Predictors of Criminality and Substance Use in Adolescents with ADHD: A 23-Year Follow-up Study

Authors: Mathilde Solberg Jensen and Karethe Hustad Torgersen Title: Predictors of Criminality and Substance Use in Adolescents with ADHD: A 23-Year Follow-up Study Supervisor I: Merete Glenne Øie; Supervisor II: Jens Egeland. Background: The literature shows a strong link between the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) and criminality and substance use. However, less is known about the potential predictors of criminality and substance use within the ADHD population. The first aim of this study is to investigate the longitudinal criminality and substance use outcomes in adolescents with ADHD followed over 23 years. The second aim is to investigate potential predictive effects of neuropsychological impairment, ADHD symptoms and global symptom load, co-occurring externalizing and internalizing problems, and comorbid Oppositional Defiant Disorder (ODD) in adolescence on criminality and substance use after 23 years follow-up. Methods: Forty-five individuals between 12-18 years of age, 19 males with ADHD and 26 healthy controls (M= 13, F=13), were investigated 13 and 23 years after an initial baseline study. At baseline they underwent comprehensive neuropsychological testing. Emotional and behavioral problems were measured with the Attention problems, Externalizing-, Internalizing-, and Total Scale of the Child Behavior CheckList/4-18 (CBCL). Symptom load was measured with the Global Assessment Scale of Symptoms (GAS), and comorbid ODD was diagnosed by a clinician at baseline. The participants in the ADHD group were asked about criminal convictions at 13- and 23-year follow-ups. Substance use was measured in both groups using the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Use Disorder Identification Test (DUDIT) in the 23-years follow-up. Simple linear regression analyses, Analyses of variance, Chi square analyses of independence and Spearman’s rank-order correlations were used to investigate the longitudinal associations between the baseline and the outcome measures. Results: A substantial proportion of adolescents with ADHD (47%) had committed crimes by the 23-years follow-up. Two baseline measures predicted criminality in the ADHD group: overall symptom load measured with the GAS, and externalizing problems measured with the CBCL Externalizing scale. Neuropsychological functioning and comorbid ODD in the adolescents with ADHD did not predict later criminality. There were no statistically significant differences between the ADHD group and the healthy control group regarding substance use after 23 years. However, numerical differences similar to those reported in other studies were found, with the ADHD group had higher scores on all substance measures than the healthy control group. None of our baseline measures predicted substance use through the course of the 23-year study. Conclusion: A substantial amount of adolescents with ADHD were convicted of crimes and reported problematic substance use in adulthood. In individuals with ADHD, overall symptom load, and externalizing problems in adolescence, predicted criminality in adulthood. These findings indicate that it is possible to predict the risk of criminality in adulthood for adolescents with ADHD. The findings of this study highlight the need for long-term treatment planning from adolescence and into adulthood, especially in cases with high symptom load and externalizing problems