Adolescent Mediators of Unplanned Pregnancy among Women with and without Childhood ADHD

Abstract

We aimed to identify adolescent mediators of the significant and sizable link between childhood attention deficit/hyperactivity disorder (ADHD) and later unplanned pregnancy in our prospectively followed, all-female sample. Participants included an ethnically diverse (47% non-White) sample of women with (n = 140) and without (n = 88) childhood ADHD who were assessed 4 times across childhood, adolescence, and adulthood. Potential mediators were measured via self, parent, and teacher report on questionnaires and interviews and by objective testing. We tested 5 early adolescent variables in three domains (personality, behavioral, and academic) as components of serial mediation pathways from (a) childhood ADHD status to (b) the early adolescent putative mediator to (c) risky sexual behavior in late adolescence and finally to (d) unplanned pregnancy by early adulthood. Of these, academic achievement (indirect effect = .1339, SE = .0721), 95% confidence interval (CI) [.0350, .3225] and substance use frequency (indirect effect = .0211, SE = .0167), 95% CI [.0013, .0711] operated through late-adolescent risky sexual behavior to explain rates of unplanned pregnancy, even adjusting for the effects of age, IQ, and family socioeconomic status (SES). When these 2 indirect effects were entered simultaneously, only the pathway from childhood ADHD to low academic achievement to higher rates of risky sexual behavior to unplanned pregnancy was significant (indirect effect = .0295, SE = .0145), 95% CI [.0056, .0620]. We discuss the significance of these early adolescent mediators, particularly academic engagement, as potential intervention targets intended to reduce rates of later unplanned pregnancies among female individuals with ADHD.