RESEARCH ARTICLE

“I Use Weed for My ADHD”: A Qualitative

Analysis of Online Forum Discussions on
Cannabis Use and ADHD
John T. Mitchell1,2*, Maggie M. Sweitzer1,2, Angela M. Tunno1, Scott H. Kollins1,2, F.
Joseph McClernon1,2
1 Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North
Carolina, United States of America, 2 Duke Center for Addiction Science and Technology, Durham, North
Carolina, United States of America
a11111
* [email protected]

Abstract
Background
OPEN ACCESS
Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for problematic cannabis use.
Citation: Mitchell JT, Sweitzer MM, Tunno AM,
Kollins SH, McClernon FJ (2016) “I Use Weed for My However, clinical and anecdotal evidence suggest an increasingly popular perception that
ADHD”: A Qualitative Analysis of Online Forum cannabis is therapeutic for ADHD, including via online resources. Given that the Internet is
Discussions on Cannabis Use and ADHD. PLoS increasingly utilized as a source of healthcare information and may influence perceptions,
ONE 11(5): e0156614. doi:10.1371/journal.
we conducted a qualitative analysis of online forum discussions, also referred to as threads,
pone.0156614
on the effects of cannabis on ADHD to systematically characterize the content patients and
Editor: Karen Lidzba, University Children's Hospital
caregivers may encounter about ADHD and cannabis.
Tuebingen, GERMANY

Received: January 22, 2016

Methods
Accepted: May 17, 2016
A total of 268 separate forum threads were identified. Twenty percent (20%) were randomly
Published: May 26, 2016
selected, which yielded 55 separate forum threads (mean number of individual posts per
Copyright: © 2016 Mitchell et al. This is an open forum thread = 17.53) scored by three raters (Cohen’s kappa = 0.74). A final sample of 401
access article distributed under the terms of the
Creative Commons Attribution License, which permits
posts in these forum threads received at least one endorsement on predetermined topics
unrestricted use, distribution, and reproduction in any following qualitative coding procedures.
medium, provided the original author and source are
credited.
Results
Data Availability Statement: All relevant data are
within the paper and its Supporting Information files. Twenty-five (25%) percent of individual posts indicated that cannabis is therapeutic for
ADHD, as opposed to 8% that it is harmful, 5% that it is both therapeutic and harmful, and
Funding: This study was supported by the National
Institute on Drug Abuse (K23 DA032577 to JTM and 2% that it has no effect on ADHD. This pattern was generally consistent when the year of
K24 DA023464 to SHK). The funders had no role in each post was considered. The greater endorsement of therapeutic versus harmful effects
study design, data collection and analysis, decision to of cannabis did not generalize to mood, other (non-ADHD) psychiatric conditions, or overall
publish, or preparation of the manuscript.
domains of daily life. Additional themes emerged (e.g., cannabis being considered sanc-
Competing Interests: Dr. Kollins has received tioned by healthcare providers).
research support and/or consulting fees from the
following: Akili Interactive, Alcobra, Arbor, Atentiv,
Ironshore, Neos, NIH, Neurovance, Purdue Canada,

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 1 / 13

 Qualitative Analysis of Cannabis Use for ADHD

Rhodes, Shire, Sunovion, and Tris in the past 2 Conclusions

years. This does not alter the authors’ adherence to
PLOS ONE policies on sharing data and materials. Despite that there are no clinical recommendations or systematic research supporting the
None of the other authors have any additional beneficial effects of cannabis use for ADHD, online discussions indicate that cannabis is
declarations. considered therapeutic for ADHD—this is the first study to identify such a trend. This type of
online information could shape ADHD patient and caregiver perceptions, and influence can-
nabis use and clinical care.

Introduction
Cannabis use disorder (CUD) refers to a problematic pattern of cannabis use leading to clini-
cally significant impairment or distress within a 12 month period and includes at least two
symptoms occurring in this context (e.g., cannabis being taken in a larger amount or over a
longer period than was intended, unsuccessful attempts to control use, a strong desire to use
cannabis, and recurrent use resulting in failure to fulfill major life obligations) [1]. Individuals
with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for both cannabis
use and CUD compared to the general population. In the largest meta-analysis to date examin-
ing the prospective association of ADHD with cannabis use, ADHD youth were nearly three
times as likely to report cannabis use in later life compared to non-ADHD youth; and ADHD
children were more than 1.5 times as likely to be subsequently diagnosed with a CUD [2]. In a
large, multisite longitudinal study, individuals initially diagnosed with ADHD between the
ages of 7–9 years were significantly more likely than controls to report cannabis use at 8-year
follow-up (32.1% and 24.0% for ADHD and non-ADHD, respectively) [3]. ADHD adolescents
were more likely to meet criteria for a CUD as well, which persisted into early adulthood [4].
Conversely, in samples with a CUD, comorbidity with ADHD ranges from 33%-38% [5]. Even
in non-clinical samples, ADHD symptoms are associated with increased cannabis use severity,
craving, abuse, dependence, and earlier initiation of use [6, 7].
This relationship between ADHD and cannabis use is relevant given the known adverse
effects of use. For instance, short-term effects of cannabis use include impaired short-term
memory and motor coordination, altered judgement, and (in high doses) paranoia and psycho-
sis [8]. Real-world outcomes of such effects include higher rates of motor vehicle accidents.
The effect of long-term or heavy use include altered brain development, poorer educational
outcomes (e.g., higher likelihood of dropping out of school), lower intelligence, diminished life
satisfaction, symptoms of chronic bronchitis, and increased risk for chronic psychosis disor-
ders in people with a predisposition to such disorders [8]. Cardiovascular disease, poorer men-
tal health, use of other illicit substances, and a range of poorer neurocognitive outcomes (e.g.,
attention, executive functioning, and inhibition) have also been identified [9–14]. Given that
similar outcomes are associated with ADHD independent of cannabis use, including neurocog-
nitive deficits [15, 16] and poor driving [17], the maladaptive effects of cannabis use may be
particularly pronounced in ADHD patients. Indeed, heavier cannabis use in people with
ADHD appears to have an additive effect on poor neurocognitive outcomes [18] and alters hip-
pocampal and cerebellar-dependent function [19], along with frontal and postcentral cortical
thickness [20]. Further, this comorbidity will likely impact successful treatment of cannabis use
since ADHD symptoms are correlated with cannabis craving [7] and such craving is associated
with relapse [21].
Despite the increased risk for problematic cannabis use outcomes, anecdotal clinical obser-
vations suggest there is a growing popular perception that cannabis is therapeutic for ADHD.
Even some medical professionals have advocated for cannabis as a treatment for ADHD,

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 2 / 13

 Qualitative Analysis of Cannabis Use for ADHD

including before a congressional subcommittee on drug policy [22] (also see [23]). Consistent
with such observations, the perceived risk associated with regular cannabis use in the general
population has decreased among adolescents and young adults to its lowest point since the late
1970s [24], which is paralleled by patients and caregivers increasingly inquiring about the thera-
peutic effects of cannabis for developmental and behavioral disorders [25]. It is particularly rele-
vant to address factors that may influence perceptions about the effects of cannabis on ADHD
given that substance use perceptions can influence use [26, 27] and, as noted above, cannabis has
adverse effects, especially for at-risk populations such as those with ADHD. As legalized recrea-
tional use among adults could significantly increase access to cannabis among youth and is a
growing concern for pediatric health in the US [28], identifying factors that may impact percep-
tions promoting cannabis use is a timely issue that is likely to become increasingly important.
The overall aim of this study was to systematically characterize one source of information
that patients and caregivers may use to inform their opinions about ADHD and cannabis: the
Internet. Approximately 72% of adult [29] and 84% of adolescent [30] US Internet users query
the Internet for healthcare information. Analysis of online information has been increasingly
used to identify emerging patterns of substance use [31–34], though this has not been extended
to substance use in ADHD. Online forums in particular were selected for this study since psy-
chiatric and substance use populations report using forums to inform their healthcare decisions
[35, 36]. Indeed, more individuals indicate they are more likely to use online forums to address
mental health concerns than face-to-face with another person [37]. These forums facilitate
social interactions and allow individuals to self-disclose their unfiltered experiences, inquiries,
and opinions about substance use in an anonymous format [34, 38–43], and may be a fruitful
starting point for understanding what patients and caregivers are exposed to when searching
for information about the effects of cannabis on ADHD.
A qualitative methodology was adopted for the current study to examine the content of
online forum threads on the topic of ADHD and cannabis use to identify trends in comments
about their relation, particularly regarding therapeutic and adverse effects of cannabis on
ADHD. This is an important topic since ADHD patients and caregivers may use such online
resources to learn about and inform treatment decisions for ADHD. There are no studies
examining how ADHD and cannabis are portrayed online, therefore we adopted a largely
exploratory approach to identify trends in forum content that will inform future studies. How-
ever, based on changes in the perceived risks of cannabis use [24], patients and caregivers
increasingly inquiring about the therapeutic effects of cannabis [25], and anecdotal clinical
observations on the relationship between ADHD and cannabis, we hypothesized that the
majority of forum posts would advocate for the therapeutic effects of cannabis for ADHD in
comparison to harmful effects.

Methods
Sample and Procedure
A qualitative descriptive methodological approach was adopted. As outlined in Flower et al.
[44], this approach can be utilized to examine naturalistic language to characterize perceptions
and experiences with a particular topic that is poorly understood [45, 46]; however, the aim of
this study was to examine online forum content patients and caregivers may be exposed to as
opposed to characterize perceptions of forum members. To identify forum threads, past studies
[44, 47] have collected posts from a particular online forum dedicated to a specific patient pop-
ulation. We attempted to expand upon this approach and sample a variety of online forums
that patients with ADHD and caregivers may come across when conducting a search for dis-
cussions on the topic of ADHD and cannabis.

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 3 / 13

 Qualitative Analysis of Cannabis Use for ADHD

A search via Google, the most frequently used online search engine in the US [48], was con-
ducted on 10/28/14-10/29/14 using every combination of three different groups of search
terms: (a) “ADHD,” “ADD,” or “attention deficit” with (b) “marijuana,” cannabis,” “pot,” or
“weed,” with (c) “forum.” At least the first 50 results that emerged from each search were con-
sidered. Forum threads that included links to any other forum threads addressing ADHD and
cannabis were also included. This resulted in a total sample of 268 forum threads identified for
the current study.
We randomly selected 55 threads (20%) for analysis, which were coded for the presence or
absence of particular topics (see Qualitative Coding below). The average number of individual
posts within each forum thread was 17.63 (SD = 17.22, range = 1 to 85, median = 13, mode = 4).
A random selection of 20% is consistent with other qualitative studies of online forums on the
topic of substance use [47] and yields a relatively higher number of individual posts than other
studies on online forums [49, 50]. The 55 threads yielded a total of 964 individual posts. Among
these 55 threads, 9 (16%) did not contain any individual posts that received at least one endorse-
ment for the topics coded for this study. Such threads included wording used in our search, but
did not actually include any comments on any aspect of the relationship between ADHD and
cannabis use. Removal of these 9 threads (totaling 84 individual posts) resulted in 46 threads for
analysis. These 46 threads contained 880 individual posts. The average number of individuals
posts within each forum thread was 19.13 (SD = 17.97, range = 1 to 85 posts, median = 15,
mode = 15). Among the 46 threads, 27 (59%) were hosted on sites devoted to ADHD generally
(e.g., http://www.addforums.com, http://www.adhdmarriage.com), 10 (22%) were hosted on sites
devoted to cannabis generally (http://marijuana.com, http://www.rollitup.org), 6 (13%) were
hosted on sites devoted to overall physical or mental health generally (http://ehealthforum.com,
http://www.psychforums.com), and 3 (7%) were hosted on other sites (http://www.thetechgame.
com, http://www.econjobrumors.com).
A total 479 of the 880 individual posts within the 46 threads did not receive an endorsement
for various reasons, such as thanking others for commenting on a question, introducing them-
selves to the discussion, or tangentially commenting on a discussion about cannabis and
ADHD (e.g., stating that they don’t use cannabis, but smoke cigarettes). These posts were
excluded given the primary aim of this study to characterize the content of comments on
ADHD and cannabis. A total of 401 individual forum posts received at least one topic endorse-
ment within the 46 threads (see Qualitative Coding below). See Fig 1 for a summary. To allow
for analysis of temporal distribution of forum threads, the year of each post was recorded. This
study was exempted from human subjects review by the Duke Institutional Review Board due
to the anonymous and public-access format of the source data.

Qualitative Coding
A list of topics for coding individual posts in a binary response format (i.e., each post received
either a “1” for an endorsement or “0” for a non-endorsement for topics such as “Cannabis
helps with attention, hyperactivity-impulsivity, or ADHD”) was created through an iterative
process. First, a list of potential codes was created a priori by the authors for anticipated online
forum discussions involving cannabis and ADHD based on knowledge of the literature and
aims of this study. This was followed by a review of 266 individual posts across 30 different
threads, prior to random selection of posts, to assess topics that emerged that were not previ-
ously considered in the first stage. The authors then finalized the list of specific topics that were
coded based on the primary aims of the current study—additional topics on the subject of
ADHD and cannabis were coded as well, but are not reported in this study. All 401 individual
posts analyzed in this study received at least one endorsement from any of the topics on the

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 4 / 13

 Qualitative Analysis of Cannabis Use for ADHD

Fig 1. Internet Forum Identification Summary.

doi:10.1371/journal.pone.0156614.g001

subject of ADHD and cannabis used in the coding process (including the additional topics not
reported on in this study).
Among the topics that were coded for the current study, we assessed if cannabis was stated
to impact ADHD or ADHD symptoms, mood, non-ADHD psychiatric disorders, and different
domains of daily living (i.e., sleep, driving, social functioning, motivation, academic perfor-
mance, and general quality of life). For each of these topics, coding was carried out to indicate
if the effect of cannabis was stated to be therapeutic, harmful, or both therapeutic and harmful.
For the code on the effect of cannabis on ADHD, a null effects option (i.e., the post specifically
stated there is no effect of cannabis on ADHD) was also included—null effects were not coded
for cannabis effects on mood, non-ADHD psychiatric disorders, or different domains of daily
living given that this endorsement option was not observed in the code creation process.
Comments about medicinal aspects of cannabis in the context of ADHD were also coded (see
Table 1).
The randomly selected 20% of forum threads were all read in full by one of three raters.
From these forum threads, 401 individual posts received at least one code endorsement by a
rater. In cases where a person posting quoted another post that was endorsed but they them-
selves did not clearly endorse or provide sufficient information for the rater to determine if an
endorsement was warranted for a particular code, then an endorsement was not made by the

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 5 / 13

 Qualitative Analysis of Cannabis Use for ADHD

Table 1. Topic Endorsement Summary Among Forum Thread Posts.

% Topic Endorsed
Impact of cannabis on ADHD or ADHD symptoms
Therapeutic 25%
Harmful 8%
Therapeutic and harmful 5%
Null effect 2%
Impact of cannabis in other domains
Mood
Therapeutic 14%
Harmful 13%
Therapeutic and harmful 3%
Other psychiatric conditions
Therapeutic 10%
Harmful 8%
Therapeutic and harmful 1%
Different domains of daily life (e.g., sleep)
Therapeutic 11%
Harmful 7%
Therapeutic and harmful 4%
Comments about cannabis as medicinal
Cannabis more effective than ADHD medications 5%
Cannabis less effective than ADHD medications 3%
Reference to cannabis as medicinal or sanctioned by 15%
healthcare providers

Notes. Percentage calculations based on a denominator of 401.

doi:10.1371/journal.pone.0156614.t001

rater. Multiple posts by the same person (as indicated by a user identification name or number)
were allowed since the main purpose of this study was to assess what forum users might be
exposed to when looking for information on the topic of ADHD and cannabis use, therefore
multiple posts by the same person would not have a meaningful impact on interpretation of
the results.
A random selection of 10% of posts was coded by the other two raters for inter-rater reliabil-
ity. The average agreement between each grouping of raters was 93% (range: 92%-93%).
Cohen’s kappa takes chance agreement into account and was 0.74 (ranging from 0.72 and 0.76
between different pairs of raters), indicating substantial agreement [51].
Examples that typified endorsements for different topics are reported. Spelling and gram-
matical errors were not corrected, although vague use of pronouns (e.g., “it”) were replaced
with specific terms used elsewhere in the post (e.g., “medical marijuana”) and denoted by use
of parentheses. Also, use of “. . .” within quotes indicates sections that were removed to allow
for brevity while maintaining the overall context of the quote.

Results
Table 1 shows that out of the 401 individual posts examined, 25% (99 posts) endorsed that can-
nabis improved ADHD or ADHD symptoms, compared to 8% that it is harmful (31 posts), 5%
that it is both therapeutic and harmful (19 posts), and 2% that it has null effects (7 posts). We
also compared posts proposing that cannabis is therapeutic to domains other than ADHD.

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 6 / 13

 Qualitative Analysis of Cannabis Use for ADHD

Table 1 demonstrates that the higher percentage of posts supporting therapeutic versus harm-
ful effects of cannabis was not as apparent for other outcomes (i.e., mood, other psychiatric
conditions, general quality of life), which ranged from 1% (5 posts) to 14% (56 posts) of the
401 posts.
The majority of forums (59%) included posts that advocated for the therapeutic effects of
cannabis for ADHD (i.e., 27 of 46 forum threads). In terms of comments about cannabis as
therapeutic for ADHD or ADHD symptoms, below are examples that typified endorsements
for this topic:

“Marijuana works for ADHD”

"(Cannabis) helps me greatly with my ADHD"

“In regard to the ADD, while you are high . . . you will be able to focus much, much better
than you normally would.”

“medical marijuana improves the ability to concentrate in some types of ADD.”

“There are many, many studies showing the efficacy of (medical marijuana) for ADD.”

Regarding the relatively fewer posts about cannabis’ adverse effect on ADHD or ADHD
symptoms, typical comments included:

“For me, pot does nothing for my ADD. If anything, it makes it worse. I cant pay attention
sober much less high.”

“Smoking weed is bad for people with ADHD.”

Among the few that stated cannabis is both therapeutic and worsens ADHD, comments
such as “Cannabis both helps and makes (my ADHD symptoms) more intense” emerged.
Within the 99 posts that endorsed that cannabis improved ADHD or ADHD symptoms,
there were 62 posts that mentioned improvement on at least one DSM-5 ADHD symptom set
(i.e., inattention or hyperactivity-impulsivity), as opposed to posts that stated that cannabis
helped ADHD but not at the symptom level. Among the 62 posts that commented on ADHD
symptoms, 74% (46 posts) endorsed that cannabis helped inattentive symptoms (e.g., “(Canna-
bis) helps me focus” and “i find im able to concentrate so much better after a bit of cannabis"),
16% (10 posts) that cannabis helped hyperactive-impulsive symptoms (e.g., “(cannabis) sort of
helps eliminate excess pent up hyperactivity” and “i just smoke (cannabis) everyday after school
and then around night and im good i dont get to hyper and i have total control of how i act”),
and 10% (6 posts) that cannabis helped both inattentive and hyperactive-impulsive symptoms
(e.g., “when (I) attend class stoned . . . (I am) more focused and less nervous and hyperactive”
and “(I) use pot for (ADHD), and it helps quell racing thoughts, hyperactivity, and rage, while
considerably extending attention span.”).
We also evaluated changes in the content of posts involving impact of cannabis on ADHD
or ADHD symptoms over time across the 401 posts. All 401 posts were made between 2004
and 2014. The percentage of individual post endorsements on the therapeutic, harmful, thera-
peutic and harmful, and null effects of cannabis on ADHD per year was considered (e.g., the
number of endorsements that cannabis is effective for ADHD for a particular year divided by
the total number of posts for that year). As shown in Fig 2, endorsements indicating that

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 7 / 13

 Qualitative Analysis of Cannabis Use for ADHD

Fig 2. The percentage of individual post endorsements for each respective code on the effects of cannabis on ADHD per year
(2004–2014) among the 401 posts analyzed.
doi:10.1371/journal.pone.0156614.g002

cannabis is therapeutic for ADHD has been consistently higher since 2006 relative to posts
about its potential harmful impact, combined therapeutic and harmful effects, or null effect.
Comments about the medicinal aspects of cannabis use in the context of discussing ADHD
were also considered across the 401 posts (Table 1). Overall, few commented on how cannabis
compares to ADHD medications (i.e., 5% [22 posts] indicated that cannabis is more effective
and 3% [12 posts] that it is less effective). Fifteen percent (62 posts) indicated that cannabis
was considered medicinal or sanctioned by healthcare providers. In many cases, these posts
pertained to the medicinal use of cannabis for ADHD. For example, one post stated “I am 21
years of age and strongly believe in medical marijuana and why people with adhd should be get-
ting percribed it in this country” and then listed a link to a website from a physician purportedly
advocating cannabis as a treatment for ADHD. Other examples of posts that typified this topic
include:

“(A physician) has also worked with one family of a 15-year-old—whose family had tried
every drug available to help their son, who by age 13 had become a problem student diag-
nosed as suffering from ADHD. Under (a physician’s) supervision, he began marijuana
treatment, settling on cannabis in food and candy form, and he has since found equilibrium
and regularly attends school.”

“I have ADD and I use (medical marijuana) for it. It works very well. I'm 64 and was diag-
nosed with adult ADD 4 years ago. I had it confirmed by two MD's and a psychiatrist.. . .I
now use marijuana exclusively.”

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 8 / 13

 Qualitative Analysis of Cannabis Use for ADHD

Discussion
This study is the first to systematically analyze a source of online information that patients and
caregivers may use to inform their opinions about ADHD and cannabis. A qualitative analysis
examining the content of online forum threads on the topic of ADHD and cannabis use indi-
cated that at least three times as many comments advocated for therapeutic effects of cannabis
on ADHD compared to comments that cannabis is harmful, both therapeutic and harmful, or
has no effect on ADHD. The disproportionate number of comments favoring the therapeutic
over harmful effects of cannabis was specific to ADHD and was not generalizable when mood,
non-ADHD psychiatric conditions, or general quality of life were considered. Analysis of the
temporal distribution of posts about the effects of cannabis on ADHD indicated that the ten-
dency to advocate for its therapeutic effects has generally been consistent since 2006. Qualita-
tive analysis also indicated that comments purporting the therapeutic effects of cannabis for
ADHD predominantly referenced improvement in inattentive symptoms, as opposed to hyper-
active-impulsive symptoms. Relatively few comments comparing cannabis against ADHD
medications emerged. However, there were a number of comments indicating that cannabis is
considered “medicinal” or sanctioned by healthcare providers.
The primary motivation in conducting this analysis was to systematically identify and ana-
lyze a source of information patients and caregivers might access to learn about the effects of
cannabis use on ADHD. The majority of US Internet users query the Internet for healthcare
information [29]. This necessitates addressing patient use of the Internet in clinical practice
and how it affects the patient-provider relationship [52]. Our data suggest that patients seeking
information regarding cannabis effects on ADHD will find a greater amount of information on
Internet forums biased toward cannabis improving ADHD. This is relevant for healthcare pro-
viders so that they can anticipate perceptions informed by online resources and develop a com-
munication style that is both inclusive of patient concerns based on such searches and
contributes to quality health care [53, 54].
Our findings indicating bias towards cannabis being beneficial for ADHD is consistent with
national trends about the decreased perceived risk associated with regular cannabis use [24]
and is relevant to individuals diagnosed with ADHD. Such online information may impact per-
ceptions promoting use, which can be problematic given the maladaptive effects of use [8, 12–
14]. In particular, the adverse neurocognitive effects of cannabis use [9–11] may have an addi-
tive effect on neurocognitive deficits observed in ADHD independent of cannabis use [15, 16]
—emerging findings support this additive effect in those with ADHD [18]. Consequently, the
actual effects of cannabis use may be particularly maladaptive in ADHD patients, which stands
in stark contrast to messages arguing for therapeutic effects identified in this study. Further,
there are no systematically collected data to support that cannabis is therapeutic for ADHD.
Findings from this study are particularly relevant as nearly half of all US states have enacted
legislation legalizing medicinal cannabis, while four states plus the District of Columbia have
passed laws legalizing recreational use that will likely translate into greater cannabis availability
to adolescents (and more certainly young adults).
The current findings demonstrate that an online source that may be used by caregivers and
patients with ADHD seeking more information about cannabis favors the beneficial effects of
use on ADHD. Future studies are needed to assess if these attitudes are endorsed by ADHD
patients. To our knowledge, only one study has examined perceptions of cannabis use in
ADHD [55], though this study did not assess the perceived impact on ADHD. If this is sup-
ported, future studies are needed to (a) assess if such perceptions predict cannabis use in
ADHD samples and (b) compare these perceptions against objective effects of cannabis in
ADHD samples. Increased understanding of these relationships can inform treatment of

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 9 / 13

 Qualitative Analysis of Cannabis Use for ADHD

ADHD patients and cannabis prevention efforts (e.g., education about the inaccuracy of per-
ceptions about the effects of cannabis use on ADHD symptoms).
In terms of study limitations, although data was collected from a resource that patients and
caregivers may use to learn about cannabis and ADHD (i.e., online forums), it is unclear how
often ADHD patients and caregivers access this online resource or online resources in general
to learn more about treatment options. However, past studies do demonstrate that individuals
seek out healthcare information online [29] and that this extends to inquiries about therapeutic
effects of cannabis for different psychiatric disorders [25]. Another limitation is that this study
only focuses on one Internet resource: forums. Although this study was therefore restricted in
scope, forums are commonly used to inform mental health care decisions [35–37] and were
therefore targeted for this study. Also, given the anonymous format of forum threads, there are
no demographic data or information about diagnostic status available for individuals who
posted information. Further, individuals who post on forums may be a self-selected sample
that may not represent views of the general population of ADHD patients. However, this is not
a limitation of the current study given that our main aim was to assess what is advocated
through online forums, regardless of who is posting on such forums. Relatedly, no inferences
can be drawn about the prevalence of perceptions regarding the effects of cannabis on ADHD
in patients with the disorder—that was beyond the scope of the present study (i.e., to assess the
content of online data referring to cannabis and ADHD in forums). To address this concern, as
mentioned above, future studies that examine perceptions among well-characterized ADHD
samples are needed.

Conclusions
In summary, there is a dearth of systematic studies analyzing a source of online information
patients and caregivers might access to learn about the effects of cannabis on ADHD—this is the
first study, to our knowledge, to do so. Our findings involving the trend of online forum threads
advocating for the therapeutic effects of cannabis for ADHD are particularly important since
patients and caregivers seek out information online. Moreover, this topic is likely to be increasingly
broached in clinical settings. This study also demonstrates the utility of online data to examine
trends in substance use and inform future studies. In particular, findings from this study indicate
the need to assess perceptions involving cannabis use and ADHD in ADHD patients, in addition
to examining the objective effects of cannabis use on ADHD symptoms and associated features.

Supporting Information
S1 Dataset. The additional file “S1_Dataset” contains data. In this Excel file, we provide one
file: S1_Dataset.xlsx.
(XLSX)

Acknowledgments
We thank Chelsea Hagmann and Simar Nagyal for assistance with data collection and cleaning.
Preliminary findings from this study were presented at the 77th annual conference for the Col-
lege on Problems of Drug Dependence, Phoenix, AZ.

Author Contributions
Conceived and designed the experiments: JTM FJM SHK. Performed the experiments: JTM
MMS AMT FJM. Analyzed the data: JTM. Contributed reagents/materials/analysis tools: JTM.
Wrote the paper: JTM MMS AMT SHK FJM.

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 10 / 13

 Qualitative Analysis of Cannabis Use for ADHD

References
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition
(DSM-5). Washington, D.C.: American Psychiatric Association; 2013.
2. Lee SS, Humphreys KL, Flory K, Liu R, Glass K. Prospective association of childhood attention-deficit/
hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin
Psychol Rev. 2011; 31(3):328–41. Epub 2011/03/09. doi: 10.1016/j.cpr.2011.01.006 PMID: 21382538.
3. Molina BS, Hinshaw SP, Eugene Arnold L, Swanson JM, Pelham WE, Hechtman L, et al. Adolescent
substance use in the multimodal treatment study of Attention-Deficit/Hyperactivity Disorder (ADHD)
(MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent
medication. J Am Acad Child Adolesc Psychiatry. 2013; 52(3):250–63. Epub 2013/03/05. doi: 10.1016/
j.jaac.2012.12.014 PMID: 23452682; PubMed Central PMCID: PMC3589108.
4. Hechtman L, Swanson J, Arnold LE, Sibley M, Owens EB, Mitchell JT, et al. Functional adult outcomes
16 years after childhood diagnosis of Attention-Deficit/Hyperactivity Disorder: MTA results. Submitted.
5. Zaman T, Malowney M, Knight J, Boyd JW. Co-occurrence of substance-related and other mental
health disorders among adolescent cannabis users. J Addict Med. 2015; 9(4):317–21. Epub 2015/06/
18. doi: 10.1097/ADM.0000000000000138 PMID: 26083957.
6. De Alwis D, Lynskey MT, Reiersen AM, Agrawal A. Attention-deficit/hyperactivity disorder subtypes
and substance use and use disorders in NESARC. Addict Behav. 2014; 39(8):1278–85. doi: 10.1016/j.
addbeh.2014.04.003 PMID: 24821471; PubMed Central PMCID: PMC4135513.
7. Bidwell LC, Henry EA, Willcutt EG, Kinnear MK, Ito TA. Childhood and current ADHD symptom dimen-
sions are associated with more severe cannabis outcomes in college students. Drug Alcohol Depend.
2014; 135:88–94. doi: 10.1016/j.drugalcdep.2013.11.013 PMID: 24332802; PubMed Central PMCID:
PMC3904106.
8. Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J
Med. 2014; 370(23):2219–27. doi: 10.1056/NEJMra1402309 PMID: 24897085.
9. Crane NA, Schuster RM, Fusar-Poli P, Gonzalez R. Effects of cannabis on neurocognitive functioning:
recent advances, neurodevelopmental influences, and sex differences. Neuropsychol Rev. 2013; 23
(2):117–37. doi: 10.1007/s11065-012-9222-1 PMID: 23129391; PubMed Central PMCID:
PMC3593817.
10. Crean RD, Crane NA, Mason BJ. An evidence based review of acute and long-term effects of cannabis
use on executive cognitive functions. J Addict Med. 2011; 5(1):1–8. doi: 10.1097/ADM.
0b013e31820c23fa PMID: 21321675; PubMed Central PMCID: PMC3037578.
11. Lisdahl KM, Wright NE, Kirchner-Medina C, Maple KE, Shollenbarger S. The effects of regular canna-
bis use on neurocognition in adolescents and young adults. Curr Addict Rep. 2014; 1(2):144–56. doi:
10.1007/s40429-014-0019-6 PMID: 25013751; PubMed Central PMCID: PMC4084860.
12. Volkow ND, Swanson JM, Evins AE, DeLisi LE, Meier MH, Gonzalez R, et al. Effects of cannabis use
on human behavior, including cognition, motivation, and psychosis: a review. JAMA Psychiatry. 2016.
doi: 10.1001/jamapsychiatry.2015.3278 PMID: 26842658.
13. Hall W. The adverse health effects of cannabis use: what are they, and what are their implications for
policy? Int J Drug Policy. 2009; 20(6):458–66. doi: 10.1016/j.drugpo.2009.02.013 PMID: 19362460.
14. Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009; 374
(9698):1383–91. doi: 10.1016/S0140-6736(09)61037-0 PMID: 19837255.
15. Hervey AS, Epstein JN, Curry JF. Neuropsychology of adults with attention-deficit/hyperactivity disor-
der: a meta-analytic review. Neuropsychology. 2004; 18(3):485–503. doi: 10.1037/0894-4105.18.3.485
PMID: 15291727.
16. Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF. Validity of the executive function theory of
attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry. 2005; 57(11):1336–46.
Epub 2005/06/14. doi: 10.1016/j.biopsych.2005.02.006 PMID: 15950006.
17. Barkley RA, Cox D. A review of driving risks and impairments associated with attention-deficit/hyperac-
tivity disorder and the effects of stimulant medication on driving performance. J Safety Res. 2007; 38
(1):113–28. doi: 10.1016/j.jsr.2006.09.004 PMID: 17303170.
18. Tamm L, Epstein JN, Lisdahl KM, Molina B, Tapert S, Hinshaw SP, et al. Impact of ADHD and cannabis
use on executive functioning in young adults. Drug Alcohol Depend. 2013; 133(2):607–14. Epub 2013/
09/03. doi: 10.1016/j.drugalcdep.2013.08.001 PMID: 23992650; PubMed Central PMCID:
PMC3820098.
19. Rasmussen J, Casey BJ, van Erp TG, Tamm L, Epstein JN, Buss C, et al. ADHD and cannabis use in
young adults examined using fMRI of a Go/NoGo task. Brain Imaging Behav. 2015. Epub 2015/10/23.
doi: 10.1007/s11682-015-9438-9 PMID: 26489976.

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 11 / 13

 Qualitative Analysis of Cannabis Use for ADHD

20. Lisdahl KM, Tamm L, Epstein JN, Jernigan T, Molina BS, Hinshaw SP, et al. The impact of ADHD per-
sistence, recent cannabis use, and age of regular cannabis use onset on subcortical volume and corti-
cal thickness in young adults. Drug Alcohol Depend. 2016. Epub 2016/02/22. doi: 10.1016/j.
drugalcdep.2016.01.032 PMID: 26897585.
21. Allsop DJ, Copeland J, Norberg MM, Fu S, Molnar A, Lewis J, et al. Quantifying the clinical significance
of cannabis withdrawal. PloS one. 2012; 7(9):e44864. doi: 10.1371/journal.pone.0044864 PMID:
23049760; PubMed Central PMCID: PMC3458862.
22. Marijuana and Medicine: The Need for a Science-Based Approach: Hearing before the Subcommittee
on Criminal Justice, Drug Policy and Human Resources, U.S. House of Representatives, Second Ses-
sion Sess. (April 1, 2004).
23. Strohbeck-Kuehner P, Skopp G, Mattern R. Cannabis improves symptoms of ADHD. Cannabinoids.
2008; 3(1):1–3.
24. Johnston LD, O'Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the Future national
results on drug use: 1975–2013: overview, key findings on adolescent drug use. Ann Arbor, MI. Insti-
tute for Social Research, University of Michigan; 2014.
25. Hadland SE, Knight JR, Harris SK. Medical marijuana: review of the science and implications for devel-
opmental-behavioral pediatric practice. J Dev Behav Pediatr. 2015; 36(2):115–23. Epub 2015/02/05.
doi: 10.1097/DBP.0000000000000129 PMID: 25650954; PubMed Central PMCID: PMC4318349.
26. Del Boca FK, Darkes J, Goldman MS, Smith GT. Advancing the expectancy concept via the interplay
between theory and research. Alcohol Clin Exp Res. 2002; 26(6):926–35. Epub 2002/06/18. PMID:
12068263.
27. Goldman MS. Expectancy and risk for alcoholism: the unfortunate exploitation of a fundamental charac-
teristic of neurobehavioral adaptation. Alcohol Clin Exp Res. 2002; 26(5):737–46. Epub 2002/06/05.
PMID: 12045484.
28. Saloner B, McGinty EE, Barry CL. Policy strategies to reduce youth recreational marijuana use. Pediat-
rics. 2015; 135(6):955–7. Epub 2015/05/06. doi: 10.1542/peds.2015-0436 PMID: 25941304.
29. Fox S, Duggan M. Health Online 2013 Washington, D.C.: Pew Research Center; 2013 [August 28,
2015]. Available from: http://pewinternet.org/Reports/2013/Health-online.aspx.
30. Wartella E, Rideout V, Zupancic H, Beaudoin-Ryan L, Lauricella A. Teens, health, and technology: a
national survey. Evanston, IL: Northwestern University; 2015.
31. Griffiths P, Vingoe L, Hunt N, Mounteney J, Hartnoll R. Drug information systems, early warning, and
new drug trends: can drug monitoring systems become more sensitive to emerging trends in drug con-
sumption? Subst Use Misuse. 2000; 35(6–8):811–44. Epub 2000/06/10. PMID: 10847213.
32. Schifano F, Deluca P, Baldacchino A, Peltoniemi T, Scherbaum N, Torrens M, et al. Drugs on the web;
the Psychonaut 2002 EU project. Progress Neuropsychopharmacol Biol Psych. 2006; 30(4):640–6.
Epub 2006/02/07. doi: 10.1016/j.pnpbp.2005.11.035 PMID: 16458404.
33. Mounteney J, Fry C, McKeganey N, Haugland S. Challenges of reliability and validity in the identifica-
tion and monitoring of emerging drug trends. Subst Use Misuse. 2010; 45(1–2):266–87. Epub 2009/12/
23. doi: 10.3109/10826080903368598 PMID: 20025453.
34. Miller PG, Sonderlund AL. Using the internet to research hidden populations of illicit drug users: a
review. Addiction. 2010; 105(9):1557–67. Epub 2010/07/16. doi: 10.1111/j.1360-0443.2010.02992.x
PMID: 20626378.
35. Blume A, Mergl R, Niedermeier N, Kunz J, Pfeiffer-Gerschel T, Karch S, et al. Evaluation of an online
discussion forum for depressive patients and their relatives—an examination focussing motives and
effects of participation. Neuropsychiatr. 2009; 23(1):42–51. Epub 2009/03/11. PMID: 19272291.
36. Burri M, Baujard V, Etter JF. A qualitative analysis of an internet discussion forum for recent ex-smok-
ers. Nicotine Tob Res. 2006; 8 Suppl 1:S13–9. Epub 2007/05/12. PMID: 17491166.
37. Kummervold PE, Gammon D, Bergvik S, Johnsen JA, Hasvold T, Rosenvinge JH. Social support in a
wired world: use of online mental health forums in Norway. Nord J Psychiatry. 2002; 56(1):59–65. Epub
2002/03/01. doi: 10.1080/08039480252803945 PMID: 11869468.
38. Boyer C. Realizing the potential of the internet for health and medical information. Stud Health Technol
Inform. 2004; 100:159–63. Epub 2005/02/19. PMID: 15718574.
39. Boyer EW, Lapen PT, Macalino G, Hibberd PL. Dissemination of psychoactive substance information
by innovative drug users. Cyberpsychol Behav. 2007; 10(1):1–6. Epub 2007/02/20. doi: 10.1089/cpb.
2006.9999 PMID: 17305442.
40. Boyer EW, Shannon M, Hibberd PL. Web sites with misinformation about illicit drugs. N Engl J Med.
2001; 345(6):469–71. Epub 2001/08/11. doi: 10.1056/NEJM200108093450619 PMID: 11496870.

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 12 / 13

 Qualitative Analysis of Cannabis Use for ADHD

41. Boyer EW, Shannon M, Hibberd PL. The Internet and psychoactive substance use among innovative
drug users. Pediatrics. 2005; 115(2):302–5. Epub 2005/02/03. doi: 10.1542/peds.2004-1199 PMID:
15687436.
42. Falck RS, Carlson RG, Wang J, Siegal HA. Sources of information about MDMA (3,4-methylenedioxy-
methamphetamine): perceived accuracy, importance, and implications for prevention among young
adult users. Drug Alcohol Depend. 2004; 74(1):45–54. Epub 2004/04/10. doi: 10.1016/j.drugalcdep.
2003.11.009 PMID: 15072806.
43. Lange JE, Daniel J, Homer K, Reed MB, Clapp JD. Salvia divinorum: effects and use among YouTube
users. Drug Alcohol Depend. 2010; 108(1–2):138–40. Epub 2009/12/25. doi: 10.1016/j.drugalcdep.
2009.11.010 PMID: 20031341.
44. Flower A, Bishop FL, Lewith G. How women manage recurrent urinary tract infections: an analysis of
postings on a popular web forum. BMC Fam Pract. 2014; 15:162. Epub 2014/09/28. doi: 10.1186/1471-
2296-15-162 PMID: 25260870; PubMed Central PMCID: PMC4262982.
45. Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description—the poor cousin of
health research? BMC Med Res Methodology. 2009; 9:52. Epub 2009/07/18. doi: 10.1186/1471-2288-
9-52 PMID: 19607668; PubMed Central PMCID: PMC2717117.
46. Sandelowski M. What's in a name? qualitative description revisited. Res Nurs Health. 2010; 33(1):77–
84. Epub 2009/12/17. doi: 10.1002/nur.20362 PMID: 20014004.
47. Daniulaityte R, Carlson R, Falck R, Cameron D, Perera S, Chen L, et al. "I just wanted to tell you that
loperamide WILL WORK": a web-based study of extra-medical use of loperamide. Drug Alcohol
Depend. 2013; 130(1–3):241–4. Epub 2012/12/04. doi: 10.1016/j.drugalcdep.2012.11.003 PMID:
23201175; PubMed Central PMCID: PMC3633632.
48. Lipsman A, Lella A. 2015 U.S. Digital Future in Focus Reston, VA: comScore [August 28, 2015]. Avail-
able from: http://www.comscore.com/Insights/Presentations-and-Whitepapers/2015/2015-US-Digital-
Future-in-Focus.
49. Blakely G, Hennessy C, Chung MC, Skirton H. Adaption and adjustment of military spouses to over-
seas postings: an online forum study. Nurs Health Sci. 2014; 16(3):387–94. Epub 2014/03/19. doi: 10.
1111/nhs.12122 PMID: 24636280.
50. Poole R, Smith D, Simpson S. How Patients contribute to an online psychoeducation forum for bipolar
disorder: a virtual participant observation study. JMIR Ment Health. 2015; 2(3):e21. Epub 2015/11/07.
doi: 10.2196/mental.4123 PMID: 26543925; PubMed Central PMCID: PMC4607375.
51. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;
33(1):159–74. Epub 1977/03/01. PMID: 843571.
52. McMullan M. Patients using the Internet to obtain health information: how this affects the patient-health
professional relationship. Patient Educ Couns. 2006; 63(1–2):24–8. Epub 2006/01/13. doi: 10.1016/j.
pec.2005.10.006 PMID: 16406474.
53. Wald HS, Dube CE, Anthony DC. Untangling the web—the impact of Internet use on health care and
the physician-patient relationship. Patient Educ Couns. 2007; 68(3):218–24. Epub 2007/10/09. doi: 10.
1016/j.pec.2007.05.016 PMID: 17920226.
54. Bylund CL, Gueguen JA, Sabee CM, Imes RS, Li Y, Sanford AA. Provider-patient dialogue about Inter-
net health information: an exploration of strategies to improve the provider-patient relationship. Patient
Educ Couns. 2007; 66(3):346–52. Epub 2007/03/03. doi: 10.1016/j.pec.2007.01.009 PMID: 17329062.
55. Harty SC, Pederson SL, Gnagy EM, Pelham WE Jr., Molina BSG. ADHD and marijuana use expectan-
cies in young adulthood. Subst Use Misuse. 2015; 50(11):1470–8. doi: 10.3109/10826084.2015.
1018545 PMID: 26548364

PLOS ONE | DOI:10.1371/journal.pone.0156614 May 26, 2016 13 / 13