The “Younger-Sibling-at-Risk Design”: a Pilot Study of Adolescents with ADHD and an Older Sibling with Substance Use Disorder
Open accessAbstract
INTRODUCTION: This article introduces a ?younger at-risk sibling? design to study progression from other psychopathologies to their substance use disorder (SUD) complications. The design selects not-yet-SUD adolescents with high-risk-for-SUD psychopathology only if an older sibling has SUD. This "proof of concept' pilot study examines the design?s feasibility if the younger sibling has attention deficit hyperactivity disorder (ADHD). METHOD: Subjects were recruited from families at substance abuse treatment centers that had a non-SUD younger child with ADHD, from families at behavior disorder clinics that had a younger child with ADHD and SUD older child, and through general advertisements. Subjects were seen weekly for at least 3 months and monthly thereafter for 3 months. All were treated with open-label lisdexamfetamine dimesylate 30-70 mg per day. Outcomes explored were recruitment, compliance, diversion, ADHD improvement, and substance use interest. RESULTS: 25 families were screened, 13 evaluated, and 8 began medication. ADHD Rating Scale-IV scores obtained by parent?adolescent consensus improved as expected with a stimulant. Rating forms could quantify substance use interest in subjects with some drug culture exposure but encountered a floor effect in those without. The design's complexity and implicit commentary on family dynamics complicated recruitment but may have facilitated retention. CONCLUSION: Sibling pairs in which the older sibling has substance use and the younger sibling has ADHD exist. Such younger siblings can be recruited into a treatment study. The design may shed light on the pathogenesis and prevention of SUD complications from ADHD and theoretically other SUD comorbidities.
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In Donovan and Levin open-label study of eight adolescents with ADHD whose older siblings had substance misuse problems, subjects showed improvement in ADHD symptoms and on the modified Pretcher and Nash scale measuring perceived benefit of substance abuse.
“In an open-label lisdexamfetamine study with an innovative design, Donovan and Levin41 treated eight adolescents with ADHD whose older siblings had substance misuse problems. In addition to improvement in ADHD symptoms, the subjects also showed an improvement on the modified Pretcher and Nash scale which measures perceived benefit of substance abuse.”
From Update on optimal use of lisdexamfetamine in the treatment of ADHD (2013) · cites this paper as [41]
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Experimental — accuracy not yet measuredIn that study, drug accountability records showed that 90% of the unreturned medication was presumably taken as prescribed.
“Drug accountability records showed that 90% of the unreturned medication was “presumably having taking the pills as prescribed”.”
From Update on optimal use of lisdexamfetamine in the treatment of ADHD (2013) · cites this paper as [41]
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Donovan, S. J., Stewart, J. W., Nunes, E. V., Quitkin, F. M., Parides, M., Daniel, W., Susser, E., & Klein, D. F. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.5.818 · Cited by 273 · cited 2× · see citing works
“We found that, as in previous studies of aggression (9), peers were impractical and junior high school teachers were unresponsive, but parents and adolescent were able to reach consensus on ADHD symptoms as long as the questions were not seen as a venue to deliver criticism.”
MethodResultSelf-citationCommentary: Advent of sibling designs
Donovan, S. J., & Susser, E. (2011) · International Journal of Epidemiology · doi:10.1093/ije/dyr057 · Cited by 161 · see citing works
Self-citationWigal, T., Brams, M., Gasior, M., Gao, J., Squires, L., Giblin, J., & 316 Study Group (2010) · Behavioral and Brain Functions · doi:10.1186/1744-9081-6-34 · Cited by 136 · cited 1× · see citing works
“After oral ingestion, the inactive prodrug LDX is converted, primarily in the blood (11), to L-lysine and D-amphetamine, the latter being responsible for the therapeutic effect.”
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Update on optimal use of lisdexamfetamine in the treatment of ADHD
Madaan, V., Kolli, V., Bestha, D., & Shah, M. (2013) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s34092 · Cited by 19 · see citing works
“In an open-label lisdexamfetamine study with an innovative design, Donovan and Levin 41 treated eight adolescents with ADHD whose older siblings had substance misuse problems.”
- Authors
- Donovan, S. J., & Levin, F. R.
- Affiliations
- New York State Psychiatric Institute (US)
- National Center on Addiction and Substance Abuse at Columbia University (US)
- Corresponding author
- Donovan, Stephen J.
- ORCID
- Levin, Frances R.
- Venue
- The American Journal of Drug and Alcohol Abuse
- Publisher
- Informa UK Limited
- Published
- 2011-04-26
- Volume
- 37
- Issue
- 4
- Pages
- 235-239
- ISSN
- 0095-2990 (ISSN-L)
- 1097-9891
- PMC
- PMC3154771
- OpenAlex
- W2128494349
- Cited by
- 5
- References
- 3
- Citations by year
- 2018: 1 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Drug and Alcohol Abuse (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Shire
- National Institute on Drug Abuse (K02 DA 00451, K02DA000451, K24DA029647)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- attention deficit hyperactivity disorder, substance use disorders, adolescents, lisdexamfetamine, stimulant medication, family dynamics, recruitment and retention, ADHD comorbidity
- MeSH terms
- Lisdexamfetamine Dimesylate, Assessment of Medication Adherence, Adolescent, Adolescent Behavior, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Dextroamphetamine, Female, Humans, Male, Pilot Projects, Research Design, Risk Factors, Drug Monitoring, Diagnosis, Dual (Psychiatry), Substance-Related Disorders, Siblings, Medication Adherence
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