Aims Adolescents with Attention Deficient Hyperactivity disorder (ADHD) are more likely to smoke cigarettes, initiate smoking earlier and find it harder to quit as an adult. Cigarette smoking has a strong association with long term health complications and a financial burden on the NHS. We reviewed the literature to see what interventions we could recommend to our patients to prevent them starting smoking.

Methods We performed a literature search using Pubmed and EMBASE using search terms ‘ADHD’, ‘adolescent’, ‘smoking’, ‘Prevention’.

Results There are limited studies that directly address the issue however there is some evidence that support using Methylphenidate can reduce the likelihood of adolescents with ADHD starting smoking. School based behavioural therapies are also useful. Nicotine replacement was not helpful in preventing children starting smoking.

Conclusion Understanding why children with ADHD smoke is the key to developing interventions. Nicotine acts on dopamine activated pathways which alleviate the symptoms of ADHD, this concept is ‘self medication’. Improving control of ADHD symptoms would be expected to reduce risk of commencement of smoking. There is evidence that pharmacological and behavioural therapy can have positive effects on reducing the incidence of smoking in adolescents with ADHD. More prospective studies are required to compare the different approaches.