Heavy alcohol use in early adulthood as a function of childhood ADHD: developmentally specific mediation by social impairment and delinquency

Abstract

Frequent heavy drinking in early adulthood, particularly prior to age 21, is associated with multiple health and legal consequences including continued problems with drinking later into adulthood. Children with attention-deficit/hyperactivity disorder (ADHD) are at risk of alcohol use disorder in adulthood, but little is known about their frequency of underage drinking as young adults or about mediational pathways that might contribute to this risky outcome. The current study used data from the Pittsburgh ADHD Longitudinal Study to test social impairment and delinquency pathways from childhood ADHD to heavy drinking in early adulthood for individuals with (n = 148) and without (n = 117) childhood ADHD. Although ADHD did not predict heavy drinking, indirect mediating effects in opposing directions were found. A delinquency pathway from childhood ADHD to increased heavy drinking included adolescent and subsequently adult delinquent behavior. A social impairment pathway from childhood ADHD to decreased heavy drinking included adolescent, but not adult, social impairment. These findings help explain the heterogeneity of results for alcohol use among individuals with ADHD and suggest that common ADHD-related impairments may operate differently from each other and distinctly across developmental periods.

Figure 1

Social impairment and delinquency as mediators of childhood ADHD and young adult heavy alcohol use. The reported path coefficients are standardized. Alcohol use at age 17, race/ethnicity, proportion of time living at home from 18 to 20, and proportion of time enrolled in school from 18 to 20 were controlled for in the model. χ² = 58.71, df = 21, p < .001 RMSEA = .06, CFI = .92 Coefficients are standardized. ⁺p < .10, *p < .05, **p < .01, *** p < .001