BACKGROUND:
Recent
studies have linked attention-deficit/hyperactivity disorder (ADHD) to elevated
rates of risky sexual behavior (RSB) in adult samples. The current study tested
whether ADHD symptoms were associated with RSB among adolescents, and examined
comorbid conduct problems and problematic substance use as joint mediators of
this association.
METHODS:
ADHD
symptoms, conduct problems (oppositional defiant disorder/conduct disorder
symptoms), problematic alcohol use (alcohol use disorder symptoms, alcohol use
frequency), problematic marijuana use (marijuana use disorder symptoms,
marijuana use frequency), and RSB were assessed among an ethnically diverse
cross-sectional sample of adolescents (N = 115; mean
age = 14.9 years) involved in the juvenile justice system.
RESULTS:
Bootstrapped
mediation models revealed an initial association between ADHD symptoms and RSB
that was accounted for fully by the influence of problematic alcohol and
marijuana use, but not conduct problems. A follow-up multiple groups mediation
analysis demonstrated that the relationship between ADHD symptoms and RSB
emerged only among youth with clinically elevated conduct problems, and that
problematic marijuana use fully accounted for this relationship.
Hyperactive/impulsive, but not inattentive, symptoms were related to RSB,
although the pattern of indirect effects was consistent with the multiple
groups analysis.
CONCLUSIONS:
The
association between ADHD and adolescent RSB is restricted to youth with
elevated comorbid conduct problems and reflects the contributions of comorbid
marijuana use problems, and to a lesser extent alcohol use problems. Early
identification and treatment of these comorbid conditions may be important for
the prevention of negative sexual health outcomes among youth with ADHD.
Table 1
Descriptive Statistics for Clinical Disorders and Risky Sexual Behaviors
| Variable | n (%) | Symptom Count M (SD) |
|---|
| Clinical Disorders |
| ADHD | 18 (15.65) | 10.29 (6.63) |
| ODD/CD | 49 (42.60) | 11.00 (5.90) |
| MUD | 64 (55.65) | 2.83 (3.15) |
| AUD | 17 (14.8) | 0.51 (1.48) |
| Risky Sexual Behavior Indicators |
| Lifetime vaginal intercourse | 73 (63.47) | |
| Lifetime early sexual debuta | 54 (46.95) | |
| Lifetime multiple (≥3) sexual partners | 40 (34.78) | |
| Lifetime HIV testing | 18 (15.65) | |
| Past 3 month casual sexual partnerb | 11 (9.56) | |
| Past 3 month one-time sexual partnerc | 5 (4.34) | |
| Past 3 month multiple (≥2) sexual partners | 5 (4.34) | |
| Past 3 month inconsistent condom used | 13 (11.30) | |
Note: ADHD = attention-deficit/hyperactivity disorder; ODD = oppositional defiant disorder; CD = conduct disorder; MUD = marijuana use disorder; AUD = alcohol use disorder.
aDefined as first sexual intercourse at age ≤ 14.
bDefined as sexual interourse with a non-romantic partner (e.g., a friend).
cDefined as sexual intercourse with a stranger or acquaintance.
dDefined as < 100% of sexual intercourse encounters.
- 1Center to Promote Effective Youth Development (Youth-Nex), University of Virginia, Charlottesville, VA, USA.
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