[International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder]. / Internationale Konsenserklärung zu Screening, Diagnostik und Behandlung von Jugendlichen und Heranwachsenden mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung und gleichzeitigen Störungen durch Substanzgebrauch.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder.

BACKGROUND: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. OBJECTIVE: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. METHOD: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. RESULTS: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. CONCLUSION: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Stability and predictors of psychopathic traits from mid-adolescence through early adulthood.

High levels of psychopathic traits in youth are associated with multiple negative outcomes including substance misuse, aggressive behavior, and criminality. Evidence regarding stability of psychopathic traits is contradictory. No previous study has examined long-term stability of psychopathic traits assessed with validated clinical measures. The present study examined the stability of psychopathic traits from mid-adolescence to early adulthood and explored adolescent factors that predicted psychopathic traits five years later. The sample included 99 women and 81 men who had consulted a clinic for substance misuse in adolescence. At an average age of 16.8 years, the adolescents were assessed using the Psychopathy Checklist: Youth Version (PCL: YV) and five years later using the PCL-Revised (PCL-R). Additionally, extensive clinical assessments of the adolescents and their parents were completed in mid-adolescence. Among both females and males, moderate to high rank-order stability was observed for total PCL and facet scores. Among both females and males, there was a decrease in the mean total PCL score, interpersonal facet score, affective facet score, and lifestyle facet score. However, the great majority of females and males showed no change in psychopathy scores over the five-year period as indicated by the Reliable Change Index. Despite the measures of multiple family and individual factors in adolescence, only aggressive behavior and male sex predicted PCL-R total scores in early adulthood after taking account of PCL:YV scores. Taken together, these results from a sample who engaged in antisocial behavior in adolescence suggest that factors promoting high psychopathy scores act early in life.

The validity of the Health-Relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI) among adolescents referred for a substance misuse problem.

The aim was to study the validity of 2 personality instruments, the Health-Relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI), among adolescents with a substance use problem. Clinical interviews were completed with 180 adolescents and followed up after 12 months. Discriminant validity was demonstrated in the lack of correlation to intelligence in both instruments' scales. Two findings were in support of convergent validity: Negative affectivity (HP5i) and harm avoidance (JTCI) were correlated to internalizing symptoms, and impulsivity (HP5i) and novelty seeking (JTCI) were correlated to externalizing symptoms. The predictive validity of JTCI was partly supported. When psychiatric symptoms at baseline were controlled for, cooperativeness predicted conduct disorder after 12 months. Summarizing, both instruments can be used in adolescent clinical samples to tailor treatment efforts, although some scales need further investigation. It is important to include personality assessment when evaluating psychiatric problems in adolescents.

Associations between psychopathic traits and mental disorders among adolescents with substance use problems.

OBJECTIVES: The aim of this study was to examine the association between psychopathic traits and mental disorders and to study associations between psychopathic traits and familial problems across gender. DESIGN: This is a cross-sectional study. METHODS: One hundred and Eighty adolescents seeking help at a substance abuse treatment clinic (99 girls, 81 boys) and their parents (165 mothers, 90 fathers) were studied. The assessment included Psychopathy checklist: Youth version (PCL-YV) and SCID I/II or Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). RESULTS: Across gender, there was a positive correlation between externalizing symptoms and PCL-YV score. Among boys, there was a positive correlation between internalizing symptoms and PCL-YV score. Further, the behavioural dimension of psychopathy was predictive of externalizing symptoms across gender. The interpersonal and affective dimension of psychopathy predicted oppositional defiant disorder (ODD)-symptoms among girls. Parent problem behaviour predicted PCL-YV score amongst girls only. CONCLUSIONS: Psychopathic traits do not only exist among adolescents who are identified because of their criminal behaviour. There were gender differences in the association between symptoms and psychopathic traits. It is suggested that different dimensions of psychopathy predisposed substance use for girls and for boys, and that ODD is particularly important in the expression of psychopathic traits among girls. This study showed transmission of antisocial behaviour between two generations among girls.

Do psychopathic traits assessed in mid-adolescence predict mental health, psychosocial, and antisocial, including criminal outcomes, over the subsequent 5 years?

OBJECTIVE: To determine whether psychopathic traits assessed in mid-adolescence predicted mental health, psychosocial, and antisocial (including criminal) outcomes 5 years later and would thereby provide advantages over diagnosing conduct disorder (CD). METHOD: Eighty-six women and 61 men were assessed in mid-adolescence when they first contacted a clinic for substance misuse and were reassessed 5 years later. Assessments in adolescence include the Psychopathy Checklist-Youth Version (PCL-YV), and depending on their age, either the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Aged Children or the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). Assessments in early adulthood included the SCID, self-reports of psychosocial functioning, aggressive behaviour, and criminality and official criminal records. RESULTS: The antisocial facet score positively predicted the number of anxiety symptoms and likelihood of receiving treatment for substance use disorders (SUDs). Lifestyle and antisocial facet scores negatively predicted Global Assessment of Functioning scores. By contrast, the interpersonal score and male sex independently and positively predicted the number of months worked or studied, as did the interaction of Lifestyle × Sex indicating that among men, but not women, an increase in lifestyle facet score was associated with less time worked or studied. Interpersonal and antisocial scores positively predicted school drop-out. Antisocial facet scores predicted the number of symptoms of antisocial personality disorder, alcohol and SUDs, and violent and nonviolent criminality but much more strongly among males than females. Predictions from numbers of CD symptoms were similar. CONCLUSIONS: Psychopathic traits among adolescents who misuse substances predict an array of outcomes over the subsequent 5 years. Information on the levels of these traits may be useful for planning treatment.

Objectif : Déterminer si les traits psychopathiques évalués à la mi-adolescence prédisent les résultats de santé mentale, psychosociaux, et antisociaux (y compris criminels) 5 ans plus tard et procurent par le fait même des avantages par rapport au diagnostic du trouble des conduites (TC). Méthode : Quatre-vingt-six femmes et 61 hommes ont été évalués à la mi-adolescence lors de leur première visite à une clinique pour abus de substances et ont été réévalués 5 ans plus tard. Les évaluations à l'adolescence comprennent la liste de psychopathie­version pour adolescents (PCL-YV), et selon leur âge, l'échelle des troubles affectifs pour enfants et de schizophrénie pour enfants d'âge scolaire, ou l'entrevue clinique structurée pour le Manuel diagnostique et statistique des troubles mentaux, 4e édition (SCID). Les évaluations au début de l'âge adulte comprenaient la SCID, les auto-déclarations du fonctionnement psychologique, du comportement agressif, de la criminalité et d'autres casiers judiciaires officiels. Résultats : Le score à l'élément antisocial prédisait positivement le nombre de symptômes d'anxiété et la probabilité de recevoir un traitement pour troubles d'utilisation de substances (TUS). Les scores aux éléments mode de vie et antisocial prédisaient négativement les scores à l'évaluation globale de fonctionnement. Par contre, le score interpersonnel et le sexe masculin prédisaient indépendamment et positivement le nombre de mois de travail ou d'études, tout comme l'interaction du mode de vie avec le sexe indiquait chez les hommes, mais pas chez les femmes, qu'une augmentation du score à l'élément mode de vie était associée à moins de temps de travail ou d'études. Les scores interpersonnel et antisocial prédisaient positivement le décrochage scolaire. Les scores à l'élément antisocial prédisaient le nombre de symptômes du trouble de la personnalité antisociale, du TUS et d'utilisation d'alcool, ainsi que la criminalité violente et non violente, mais beaucoup plus fortement chez les hommes que chez les femmes. Les prédictions des nombres de symptômes du TC étaient semblables. Conclusions : Les traits psychopathiques chez les adolescents qui abusent de substances prédisent une gamme de résultats pour les 5 années subséquentes. L'information sur le niveau de ces traits peut être utile pour planifier un traitement.