Girls with ADHD face increased risk of becoming smokers, study finds

New research has found evidence that female adolescents with ADHD are at heightened risk for nicotine addiction.

“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. Unless you read the ‘fine print’, the assumption is often that the risk is similar for girls, and untested assumptions bother me,” explained study author Irene J. Elkins of the University of Minnesota, Twin Cities.

The study, published in the American Journal of Psychiatry, confirmed there is a link between inattention and smoking. The researchers found that adolescents with more ADHD symptoms were at greater risk of starting smoking earlier and were more likely to progress to nicotine dependence by age 17.

“Like others, we found that boys and girls with ADHD are both more likely to smoke than those without ADHD,” Elkins told PsyPost. “However, by including a larger sample of girls with ADHD, we discovered that adolescent girls with ADHD progressed faster to heavier smoking and becoming dependent on nicotine than did boys.”

The study was based on data from 3,762 individuals who participated in the Minnesota Twin Family Study, a longitudinal investigation of 11-year-old and 17-year-old twins and their parents.

“Obviously, it is impossible to ‘randomly assign’ behaviors, like ADHD and smoking, to one person but not another, so determining whether one causes the other is difficult,” Elkins told PsyPost.

“However, we found that even within identical twin pairs of girls raised together, who share the same genetic and familial background, the twin with more severe attentional problems starting in childhood was more likely to smoke more, smoke daily, and become dependent during her teen years than her co-twin. This points to a possible causal influence of attention on smoking for girls that was not evident for boys.”

Another component of ADHD — hyperactivity and impulsivity — also was linked to smoking. But it appears to act indirectly.

Elkins said that youth with ADHD may be more likely to start smoking because it helps them pay attention.

“One motivation for smoking may be to self-medicate attentional problems because similar to medications used to treat ADHD, nicotine stimulates certain brain regions. However, even if inattention is causal, other factors may be involved,” she explained.

“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.”

The study, “Increased Risk of Smoking in Female Adolescents Who Had Childhood ADHD“, was also co-authored by Gretchen R.B. Saunders, Stephen M. Malone, Margaret A. Keyes, Diana R. Samek, Matt McGue, and William G. Iacono.