The association between attention deficit/hyperactivity disorder (ADHD) and psychoactive substance use disorders (PSUD) was studied by familial risk analysis at the Massachusetts General Hospital, Boston, MA. Blind rating of first-degree relatives of children and adolescents referred with ADHD (131 probands, 413 relatives) and healthy controls (106 probands, 323 relatives) showed that the risk for ADHD among relatives of probands with ADHD did not differ by the presence of PSUD in the proband, and ADHD is likely to be causally independent from PSUD. ADHD and drug use disorders may share familial etiological factors. 
COMMENT. Familial risk analyses suggest that ADHD is causally independent from substance use disorders. Patients would need to be followed through the age at risk for PSUD to rule out a common familial risk factor for ADHD and PSUD.
Variations in ADHD treatment patterns were studied in 102 special education students sampled at the University of Florida, Gainesville. Nearly three fourths were treated by a primary care provider, and less than one third of these were seen by a mental health specialist. ADHD children receiving only primary care had fewer comorbid conditions, less impairment, less family burden, and less use of multimodal therapies than those seen by a mental health specialist . Reports of clinical outcomes and comorbidity of ADHD vary with the specialty and type of care provider.