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Study: Teen Girls with ADHD More Likely to Smoke Heavily

Most studies on smoking and ADHD have focused on male subjects. Now, a new study confirms that girls with ADHD are just as likely to start smoking — and may be prone to smoking more than their male counterparts.




September 27, 2017

Individuals with ADHD are more likely to smoke cigarettes. Past studies have repeatedly found that the more severe a person’s ADHD symptoms, the more likely it is he or she will develop nicotine dependence.

Most past studies, however, were conducted on adults, and — due to longstanding imbalances in ADHD diagnosis rates — a vast majority of the subject were male. A new study, conducted on adolescents, confirms that teen girls with ADHD are just as likely as boys with the condition to start smoking before age 17 — and are, in fact, more likely to develop extreme habits and a severe dependence on nicotine.

The study, published in August 2017 in the American Journal of Psychiatry, looked at nearly 4,000 individuals, 52 percent of whom were female, and 1,881 of whom were part of a twin pair. The sample was divided into two groups; the first, larger group was followed from age 11 to age 17, while the second was assessed only at age 17. Researchers measured ADHD symptoms (both hyperactive and inattentive), as well as cigarettes smoked per day and levels of nicotine dependence across all ages.

Confirming the results of past studies, the data showed that individuals with more severe ADHD symptoms were more likely to be smokers by age 17. But, somewhat surprisingly, girls with ADHD were more likely than boys to progress quickly toward heavy smoking — they smoked more cigarettes on more days, and had higher rates of nicotine dependence than did their male peers.

“Because ADHD and substance abuse are more common in males than in females, many conclusions regarding risk for smoking among those with ADHD are based on what ADHD is like for boys,” said study author Irene Elkins of the University of Minnesota, Twin Cities. “Unless you read the ‘fine print,’ the assumption is often that the risk is similar for girls, and untested assumptions bother me.”

Smoking can be self-medicating for people with ADHD — particularly those who haven’t been diagnosed — since nicotine affects the same brain regions as certain ADHD medications. Girls with ADHD, even if they’ve been diagnosed, struggle more frequently with anxiety and depression, leading Elkins to hypothesize that smoking may be a form of self-medication for this group.

“The increased vulnerability of females to peer and academic consequences of inattention may contribute to greater depression and anxiety among inattentive females relative to inattentive males, increasing their receptivity to nicotine’s effects on attention and mood,” she said.

A small silver lining, perhaps, is that another recent study found that the more severe a smoker’s ADHD, the more likely they were to respond positively to smoking cessation aids. While that research didn’t take gender into account, it may open the door to effective treatment strategies for teens with ADHD — male or female — who want to quit smoking.



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