The indirect effects of childhood attention deficit hyperactivity disorder on alcohol problems in adulthood through unique facets of impulsivity.

BACKGROUND AND AIMS Research has not studied unique impulsivity dimensions as prospective links between childhood attention deficit hyperactivity disorder (ADHD) and alcohol problems. We examined the association between childhood ADHD, five facets of impulsivity and alcohol problems in adulthood and the indirect effects of childhood ADHD-to-impulsivity-to-alcohol problems. DESIGN, SETTING AND PARTICIPANTS Participants were from a longitudinal study (n = 289, meanage  = 28.67) of individuals with (n = 170) and without (n = 119) childhood ADHD. The ADHD sample, as part of an ADHD summer treatment program, was diagnosed initially in childhood (1987-96, Pittsburgh, PA, USA) via structured parent interview and standardized parent/teacher ratings. The ADHD sample and demographically similar individuals without ADHD (living in the greater Pittsburgh area) were recruited to participate in the Pittsburgh ADHD Longitudinal Study (PALS) between 1999 and 2003. MEASUREMENTS Self-reported impulsivity (UPPS-P) and alcohol-related problems were assessed in adulthood (2011-14). FINDINGS Adults with, compared with those without, childhood ADHD had more alcohol problems (β = 0.34, P < 0.05) and higher levels of negative urgency, positive urgency, lack of perseverance and lack of planning (βs = 0.24-0.31, Ps < 0.001). Impulsivity facets (except sensation-seeking) were related to number of alcohol problems (βs = 0.34-0.61, Ps < 0.05). Negative (β = 0.26, P < 0.01) and positive (β = 0.27, P < 0.01) urgency mediated the association between childhood ADHD and number of adult alcohol problems. CONCLUSIONS Elevated levels of emotional impulsivity (negative/positive urgency) may place children with attention deficit hyperactivity disorder at increased risk for alcohol problems in adulthood.