of all children born in Denmark 1990 to 2003, for males with ADHD alone, the fully adjusted hazard ratio for cannabis abuse is 4.20 (95% CI 3.36-5.24).

    “Males | 1.81 (1.54e2.14) | 4.20 (3.36e5.24) | 4.10 (3.24e5.21)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Although in crude and partially adjusted models, females did have significantly higher risk of SUD than males with ADHD, this was explained mainly by differences in comorbidities, as no statistically significant gender differences were found in fully adjusted analyses.

    “Although in the crude and partially adjusted models, females did have significantly higher risk of SUD than males with ADHD, this was explained mainly by differences in comorbidities, as no statistically significant gender differences were found in the fully adjusted analyses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    This may have biased our results, as comorbidities of moderate to severe severity may more likely have been diagnosed as compared to individuals with less severe or less impairing comorbid conditions.

    “This may have biased our results, as comorbidities of moderate to severe severity may more likely have been diagnosed as compared to individuals with less severe or less impairing comorbid conditions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    We were not able to include use of nicotine in individuals with ADHD, and the estimated risk of SUD may have been underestimated due to this.

    “In addition, we were not able to include use of nicotine in individuals with ADHD, and the estimated risk of SUD may have been underestimated due to this.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Bias in selection of study population and nondifferentiated attrition during follow-up are unlikely explanations of our findings.

    “Thus, bias in selection of study population and nondifferentiated attrition during follow-up are unlikely explanations of our findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Females with ADHD are often perceived as less impaired than males with ADHD.

    “although females with ADHD are often perceived as less impaired than males with ADHD”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Quinn, 2004, Perceptions of girls and ADHD: results from a national survey, MedGenMed

  • May combine two claims.

    Study design and conductreasoning

    The extensive Danish registers provide detailed information about birth characteristics, SES, familial history of psychiatric disorders, and psychiatric disorders of the children themselves, which enabled adjustment for these possible confounders and also follow-up of exposure and outcomes over the course of time, by applying time-dependent variables in a time-to-event model.

    “The extensive Danish registers provide detailed information about birth characteristics, SES, familial history of psychiatric disorders, and psychiatric disorders of the children themselves, which enabled adjustment for these possible confounders and also follow-up of exposure and outcomes over the course of time, by applying time-dependent variables in a time-to-event model.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationcitation

    This contrasts with findings from a meta-analysis of 15 studies... which found that individuals with ADHD without comorbid ODD/CD were not at increased risk for SUD.

    “This contrasts with findings from a meta-analysis of 15 studies including 1,000 participants (ADHD and controls), which found that individuals with ADHD without comorbid ODD/CD were not at increased risk for SUD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Serra-Pinheiro, 2013, Is ADHD a risk factor independent of conduct disorder for illicit substance use? A meta-analysis and metaregression investigation, J Atten Disord source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Prevalence of comorbid disorders was lower than in some other studies, and this may be due to underreporting of comorbidities in the registers.

    “Prevalence of comorbid disorders was lower than in some other studies, and this may be due to underreporting of comorbidities in the registers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    We included only children diagnosed with ADHD at a hospital department, and these individuals may have more impairing ADHD than those diagnosed by child and adolescent psychiatrists in private practices, and our results may not be generalizable to the latter.

    “We included only children diagnosed with ADHD at a hospital department, and these individuals may have more impairing ADHD than those diagnosed by child and adolescent psychiatrists in private practices, and our results may not be generalizable to the latter.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Females tend to be diagnosed with ADHD at an older age than males.

    “In addition, females tend to be diagnosed with ADHD at an older age than males”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Dalsgaard, 2015, Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study, Lancet Psychiatry source

  • May combine two claims.

    Study design and conductnone given

    We studied a nationwide population-based cohort including all children born in Denmark between 1990 and 2003, with almost complete follow-up data for up to 22 years.

    “We studied a nationwide population-based cohort including all children born in Denmark between 1990 and 2003, with almost complete follow-up data for up to 22 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Our study had stronger power to assess effects of comorbid ODD/CD, and estimated fully adjusted risk of SUD in individuals without such comorbidity.

    “However, compared to the meta-analysis, our study had stronger power to assess the effects of comorbid ODD/CD, and estimated the fully adjusted risk of SUD in individuals without such comorbidity.”
    Quote in the paperSubstantial claim
20 of 20

  • The paper relies on this without support.

    SUD diagnoses recorded in the Danish registers are valid and complete enough to estimate associations with ADHD.

    “Diagnoses in the registers are clinical diagnoses, not the result of systematic, well-described, uniform assessments.”

  • The paper relies on this without support.

    The measured covariates (birth characteristics, SES, family psychiatric history) adequately control for confounding of the ADHD-SUD association.

    “The extensive Danish registers provide detailed information about birth characteristics, SES, familial history of psychiatric disorders, and psychiatric disorders of the children themselves, which enabled adjustment for these possible confounders”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Overall cannabis incidence falls below both gender-specific rates

    Major

    The reported overall cannabis incidence rate for children with ADHD is 25.0 per 10,000 person-years. It cannot be lower than both the female rate of 27.56 and the male rate of 28.59 for the same group.

  • Overall illicit-substance incidence exceeds both gender-specific rates

    Major

    The reported overall rate of 28.7 per 10,000 person-years is higher than both the female rate of 23.54 and the male rate of 22.40. A combined incidence rate for these groups must lie between their rates.

  • Female ADHD sibling-history percentage does not match its count

    Minor

    Table S3 lists 4,208 females with ADHD as having no sibling history of psychiatric illness, but labels that count 78.30%. Against the stated total of 5,144 females with ADHD, the count represents 81.80%.

    Reported 78.3 · recomputed 81.804044

  • Female ADHD education percentage does not match its count

    Minor

    Table S3 reports 2,098 females with ADHD in the high-school-diploma category as 14.14%. Even using all 5,144 females with ADHD as the denominator gives 40.79%; excluding any missing education records would increase that percentage.

    Reported 14.14 · recomputed 40.785381

4 of 4

Cites

Flagged first, then by citations

4 of the 63 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Ottosen, C., Petersen, L., Larsen, J. T., & Dalsgaard, S.
Affiliations
Aarhus University (DK)
Corresponding author
Dalsgaard, Søren
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2016-03
Volume
55
Issue
3
Pages
227-234.e4
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2015.12.010
OpenAlex
W2200089041
Cited by
67
References
63
Citations by year
2026: 1 · 2025: 7 · 2024: 5 · 2023: 6 · 2022: 4 · 2021: 9 · 2020: 7 · 2019: 7 · 2018: 6 · 2017: 8 · 2016: 6 · 2013: 1
FWCI
4.22
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Keywords
attention deficit hyperactivity disorder, substance use disorders, gender differences, comorbidities, alcohol abuse, cannabis use disorder, conduct disorder, depression
MeSH terms
Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Denmark, Female, Humans, Male

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review