Pathways to Substance Use and Sexual Risk Behavior Among College Students with ADHD Symptomatology

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While growing numbers of students with attention deficit hyperactivity disorder (ADHD) symptomatology are pursuing postsecondary education, there is a dearth of information concerning the social functioning of these students. ADHD symptomatology has been strongly linked with risk behaviors that contribute to chronic health problems, including substance use and risky sexual behavior, resulting in twice the health care costs for these students in the United States. Despite such critical findings, specific pathways between ADHD and substance use and sexual risk, have not been identified. A large body of literature has demonstrated that individuals with ADHD are at greater risk for developing externalizing behavior problems, which in turn appear to predict substance use and sexual risk behavior. Evidence also suggests that individuals with ADHD symptomatology often exhibit executive function (EF) deficits, and several studies have linked executive dysfunction to substance use problems and sexual risk behavior. Therefore, the purpose of the present study was to: a) examine the relationship among ADHD symptomatology, externalizing symptomatology, EF deficits, substance use, and sexual risk behavior among N=411 college students; b) propose and test three nested, latent variable models (i.e., a mediation, full, and a direct effects model) and identify significant paths between the variables; and c) examine the three latent variable models and determine which model best represents the relationship between the variables. Overall, results revealed significant correlations among ADHD symptomatology, externalizing symptomatology, EF deficits, substance use, and sexual risk behavior. While the mediation and full models demonstrated specification errors that could not be resolved into meaningful solutions, significant pathways were identified within the direct latent variable model, including paths between ADHD symptomatology, externalizing symptomatology, EF deficits, substance use, and sexual risk behavior, respectively. Furthermore, the direct model proved to best represent the data, over and above the two other latent variable models. The present findings have implications for public health policy, particularly as it relates to the college population. Limitations of the study and suggestions for future research are discussed.