This study examined the effects of childhood attention deficit hyperactivity disorder (ADHD) symptoms, both inattention and hyperactivity-impulsivity, on the development of smoking in male and female adolescents.

Twin difference methods were used to control for shared genetic and environmental confounders in three population-based, same-sex twin samples (N=3,762; 64% monozygotic). One cohort oversampled female adolescents with ADHD beginning in childhood. Regressions of childhood inattentive and hyperactive-impulsive symptoms were conducted to predict smoking outcomes by age 17. ADHD effects were divided into those shared between twins in the pair and those nonshared, or different within pairs.

Adolescents who had more severe ADHD symptoms as children were more likely to initiate smoking and to start smoking younger. The association of ADHD symptoms with daily smoking, number of cigarettes per day, and nicotine dependence was greater in females than in males. Monozygotic female twins with greater attentional problems than their co-twins had greater nicotine involvement, consistent with possible causal influence. These effects remained when co-occurring externalizing behaviors and stimulant medication were considered. Hyperactivity-impulsivity, while also more strongly related to smoking for female adolescents, appeared primarily noncausal.

Smoking initiation and escalation are affected differentially by ADHD subtype and gender. The association of inattention with smoking in female adolescents may be causal, whereas hyperactivity-impulsivity appears to act indirectly, through shared propensities for both ADHD and smoking.

这项研究检查了注意力不集中和冲动过度的儿童注意缺陷多动障碍（ADHD）症状对男性和女性青少年吸烟发展的影响。

在三个基于人群的同性双胞胎样本中，双胞胎差异方法用于控制共有的遗传和环境混杂因素（N = 3,762； 64％单卵）。一个队列从儿童期开始就对患有ADHD的女性青少年进行了超采样。对儿童注意力不集中和冲动过度症状进行了回归分析，以预测17岁时吸烟的结果。ADHD的影响分为一对双胞胎和非双胞胎共有，或成对差异。

青少年多动症的症状较严重，因为儿童更容易开始吸烟并开始更年轻地吸烟。女性多动症的症状与每天吸烟，每天抽烟的数量和尼古丁依赖性的相关性高于男性。与同卵双胞胎相比，注意力较集中的单卵双胞胎女性对尼古丁的影响更大，这与可能的因果关系一致。当考虑同时发生的外在行为和刺激性药物时，这些作用仍然存在。多动症冲动，虽然也与女性青少年吸烟更密切相关，但主要表现为无因果关系。

吸烟的开始和升级受ADHD亚型和性别的影响不同。女性青少年注意力不集中与吸烟有关可能是因果关系，而多动冲动似乎是通过多动症和吸烟的共同倾向间接起作用的。