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.

Acknowledgment

We gratefully acknowledge the girls—now young women—and their caregivers who have participated in our ongoing investigation without whose efforts and patience this work would not be possible. Thanks also to our many graduate students and research assistants.

Notes

¹ The significant indirect effects for W2 mediators are each positive because for the “beneficial” mediators (e.g., academic achievement), there are two negative coefficients (between diagnostic status and the mediator, and between the mediator and risky sex), which when multiplied produce a positive coefficient. This positive coefficient is then multiplied by another positive coefficient (between risky sex and unplanned pregnancy), resulting in a positive indirect effect. For the “detrimental” mediators (e.g., substance use), all coefficients are positive, also resulting in a positive indirect effect.

Additional information

Funding

This project was supported by National Institute of Mental Health Grant 45064.