International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Heval Özgen; Renske Spijkerman; Moritz Noack; Martin Holtmann; Arnt S. A. Schellekens; Geurt van de Glind; Tobias Banaschewski; Csaba Barta; Alex Begeman; Miguel Casas; Cleo L. Crunelle; Constanza Daigre Blanco; S. ren Dalsgaard; Zsolt Demetrovics; Jacomine den Boer; Geert Dom; Valsamma Eapen; Stephen V. Faraone; Johan Franck; Rafael A. González; Lara Grau-López; Annabeth P. Groenman; Malin Hemphälä; Romain Icick; Brian Johnson; Michael Kaess; M. té Kapitány-Fövény; John G. Kasinathan; Sharlene S. Kaye; Falk Kiefer; Maija Konstenius; Frances R. Levin; Mathias Luderer; Giovanni Martinotti; Frieda I. A. Matthys; Gergely Meszaros; Franz Moggi; Ashmita P. Munasur-Naidoo; Marianne Post; Sharon Rabinovitz; J. Antoni Ramos-Quiroga; Regina Sala; Abu Shafi; Ortal Slobodin; Wouter G. Staal; Rainer Thomasius; Ilse Truter; Michiel W. van Kernebeek; Maria C. Velez-Pastrana; Sabine Vollstädt-Klein; Florence Vorspan; Jesse T. Young; Amy Yule; Wim van den Brink; Vincent Hendriks

doi:10.1159/000508385

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Heval Özgen
, Renske Spijkerman
, Moritz Noack
, Martin Holtmann
, Arnt S. A. Schellekens
, Geurt van de Glind
, Tobias Banaschewski
, Csaba Barta
, Alex Begeman
, Miguel Casas
, Cleo L. Crunelle
, Constanza Daigre Blanco
, S. ren Dalsgaard
, Zsolt Demetrovics
, Jacomine den Boer
, Geert Dom
, Valsamma Eapen
, Stephen V. Faraone
, Johan Franck
, Rafael A. González

Lara Grau-López, Annabeth P. Groenman, Malin Hemphälä, Romain Icick, Brian Johnson, Michael Kaess, M. té Kapitány-Fövény, John G. Kasinathan, Sharlene S. Kaye, Falk Kiefer, Maija Konstenius, Frances R. Levin, Mathias Luderer, Giovanni Martinotti, Frieda I. A. Matthys, Gergely Meszaros, Franz Moggi, Ashmita P. Munasur-Naidoo, Marianne Post, Sharon Rabinovitz, J. Antoni Ramos-Quiroga, Regina Sala, Abu Shafi, Ortal Slobodin, Wouter G. Staal, Rainer Thomasius, Ilse Truter, Michiel W. van Kernebeek, Maria C. Velez-Pastrana, Sabine Vollstädt-Klein, Florence Vorspan, Jesse T. Young, Amy Yule, Wim van den Brink, Vincent Hendriks

Parnassia Bavo Groep
Leiden University
Ruhr University Bochum
Donders Center, Nijmegen, Netherlands
Donders Centre for Neuroscience, Nijmegen, Netherlands
International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, Netherlands
Heidelberg University
Semmelweis University
Peter Pazmany Catholic University
De Hoop GGZ, Dordrecht, Netherlands
Autonomous University of Barcelona
Vrije Universiteit Brussel
CIBER - Center for Biomedical Research Network
Aarhus University
Eötvös Loránd University
University of Antwerp
University of New South Wales
SUNY Upstate Medical University
Child- and Adolescent Department, Piteå, Sweden
Imperial College London
East London NHS Foundation Trust
University of Amsterdam
University of Groningen, University Medical Center Groningen
Assistance publique – Hôpitaux de Paris
Institut national de la santé et de la recherche médicale
University of Bern
Drug Outpatient Centre, Hungary
Justice Health and Forensic Mental Health Network
Zentralinstitut fur Seelische Gesundheit
Columbia University
Goethe University Frankfurt
Gabriele d'Annunzio University
Nelson Mandela University
Cipla Medpro Pharmaceuticals, Durban, South Africa
University of Haifa
Queen Mary University of London
Ben-Gurion University of the Negev
Radboud University Nijmegen
University of Hamburg
PhD Program in Clinical Psychology, Puerto Rico
Université Paris-Saclay
FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
University of Melbourne
Murdoch Children's Research Institute
University of Western Australia
Curtin University
Boston University

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Original language	English
Pages (from-to)	223-232
Number of pages	10
Journal	European addiction research
Volume	26
Issue number	4-5
DOIs	https://doi.org/10.1159/000508385
Publication status	Published - 1 Aug 2020

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adolescents
Attention-deficit/hyperactivity disorder
Consensus statement
Substance use disorder

Access to Document

10.1159/000508385

International-consensus-statement-for-the-screening-diagnosis-and-treatment-of-adolescents-with-concurrent-attention-d.pdfFinal published version, 242 KBLicence: CC BY

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Özgen, H., Spijkerman, R., Noack, M., Holtmann, M., Schellekens, A. S. A., van de Glind, G., Banaschewski, T., Barta, C., Begeman, A., Casas, M., Crunelle, C. L., Daigre Blanco, C., Dalsgaard, S. R., Demetrovics, Z., den Boer, J., Dom, G., Eapen, V., Faraone, S. V., Franck, J., ... Hendriks, V. (2020). International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder. European addiction research, 26(4-5), 223-232. https://doi.org/10.1159/000508385

@article{bae8e56e2a2a48a1ae6de64647db99de,

title = "International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder",

abstract = "Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.",

keywords = "Adolescents, Attention-deficit/hyperactivity disorder, Consensus statement, Substance use disorder",

author = "Heval {\"O}zgen and Renske Spijkerman and Moritz Noack and Martin Holtmann and Schellekens, \{Arnt S. A.\} and \{van de Glind\}, Geurt and Tobias Banaschewski and Csaba Barta and Alex Begeman and Miguel Casas and Crunelle, \{Cleo L.\} and \{Daigre Blanco\}, Constanza and Dalsgaard, \{S. ren\} and Zsolt Demetrovics and \{den Boer\}, Jacomine and Geert Dom and Valsamma Eapen and Faraone, \{Stephen V.\} and Johan Franck and Gonz{\'a}lez, \{Rafael A.\} and Lara Grau-L{\'o}pez and Groenman, \{Annabeth P.\} and Malin Hemph{\"a}l{\"a} and Romain Icick and Brian Johnson and Michael Kaess and Kapit{\'a}ny-F{\"o}v{\'e}ny, \{M. t{\'e}\} and Kasinathan, \{John G.\} and Kaye, \{Sharlene S.\} and Falk Kiefer and Maija Konstenius and Levin, \{Frances R.\} and Mathias Luderer and Giovanni Martinotti and Matthys, \{Frieda I. A.\} and Gergely Meszaros and Franz Moggi and Munasur-Naidoo, \{Ashmita P.\} and Marianne Post and Sharon Rabinovitz and Ramos-Quiroga, \{J. Antoni\} and Regina Sala and Abu Shafi and Ortal Slobodin and Staal, \{Wouter G.\} and Rainer Thomasius and Ilse Truter and \{van Kernebeek\}, \{Michiel W.\} and Velez-Pastrana, \{Maria C.\} and Sabine Vollst{\"a}dt-Klein and Florence Vorspan and Young, \{Jesse T.\} and Amy Yule and \{van den Brink\}, Wim and Vincent Hendriks",

year = "2020",

month = aug,

day = "1",

doi = "10.1159/000508385",

language = "English",

volume = "26",

pages = "223--232",

journal = "European addiction research",

issn = "1022-6877",

publisher = "S. Karger AG",

number = "4-5",

}

Özgen, H, Spijkerman, R, Noack, M, Holtmann, M, Schellekens, ASA, van de Glind, G, Banaschewski, T, Barta, C, Begeman, A, Casas, M, Crunelle, CL, Daigre Blanco, C, Dalsgaard, SR, Demetrovics, Z, den Boer, J, Dom, G, Eapen, V, Faraone, SV, Franck, J, González, RA, Grau-López, L, Groenman, AP, Hemphälä, M, Icick, R, Johnson, B, Kaess, M, Kapitány-Fövény, MT, Kasinathan, JG, Kaye, SS, Kiefer, F, Konstenius, M, Levin, FR, Luderer, M, Martinotti, G, Matthys, FIA, Meszaros, G, Moggi, F, Munasur-Naidoo, AP, Post, M, Rabinovitz, S, Ramos-Quiroga, JA, Sala, R, Shafi, A, Slobodin, O, Staal, WG, Thomasius, R, Truter, I, van Kernebeek, MW, Velez-Pastrana, MC, Vollstädt-Klein, S, Vorspan, F, Young, JT, Yule, A, van den Brink, W & Hendriks, V 2020, 'International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder', European addiction research, vol. 26, no. 4-5, pp. 223-232. https://doi.org/10.1159/000508385

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder. / Özgen, Heval; Spijkerman, Renske; Noack, Moritz et al.
In: European addiction research, Vol. 26, No. 4-5, 01.08.2020, p. 223-232.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

AU - Özgen, Heval

AU - Spijkerman, Renske

AU - Noack, Moritz

AU - Holtmann, Martin

AU - Schellekens, Arnt S. A.

AU - van de Glind, Geurt

AU - Banaschewski, Tobias

AU - Barta, Csaba

AU - Begeman, Alex

AU - Casas, Miguel

AU - Crunelle, Cleo L.

AU - Daigre Blanco, Constanza

AU - Dalsgaard, S. ren

AU - Demetrovics, Zsolt

AU - den Boer, Jacomine

AU - Dom, Geert

AU - Eapen, Valsamma

AU - Faraone, Stephen V.

AU - Franck, Johan

AU - González, Rafael A.

AU - Grau-López, Lara

AU - Groenman, Annabeth P.

AU - Hemphälä, Malin

AU - Icick, Romain

AU - Johnson, Brian

AU - Kaess, Michael

AU - Kapitány-Fövény, M. té

AU - Kasinathan, John G.

AU - Kaye, Sharlene S.

AU - Kiefer, Falk

AU - Konstenius, Maija

AU - Levin, Frances R.

AU - Luderer, Mathias

AU - Martinotti, Giovanni

AU - Matthys, Frieda I. A.

AU - Meszaros, Gergely

AU - Moggi, Franz

AU - Munasur-Naidoo, Ashmita P.

AU - Post, Marianne

AU - Rabinovitz, Sharon

AU - Ramos-Quiroga, J. Antoni

AU - Sala, Regina

AU - Shafi, Abu

AU - Slobodin, Ortal

AU - Staal, Wouter G.

AU - Thomasius, Rainer

AU - Truter, Ilse

AU - van Kernebeek, Michiel W.

AU - Velez-Pastrana, Maria C.

AU - Vollstädt-Klein, Sabine

AU - Vorspan, Florence

AU - Young, Jesse T.

AU - Yule, Amy

AU - van den Brink, Wim

AU - Hendriks, Vincent

PY - 2020/8/1

Y1 - 2020/8/1

N2 - Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

AB - Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

KW - Adolescents

KW - Attention-deficit/hyperactivity disorder

KW - Consensus statement

KW - Substance use disorder

UR - https://www.scopus.com/pages/publications/85089204278

U2 - 10.1159/000508385

DO - 10.1159/000508385

M3 - Article

C2 - 32634814

SN - 1022-6877

VL - 26

SP - 223

EP - 232

JO - European addiction research

JF - European addiction research

IS - 4-5

ER -

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Abstract

UN SDGs

Keywords

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