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Hyperactivity/impulsivity in childhood, but not inattention, is associated with early-onset tobacco and alcohol use

Statistics from


Question: Are attention-deficit hyperactivity disorder (ADHD) symptoms in children associated with early-onset substance use?

People: 1480 twin pairs born in Sweden between May 1985 and December 1986 who were alive and lived in Sweden at the time of data collection.

Setting: The Twin Study of Child and Adolescent Development (TCHAD), Sweden; 1994–2005.

Risk factors: ADHD symptoms, and conduct problem behaviours (CPB) at ages 8–9 years (wave 1) and at ages 13–14 years (wave 2). ADHD symptoms were measured using parent-reported checklists including 14 Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV-based items at wave 1 and 17 at wave 2. To assess CPB, parents completed a questionnaire with elements from the Child Behavior Checklist for Ages 6–18 (CBCL/6–18)—DSM-oriented conduct problems scale. ORs were adjusted for gender, the other ADHD symptom dimension and CPBs.

Outcomes: Substance use in the past 12 months, including tobacco, alcohol and illicit drug use, assessed at ages 13–14 years using self-report that was adopted from the Finnish longitudinal study of adolescent twins (FinnTwin12). Tobacco use ‘1–2 times’ or ‘once in a while’ in the past 12 months was classified as …

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  • Sources of funding: The Swedish Council for Working Life and Social Research and the Swedish Research Council. HL was supported by grants from the Swedish Research Council, Swedish Brain Foundation and Karolinska Institutet Center of Neurodevelopmental Disorders.

  • ▸ Additional data is published online only. To view this file please visit the journal online (


  • Competing interests None.

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