Known comorbidities for Attention-Deficit Hyperactivity Disorder (ADHD) include conduct problems, substance use disorder and gaming. Comorbidity with conduct problems may increase the risk for substance use disorder and gaming in individuals with ADHD. The aim of the study was to build a causal model of the relationships between ADHD and comorbid conduct problems, and alcohol, nicotine, and other substance use, and gaming habits, while accounting for age and sex. We used a state-of-the-art causal discovery algorithm to analyze a case-only sample of 362 ADHD-diagnosed individuals in the ages 12-24 years. We found that conduct problem severity mediates between ADHD severity and nicotine use, but not with more severe alcohol or substance use. More severe ADHD-inattentive symptoms lead to more severe gaming habits. Furthermore, our model suggests that ADHD severity has no influence on severity of alcohol or other drug use. Our findings suggest that ADHD severity is a risk factor for nicotine use, and that this effect is fully mediated by conduct problem severity. Finally, ADHD-inattentive severity was a risk factor for gaming, suggesting that gaming dependence has a different causal pathway than substance dependence and should be treated differently. By identifying these intervention points, our model can aid both researchers and clinicians.

中文翻译：

---

行为问题在注意力缺陷多动障碍、物质使用和游戏之间的关系中的作用

注意缺陷多动障碍 (ADHD) 的已知合并症包括品行问题、物质使用障碍和游戏。行为问题的共病可能会增加 ADHD 患者出现物质使用障碍和游戏的风险。该研究的目的是建立一个关于 ADHD 与共病行为问题、酒精、尼古丁和其他物质使用以及游戏习惯之间关系的因果模型，同时考虑到年龄和性别。我们使用最先进的因果发现算法来分析 362 名年龄在 12-24 岁之间的多动症诊断个体的病例样本。我们发现行为问题的严重程度在 ADHD 严重程度和尼古丁使用之间起到中介作用，但与更严重的酒精或物质使用无关。更严重的注意力缺陷多动障碍症状会导致更严重的游戏习惯。此外，我们的模型表明 ADHD 的严重程度对酒精或其他药物使用的严重程度没有影响。我们的研究结果表明，多动症的严重程度是尼古丁使用的危险因素，这种影响完全由行为问题的严重程度介导。最后，注意力缺陷多动障碍的严重程度是游戏的一个危险因素，这表明游戏依赖与物质依赖具有不同的因果途径，应该区别对待。通过识别这些干预点，我们的模型可以帮助研究人员和临床医生。表明游戏依赖与物质依赖具有不同的因果途径，应该区别对待。通过识别这些干预点，我们的模型可以帮助研究人员和临床医生。表明游戏依赖与物质依赖具有不同的因果途径，应该区别对待。通过识别这些干预点，我们的模型可以帮助研究人员和临床医生。