ADHD Hyperactivity Made the Link Between Anxiety/Depression and Cannabis Use Stronger in Adolescent Girls
Among 1,424 adolescents at age 13, the association between internalizing symptoms (anxiety/depression) and cannabis use was significant only in girls with high ADHD hyperactivity-impulsivity symptoms.
Quick Facts
What This Study Found
A significant three-way interaction between internalizing symptoms, ADHD hyperactivity-impulsivity, and sex was found for cigarette use (BF=48.40) and supported for cannabis use (BF=3.54-9.08). Internalizing symptoms predicted cannabis use only among females with high ADHD-HI symptoms (β=0.14-0.21).
Key Numbers
1,424 adolescents, 53% female. Cigarette use three-way interaction: BF=48.40 (very strong evidence). Cannabis use: self-report ADHD BF=3.54, father-report BF=9.08 (substantial evidence). Effect among females with high ADHD-HI: cigarette β=0.15, cannabis β=0.14-0.21.
How They Did This
Cross-sectional analysis of 1,424 adolescents (53% female) at age 13 from the Quebec Longitudinal Study of Child Development. Alcohol, cigarette, and cannabis use along with internalizing and ADHD hyperactivity-impulsivity symptoms were assessed. Used multi-informant ADHD ratings (self, teacher, father).
Why This Research Matters
The inconsistent relationship between anxiety/depression and substance use in adolescents has puzzled researchers. This study reveals that ADHD hyperactivity-impulsivity is a key moderator, particularly in girls, helping explain who is actually at risk.
The Bigger Picture
ADHD is often underdiagnosed in girls, partly because hyperactivity-impulsivity presents differently in females. This study suggests that the combination of internalizing distress and hyperactive-impulsive traits in girls creates a specific risk profile for substance use that deserves targeted intervention.
What This Study Doesn't Tell Us
Cross-sectional design at a single age point cannot establish temporal ordering. ADHD-HI symptoms were not clinical diagnoses. The cannabis finding did not reach conventional statistical significance but was supported by Bayesian evidence.
Questions This Raises
- ?Would treating ADHD in girls with internalizing symptoms reduce their cannabis use risk?
- ?Does this three-way interaction persist into later adolescence?
- ?Why is this pattern specific to girls?
Trust & Context
- Key Stat:
- Internalizing predicted cannabis use only in females with high ADHD-HI symptoms
- Evidence Grade:
- Moderate: large population-based cohort with multi-informant assessment, though cross-sectional and cannabis interaction did not reach conventional significance.
- Study Age:
- Published in 2022.
- Original Title:
- The moderating role of sex and self-, teacher-, and father-reported ADHD hyperactivity-impulsivity symptoms, on the association between early adolescent internalizing symptoms and substance use.
- Published In:
- Addictive behaviors, 135, 107437 (2022)
- Authors:
- Pocuca, Nina(4), Parent, Sophie(2), Côté, Sylvana(2), Boivin, Michel, Tremblay, Richard E, Séguin, Jean R, Castellanos-Ryan, Natalie
- Database ID:
- RTHC-04150
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Are girls with ADHD at higher risk for cannabis use?
Girls with both internalizing symptoms (anxiety/depression) and ADHD hyperactivity-impulsivity were the only group where anxiety/depression predicted cannabis use. This specific combination appeared to be the risk factor, not ADHD alone.
Why does this only affect girls?
The study did not determine the mechanism, but one possibility is that girls with both internalizing distress and impulsivity may be more likely to self-medicate with substances, while boys may express distress through different pathways.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-04150APA
Pocuca, Nina; Parent, Sophie; Côté, Sylvana; Boivin, Michel; Tremblay, Richard E; Séguin, Jean R; Castellanos-Ryan, Natalie. (2022). The moderating role of sex and self-, teacher-, and father-reported ADHD hyperactivity-impulsivity symptoms, on the association between early adolescent internalizing symptoms and substance use.. Addictive behaviors, 135, 107437. https://doi.org/10.1016/j.addbeh.2022.107437
MLA
Pocuca, Nina, et al. "The moderating role of sex and self-, teacher-, and father-reported ADHD hyperactivity-impulsivity symptoms, on the association between early adolescent internalizing symptoms and substance use.." Addictive behaviors, 2022. https://doi.org/10.1016/j.addbeh.2022.107437
RethinkTHC
RethinkTHC Research Database. "The moderating role of sex and self-, teacher-, and father-r..." RTHC-04150. Retrieved from https://rethinkthc.com/research/pocuca-2022-the-moderating-role-of
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.