Stability and Change in Psychosocial Risk and Protective Profiles for Substance Use in Adolescents With and Without ADHD: A Person-Centered Approach

PROJECT SUMMARY/ABSTRACT Attention-deficit hyperactivity disorder (ADHD), a neurodevelopmental disorder characterized by difficulties with sustained attention, hyperactivity/impulsivity, and executive functioning, is a well-established developmental risk factor for substance use, including during the adolescent period. Alcohol, cannabis, and nicotine/electronic nicotine delivery system (ENDS) use is particularly prevalent during adolescence. Unfortunately, earlier initiation of substance use (SU) during adolescence is associated with high-risk drinking behaviors, problems associated with cannabis and nicotine use, and overall poorer substance use related outcomes in adolescence and adulthood. This is particularly true for adolescents with ADHD, who initiate substance use earlier and escalate substance use faster than adolescents without ADHD. Dynamic interactions in multiple ecological domains, including peers, family, and school have been implicated in the etiology of adolescent SU. ADHD is associated with vulnerability across all of these domains and pathways to SU through individual psychosocial and ecological factors have been identified in youth with ADHD. However, risk and protective profiles for SU spanning multiple ecological domains remain largely underexplored in adolescents with ADHD, and little work has harnessed data-driven, person-centered (as opposed to variable-centered) statistical methods to explore dynamic changes in both exposure to psychosocial risk and protective factors and the onset of substance use behaviors, in youth with and without ADHD. To address these gaps, the aims of the proposed study are to: (1) Utilize multigroup latent profile analysis (LPA) to identify whether profiles of psychosocial risk and protective factors for SU across peer, familial, and school contexts from early to middle adolescence (ages 9-14) are similar or distinct for youth with and without ADHD. (2) Utilize latent transition analysis (LTA) to examine patterns of stability and change in these risk and protective profiles for youth with and without ADHD across adolescence. (3) Examine associations between shifts in profile membership across early adolescence and SU behaviors (odds of SU initiation and frequency of SU) in middle adolescence (ages 13-14) for youth with and without ADHD. This research is responsive to priority area 1.2 in NIDA’s 2022-2026 strategic plan of advancing understanding of the influence of youth’s social ecologies developmental substance use trajectories. Funding this project will provide critical experience to further the applicant’s career goals of becoming independent investigator and set up her future work in developing prevention and treatment interventions targeting risky SU in adolescents with ADHD by addressing critical risk and protective factors on the individual level.