Original article
Adolescents With Attention-Deficit/Hyperactivity Disorder: Adverse Behaviors and Comorbidity

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Abstract

Purpose and Objective

There is growing evidence that adolescents with ADHD develop long-term impairments and adverse outcomes, yet less is known about their adverse behaviors. To quantify rates of mental health comorbidities in adolescents with ADHD and compare the risks of adverse behaviors among adolescents with and without ADHD.

Methods

We performed a cohort analysis of 6,483 youth from the National Comorbidity Survey Adolescent Supplement (NCS-A), a nationally representative in-person structured diagnostic interview of adolescents aged 14–18 years focusing on mental, emotional, and behavioral disorders. Main Outcomes: (1) Percentages with comorbid anxiety, mood, disruptive behavior, and substance use disorders. (2) Strength of associations of ADHD with several adverse behaviors, including suicidal symptoms, aggression, behavior regulation, life events, education, and substance use. Odds ratios were adjusted for age, sex, and race.

Results

Among the sample of 6,483 adolescents, overall, 9.5% met the criteria for ADHD. Most (69.5%) of adolescents with ADHD had at least one comorbid mental health condition. As compared to adolescents without ADHD, those with ADHD were significantly more likely to have had a suicide attempt (aOR 2.9, 95% CI = 1.3–6.6) and to have had perpetrated physical aggression (aOR 2.3, 95% CI = 1.7–3.2). Adolescents with ADHD were also more likely to have been expelled from school or fired from a job (aOR 3.3, 95% CI = 1.7–6.5) and to have had problems related to drinking alcohol (95% CI = 1.2–2.9).

Conclusions

ADHD in adolescents is a complicated disorder with elevated risks for a wide range of adverse behaviors.

Section snippets

Data source and study cohort

NCS-A was a nationally representative face-to-face survey of 6,483 adolescents aged 13–18 years, conducted in the continental United States [38]. The design and sampling are described in detail elsewhere. Briefly, the NCS-A was based on face-to-face interviews with adolescents and their parents (or parent surrogates). Parents and adolescents were interviewed separately, and their combined responses were used in determining diagnoses. All interviews were conducted using the Composite

Overview

All Odds ratios in primary tables and figures adjust for demographic characteristics (age, sex, and race/ethnicity).

Background characteristics of cohort

Table 1 compares baseline sociodemographic characteristics for youth with and without lifetime ADHD by age group, sex, race/ethnicity, and family income. The ADHD group was significantly more likely than the non-ADHD group to meet the criteria for all four comorbid mental disorder categories. Most of the ADHD sample (69.5%) had at least one comorbid mental disorder.

Lifetime suicidal behaviors

After adjusting

Discussion

In this large nationally representative sample of youth, ADHD was correlated with a range of adverse behaviors. As compared to their peers, adolescents with ADHD had a higher level of impairment in several important domains. Lifetime risks for suicidal behaviors were approximately three times greater for adolescents with ADHD. These teens were also at risk for aggressive behaviors involving physical aggression or property damage with greater than twice the likelihood than non-ADHD teens.

Conclusion

Adolescents with ADHD were found to have had an increased risk of several adverse behaviors previously reported in adults with persistent ADHD. The results offer a broad view of behavioral risks in adolescents with ADHD. Given strong correlations between ADHD and these adverse behaviors and evidence that many continue into adulthood, assessments of ADHD in pediatric primary care settings should include evaluation of these functional domains. Symptom-based evaluations and treatment guidelines do

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    Conflicts of interest: Drs Sultan, Hacker, and Olfson and Ms Liu report no conflicts to disclose.

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