Adolescent Self-reports Research Articles

Psychological Adjustment in Adolescents with Vision Impairment

The present study compared psychological adjustment of 158 adolescents with vision impairment and 158 sighted adolescents with a matched-pair design using the Strengths and Difficulties Questionnaire. Adolescent self-reports and teacher reports on emotional problems, peer problems, and total difficulties showed higher scores in students with vision impairment than in sighted students. However, the size of between-group differences was small, and adolescents who are blind and their peers with low vision showed similar levels of psychological adjustment. In addition, older students reported more emotional problems than younger students. Furthermore, differences between self-reported emotional problems of students with and without vision impairment were stronger in older participants. In both groups, girls showed more emotional problems and less conduct problems than boys. We conclude that most students with vision impairment are well adjusted but a minority may benefit from psychological interventions.

Interpersonal predictors of early therapeutic alliance in a transdiagnostic cognitive-behavioral treatment for adolescents with anxiety and depression.

The importance of therapeutic alliance in predicting treatment success is well established, but less is known about client characteristics that predict alliance. This study examined alliance predictors in adolescents with anxiety and/or depressive disorders (n=31) who received a transdiagnostic cognitive-behavioral treatment, the Unified Protocol for the Treatment of Emotional Disorders in Youth (Ehrenreich, Buzzella, Trosper, Bennett, & Barlow, 2008) in the context of a larger randomized controlled trial. Alliance was assessed at session three by therapists, clients, and independent observers. Results indicated that alliance ratings across the three informant perspectives were significantly associated with one another, but that pretreatment interpersonal variables (e.g., social support, attachment security, and social functioning in current family and peer relationships) were differentially associated with varying informant perspectives. Adolescent and observer ratings of alliance were both predicted by adolescent self-reports on measures reflecting how they perceive their interpersonal relationships. In addition, adolescent-reported symptom severity at pretreatment predicted observer ratings of alliance such that adolescents who indicated greater anxiety and depressive symptoms were rated as having stronger early alliances by independent observers. Therapists perceived having weaker early alliances with adolescents evidencing clinically significant depression at intake as compared with adolescents diagnosed with anxiety disorders alone. Future research is needed to examine whether identification of relevant interpersonal factors at intake can help improve initial therapeutic engagement and resulting outcomes for the psychosocial treatment of adolescents with anxiety and depressive disorders.

Cognitive Behavioral Treatment Outcomes in Adolescent ADHD

Objective: To assess the efficacy of cognitive behavioral therapy (CBT) for managing adolescent ADHD. Method: A total of 68 adolescents with ADHD and associated psychiatric comorbidities completed a manualized CBT treatment protocol. The intervention used in the study was a downward extension of the Safren et al. program for adults with ADHD who have symptoms unresolved by medication. Outcome variables consisted of narrow band (ADHD) and broadband (e.g., mood, anxiety, conduct) symptom measures (Behavior Assessment System for Children–2nd edition and ADHD–Rating Scales) as well as functioning measures (parent/teacher ratings and several ecologically real-world measures). Results: Treatment effects emerged on the medication dosage, parent rating of pharmacotherapy adherence, adolescent self-report of personal adjustment (e.g., self-esteem), parent and teacher ratings of inattentive symptoms, school attendance, school tardiness, parent report of peer, family and academic functioning and teacher report of adolescent relationship with teacher, academic progress, and adolescent self-esteem. Adolescents with ADHD with oppositional defiant disorder were rated by parents and teachers as benefiting less from the CBT intervention. Adolescents with ADHD and comorbid anxiety/depression were rated by parents and teachers as benefiting more from the CBT intervention. Conclusion: A downward extension of an empirically validated adult ADHD CBT protocol can benefit some adolescents with ADHD.

Adolescent Self-Reports of Social Anxiety: Can They Disagree with Objective Psychophysiological Measures and Still Be Valid?

We examined self-reported and parent-reported adolescent social anxiety symptoms and objective baseline measures of psychophysiological flexibility in 62 families. Measures completed by 31 adolescents referred for a clinical screening evaluation for social anxiety were compared to an age- and gender-matched community control sample of 31 adolescents (total sample: age range 14 to 17 years; 22 boys and 40 girls; M = 15.32 years; SD = 1.1). Clinic referred adolescents reported significantly fewer social anxiety symptoms than parents reported about adolescents. Further, for all adolescents, self-reported social anxiety symptoms exhibited low correspondence with objective psychophysiological measures. Yet, both measures uniquely discriminated between adolescents on whether they were clinic referred for a social anxiety screening. Further, adolescent self-reported social anxiety symptoms exhibited high levels of internal consistency and convergent validity. Findings indicate that researchers and practitioners should refrain from using disagreements between adolescent self-reports and other measures (e.g., parent report, objective measures) as indicators of the veracity of adolescent self-reports.

Individual and environmental predictors of health risk behaviours among Dutch adolescents: The HBSC study

To examine unique and common predictors of tobacco smoking, binge drinking, cannabis smoking, early sexual intercourse and multiple health risk behaviours. Cross-sectional survey study. The Dutch Health Behaviour in School-aged Children (HBSC) study was used to provide data on 1742 adolescents aged 15 and 16 years of age. This study focused on a variety of individual and environmental predictors of health risk behaviours, tapping into four domains (mental health, family, peers and school), retrieved by adolescent self-reports and corrected for sociodemographic variables. Logistic and linear regression analyses were performed. Unique predictors (i.e., gender, low and very low education level, general health, hyperactivity problems, conduct problems, incomplete family, religion, knowledge of mother, parental rules on alcohol drinking, time spent with friends, number of friends, perceived tobacco use of classmates, truancy) were identified. In addition, common predictors (i.e., permissive rules on alcohol drinking and much time spent with friends) were also identified, explaining an increase in engagement in all investigated health risk behaviours in adolescence, including multiple risk behaviours. A prevention strategy targeting restrictive parenting and time spent with friends may be effective to reduce/discourage engagement in health risk behaviours.

Virtual reality for acute pain reduction in adolescents undergoing burn wound care: A prospective randomized controlled trial

BackgroundEffective pain management remains a challenge for adolescents during conscious burn wound care procedures. Virtual reality (VR) shows promise as a non-pharmacological adjunct in reducing pain. AimsThis study assessed off-the-shelf VR for (1) its effect on reducing acute pain intensity during adolescent burn wound care, and (2) its clinical utility in a busy hospital setting. MethodsForty-one adolescents (11–17 years) participated in this prospective randomized controlled trial. Acute pain outcomes including adolescent self-report, nursing staff behavioral observation, caregiver observation and physiological measures were collected. Length of procedure times and adolescent reactions were also recorded to inform clinical utility. ResultsNursing staff reported a statistically significant reduction in pain scores during dressing removal, and significantly less rescue doses of Entonox given to those receiving VR, compared to those receiving standard distraction. For all other pain outcomes and length of treatment, there was a trend for lower pain scores and treatment times for those receiving VR, but these differences were not statistically significant. ConclusionDespite only minimal pain reduction achieved using off-the-shelf VR, other results from this trial and previous research on younger children with burns suggest a customized, adolescent and hospital friendly device may be more effective in pain reduction.

Diagnosing ADHD in adolescence.

This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing attention-deficit/hyperactivity disorder (ADHD) to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self- versus informant ratings, diagnostic threshold, and retrospective reporting of childhood symptoms were addressed. Using data from the Pittsburgh ADHD Longitudinal Study (PALS), parent, teacher, and self-reports of symptoms and impairment were examined for 164 adolescents with a childhood diagnosis of ADHD (age M = 14.74 years) and 119 demographically similar non-ADHD controls (total N = 283). Results indicated that 70% of the well-diagnosed childhood ADHD group continued to meet Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) diagnostic criteria for ADHD in adolescence; however, an additional 17% possessed clinically significant impairment in adolescence but did not qualify for a current ADHD diagnosis. The optimal source of information was combined reports from the parent and a core academic teacher. Adolescents with ADHD met criteria for very few symptoms of hyperactivity/impulsivity, suggesting a need to revisit the diagnostic threshold for these items. Additionally, emphasis on impairment, rather than symptom threshold, improved identification of adolescents with a gold-standard childhood diagnosis of ADHD and persistent ADHD symptoms. Parent retrospective reports of baseline functioning, but not adolescent self-reports, were significantly correlated with reports collected at baseline in childhood. Recommendations are offered for diagnosing ADHD in adolescence based on these findings.

The proxy problem anatomized: child-parent disagreement in health related quality of life reports of chronically ill adolescents

BackgroundDiscrepancy between self-reports and parent-proxy reports of adolescent health-related quality of life (HRQoL) has been repeatedly acknowledged in the literature as the proxy problem. However, little is known about the extent and direction of this discrepancy. The purpose of this study is to explore to what extent and in what direction HRQoL self-reports of adolescents with chronic conditions and those of their parents differ.MethodsA cross-sectional survey was conducted among adolescents suffering from chronic conditions and their parents. Socio-demographic and disease-related characteristics were collected and information about consequences of the chronic condition was assessed. HRQoL was measured with KIDSCREEN-10 and DISABKIDS condition generic measure (DCGM-10). Agreement was analysed through defining a threshold of agreement based on half of the standard deviation of the HRQoL score with the highest variance. Agreement occurred if the difference between adolescent and parent scores was less than or equal to half of the standard deviation. Intra-class correlation coefficients and Bland-Altman plots were also computed. The characteristics associated with direction of disagreement were statistically tested with one-way ANOVA and Chi-square tests.Results584 paired HRQoL scores were obtained. Ratings from both adolescents and parents were high, compared to European norm data. Differences between adolescents and parents were statistically significant, yet relatively small. Disagreement existed in both directions: in 24.5% (KIDSCREEN-10) and 16.8% (DCGM-10) of the cases adolescents rated their HRQoL lower than did their parent, while in 32.2% (KIDSCREEN-10) and 31.7% (DCGM-10) of the cases the opposite was true. Adolescent's age, educational level and type of education, parent's educational level, number of hospital admissions and several other disease-related factors influenced direction of disagreement.ConclusionsIn a reasonable proportion of cases the adolescent and parent agreed on the adolescent's HRQoL (43-51% of the cases) and most disagreement tended to be minor. Thus, the proxy problem may be smaller than presented in the literature and its extent may differ per population. As adolescents are expected to become partners in their own health care, it is recommended to focus on adolescents' own perceptions of HRQoL.

Cultural Socialization in Families With Adopted Korean Adolescents

Transracial, transnational families understand and transmit cultural socialization messages in ways that differ from same-race families. This study explored the ways in which transracial, transnational adoptive families discuss race and ethnicity and how these family discussions compared to self-reports from adoptive parents and adolescents regarding the level of parental engagement in cultural socialization. Of the thirty families with at least one adolescent-aged child (60% female, average age 17.8 years) who was adopted from South Korea, nine families acknowledged racial and ethnic differences, six families rejected racial and ethnic differences, and fifteen families held a discrepancy of views. Parents also reported significantly greater engagement in cultural socialization than adolescents' reports of parental engagement. However, only adolescent self-reports of parental engagement in cultural socialization matched the qualitative coding of family conversations.

Electronic Self-report Symptom and Quality of Life for Adolescent Patients With Cancer

Computerized symptom and quality of life (QoL) assessment has been tested and found feasible and acceptable in outpatient settings for adult patients with cancer, but has not been used often in pediatric oncology settings in the United States. The purpose of this pilot study was to evaluate the feasibility of an innovative, computerized symptom, and QoL assessment for adolescent patients who were being treated for cancer. A convenience sample of 40 adolescent patients with cancer, who were between 13 and 20 years old and able to communicate in English, agreed to participate. Each participant answered the Web-based Electronic Self-report Assessment-Cancer Adolescent Form on a wireless touch-screen computer just prior to a treatment visit in an ambulatory clinic setting. Descriptive frequencies and central tendency were used to describe sample characteristics and feasibility outcomes. The computerized assessment was found to be feasible with regard to data completeness rates (>99%), acceptability (high), time to complete (30 minutes), and assistance required to complete (minimal). The Electronic Self-report Assessment-Cancer Adolescent Form is a feasible approach for obtaining adolescent patients' self-report of cancer symptoms and QoL in an ambulatory setting. Screening for symptoms and QoL may be integrated during check-in procedures as routine assessment for adolescent cancer patients in ambulatory settings.

Relationships Among Pain, Protective Parental Responses, and Disability for Adolescents With Chronic Musculoskeletal Pain

Children learn to cope with pain within the context of the family and parental responses to pediatric pain can impact health outcomes. The aim of this study was to examine relationships among pain, protective parental responses to pain, functional disability, and pain catastrophizing for adolescents with chronic musculoskeletal pain syndromes. Initial evaluation records for 138 adolescents with chronic musculoskeletal pain who consulted a pediatric multidisciplinary pain management clinic were examined. Measures were collected at the time of the initial evaluation and included adolescent self-reports of their own usual pain intensity, perceived parental responses to their pain, adolescent functional disability, and pain catastrophizing. Pain catastrophizing was significantly correlated with pain intensity, protective parental responses to pain, and functional disability. Multiple regression analyses further suggest that pain catastrophizing serves as a mediator of relationships between: (1) pain and disability and (2) protective parenting responses and disability. Evidence supporting a significant indirect effect for pain catastrophizing on disability was found within both models through bootstrap and Sobel analyses. Pain catastrophizing seems to play an important role in understanding relationships between pain, protective parental responses, and disability for adolescents with musculoskeletal pain. Our findings suggest that strategies that help modify adolescent catastrophic pain beliefs and parental responses to pain, may help improve adolescent functioning.

Agreement in activity energy expenditure assessed by accelerometer and self-report in adolescents: Variation by sex, age, and weight status

The agreement between self-reported and objective estimates of activity energy expenditure was evaluated in adolescents by age, sex, and weight status. Altogether, 403 participants (217 females, 186 males) aged 13–16 years completed a 3-day physical activity diary and wore a GT1M accelerometer on the same days. Partial correlations (controlling for body mass) were used to determine associations between estimated activity energy expenditure (kcal · min−1) from the diary and accelerometry. Differences in the magnitude of the correlations were examined using Fisher's r to z transformations. Bland–Altman procedures were used to determine concordance between the self-reported and objective estimates. Partial correlations between assessments of activity energy expenditure (kcal · min−1) did not differ significantly by age (13–14 years: r = 0.41; 15–16 years: r = 0.42) or weight status (normal weight: r = 0.42; overweight: r = 0.39). The magnitude of the association was significantly affected by sex (Δr = 0.11; P < 0.05). The agreement was significantly higher in males than in females. The relationship between activity energy expenditure assessed by the objective method and the 3-day diary was moderate (controlling for weight, correlations ranged between 0.33 and 0.44). However, the 3-day diary revealed less agreement in specific group analyses; it markedly underestimated activity energy expenditure in overweight/obese and older adolescents. The assessment of activity energy expenditure is complex and may require a combination of methods.

Neighborhood and Parental Supports for Physical Activity in Minority Adolescents

Few studies have examined environmental, home, and parental supports for physical activity in underserved adolescents (low income, ethnic minority). Given the increasing incidence of obesity in minority adolescents, it is important to better understand ecologic determinants of physical activity in these youth. This study used an ecologic model to evaluate the significance of neighborhood, home, and parental supports for physical activity on moderate-to-vigorous (MV) physical activity in underserved adolescents. The study was a secondary data analysis of a randomized controlled school-based trial "Active by Choice Today" (ACT) for increasing physical activity in underserved sixth-graders. Schools were matched on school size, percentage minorities, percentage entitled to free or reduced-price lunch, and urban or rural setting prior to randomization. This study used a randomly selected sample of parents (n=280) from the intervention and control schools whose adolescent was enrolled in the larger trial. A total of 679 6th-grade students (mean age=11.4 years, 70% African-American, 76% free or reduced-price lunch, 52% female) participated in the larger trial. Parents of 280 youth were contacted to participate in a telephone survey and 198 (71%) took part in the study. The ACT trial was designed to test the efficacy of a 17-week (1 academic year) motivational plus behavioral skills intervention versus comparison after-school programs on increasing physical activity. A telephone survey was developed and was administered within 6 months after the trial began on parents of 198 adolescents from the ACT randomized school-based trial during 2005-2007. The primary outcome measure was adolescent MVPA based on 7-day accelerometry estimates from baseline to mid-intervention. The data were analyzed in 2010-2011 and included both parent and adolescent self-reports of environmental, home, and family supports for physical activity. Regression analyses indicated a significant effect of parental and neighborhood supports for physical activity on adolescent MVPA. Adolescents who perceived higher (vs lower) levels of parental support for physical activity engaged in more minutes of MVPA (B=3.01, SE=1.38, p<0.05) at mid-intervention. Adolescents who lived in neighborhoods with more (vs fewer) supports for physical activity (parks, lighting), also engaged in more minutes MVPA (B=4.27, SE=2.15, p<0.05). Support from parents and neighborhood quality are both associated with increased physical activity in underserved adolescents.

Attachment in adolescence: overlap with parenting and unique prediction of behavioural adjustment

Attachment theory was conceptualized by Bowlby as relevant across the life span, from 'cradle to grave'. The research literature on attachment in infants and preschool-aged children is extensive, but it is limited in adolescence. In particular, it is unclear whether or not attachment security is distinguishable from other qualities of the parent-adolescent relationship and predicts adjustment independently of alternate measures of it. Data from three parallel studies of adolescents, representing normal- to high-risk status, were combined, n = 248. Attachment was assessed using the Child Attachment Interview, a recently constructed measure designed for older children and adolescents. Parent-adolescent relationship quality was assessed in detail through questionnaires, interviews and observation of a standard problem-solving interaction. Adolescent adjustment was assessed through parental psychiatric interview, teacher questionnaire and adolescent self-report. Bivariate analyses showed that secure attachment representations were modestly associated with diverse measures of the current parent-adolescent relationship such as monitoring, negative expressed emotion, and directly observed parental warmth and anger. In addition, attachment representations were reliably associated with key indicators of psychological adjustment in adolescence, including parent-rated oppositional-defiant disorder symptoms and teacher-reported emotional and behavioural difficulties. Regression analyses revealed that secure attachment representations explained unique variance in these indicators of adjustment, independent of alternative measures of the parent-adolescent relationship. Adolescents' representational models of attachment are related to but distinct from current parenting quality and provide unique insight into the understanding of behavioural adjustment. The findings support a distinct conceptual role of attachment representations in adolescence. Clinical assessment and treatment models should include attachment patterns in this age group.

Temperament Alters Susceptibility to Negative Peer Influence in Early Adolescence

The role of deviant peers in adolescent antisocial behavior has been well documented, but less is known about individual differences in susceptibility to negative peer influence. This study examined whether specific temperament dimensions moderate the prospective relationship between peer deviance and delinquent behavior in early adolescence. Participants included 704 adolescents recruited from the community. At baseline, parents provided information on adolescents' temperament and youth reported on their own and their friends' delinquent behavior. Self-reports of adolescents' delinquent behavior were collected again 16 months later. Peer deviance was related to delinquent behavior over time more strongly for adolescents with low levels of task orientation, flexibility, and positive mood, compared to youth with high levels of task orientation, flexibility, and positive mood. Analyses of gender differences indicated that low flexibility increased susceptibility to negative peer influence only for males, but not females. General activity level and sleep rhythmicity did not moderate the effect of peer behavior on delinquency.

Quality of life of adolescents with autism spectrum disorders: concordance among adolescents’ self-reports, parents’ reports, and parents’ proxy reports

To compare adolescent self-reports with two types of parent reports regarding the quality of life (QoL) of adolescents with Autism Spectrum Disorders (ASDs): (1) standard parent reports, in which parents give their own perspective on their adolescent child's QoL and (2) parent proxy reports, in which parents indicate how they believe their adolescent child would answer. Thirty-nine adolescents with ASDs and their parents completed the Pediatric Quality of Life Inventory (PedsQL). Parents completed the form twice, once using standard parent report instructions and again using proxy instructions. Concordance among the three reports was evaluated via Pearson correlations. Differences in means were assessed via ANOVAs. Correlations were higher between parent proxy reports and adolescent self-reports than between standard parent reports and adolescent self-reports. In addition, average scores on the parent proxy reports were closer to adolescents' self-reports than were average scores on the standard parent reports. These results demonstrate that parents of adolescents with ASDs have different opinions about their children's quality of life than their children do, and that they are aware of these differences. If the goal is to reduce discrepancy between the reports of parents and their adolescent children with ASDs, it may be advisable to ask parents to report on their child's QoL as they believe their children would.

Linking Social Environments With the Well-being of Adolescents in Dual-Earner and Single Working Parent Families

This investigation examined the relationships between middle school-aged children’s perceptions of their social environments (home, school, neighborhood, and parental work) with self-reports of well-being. In the present study, well-being was defined by measures of physical health and psychological happiness. Data from the Nurturing Families Study were collected during in-person interviews with adolescents in dual-earner and single working parent families. Adolescents’ subjective assessments were analyzed through two hierarchical regression models: mothers’ ( N = 149) and fathers’ ( N = 150). Findings suggest that child gender, perceptions of the school environment, and parents coming home from work in a good mood significantly predict the variability in adolescent self-reports of well-being. The school environment was found to have the strongest predictive power over variations in adolescents’ well-being. Implications for practice and research, including improving supports within schools and focusing more attention on parental mood after work, are discussed.

Maternal and adolescent temperament as predictors of maternal affective behavior during mother–adolescent interactions

This study examined maternal and early adolescent temperament dimensions as predictors of maternal emotional behavior during mother–adolescent interactions. The sample comprised 151 early adolescents (aged 11–13) and their mothers (aged 29–57). Adolescent- and mother-reports of adolescent temperament and self-reports of maternal temperament were collected. Mother–adolescent dyads participated in event-planning and problem-solving interactions, which were coded for frequency of aggressive, dysphoric, and positive interpersonal maternal behavior. Analyses indicated that adolescents who are higher in temperamental Negative Affectivity and lower in Effortful Control are generally exposed to more frequent aggressive and less frequent positive interpersonal maternal behavior. Furthermore, mothers lower in Effortful Control engaged in more frequent dysphoric behavior toward their adolescent. Given the associations between parental emotional behavior and the development of adolescent emotion regulation, these findings suggest that temperamental dispositions, particularly of early adolescents, may influence their ongoing socialization of emotion regulation skills, and thus their emotional well being.

Early adolescent executive functioning, intrauterine exposures and own drug use

Individual differences in adolescents' executive functioning are often attributed either to intrauterine substance exposure or to adolescents' own substance use, but both predictors typically have not been evaluated simultaneously in the same study. This prospective study evaluated whether intrauterine drug exposures, the adolescents' own substance use, and/or their potential interactions are related to poorer executive functioning after controlling for important contextual variables. Analyses were based on data collected on a sample of 137 predominantly African-American/African Caribbean adolescents from low-income urban backgrounds who were followed since their term birth. Intrauterine substance exposures (cocaine, marijuana, alcohol, and cigarettes) and adolescents' substance use were documented using a combination of biological assays and maternal and adolescent self-report. At 12–14 years of age, examiners masked to intrauterine exposures and current substance use assessed the adolescents using the Delis–Kaplan Executive Function System (D-KEFS), an age-referenced instrument evaluating multiple dimensions of executive functioning (EF). Results of covariate-controlled analyses in this study suggest that when intrauterine substance exposures and young adolescents' substance use variables were in the same analysis models, subtle differences in specific EF outcomes were identifiable in this non-referred sample. While further study with larger samples is indicated, these findings suggest that 1) research on adolescent substance use and intrauterine exposure research should evaluate both predictors simultaneously, 2) subtle neurocognitive effects associated with specific intrauterine drug exposures can be identified during early adolescence, and 3) intrauterine substance exposure effects may differ from those associated with adolescents' own drug use.

P01-285 - Childhood hyperactivity-inattention symptoms and risk behaviors in young adulthood

IntroductionAttention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) are associated with Risk Behaviors (RB) such as substance-related problems, suicidal behaviors and sex risk behaviors. However, some issues remain controversials: is ADHD an independent risk factor for RB? Is CD a confounding factor of the relationship between ADHD and RB?AimTo assess the link between childhood hyperactivity-inattention symptoms and subsequent RB, controlling for other risk factors among which conduct disorder symptoms.MethodsWe have conducted multivariate analyses from a French community-based sample (N = 1107) belonging to the youth GAZEL cohort. The sample was first assessed at ages 4 to 18, and then assessed 8 years later. Child psychopathology and RB patterns were evaluated through parent and adolescent self-reports.ResultsIn males, results show an effect of hyperactivity-inattention symptoms on more severe RB such as regular cannabis use, illicit drug experimentation and suicidal behaviors (adjusted OR = 2 to 5, all Ps significants). In females, they show an effect of hyperactivity-inattention symptoms on regular tobacco use (adjusted OR = 2, P &lt; .05). The risk of RB initiation was increased in youths with high levels of conduct disorder symptoms, particularly in combination with simultaneously high levels of hyperactivity-inattention symptoms (adjusted OR = 2, P &lt; .05).ConclusionsThis work enhances the knowledge of a link between disruptive behaviors in childhood and subsequent risk behaviors. It underscores the importance of a better acknowledgement of these disorders, in order to better identify and treat them to prevent negative long-term outcomes.