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This cohort study assesses whether stimulant medication for attention-deficit/hyperactivity disorder is associated with later substance use after considering age and other confounding factors not previously studied. Key Points: Question: Is stimulant medication for attention-deficit/hyperactivity disorder (ADHD) associated with later substance use after considering age and other confounding factors not previously studied? Findings: In this cohort study of 579 children initially treated in a randomized clinical trial for ADHD and assessed repeatedly to adulthood, comprehensive analyses did not support an association between stimulant treatment and adolescent or adulthood substance use or substance use disorder. Meaning: This study found no evidence that stimulant treatment, predominantly prescribed in childhood and adolescence, protects against or increases risk of later frequent use of alcohol, cigarettes, marijuana, or other substance use by a mean age of 25 years. Importance: Possible associations between stimulant treatment of attention-deficit/hyperactivity disorder (ADHD) and subsequent substance use remain debated and clinically relevant. Objective: To assess the association of stimulant treatment of ADHD with subsequent substance use using the Multimodal Treatment Study of ADHD (MTA), which provides a unique opportunity to test this association while addressing methodologic complexities (principally, multiple dynamic confounding variables). Design, Setting, and Participants: MTA was a multisite study initiated at 6 sites in the US and 1 in Canada as a 14-month randomized clinical trial of medication and behavior therapy for ADHD but transitioned to a longitudinal observational study. Participants were recruited between 1994 and 1996. Multi-informant assessments included comprehensively assessed demographic, clinical (including substance use), and treatment (including stimulant treatment) variables. Children aged 7 to 9 years with rigorously diagnosed DSM-IV combined-type ADHD were repeatedly assessed until a mean age of 25 years. Analysis took place between April 2018 and February 2023. Exposure: Stimulant treatment of ADHD was measured prospectively from baseline for 16 years (10 assessments) initially using parent report followed by young adult report. Main Outcomes and Measures: Frequency of heavy drinking, marijuana use, daily cigarette smoking, and other substance use were confidentially self-reported with a standardized substance use questionnaire. Results: A total of 579 children (mean [SD] age at baseline, 8.5 [0.8] years; 465 [80%] male) were analyzed. Generalized multilevel linear models showed no evidence that current (B [SE] range, −0.62 [0.55] to 0.34 [0.47]) or prior stimulant treatment (B [SE] range, −0.06 [0.26] to 0.70 [0.37]) or their interaction (B [SE] range, −0.49 [0.70] to 0.86 [0.68]) were associated with substance use after adjusting for developmental trends in substance use and age. Marginal structural models adjusting for dynamic confounding by demographic, clinical, and familial factors revealed no evidence that more years of stimulant treatment (B [SE] range, −0.003 [0.01] to 0.04 [0.02]) or continuous, uninterrupted stimulant treatment (B [SE] range, −0.25 [0.33] to −0.03 [0.10]) were associated with adulthood substance use. Findings were the same for substance use disorder as outcome. Conclusions and Relevance: This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD. These findings do not appear to result from other factors that might drive treatment over time and findings held even after considering opposing age-related trends in stimulant treatment and substance use. [ABSTRACT FROM AUTHOR]

The present study examined treatment outcomes for objectively measured parenting behavior in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD). Five hundred seventy-nine ethnically and socioeconomically diverse children with ADHD-combined type (ages 7.0-9.9 years) and their parent(s) were recruited at 6 sites in the United States and Canada and randomly assigned to 1 of 4 treatment groups for 14 months of active intervention: medication management (MedMgt), intensive behavior therapy, combination of the 2 (Comb), or a community-treated comparison (CC). Baseline and posttreatment laboratory observations of parent-child interactions were coded by observers blind to treatment condition. Comb produced significantly greater improvements in constructive parenting than did MedMgt or CC, with effect sizes approaching medium for these contrasts. Treatment effects on child behaviors were not significant. The authors discuss the importance of changes in parenting behavior for families of children with ADHD and the need for reliable and objective measures in evaluating treatment outcome.

A scoping review of published literature and dialogue with international nurse practitioner educators and researchers revealed the education of nurse practitioner students varied within and between countries. This lack of cohesiveness hinders nurse practitioner role development and practice nationally and internationally. A rapid review of grey literature was conducted on nurse practitioner education standards in six countries (Australia, Canada, Finland, Norway, the Netherlands, and USA). Data were extracted from graduate level nurse practitioner education programs' websites from each country (n = 24). Extracted data were verified for accuracy and completeness with a nurse practitioner educator from each program. Data were analyzed using content analysis. Variations in nurse practitioner education within and between countries were explored by comparing admission criteria, curricular content, clinical requirements, teaching methods, and assignment and evaluative methods. The findings will help inform education programs and further research about nurse practitioner education internationally. [ABSTRACT FROM AUTHOR]

Background: Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample., Methods: Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25., Results: In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups., Conclusions: Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels., (© 2018 Association for Child and Adolescent Mental Health.)