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Cited by 335Substance Abuse Treatment and OutcomesChild and Adolescent Psychosocial and Emotional DevelopmentAttention Deficit Hyperactivity Disorder

Childhood Psychiatric Disorders as Risk Factor for Subsequent Substance Abuse: A Meta-Analysis.

Open access
Groenman, Annabeth P., Janssen, Tieme W.P., Oosterlaan, Jaap·2017·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2017.05.004
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Abstract

Meta-analysis finding that childhood ADHD, ODD, CD, and depression increase risk of later substance-related disorders, with substantial heterogeneity.

Integrity signals

Registry

Crossref · 10.1016/j.jaac.2017.05.004

Cites

75 of 75 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

8 of 18 cited sources checked · 3 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Two recent meta-analyses focused on childhood ADHD and the development of substance-related disorders prospectively showed an increased risk.

    “Exceptions to the first limitation are 2 recent metaanalyses that focused on childhood attention-deficit/ hyperactivity disorder (ADHD) and the development of substance-related disorders prospectively, which showed an increased risk.6,7”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [6] Charach, 2011, Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses, J Am Acad Child Adolesc Psychiatry source
    • cites [7] Lee, 2011, Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review, Clin Psychol Rev source
  • Premisecitation

    Heavy use is responsible for similar consequences (e.g., health, social) as dependence.

    “We included DSMdefined outcomes (e.g., SUDs, alcohol use disorder) and heavy use, because heavy use is responsible for similar consequences (e.g., health, social) as dependence.16”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [16] Rehm, 2013, Defining substance use disorders: do we really need more than heavy use?, Alcohol Alcoholism source
  • Interpretationcitation

    The disorders included in anxiety disorders appear to have a differential risk for substance-related disorders.

    “The disorders included in anxiety disorders appear to have a differential risk for substance-related disorders.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [9] Wittchen, 2007, Cannabis use and cannabis use disorders and their relationship to mental disorders: a 10-year prospective-longitudinal community study in adolescents, Drug Alcohol Depend source

      The Results (§3.3) and Discussion (§4; page numbers unavailable) report different associations for individual anxiety disorders: panic-anxiety predicted cannabis use, while specific phobias and GAD were associated with cannabis use disorder. This supports a differential pattern, but the study examined cannabis outcomes, not substance-related disorders generally. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Findingown data

    Childhood ODD or CD is associated with an increased risk for drug-related disorder, with an odds ratio of 4.24.

    “OR drugs 4.24, 95% CI 1.3.21.5.59”
    • Also stated in: § Conduct Disorder. · plain
      “Individuals with CD were at increased risk for developing alcohol-related disorder (OR 1.73), nicotine-related disorder (OR 4.22), drug-related disorder (OR 4.24), and any SUDs (OR 4.86”
    Quote in the paperSubstantial claim
  • Findingown data

    In anxiety disorders, meta-regression did not show significant effects.

    “Meta-regression did not show significant effects, but age at baseline and follow-up age lowered I 2”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 18
  • May combine two claims. 7
  • The quote only partly states this claim. 1

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

    Premisecitation

    Another study found the highest risk for substance-related disorders in childhood internalizing disorders.

    “another found the highest risk in childhood internalizing disorders, 9”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] Wittchen, 2007, Cannabis use and cannabis use disorders and their relationship to mental disorders: a 10-year prospective-longitudinal community study in adolescents, Drug Alcohol Depend source

      The Discussion (page unavailable) says the most pronounced associations with cannabis use and cannabis use disorder were among people with multiple disorders, not those with childhood internalizing disorders. It also says the implications of early childhood conditions for that risk were not addressed in this paper. (LLM, conf=0.85)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationreasoning

    Although self-medication plays a part in the co-occurrence of mental health disorders and substance-related disorders, a shared liability between the disorders likewise plays a role.

    “We suggest that although selfmedication plays a part in the co-occurrence of mental health disorders and substance-related disorders, a shared liability between the disorders likewise plays a role.”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [60][61][62]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [63] Pettersson, 2016, Common psychiatric disorders share the same genetic origin: a multivariate sibling study of the Swedish population, Mol Psychiatry source
    • cites [64] 2013, Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis, Lancet source

      The Introduction and Results discuss shared genetic liability among five psychiatric disorders, but none of the five is a substance-related disorder. Searches for self-medication, substance use, addiction, and alcohol dependence found no passage addressing the claimed co-occurrence or its proposed explanations. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [65] Hill, 1999, Psychopathology and achievement in children at high risk for developing alcoholism, J Am Acad Child Adolesc Psychiatry source

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

    Premisecitation

    One study found the highest risk for substance-related disorders in childhood externalizing disorders.

    “One study found the highest risk for substance-related disorders in childhood externalizing disorders, 8”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Gau, 2007, Psychiatric and psychosocial predictors of substance use disorders among adolescents: longitudinal study, Br J Psychiatry source

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

    Premisecitation

    Another study found a decreased risk compared with controls in those with childhood anxiety disorders.

    “and another study found a decreased risk compared with controls in those with childhood anxiety disorders.8”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Gau, 2007, Psychiatric and psychosocial predictors of substance use disorders among adolescents: longitudinal study, Br J Psychiatry source

      Table 3 (page not provided) reports a lower estimated risk of substance use disorder for adolescents with anxiety disorder than for those without it (hazard ratio 0.69 versus 1.00). But the 95% confidence interval (0.29–1.65) includes 1, and the Psychiatric predictors section says anxiety disorders did not significantly predict substance use disorder. The claim omits that uncertainty. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

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

    Premisecitation

    Another study found a relatively equal risk for childhood internalizing and externalizing disorders.

    “and another found a relatively equal risk for childhood internalizing and externalizing disorders.10”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Copeland, 2009, Childhood and adolescent psychiatric disorders as predictors of young adult disorders, Arch Gen Psychiatry source

      The Results sections on childhood-to-young-adulthood prediction report later disorders associated with childhood anxiety or depression and with childhood conduct or oppositional defiant disorder. They do not compare the risks for internalizing and externalizing disorders as groups or establish that those risks are relatively equal. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims. The quote only partly states this claim.

    Findingown data

    Childhood anxiety disorder is not associated with an increased risk for any substance use disorder, with an odds ratio of 1.22.

    “or SUDs (OR 1.22”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The meta-analysis identified 37 studies including more than 762,187 participants for quantitative analyses.

    “Thirty-seven studies including more than 762,187 participants were identified for quantitative analyses.”
    • Also stated in: § Studies Included in Meta-Analysis · plain
      “Thirty-seven studies including 762,187 participants were identified for quantitative analyses; for a summary, see Table 1”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In ADHD, meta-regression showed significantly larger effect sizes in studies including participants younger at baseline and those with higher quality ratings.

    “Meta-regression showed significantly larger ESs in those studies including participants younger at baseline and those with higher quality ratings.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Ninety-seven effect sizes were extracted for analyses.

    “Ninety-seven effects sizes were extracted for analyses.”
    • Also stated in: § Studies Included in Meta-Analysis · plain
      “In total, 97 ESs were extracted for analyses.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    A total response rate of 73% was reached when contacting investigators for missing data.

    “A total response rate of 73% was reached.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Publication bias was assessed using funnel plots, the Egger test, and the Rosenthal failsafe N.

    “Publication bias was assessed using funnel plots, the Egger test, and the Rosenthal failsafe N.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Two researchers conducted all review stages.

    “Two researchers conducted all review stages.”
    • Also stated in: § METHOD Study Selection · plain
      “Authors A.G. and T.J. (postdoctoral researchers) performed the selection of studies.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    One study found the highest risk for substance-related disorder in those with childhood anxiety disorders compared with other disorders.

    “one study found the highest risk for substance-related Supplemental material cited in this article is available online.disorder in those with childhood anxiety disorders compared with other disorders, 4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Conway, 2016, Association of lifetime mental disorders and subsequent alcohol and illicit drug use: results from the National Comorbidity Survey–Adolescent Supplement, J Am Acad Child Adolesc Psychiatry source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Some studies have shown that ADHD is a risk factor for substance-related disorders, whereas others have shown that the risk for substance-related disorders is carried by comorbid ODD or CD.

    “Some studies have shown that ADHD is a risk factor for substance-related disorders, [12][13][14] whereas others have shown that the risk for substance-related disorders is carried by comorbid ODD or CD. 15”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12][13][14]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [15] August, 2006, Prospective study of adolescent drug use among community samples of ADHD and non-ADHD participants, J Am Acad Child Adolesc Psychiatry source

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

    Study design and conductnone given

    Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed.

    “Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed.”
    • Also stated in: § Abstract · plain
      “Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed (available on request).”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    Authors A.G. and T.J. independently rated the quality of the selected studies using the Newcastle-Ottawa Scale.

    “Authors A.G. and T.J. independently rated the quality of the selected studies using the Newcastle-Ottawa Scale.24”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Published 2014.

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

    Study design and conductnone given

    Interrater discrepancies were resolved by consensus.

    “Interrater discrepancies were resolved by consensus.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Substantial agreement was found between the authors for quality ratings (k = 0.92).

    “Substantial agreement was found between the authors (k ¼ 0.92).”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    In depression, leave-one-out analyses did not show that removal of any studies would lead to a change in results.

    “Leave-oneout analyses did not show that removal of any studies would lead to a change in results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The risk found in persons with a childhood mental health disorder is not the result of poor quality studies but is truly concerning.

    “indicating the risk found in persons with a childhood mental health disorder is not the result of poor quality studies but is truly concerning.”
    Quote in the paperSubstantial claim

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

    Interpretationreasoning

    One possible explanation for the inconsistent results is that Serra-Pinheiro et al. included studies that were statistically adjusted for other measurements, decreasing the ecologic validity of their findings.

    “One possible explanation for these inconsistent results is that Serra-Pinheiro et al. included studies that were statistically adjusted for the impact of not only comorbid ODD or CD but also other measurements, such as age, gender, socioeconomic status, parental substance use, and comorbidities other than ODD or CD, significantly decreasing the ecologic validity of their findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The use of stringent criteria for selecting studies applied across disorders increases the comparability of the results.

    “The use of stringent criteria for selecting studies applied across disorders increases the comparability of the results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study was able to assess only the effects of comorbid ODD or CD in ADHD but did not have data to study the effects of other comorbidities in other disorders.

    “We were able to assess only the effects of comorbid ODD or CD in ADHD but did not have data to study the effects of other comorbidities in other disorders.”
    Quote in the paperNot a substantial claim
23 of 23

  • The authors state this as an assumption.

    Including high-risk participants (children of parents with a psychiatric disorder or substance-related problems, or participants with prenatal exposure to substances) would artificially inflate the risk of substance-related problems and cloud the generalizability of results concerning mental health disorders.

    “We did not consider studies that included high-risk participants (i.e., children of parents with a psychiatric disorder or substance-related problems or participants with prenatal exposure to substances), because we believed this would artificially inflate the risk of substance-related problems, clouding the generalizability of results concerning mental health disorders.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • ADHD frequently co-occurs with other psychiatric conditions, particularly depression, bipolar disorder, autism, anxiety, oppositional defiant disorder, conduct disorder, eating disorders, and substance use disorders.

    “Many large epidemiologic and clinical studies show that ADHD often co-occurs with other psychiatric disorders, especially depression, bipolar disorder, autism spectrum disorders, anxiety disorders, oppositional defiant disorder, conduct disorder, eating disorders, and substance use disorders”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Groenman et al., 2017

    The discussion under Figure 2 explicitly describes ODD and conduct disorder as comorbid with childhood ADHD. The Externalizing Disorders section reports an increased risk of later substance use disorders, not their co-occurrence with ADHD. The paper does not establish frequent co-occurrence with the other listed conditions or document the claimed breadth of epidemiologic and clinical evidence; page numbers were not available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In all four meta-analyses, childhood ADHD was associated with an increased risk of SUD in adolescence or early adulthood compared with non-ADHD controls, with mean odds ratios ranging from 1.34 to 3.48 for different types of SUD.

    “In all four meta-analyses, childhood ADHD was associated with an increased risk of SUD in adolescence or early adulthood, compared with non-ADHD controls, with mean odds-ratios (OR) ranging from 1.34 to 3.48 (small-to-moderate association) for different types of SUD.”

    From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [2]

    The Externalizing Disorders section reports increased risks for four substance-related outcomes among people with childhood ADHD. But Table 2 gives pooled odds ratios of 1.52–2.61 for those outcomes, not the claimed 1.34–3.48; the Abstract uses 1.34 for anxiety disorders and 3.48 as a confidence-interval bound for depression-related nicotine disorder. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • Child- and adolescent-onset psychopathology increases the risk for developing substance use and substance use disorders.

    “Child- and adolescent-onset psychopathology is known to increase the risk for developing substance use and substance use disorders (SUDs).”

    From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Groenman et al. 2017

    The Mental Disorders in Childhood section reports increased later addiction risk among those with childhood mental disorders, and the Discussion reports increased risks of substance-related disorders for several childhood diagnoses. The Method: Study Selection section says the outcomes included disorders and heavy use, but not substance use in general; that broader part of the claim is not established by this paper. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Similar increased SUD risk findings have been shown for virtually all major psychiatric disorders of childhood.

    “Similar findings have been shown for virtually all major psychiatric disorders of childhood (Groenman et al. 2017).”

    From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Groenman et al. 2017

    The Abstract reports increased later substance-related disorder risk for childhood ADHD, ODD or CD, and depression. But it says anxiety disorders do not seem to increase that risk, so the claim's 'virtually all major psychiatric disorders' wording overstates the findings. Page numbers are not provided in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • A meta-analysis found that ADHD was associated with more than twofold greater odds of alcohol-use disorders and nicotine-related disorder.

    “A meta-analysis found that ADHD was associated with a more than twofold greater odds of alcohol-use disorders (13 studies, over 20,000 participants) and nicotine-related disorder (14 studies, over 1,800 participants) (Groenman et al., 2017).”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Groenman et al., 2017

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.

  • Publication-bias finding is assigned to nicotine instead of drugs

    Major

    The text attributes a significant Egger test and failsafe N of 2,502 to nicotine. Table 2 assigns those figures to drugs; its nicotine row instead gives a nonsignificant Egger test (p = .37).

  • Depression publication-bias figures disagree

    Minor

    The text and Table 2 give different Egger-test statistics, p values, and failsafe Ns for depression and addiction, although both indicate publication bias.

  • Anxiety pooled result differs between abstract and table

    Minor

    The abstract reports 15 studies and an OR of 1.34, while Table 2 reports 14 and an OR of 1.15 for anxiety and addiction.

  • ODD/CD pooled result differs between abstract and table

    Minor

    The abstract gives eight studies and a pooled OR of 3.18; Table 2 gives nine and an OR of 3.38 for the same addiction outcome.

  • Study categories add up to 39, not 37

    Minor

    The stated counts for studies of individual disorders and combinations sum to 39, whereas the paper reports 37 studies in the quantitative analysis.

    Reported 37 · recomputed 39

  • Conduct-disorder sample exceeds the reported total

    Minor

    The paper reports 434 participants with ODD or CD across the included studies, but its study summary lists 873 participants with CD in one study alone.

6 of 6

Cites

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Related

Authors
Groenman, A. P., Janssen, T. W. P., & Oosterlaan, J.
Affiliations
  • University Medical Center Groningen (NL)
  • Vrije Universiteit Amsterdam (NL)
Corresponding author
Groenman, Annabeth P.
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2017-07
Volume
56
Issue
7
Pages
556-569
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2017.05.004
OpenAlex
W2612899553
Semantic Scholar
3a8ee19d263aef3e474cdacacaa9d7b81826402f
Cited by
335
References
70
Citations by year
2026: 26 · 2025: 44 · 2024: 39 · 2023: 52 · 2022: 46 · 2021: 40 · 2020: 37 · 2019: 31 · 2018: 18 · 2017: 2
FWCI
3.19
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)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (acceptedVersion, other-oa)
  • VU Research Portal (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • Vrije Universiteit Amsterdam
  • Accare
  • Universitair Medisch Centrum Groningen
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Keywords
child psychopathology, substance use disorders, substance abuse risk, attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, anxiety disorders, depression, alcoholism, nicotine dependence, drug use disorders, comorbidities, addiction risk factors, psychosocial interventions, prevention programs, addiction treatment programs
MeSH terms
Adolescent, Adult, Anxiety Disorders, Child, Depressive Disorder, Humans, Attention Deficit and Disruptive Behavior Disorders, Substance-Related Disorders, Young Adult

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.

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