Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects
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Objective To compare delinquent behavior and early substance use between the children in the Multimodal Treatment Study of Children With ADHD (MTA; N = 487) and those in a local normative comparison group (n = 272) at 24 and 36 months postrandomization and to test whether these outcomes were predicted by the randomly assigned treatments and subsequent self-selected prescribed medications.Method Most MTA children were 11 to 13 years old by 36 months. Delinquency seriousness was coded ordinally from multiple measures/reporters; child-reported substance use was binary.Results Relative to local normative comparison group, MTA children had significantly higher rates of delinquency (e.g., 27.1% vs. 7.4% at 36 months; p = .000) and substance use (e.g., 17.4% vs. 7.8% at 36 months; p = .001). Children randomized to intensive behavior therapy reported less 24-month substance use than other MTA children (p = .02). Random effects ordinal growth models revealed no other effects of initial treatment assignment on delinquency seriousness or substance use. By 24 and 36 months, more days of prescribed medication were associated with more serious delinquency but not substance use.Conclusions Cause-and-effect relationships between medication treatment and delinquency are unclear; the absence of associations between medication treatment and substance use needs to be re-evaluated at older ages. Findings underscore the need for continuous monitoring of these outcomes as children with attention-deficit/hyperactivity disorder enter adolescence.
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Prospective studies of children with ADHD have provided some evidence that those with co-occurring conduct and bipolar disorders have the highest risk for developing substance use disorder.
“Prospective studies of Children with ADHD have provided some evidence that the group with conduct and bipolar disorders co-occurring with ADHD have the highest risk for developing SUD.12–19”
From Does ADHD Predict Substance-Use Disorders? A 10-Year Follow-up Study of Young Adults With ADHD (2011) · cites this paper as [17]
The Discussion reports that substance use in children with ADHD was prospectively predicted by delinquency seriousness, providing some support for the conduct-related risk. It does not identify children with co-occurring conduct and bipolar disorders as the highest-risk group, and the measured outcome here was early substance use rather than development of substance use disorder. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe finding of few long-term benefits also applies to behavioral interventions.
“This finding also applies to behavioral interventions (Molina et al., 2007; Pelham, Jr. et al., 2008).”
From The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: Can we alter the developmental trajectory of ADHD? (2011) · cites this paper as Molina et al., 2007
Collective evidence suggests that stimulant medication use has few, if any, long-term benefits for children with ADHD.
“the collective evidence suggests that stimulant medication use has few, if any, long-term benefits for children with ADHD (Charles & Schain, 1981; Loe & Feldman, 2007; Molina et al., 2007; Paternite, Loney, Salisbury, & Whaley, 1999; Satterfield, Hoppe, & Schell, 1982; Swanson et al., 2007b; Weiss & Hechtman, 1993; Molina et al., 2009).”
From The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: Can we alter the developmental trajectory of ADHD? (2011) · cites this paper as Molina et al., 2007
Based on follow-up data from the MTA study, significantly higher rates of child-reported lifetime substance use at age 13 were reported in ADHD patients compared to a local normative comparison group (HRs 2.3).
“Based on follow-up data from the MTA study, significantly higher rates of child-reported lifetime substance use at age 13 were reported in ADHD patients compared to a local normative comparison group (HRs 2.3) [94].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [94]
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- [2]2. Dr. Vitiello has consulted to Richwood Pharmaceuticals. Dr. Hoza has received research funding from MediaBalance, Inc. and support for educational conferences from Abbott Laboratories. Dr. Pelham has received research funding from Alza, Shire, Noven, Eli Lilly, and Cephalon; has served on advisory boards of or has consulted to Alza/McNeil Richwood/Shire, Noven, Eli Lilly, Cephalon, Novartis, Celgene, and Abbott; and has been on the speakers_ bureaus of Shire, and McNeil. Dr. Elliott has received research funding from Cephalon, McNeil, Shire, Sigma Tau, Copyright @ 2007 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited. and Novartis; has consulted to Cephalon and McNeil; and has been on the speakers_ bureaus of Janssen, Eli Lilly, and McNeil. Dr. Abikoff has received research funding from McNeil, Shire, Eli Lilly, and Bristol- Myers Squibb; has consulted to McNeil, Shire, Eli Lilly, Pfizer, Celltech, Cephalon, and Novartis; and has been on the speakers_ bureaus of McNeil, Shire, and Celltech. Dr. Conners has received research funding from Celgene, Shire, Noven, Eli Lilly, Targacept, and Novartis; has consulted to Celgene, Shire, Novartis, Alza, and Noven; is on the Eli Lilly Advisory Committee, and has been on the speakers_ bureaus of Shire, McNeil, and Novartis. Dr. Epstein has received research funding from McNeil, Shire, Eli Lilly, Novartis; has been on the advisory board of Shire; and has been on the speakers_ bureaus of Shire and McNeil. Dr. Greenhill has received research funding from or has been on the speakers_ bureaus of Eli Lilly, Alza, Shire, Cephalon, McNeil, Celltech, Novartis, Sanofi Aventis, Otsuka, and Janssen. Dr. March has been a consultant or scientific advisor to or received research funding from Eli Lilly, Pfizer, Wyeth, Jazz, MedAvante, Shire, Cephalon, Organon, McNeil, and AstraZeneca; serves on a DSMB for Organon, Johnson & Johnson, and AstraZeneca; and holds stock in MedAvante. Dr. Newcorn has received research funding from or has been on the speakers_ bureaus of Eli Lilly, Alza, Shire, Celgene, McNeil, Celltech/UCB, Novartis, Sanofi Aventis, Janssen, and Bristol-Myers Squibb. Dr. Wigal has received research funding from Eli Lilly, Shire, Novartis, and McNeil and has been on the speakers_ bureaus of McNeil and Shire. The other authors have no financial relationships to disclose. REFERENCES American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), Washington, DC: American Psychiatric Association
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- Authors
- MOLINA, B. S. G., FLORY, K., HINSHAW, S. P., GREINER, A. R., ARNOLD, L. E., SWANSON, J. M., HECHTMAN, L., JENSEN, P. S., VITIELLO, B., HOZA, B., PELHAM, W. E., ELLIOTT, G. R., WELLS, K. C., ABIKOFF, H. B., GIBBONS, R. D., MARCUS, S., CONNERS, C. K., EPSTEIN, J. N., GREENHILL, L. L., MARCH, J. S., NEWCORN, J. H., SEVERE, J. B., & WIGAL, T.
- Affiliations
- University of Pittsburgh (US)
- University of South Carolina (US)
- University at Buffalo, State University of New York (US)
- The Ohio State University (US)
- McGill University (CA)
- University of Vermont (US)
- University of California, Irvine (US)
- New York University (US)
- University of Illinois Chicago (US)
- Icahn School of Medicine at Mount Sinai (US)
- Columbia University (US)
- McGill University Health Centre (CA)
- Corresponding author
- MOLINA, BROOKE S.G.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2007-08
- Volume
- 46
- Issue
- 8
- Pages
- 1028-1040
- ISSN
- 0890-8567 (ISSN-L)
- OpenAlex
- W2131818611
- Cited by
- 255
- References
- 72
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 7 · 2021: 7 · 2020: 6 · 2019: 6 · 2018: 13 · 2017: 14 · 2016: 12 · 2015: 11 · 2014: 19 · 2013: 18 · 2012: 25
- FWCI
- 14.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- U.S. Department of Justice
- U.S. Department of Education
- University of Pittsburgh (U01 MH50467, N01MH 12010)
- McGill University (N01MH12008)
- York University
- National Institutes of Health (n01mh12011-0-0-1, n01mh012009-007, n01mh12008-0-0-1, n01mh12010-0-0-1, n01mh12004-0-0-0, n01mh12007-0-0-0, n01mh012012-001)
- University of North Carolina at Chapel Hill
- National Institute of Mental Health (N01MH 12011, U01MH50461, N01 MH12007, N01MH-12012, U01MH50440, N01MH12008,, U01MH050467, MH-50467, U01 MH50477, U01MH050440, N01 MH12009, U01MH050453, U01MH50467, U01MH050461, N01MH 12004, U01MH50453, N01MH 12010, 12010)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- delinquency, substance use, attention deficit hyperactivity disorder, stimulant medication, treatment effects, adolescence
- MeSH terms
- Adolescent, Behavior Therapy, Child, Cognition Disorders, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Juvenile Delinquency, Male, Surveys and Questionnaires, Prevalence, Treatment Outcome, Disease Progression, Substance-Related Disorders
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