The goal of this paper is to evaluate the significance of the co-morbidity of nicotine abuse in adolescents afflicted with ADHD (Attention-Deficit Hyperactivity Disorder). Due to the nature of the disorder and its possible underlying pathophysiology of dopaminergic dysfunction, the use of nicotine can be implicated as a form of self-medication. I will provide evidence of the co-morbidity and early onset of nicotine dependence and prevalence of smoking habit in adolescents with ADHD. Furthermore, I will discuss prenatal exposure to nicotine and its behavioral consequences, followed by an analysis of the pharmacology of nicotine and proposed circuitry of ADHD. Nicotine use in ADHD adolescents can no longer be attributed to mainstream "peer pressure". There are reinforcing effects provided by nicotine that parallel stimulant medication used to treat the disorder.
[...] Moreover, Milberger etal (1997) concluded that ADHD, particularly the co morbid subtype, is a significant risk factor for early initiation of cigarette smoking in children and adolescents. In addition, a significant association was found between cigarette smoking and drug abuse. There were some limitations to the Milberger study. In children younger than 12, mothers were responsible for the report of cigarette use. This could lead to an underreporting of smoking; however, if the latter is true, the association between ADHD and smoking would be even greater. [...]
[...] Longitudinal studies have been used to find some correlation between maternal exposure of nicotine in utero and hyperactive behavior in children in adolescents. The results show a clear connection between nicotine and decreased intellectual integrity in both animal models and human subjects. Whether it is the smoking during pregnancy, or the genes from a mother that would smoke during pregnancy that is the vehicle for dysfunction remains unclear; however, further insight into the pathophysiology of ADHD will provide clarification. The pathophysiology of ADHD is quite complex and is based upon both peripheral and central attentional systems. [...]
[...] In conclusion, if nicotine does in fact have a positive effect on ADHD patients, a less deadly form of administration is in order. References Apgar, Barbara (1997), Role of maternal smoking during pregnancy in ADHD. (Attention deficit hyperactivity disorder)(Tips from Other Journals). American Family Physician 55.n1 (Jan 1997): 268(2). Due DL, Huettel SA, Hall WG, Rubin DC (2002), Activation in mesolimbic and visuospatial neural circuits elicited by smoking cues: evidence from functional magnetic resonance imaging.(Abstract)." American Journal of Psychiatry 159.6 : 954(7). [...]
[...] In further support of the detrimental effects on attention as a result of prenatal exposure to nicotine, Kotimaa etal (2003) investigated the association between maternal smoking during pregnancy and hyperactivity in 8-year-old children. Researchers studied a population of children from the Northern Finland 1985/86 Birth Cohort. At an 8-year follow-up 9,357 children were alive and their mothers and teachers provided information at age 8. Maternal smoking was associated with hyperactivity even after adjustment for sex, family structure, socioeconomic status, maternal age, and maternal alcohol use. [...]
[...] The posterior attention system loses the ability to disengage from old stimuli and shift to new data—and read it out to the anterior system There might be a deficit in central epinephrine, leading again to an excessive activity in the LC and peripheral sympathetic system A dysfunction could exist in the peripheral EPI system There could exist a failure of brainstem mechanisms which affect a "hand off" from the posterior NE-mediated system to more dopamine-mediated anterior executive system. LC inhibits the activity of the raphe, the source of serotonergic neurons, which in turn influences the VTA. [...]
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