Pathways to alcohol use and problems in adulthood for children with attention-deficit/hyperactivity disorder (ADHD): The role of common impairments above and beyond ADHD symptom persistence.

Childhood attention-deficit/hyperactivity disorder (ADHD) is a known risk factor for later alcohol-related outcomes, such as drinking at young ages or developing alcohol use disorder by adulthood. However, research has yet to determine whether common ADHD-related impairments (e.g., lower educational attainment) in early adulthood play a role in this outcome above and beyond ADHD symptom persistence. Individuals with (n = 316) and without (n = 223) ADHD in childhood participated in a longitudinal study (Mage = 29). Childhood diagnoses were based on comprehensive, standardized assessments, and follow-up data were self-report and parent report. Mediating pathways through key impairments and ADHD symptom persistence in early adulthood were simultaneously tested, from childhood ADHD (absent/present) to later adulthood (Mage = 29) alcohol outcomes (alcohol-related problems and heavy drinking frequency), using Mplus 8.2. Support was found for the mediating roles of greater social impairment, lower educational attainment, and ADHD symptom persistence in the association between childhood ADHD and alcohol-related problems. Mediation by early adulthood delinquency for alcohol problems was not supported. No mediating pathways to heavy drinking frequency were supported. These findings illustrate the importance of social and academic functioning, in addition to ADHD symptom persistence, in risk for alcohol-related problems as individuals with a history of ADHD in childhood enter a phase of life requiring substantial adulthood responsibility. These results suggest the critical importance of focusing prevention and treatment efforts on major domains of functioning in addition to ADHD symptom reduction for prevention and treatment of harmful alcohol use. (PsycInfo Database Record (c) 2025 APA, all rights reserved).