Childhood ADHD Predicts Risky Sexual Behavior in Young Adulthood

Abstract

This study compared young adults (ages 18 to 26) with and without childhood attention deficit hyperactivity disorder (ADHD) on self-reported risky sexual behaviors. Participants were 175 men with childhood ADHD and 111 demographically similar men without ADHD in the Pittsburgh ADHD Longitudinal Study (PALS). Childhood ADHD predicted earlier initiation of sexual activity and intercourse, more sexual partners, more casual sex, and more partner pregnancies. Although childhood conduct problems did contribute significantly to risky sexual behaviors among participants with ADHD, there was also an independent contribution of ADHD, suggesting that the characteristic deficits of the disorder or other associated features may be useful childhood markers of later vulnerability.

Full text

Childhood ADHD Predicts Risky Sexual Behavior in Young Adulthood
Kate Flory
Department of Psychology, University of South Carolina
Brooke S. G. Molina
Department of Psychiatry, University of Pittsburgh School of Medicine
William E. Pelham, Jr., and Elizabeth Gnagy
Department of Psychology, State University of New York at Buffalo
Bradley Smith
Department of Psychology, University of South Carolina
This study compared young adults (ages 18 to 26) with and without childhood atten-
tion deficit hyperactivity disorder (ADHD) on self-reported risky sexual behaviors.
Participants were 175 men with childhood ADHD and 111 demographically similar
men without ADHD in the Pittsburgh ADHD Longitudinal Study (PALS). Childhood
ADHD predicted earlier initiation of sexual activity and intercourse, more sexual
partners, more casual sex, and more partner pregnancies. Although childhood con-
duct problems did contribute significantly to risky sexual behaviors among partici-
pants with ADHD, there was also an independent contribution of ADHD, suggesting
that the characteristic deficits of the disorder or other associated features may be use-
ful childhood markers of later vulnerability.
It is well documented that a childhood diagnosis of
attention deficit hyperactivity disorder (ADHD) is as-
sociated with risk for a number of academic, behav-
ioral, and social problems. Children with ADHD fail
more often at school (DuPaul & Stoner, 1994) and are
more likely to be suspended or expelled than their
non-ADHD peers (Hinshaw, 1987). These children of-
ten have poor social skills that make it difficult for
them to establish meaningful relationships (Bag-
well, Molina, Pelham, & Hoza, 2001). ADHD also fre-
quently overlaps with learning disabilities, anxiety dis-
orders, and other behavioral disorders (August, Real-
muto, MacDonald, Nugent, & Crosby, 1996).
Many of these problems persist into adolescence
and adulthood (Barkley, 2006). In addition, new prob-
lems stemming from the transition into adolescence
lead to concerns about the safety and health of individ-
uals with ADHD. For instance, childhood ADHD pre-
dicts substance use and abuse in adolescence (Molina
& Pelham, 2003) and in young adulthood (Gittelman,
Mannuzza, Shenker, & Bonagura, 1985), and drivers
with ADHD, as compared to those without, are more
likely to be cited for speeding and to be involved in
auto accidents (Barkley, Murphy, & Kwasnik, 1996).
Because behaviors that place individuals at health
risk tend to cluster together (Donovan, Jessor, &
Costa, 1988), individuals with childhood ADHD
should have a greater than average propensity to en-
gage in risky sexual behavior. However, no studies
have examined this directly. Several studies have ex-
amined, with mixed results, antisocial sexual activities
(e.g., forced sex) among individuals diagnosed with
ADHD in childhood. Barkley, Fischer, Smallish, and
Fletcher (2004) did not find differences between indi-
viduals with and without ADHD on these behaviors,
whereas Theriault and Holmberg (2001) found that
more severe ADHD symptomatology was associated
with more sexual aggression. Though these results are
intriguing, they do not address whether ADHD is asso-
ciated with nonaggressive risky sexual behaviors, such
as having multiple partners, intercourse at a young age,
or not using condoms. This study directly addresses
this gap in the ADHD literature.
Wepresentadetailedexaminationofriskysexualbe-
haviors reported by participants ages 18 to 26 in the
Pittsburgh ADHD Longitudinal Study (PALS), which
Journal of Clinical Child and Adolescent Psychology
2006, Vol. 35, No. 4, 571–577
Copyright © 2006 by
Lawrence Erlbaum Associates, Inc.
571
This study was supported by Grants T32 AA07453–20 and
AA11873 from the National Institute of Alcohol Abuse and Alcohol-
ism and Grant DA12414 from the National Institute on Drug Abuse.
The research was also supported in part by other grants from the Na-
tional Institute of Alcohol Abuse and Alcoholism (AA00202,
AA12342), the National Institute on Drug Abuse (DA016631),
the National Institute of Mental Health (MH53554, MH62946,
MH065899, MH12010), the National Institute of Neurological
Disorders and Stroke (NS39087), the National Institute of Environ-
mental Health Sciences (ES05015), and the Institute of Education
Sciences (LO3000665A).
Correspondence should be addressed to Kate Flory, Department
of Psychology, Barnwell College, University of South Carolina, Co-
lumbia, SC 29208. E-mail: floryk@gwm.sc.edu

is a large longitudinal study of individuals with and
without ADHD diagnosed in childhood. The primary
goal of this study was to examine whether young adults
diagnosed with ADHD in childhood are more likely
than those without the disorder to engage in risky sexual
behaviors. We previously reported that childhood
ADHD predicted problematic behaviors during adoles-
cence, including substance use (Molina & Pelham,
2003), deviant peer affiliation (Marshal, Molina, & Pel-
ham, 2003), peer rejection (Bagwell et al., 2001), and
less effective coping skills and cigarette use (Molina,
Marshal, Pelham, & Wirth, 2005) in this PALS sample.
Many of these adolescents are now adults, which pro-
vides the opportunity to examine risky sexual behavior
as an outcome of childhood ADHD.
We were also interested in whether antisocial be-
havior in childhood influences the likelihood of risky
sexual behavior among children with ADHD. Antiso-
cial behavior is common in children with ADHD
(Hinshaw, 1987). Although we did not find previously
that childhood conduct problems (symptoms of op-
positional defiant disorder [ODD] and conduct disor-
der [CD]) were strong predictors of adolescent sub-
stance use and abuse for children with ADHD, they did
predict adolescent CD symptoms (Molina & Pelham,
2003). Childhood conduct problems have also pre-
dicted other adverse outcomes during adulthood (e.g.,
criminality) in nonreferred samples (Kratzer &
Hodgins, 1997). Thus, to the extent that risky sexual
behavior reflects deviance-proneness, children with
ADHD and conduct problems should have the highest
risk for this outcome.
Method
Participants
A detailed description of the PALS, including infor-
mation on recruitment, participants, measures, and
data collection procedures is given in Faden et al.
(2004). Briefly, the 364 probands in the PALS were re-
cruited between 1999 and 2003 as adolescents and
young adults from a large pool of individuals diag-
nosed between 1987 and 1996 with Diagnostic and
Statistical Manual of Mental Disorders (3rd ed., rev.
[DSM–III–R] and 4th ed. [DSM–IV]; American Psy-
chiatric Association, 1987, 1994) ADHD at the West-
ern Psychiatric Institute and Clinic in Pittsburgh, Penn-
sylvania. Diagnostic information was collected from
several sources, including the parent and teacher Dis-
ruptive Behavior Disorders rating scales, which assess
the DSM–III–R symptoms of the disruptive behavior
disorders (Pelham, Gnagy, Greenslade, & Milich,
1992). In addition, parents completed a structured in-
terview consisting of the DSM–III–R descriptors for
ADHD, with supplemental probe questions regarding
situational and severity factors. Following DSM guide-
lines, diagnoses were made if a sufficient number
of symptoms were endorsed (considering information
from both parents and teachers). Probands’ age at ini-
tial evaluation ranged from 5.0 to 16.92 years, with
90% in their elementary school years. Probands were
between the ages of 11 and 28 at the time of their first
follow-up interview (Wave 1 of the PALS).
Two hundred forty demographically similar adoles-
cents and young adults without ADHD were recruited
from the Pittsburgh area. Control participants were
matched at the group level to the proband sample (as
they were screened) on age (for probands, M= 17.74,
SD = 3.38; for controls, M= 17.17, SD = 3.16), gender,
ethnicity, and level of parent education; therefore, by
design, the proband and control groups did not differ
on these variables. The total PALS sample (N= 604)
was 89% male and 82% Caucasian.
Data for this study were taken from Wave 2 of the
PALS (conducted approximately 1 year after Wave 1)
and included only men (ages 18 to 26) for whom data
were available on the Health and Sex Behavior Ques-
tionnaire, described later. We elected to use men only
because the number of women available for analysis
was small. In addition, although the PALS data set in-
cluded adolescent boys (ages 12 to 17), most of these
participants had not yet initiated sexual intercourse by
the Wave 2 data collection. Thus, to avoid drawing
conclusions about adolescents based on a small sub-
sample with a very early sexual debut, we focused on
adults only.
The sample for this study (175 probands, 111 con-
trols) was 85% Caucasian and participant annual in-
come varied widely, ranging from less than $5,000
to greater than $84,000 (Mdn = $6,000). Participant ed-
ucation levels ranged from high school to graduate
school, with the majority (69%) having attained at least
partial college or technical training. Nine were mar-
ried, 2 were separated, and 1 was divorced at the time
of Wave 2 data collection.
Procedures
The PALS study protocol was approved by the Uni-
versity of Pittsburgh Institutional Review Board. Fol-
lowing collection of written informed consent (assent
for minors) from the participants and their parents sep-
arately, participants, their mothers, and their fathers
were interviewed individually by postbaccalaureate re-
search staff.
Measures
Risky sexual behavior. The risky sexual behav-
iorvariablesweretakenfrom the Health and Sex Behav-
iorQuestionnaire developedfor the PALS.The26items
on this self-report scale were drawn or adapted from
572
FLORY ET AL.

measures by Tarter (1997), Jessor, Jessor, and Donovan
(1981), and the Sex and Dating Questionnaire used in
the Pittsburgh Adolescent Alcohol Research Center
(1996). Participants were asked whether they had en-
gaged in sexual relations (more than kissing but not in-
tercourse)orintercourseand,ifso,atwhatagetheyiniti-
ated these behaviors. Participants who had intercourse
were also asked how often during the past year they had
sex with someone they didn’t know or had just met (i.e.,
casualsex),howmanydifferent sexual partners they had
duringtheir lifetime, how often during the past year they
had intercourse while under the influence of drugs or al-
cohol, and how often they used condoms; birth control
pills;foam, jelly,orcream; or a diaphragmfor birth con-
trol or disease prevention. Participants were also asked
how often in their lifetime they had been diagnosed with
a sexually transmitted disease and how many times they
had been pregnant or gotten a partner pregnant. In gen-
eral, items were dichotomized to be consistent with cut-
offs for risky sexual behavior used in other studies (e.g.,
Grunbaum et al., 2004; see Table 1).
Childhood conduct problems. Parents and teach-
ers completed ratings on the Disruptive Behavior Dis-
orders scales (Pelham et al., 1992) of childhood ODD
and CD symptoms. These ratings were collected when
the probands were originally seen at the Western Psy-
chiatric Institute and Clinic and items were those in
common between the DSM–III–R and DSM–IV (8
ODD and 13 CD items, α= .93). For the CD items, par-
ents and teachers were asked if the child had engaged
in the behavior (e.g., fighting), and, for the ODD items,
parents and teachers were asked if the behavior oc-
curred often (e.g., loses temper). Responses ranged
from 0 (not at all)to3(very much). For each item, the
maximum of the parent and teacher ratings were used,
as is customary (Lahey et al., 1994), and the maximum
responses were then averaged across items. ODD or
CD diagnosis was made by also taking the maximum
of the two ratings for each symptom and counting the
symptom present if either rater answered 2 (pretty
much)or3(very much). DSM symptom cutoffs were
then applied to generate a diagnosis. For this study,
participants were considered positive for ODD or CD
diagnosis if they met DSM criteria for either disorder.
Results
Eighty-two percent of probands and 87% of con-
trols had experienced sexual relations in their lifetime,
χ2(1, N= 286) = 1.37, p=ns. Similarly, 75% of
probands and 71% of controls reported having had sex-
ual intercourse, χ2(1, N= 286) = .47, p=ns. Kap-
lan–Meier survival analysis revealed that probands re-
ported on average an earlier age of both sexual
relations and intercourse than controls (Figure 1).
There were also significant group differences on four
of the seven risky sexual behaviors (Table 1). Probands
were more likely to have had casual sex during the past
year, χ2(1, N= 208) = 7.54, p<.01; casual sex with in-
frequent condom use, χ2(1, N= 209) = 5.51, p<.05;
intercourse that led to pregnancy, χ2(1, N= 202) =
13.44, p<.001; and more than four sexual partners,
χ2(1, N= 210) = 21.36, p<.001; Mfor probands =
6.28, SD=3.81; Mfor controls = 3.90, SD=3.38,
which is not surprising given their earlier age of sexual
debut. There was a marginally significant group differ-
ence, χ2(1, N= 194) = 2.96, p= .09, in participants’ use
of reliable birth control methods.
The relation of childhood ODD or CD symptoms to
each of the risky sex variables among probands was ex-
amined using independent samples ttests. ODD or CD
symptoms were not significantly related (at p< .05) to
any of the risky sex outcomes listed in Table 1 or to
whether probands had engaged in sexual relations or
intercourse. Zero-order correlations between childhood
ODD or CD symptoms and the risky sex variables
ranged from –.05 to .17 (all ps=ns).
Logistic regression analysis, using dummy coding
to compare probands with and without ODD or CD di-
agnosis in childhood to controls, was used for each of
the four risky sexual behaviors for which there were
significant ADHD group differences. These results are
reported in Table 2. ODD or CD diagnosis in childhood
was significantly associated with increased risk of ca-
573
ADHD AND RISKY SEX
Table 1. Group Differences in Risky Sexual Behaviors Among Young Adult (Ages 18–26) Controls and Probands
Behavior
Controls Probands Risk
Difference% n%nχ2(1) p
Casual sex past year? 19 15/78 37 48/130 7.54 .01 18
Multipleasex partners in lifetime? 28 22/79 60 79/131 21.36 .00 32
Have sex while using drugs or alcoholb? 48 36/75 46 57/123 0.05 .82 —
Casual sex past year with infrequentccondom use? 5 4/78 15 20/131 5.51 .02 10
Ever had an STD? 2 2/110 4 7/174 1.15 .28 2
Infrequentcuse of reliabledbirth control methods? 20 15/75 31 37/119 2.96 .09 11
Ever gotten someone pregnant? 5 4/76 24 30/126 13.44 .00 19
aMultiple is defined as more than 4. bDefined as some of the time, half of the time, most of the time, or almost always during the past year.
cInfrequent is defined as less than almost always.dReliable methods of birth control included the pill, condoms, foam, and diaphragms.

sual sex (odds ratio = 2.37, p<.01), having multiple
sexual partners (odds ratio = 4.41, p<.001), and part-
ner pregnancies (odds ratio = 6.31, p<.001) and mar-
ginally with infrequent condom use (odds ratio = 2.98,
p= .06). However, there also appeared to be a contribu-
tion of childhood ADHD to adult risky sexual behavior
that was not explained by ODD or CD comorbidity in
childhood. That is, when compared to controls, ADHD
probands without an ODD or CD diagnosis were at in-
creased risk for casual sex (odds ratio = 2.91, p<.05)
and infrequent condom use (odds ratio = 5.14, p<.05)
and marginally for multiple sexual partners (odds ratio
= 2.38, p= .08). These findings are noteworthy because
only about 22% of probands did not meet childhood
ODD or CD diagnostic criteria.
Discussion
This study was the first to examine whether individ-
uals with a childhood diagnosis of ADHD are more
likely than those without the disorder to engage in risky
574
FLORY ET AL.
Figure 1. Survival curves showing initiation of sexual relations (more than kissing but not intercourse) and sexual intercourse for con-
trol and proband young adults.

sexual behaviors during young adulthood. We found
robust ADHD group differences for multiple risky sex-
ual behaviors. Although we found some evidence that
childhood conduct problems play a role in predicting
adult risky sexual behavior among individuals with
ADHD, we also demonstrated an independent contri-
bution of ADHD. These findings suggest a need for in-
creased attention to risky sexual behavior by profes-
sionals who work with individuals with ADHD.
Why do individuals with ADHD engage in risky
sexual behaviors? The answer to this question may be
complex, with interpersonal factors and the core char-
acteristics of the disorder both playing prominent
roles. Peer factors, particularly association with peers
whose attitudes favor involvement in nonconventional
activities, are strongly related to risky sexual behavior
among adolescents and young adults (e.g., Bachanas et
al., 2002). Peer relationship problems are common
among children and adolescents with ADHD (Bagwell
et al., 2001), and these social failures may promote af-
filiation with and vulnerability to peers outside of
mainstream social networks. Our earlier finding of a
stronger association between adolescent substance use
and peer deviance for adolescents with childhood
ADHD than among adolescents without ADHD is con-
sistent with this possibility (Marshal et al., 2003).
Family factors may also contribute to the higher rate
of risky sexual behavior among children with ADHD.
Low levels of perceived parental monitoring and trust
(Borawski, Ievers-Landis, Lovegreen, & Trapl, 2003),
high levels of family conflict (Ary, Duncan, Duncan, &
Hops, 1999), and poor quality of parent–teen commu-
nication regarding safe sex (Wilson & Donenberg,
2004) are all associated with engagement in risky sex-
ual behaviors. This evidence, considered alongside
findings that youth with ADHD frequently have con-
flictual relationships with their parents (Barkley,
2006), implies another probable link between ADHD
and risky sexual behaviors.
Finally, it is very likely that the core characteristics
of ADHD, especially impulsivity, interact with peer
and family factors to influence engagement in risky
sexual behaviors. Additional studies of these possibili-
ties, as well as the potential mediating role of later-de-
veloping (or childhood-persistent) conduct problems,
are needed. In fact, we will be in a position to conduct
this research ourselves as more of the PALS partici-
pants become sexually active, allowing tests of more
involved mediating and moderating hypotheses.
Results from this study have direct implications for
parents, educators, and clinicians who work with indi-
viduals with ADHD. Unfortunately, many children
with ADHD stop receiving treatment when they exit
childhood (Barkley, Fischer, Smallish, & Fletcher,
2003). Our findings suggest that this is precisely the
time when increased attention to potential health-risk
behaviors is needed. Even for children with ADHD
who remain in treatment though adolescence and young
adulthood, little guidance is available on psychosocial
interventions for ADHD at these ages (Smith, Wasch-
busch, Willoughby, & Evans, 2000). For many adoles-
cents and young adults who seek help for their ADHD,
the only widely available treatment is stimulant medi-
cation (Smith et al., 2000). However, it is unlikely that
behaviors related to safe sex will be affected by medi-
cation alone.
The successful reduction or prevention of unsafe
sexual behaviors among individuals with ADHD will
likely require a combination of approaches that is more
comprehensive than education alone. For example, if
poor family relationships are found to predict engage-
ment in risky sexual behaviors among individuals with
ADHD, successful prevention programs may need
to include family involvement such as instruction to
improve parent–child communication. Sex education
programs that include family components have already
shown some success within at-risk populations (e.g.,
Burgess, Dziegielewski, & Green, 2005; Klein et al.,
2005). For instance, the Parents as Primary Sexuality
Educators program, which was developed to help par-
ents become more confident and competent in commu-
nicating with their children about sex, resulted in pa-
rental initiation of more conversations regarding sex
and increased parental comfort in having these conver-
sations with their children (Klein et al., 2005).
Our findings should be considered in light of several
limitations. First, we caution readers against generaliz-
ing our results to the entire population of individuals
575
ADHD AND RISKY SEX
Table 2. Comparison of Probands With and Without a Childhood Diagnosis of ODD/CD to Controls
on Risky Sexual Behaviors
Probands With ODD/CD
vs. Controls
Probands Without ODD/CD
vs. Controls
Behavior Odds ratio pOdds ratio p
Casual sex past year? 2.37 .01 2.91 .04
Multiple sex partners in lifetime? 4.41 .00 2.38 .08
Casual sex past year with infrequent condom use? 2.98 .06 5.14 .02
Ever gotten someone pregnant? 6.31 .00 2.84 .20
Note: ODD = oppositional defiant disorder; CD = conduct disorder. Ns for probands without ODD/CD, probands with ODD/CD, and controls are
31, 144, and 111, respectively.

with childhood ADHD, particularly girls and adoles-
cents. A second limitation is that our measure of risky
sexual behavior relied on self-report. Participants may
have overreported sexual activity, perhaps to gain so-
cial status, or underreported sexual activity because of
concerns about the confidentiality of their responses or
embarrassment. However, participants in the PALS
have been involved with our research staff for a number
of years, and the study is protected with a Department
of Health and Human Services Certificate of Confiden-
tiality. It is also possible that participants underre-
ported occurrence of sexually transmitted diseases, as
these are often asymptomatic. Finally, there is the pos-
sibility that our married participants, for whom the use
of birth control may be less normative, are responsible
for our findings of an association between ADHD and
risky sexual behavior. We tested this directly by rerun-
ning our analyses after excluding the married partici-
pants and found that excluding these individuals did
not change our findings.
In sum, we present the first study of risky sexual be-
havior among individuals with childhood ADHD, and
our results suggest that individuals with the disorder
are more likely to engage in a variety of risky sexual
behaviors by young adulthood. Given the additional
hardships associated with ADHD during adolescence
and young adulthood, the prevention of risky sexual
behavior and associated deleterious outcomes (e.g.,
unwanted pregnancy) is imperative. Our study takes
the crucial first step toward this goal by documenting
that risky sexual behaviors are problematic for individ-
uals with ADHD. Future research must examine why
these persons are at risk and use this information to be-
gin to develop appropriate programs for preventing
risky sexual behavior among individuals with ADHD.
References
Ary, D. V., Duncan, T. E., Duncan, S. C., & Hops, H. (1999). Adoles-
cent problem behavior: The influence of parents and peers. Be-
haviour Research & Therapy, 37, 217–230.
American Psychiatric Association. (1987). Diagnostic and statisti-
cal manual of mental disorders (3rd ed., rev.). Washington, DC:
Author.
American Psychiatric Association. (1994). Diagnostic and statisti-
cal manual of mental disorders (4th ed.). Washington, DC:
Author.
August, G. J., Realmuto, G. M., MacDonald, A. W., Nugent, S. M.,
& Crosby, R. (1996). Prevalence of ADHD and comorbid disor-
ders among elementary school children screened for disruptive
behavior. Journal of Abnormal Child Psychology, 24, 571–596.
Bachanas, P. J., Morris, M. K., Lewis-Gess, J. K., Sarett-Cuasay, E.
J., Sirl, K., Ries, J. K., et al. (2002). Predictors of risky sexual
behavior in African American adolescent girls: Implications for
prevention interventions. Journal of Pediatric Psychology, 27,
519–530.
Bagwell, C. L., Molina, B. S. G., Pelham, W. E., & Hoza, B. (2001).
Attention-deficit hyperactivity disorder and problems in peer
relations: Predictions from childhood to adolescence. Journal
of the American Academy of Child & Adolescent Psychiatry,
40, 1285–1292.
Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A
handbook for diagnosis and treatment (3rd ed.). New York:
Guilford.
Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2003).
Does the treatment of attention-deficit/hyperactivity disorder
with stimulants contribute to drug use/abuse? Pediatrics, 111,
97–109.
Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2004).
Young adult follow-up of hyperactive children: Antisocial ac-
tivities and drug use. Journal of Child Psychology & Psychia-
try, 45, 195–211.
Barkley, R. A., Murphy, K. R., & Kwasnik, D. (1996). Motor vehi-
cle driving competencies and risks in teens and young adults
with attention deficit hyperactivity disorder. Pediatrics, 98,
1089–1095.
Borawski, E. A., Ievers-Landis, C. E., Lovegreen, L. D., & Trapl, E.
S. (2003). Parental monitoring, negotiated unsupervised time,
and parental trust: The role of perceived parenting practices in
adolescent health risk behaviors. Journal of Adolescent Health,
33, 60–70.
Burgess, V., Dziegielewski, S. F., & Green, C. E. (2005). Improving
comfort about sex communication between parents and their
adolescents: Practice-based research within a teen sexuality
group. Brief Treatment and Crisis Intervention, 5, 379–390.
Donovan, J. E., Jessor, R., & Costa, F. M. (1988). Syndrome of prob-
lem behavior in adolescence: A replication. Journal of Con-
sulting & Clinical Psychology, 56, 762–765.
DuPaul, G. J., & Stoner, G. D. (1994). ADHD in the schools: Assess-
ment and intervention strategies. New York: Guilford.
Faden, V. B., Day, N. L., Windle, M., Windle, R., Grube, J. W.,
Molina, B. S. G., et al. (2004). Collecting longitudinal data
through childhood, adolescence, and young adulthood: Meth-
odological challenges. Alcoholism: Clinical and Experimental
Research, 28, 330–340.
Gittelman, R., Mannuzza, S., Shenker, R., & Bonagura, N. (1985).
Hyperactive boys almost grown up. Archives of General Psy-
chiatry, 42, 937–947.
Grunbaum, J. A., Kann, L., Kinchen, S., Ross, J., Hawkins, J., Low-
ry, R., et al. (2004, May 21). Youth risk behavior surveil-
lance-United States, 2003 [Electronic version]. In CDC MMWR
Surveillance Summaries, 51(SS02), 1–96.
Hinshaw, S. P. (1987). On the distinction between attentional defi-
cits/hyperactivity and conduct problems/aggression in child
psychopathology. Psychological Bulletin, 101, 443–463.
Jessor, R., Jessor, L., & Donovan, J. E. (1981). Young adult follow-up
study, 1981 annual questionnaire. Boulder: University of Colo-
rado, Institute of Behavioral Science.
Klein, J. D., Sabaratnam, P., Pazos, B., Auerbach, M. M., Havens, C.
G., & Brach, M. J. (2005). Evaluation of the parents as primary
sexuality educators program. Journal of Adolescent Health, 37,
S94–S99.
Kratzer, L., & Hodgins, S. (1997). Adult outcomes of child conduct
problems: A cohort study. Journal of Abnormal Child Psychol-
ogy, 25, 65–81.
Lahey,B. B., Applegate, B., Barkley, R. A., Garfinkel,B., McBurnett,
K., Kerdyk, L., et al. (1994). DSM–IV field trials for oppositional
defiant disorder and conduct disorder in children and adoles-
cents. American Journal of Psychiatry, 151, 1163–1171.
Marshal, M. P., Molina, B. S. G., & Pelham, W. E. (2003). Childhood
ADHD and adolescent substance use: An examination of devi-
ant peer group affiliation as a risk factor. Psychology of Addic-
tive Behaviors, 17, 293–302.
Molina, B. S. G., Marshal, M. P., Pelham, W. E., & Wirth, R. J.
(2005). Coping skills and parental support mediate the associa-
tion between childhood ADHD and adolescent cigarette use.
Journal of Pediatric Psychology, 30, 345–357.
576
FLORY ET AL.

Molina, B. S. G., & Pelham, W. E. (2003). Childhood predictors of
adolescent substance use in a longitudinal study of children
with ADHD. Journal of Abnormal Psychology, 112, 497–507.
Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R.
(1992). Teacher ratings of DSM–III–R symptoms for the dis-
ruptive behavior disorders. Journal of the American Academy
of Child & Adolescent Psychiatry, 31, 210–218.
Pittsburgh Adolescent Alcohol Research Center. (1996). Sex and
Dating Questionnaire. Pittsburgh,PA: University of Pittsburgh.
Smith, B. H., Waschbusch, D. A., Willoughby, M. T., & Evans, S.
(2000). The efficacy, safety, and practicality of treatments for
adolescents with attention-deficit/hyperactivity disorder. Clini-
cal Child and Family Psychology Review, 3, 243–267.
Tarter, R. (1997). CEDAR follow-up protocol. Pittsburgh: University
of Pittsburgh.
Theriault, S. W., & Holmberg, D. (2001). Impulsive, but violent? Vi-
olence Against Women, 7, 1464–1489.
Wilson, H. W., & Donenberg, G. (2004). Quality of parent communi-
cation about sex and its relationship to risky sexual behavior
among youth in psychiatric care: A pilot study. Journal of Child
Psychology & Psychiatry, 45, 387–395.
Received July 7, 2005
Accepted April 3, 2006
577
ADHD AND RISKY SEX