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

Abstract

Objective: We aimed to identify adolescent mediators of the significant and sizable link between childhood ADHD and later unplanned pregnancy in our prospectively followed, all-female sample. Method: Participants included an ethnically diverse (47% non-white) sample of women with (n = 140) and without (n = 88) childhood ADHD who were assessed four times across childhood, adolescence, and adulthood. Potential mediators were measured via self, parent, and teacher report on questionnaires and interviews, and by objective testing. Results: We tested five 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 the these, academic achievement (indirect effect = .1339, se = .0721, CI 95 = .0350 to .3225) and substance use frequency (indirect effect =. 0211, se = .0167, CI 95 = .0013 to .0711) operated through late-adolescent risky sexual behavior to explain rates of unplanned pregnancy, even adjusting for the effects of age, IQ, and family SES. When these two 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, CI 95 = .0056 to .0620). Conclusion: 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 females with ADHD.

Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

“…Maintaining strong links with school is key to promoting adolescent health and social development [ 110 ]. Whilst early or unplanned pregnancy is associated with a reduction in educational and occupational opportunities, school achievement problems in adolescent girls with ADHD have also been shown to predate and predict risky sexual behaviour and unplanned pregnancy [ 200 ]. The consensus group noted that exclusion, truancy and school phobia are associated with increased vulnerability of teenage girls with ADHD in relation to later substance misuse, antisocial behaviour, criminality, sexual exploitation and early pregnancy.…”

Family Well-being in Grandparent- Versus Parent-Headed Households

“…A possible explanation may be the heritability of ADHD. 36 Mothers with ADHD are more likely to experience unplanned pregnancies, 37 which are a common precipitating factor for grandparents raising their grandchildren; because the children of mothers with ADHD are more likely to also have ADHD, this pathway may explain elevated rates of ADHD among children in grandparent-headed households. Furthermore, there is a higher prevalence of substance abuse among adults with ADHD 38 ; substance abuse, as well as the elevated incarceration rates associated with it, further contributes to grandparent caregiving because of parents' inability to effectively care for their children.…”

Childhood mental health and adult family relationships: How ADHD shapes experiences with intimate unions and parenthood

“…By young adulthood, individuals with ADHD report a higher number of lifetime sexual partners, more unprotected sex and more unplanned pregnancies than those without ADHD (Barkley et al., 2006; Owens & Hinshaw, 2020; Rokeach & Wiener, 2018). Some research suggests that the negative life outcomes associated with ADHD are larger in magnitude when comorbid disorders, such as depression, are also present (Biederman et al., 2008).…”