Are Risky Behaviors and Substance Use Higher Among Adolescence with Externalizing Disorders?

Externalizing disorders, including Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiance Disorder (ODD), Conduct Disorder (CD), and Impulse Control Disorder (ICD), are characterized by behavioral disinhibition/disruptive behaviors (King at al., 2004) and have been linked to high rates of substance use (Brady et al., 1998; De Sanctis, et al., 2008; Flory & Lynam, 2003; King et al., 2004). Specifically, Substance Use Disorders (SUDs) are three times higher among adolescents with ADHD and ten times higher for those with CD compared to those without these disorders (Kuperman et al., 2001). Additionally, adolescents with externalizing disorders tend to use substances earlier compared to others (Lillehoj et al., 2005), with many exposed to/regular use of alcohol, nicotine, and marijuana by age 14 (King et al., 2004). Unfortunately, adolescents with comorbid externalizing disorders and SUDs have a poorer prognosis, tending to display more substance use compared to those with SUDs only (Randall et al., 1999). Parental substance abuse disorders have also been related to a higher risk of substance use among adolescents (Hawkins et al., 1992), perhaps due to factors like accessibility and genetic predisposition. Research also suggests high rates of other risky/illegal behaviors for adolescents with externalizing disorders, including an increased number of sexual partners, rates of pregnancy, and sexually transmitted infections among adolescent females with CD (Bardone et al., 1996; 1998). Criminal behavior is more frequent among adolescents with externalizing disorders and comorbid SUDs (Randall et al., 1999). Additional factors like behavioral disinhibition and sensation seeking, typically seen in adolescents with externalizing disorders, contribute to greater engagement in illegal activities (Hawkins et al., 1992). The current study seeks to investigate male adolescents with and without externalizing disorders (i.e., ADHD, ODD, CD, and ICD) by investigating a sample of youth in a residential treatment facility for sexually abusive behaviors (N = 295). Data related to adolescents’ substance use, criminal behavior, risky sexual behaviors, and participant/parental substance abuse history were gathered from archival records. Within the sample, 234 participants were diagnosed with at least one externalizing disorder, including ADHD (n = 209), ODD (n = 91), CD (n = 102), and ICD (n = 50). Chi-square analyses and one-way ANOVAs will be conducted to explore relationships among externalizing disorders, substance use, criminal behavior, and risky sexual behaviors. The results of this study intend to inform the literature by identifying important areas of concern among adolescents with externalizing disorders. Clinical implications from the findings of the current study will help to inform prevention, risk reduction, and therapeutic goals for the treatment of adolescents with externalizing disorders