Childhood attention problems may set the stage for adolescent delinquency

Children who exhibit attention problems in elementary school may face heightened risks for certain negative outcomes in adolescence, according to new research published in the Journal of Attention Disorders. Using a large, nationally representative U.S. sample, the study found that children with higher scores for attention problems at age 9 were more likely to smoke cigarettes and engage in delinquent behaviors by age 15.

Attention-deficit/hyperactivity disorder (ADHD) is a common condition that begins in childhood and often continues into adolescence and adulthood. It is typically marked by persistent difficulties with paying attention, controlling impulses, and regulating activity levels. These symptoms can interfere with performance at school and relationships with peers and family members.

While the core symptoms of ADHD tend to fall into categories of inattention and hyperactivity-impulsivity, the disorder often co-occurs with other challenges, including learning problems and emotional difficulties. Estimates suggest that between 8 and 10 percent of children in the United States have been diagnosed with ADHD, making it one of the most frequently identified neurodevelopmental conditions in youth.

Previous research has linked ADHD to a variety of long-term difficulties, including increased risk for substance use, risky sexual behavior, and criminal involvement. However, much of that research has focused on clinical samples or examined outcomes in adulthood. Fewer studies have explored how attention problems during middle childhood might relate to risk-taking behaviors during adolescence—a critical developmental period when experimentation with substances, rule-breaking, and impulsive actions often begin.

The new study aimed to address that gap by analyzing longitudinal data from a large, population-based cohort. The goal was to determine whether children with attention problems—regardless of a formal ADHD diagnosis—were more likely to engage in specific risky or antisocial behaviors during their teenage years.

“ADHD is the most common neurodevelopmental disorder among children and adolescents in the United States. And every year more and more children and adults are being diagnosed with this condition,” said study author Myriam Casseus, an instructor at Child Health Institute of New Jersey at Rutgers Robert Wood Johnson Medical School.

“We hear about the negative outcomes associated with having ADHD. However, much of the research has focused on attention problems in childhood and negative outcomes in adulthood. Few studies have looked at attention problems in middle childhood and adolescent outcomes. My colleagues and I felt that this study of a prospective cohort of children was an opportunity to address this gap in the literature.”

The researchers used data from the Future of Families and Child Wellbeing Study, a national birth cohort that followed nearly 5,000 children born in large U.S. cities between 1998 and 2000. Participants were surveyed multiple times from birth through early adulthood.

For the present analysis, the team focused on 2,716 adolescents who had complete data on attention problems at age 9 and risk behaviors at age 15. Attention issues were assessed using a widely used checklist completed by primary caregivers, typically the mother. The measure asked caregivers to rate how true various statements were about the child’s behavior, including whether the child was easily distracted or had trouble staying focused. Scores above a certain threshold—one standard deviation above the sample mean—were considered “elevated.”

At age 15, the adolescents themselves answered questions about their experiences with cigarette smoking, alcohol and marijuana use, unprotected sex, and a range of delinquent behaviors such as stealing or fighting.

About 18 percent of the children in the sample had elevated attention problem scores at age 9. The researchers found that these children were more likely to engage in some risky behaviors as adolescents, particularly smoking and delinquency.

By age 15, 9 percent of children with elevated attention problem scores had smoked an entire cigarette, compared to 4 percent of those without elevated scores. After accounting for demographic factors such as gender, race, family income, and parental education, the researchers found that children with elevated attention problems were more than twice as likely to have tried smoking.

These children also had higher scores on a delinquency scale that included acts like physical fights, damaging property, shoplifting, and stealing. On average, they scored 30 percent higher on this scale than their peers.

“Children with attention problems in middle childhood are at higher risk of engaging in health risk behaviors including tobacco use and delinquent behaviors,” Casseus told PsyPost. “The results of this study provide support for screening for attention problems among elementary school-age children and early intervention strategies to prevent health risk behaviors in adolescence.”

In contrast, there was no clear association between elevated attention problem scores and alcohol use, marijuana use, or unprotected sex once demographic factors were taken into account. While unadjusted data suggested a slight increase in marijuana use, this difference disappeared when controlling for other variables.

“We were surprised that children in our study with elevated attention problem scores did not have higher risk of alcohol or marijuana use in adolescence compared with their peers who did not have elevated attention problem scores,” Casseus said. “However, this finding is consistent with previous research.”

The researchers also examined which types of delinquent behaviors were more common among adolescents who had attention problems in childhood. These adolescents were more likely to report physically aggressive acts, such as getting into serious fights or injuring someone badly enough to need medical care. They were also more likely to engage in property-related offenses, such as damaging property, shoplifting, or stealing small items.

The researchers did not find a significant link between attention problems and more severe or less common behaviors, such as armed robbery or breaking into buildings. Still, the pattern of findings suggests that early attention difficulties may contribute to a broader tendency toward impulsive or rule-breaking behavior during adolescence.

The findings are in line with previous research suggesting that children with ADHD or similar attention difficulties may be more prone to smoking and antisocial behavior. One explanation is that attention problems in childhood often co-occur with impulsivity, poor decision-making, and difficulty with self-regulation—all traits that can increase the likelihood of engaging in risky behavior during adolescence.

While the study did not examine brain mechanisms directly, previous work has linked attention problems and impulsivity to altered development in brain areas involved in decision-making and reward processing. These changes may make adolescents more sensitive to the immediate rewards of smoking or acting out, while being less able to consider long-term consequences.

“The findings highlight the importance of screening young children for attention problems and providing treatment based on accepted guidelines to improve health outcomes for this vulnerable population,” Casseus said.

Early interventions, such as parent training, classroom supports, or behavioral therapy, may help reduce the likelihood that these children will engage in harmful behaviors during adolescence.

But like all observational studies, this one cannot demonstrate cause and effect. It is possible that other unmeasured factors—such as exposure to trauma or parenting style—could explain some of the observed associations. The sample also overrepresented children born to unmarried mothers in large cities, which may limit how well the results apply to the broader population.

“We used data from the Future of Families and Child Wellbeing Study, which is a prospective observational study and thus causality cannot be inferred,” Casseus noted.

Additionally, the data relied on self-reports from adolescents about sensitive behaviors, which may be subject to underreporting. The measure of sexual risk behavior was also limited, focusing only on condom use and possibly missing other dimensions of risk.

The study raises several questions for further investigation. Future research could examine whether early intervention for attention problems reduces the likelihood of adolescent smoking or delinquency. It may also be useful to explore whether the timing, intensity, or type of intervention makes a difference in long-term outcomes.

Longer follow-up could help determine whether the patterns seen in adolescence continue into adulthood, affecting employment, relationships, or involvement in the criminal justice system. Researchers may also want to examine how peer relationships, school environments, or mental health services influence the pathways from childhood attention problems to adolescent behavior.

“My colleagues and I want to continue to explore the developmental trajectories associated with attention problems throughout childhood, adolescence and adulthood,” Casseus said.

The study, “Attention Problems in Childhood and Subsequent Health Risk Behaviors in Adolescence,” was authored by Myriam Casseus, Hope Corman, Kelly Noonan, and Nancy E. Reichman.