Smoking and ADHD: Is There a Connection?

Female adolescents who had severe symptoms of attention deficit hyperactivity disorder (ADHD) as children are more likely to become smokers, a new study showed.

For their study, the researchers assessed 3 samples of same-sex twins (N=3762; 64% monozygotic). Of these, 1 cohort had oversampled female adolescents who had ADHD as children.
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The researchers estimated smoking outcomes by age 17 years by assessing regressions of ADHD-related symptoms. ADHD effects were categorized based as shared or nonshared among sets of twins or within different pairs.

Findings revealed that participants with more severe ADHD symptoms during childhood had greater odds of becoming smokers at a younger age. The association between ADHD symptoms and daily smoking, number of cigarettes per day, and nicotine dependence was more pronounced in adolescent girls than adolescent boys.

In monozygotic female twins, those with greater attentional issues than their co-twins had a greater involvement with nicotine. This was found to be consistent with possible causal influence.

The association of hyperactivity-impulsivity with smoking was also stronger in adolescent girls. However, it appeared primarily noncausal.

“Smoking initiation and escalation are affected differentially by ADHD subtype and gender,” the researchers wrote. “The association of inattention with smoking in female adolescents may be causal, whereas hyperactivity-impulsivity appears to act indirectly, through shared propensities for both ADHD and smoking.”

—Christina Vogt

Reference:

Elkins IJ, Saunders GRB, Malone SM, et al. Increased risk of smoking in female adolescents who had childhood ADHD. Am J Psychiatry. 2018;175(1):63-70. https://doi.org/10.1176/appi.ajp.2017.17010009.