Date of Award

August 2022

Degree Type


Degree Name

Doctor of Philosophy



First Advisor

Krista M Lisdahl

Committee Members

Christine L Larson, Hanjoo Lee, Ryan C Shorey, Bonita P Klein-Tasman


Previous literature has demonstrated a link between Attention-Deficit/Hyperactivity Disorder (ADHD) and substance use. However, few studies have examined how early substance use initiation in late childhood and early adolescents impacts ADHD symptoms overtime. To help investigate these trajectories we utilized the Adolescent Brain Cognitive Development (ABCD) Study, which includes 11,875 children (ages nine and ten at baseline) recruited from schools across 21 different study sites across the United States and followed for ten years. During study visits, participants and their parents completed questionnaires and interviews which were utilized for the current study. Participants were asked about past year substance use and ADHD symptoms, which were obtained through the Child Behavioral Checklist (CBCL) completed by parents. Further, additional demographic information, health factors, and substances use risk factors were collected and incorporated into analyses to account for confounding factors. Multivariate analyses were run to determine differences in ADHD symptomology at baseline by substance use group. Then, multilevel linear mixed effect models were run to examine the impact of early substance use on ADHD symptomology from baseline, one-year, and two-year follow-up. Lastly, follow-up sex analyses were run to determine if different substance use and ADHD patterns emerged between male and female participants. Substance use groupings of caffeine use, alcohol sipping, and total substance use were run separately. At baseline, moderate caffeine use and mild alcohol sipping was associated with higher ADHD symptomology. Total substance use was not associated with ADHD symptoms at baseline. Longitudinal analyses demonstrated that moderate caffeine use and moderate total substance use was associated with high ADHD symptoms at two-year follow-up. Sex analyses demonstrated that moderate total substance use in male participants and moderate caffeine use in female participants was associated with higher ADHD symptoms at two-year follow-up. These findings suggest that even light and early use can start to impact ADHD symptom trajectories within a normative population. More work is needed to investigate the mechanisms behind the effects of early substance use on ADHD symptoms in late childhood as well as the differences in these patterns by biological sex.

Available for download on Thursday, August 29, 2024