Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time

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Abstract

We examined the joint predictive effects of childhood and adolescent onset psychiatric and substance use disorders on failure to graduate high school (HS) on time. Structured diagnostic interviews were conducted with a US national sample of adults (18 and over). The analysis sample included respondents with at least 8 years of education who were born in the US or arrived in the US prior to age 13 (N = 29,662). Psychiatric disorders, substance use and substance use disorders were examined as predictors of termination or interruption of educational progress prior to HS graduation, with statistical adjustment for demographic characteristics and childhood adversities. Failure to graduate HS on time was more common among respondents with any of the psychiatric and substance use disorders examined, ranging from 18.1% (specific phobia) to 33.2% (ADHD-combined type), compared with respondents with no disorder (15.2%). After adjustment for co-occurring disorders, significant associations with failure to graduate on time remained only for conduct disorder (OR = 1.89, 95% CI 1.57–2.26) and the three ADHD subtypes (Inattentive OR = 1.78, 95% CI 1.44–2.20, Hyperactive–Impulsive OR = 1.38, 95% CI 1.14–1.67, and Combined OR = 2.06, 95% CI 1.66–2.56). Adjusting for prior disorders, tobacco use was associated with failure to graduate on time (OR = 1.97, 95% CI 1.80–2.16). Among substance users, substance use disorders were not associated with on-time graduation. The findings suggest that the adverse impact of childhood and adolescent onset psychiatric disorders on HS graduation is largely accounted for by problems of conduct and inattention. Adjusting for these disorders, smoking remains strongly associated with failure to graduate HS on time.

Section snippets

Sample

Data come from waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC). The survey sampled the US household population age 18 and older at the time of wave 1 data collection (2001–2002). 43,093 respondents were interviewed at wave 1 (Grant et al., 2003), and 34,653 (86.7% of eligible respondents) were re-interviewed at wave 2 (2004–2005) (Grant and Kaplan, 2005). The response rate at wave 1 was 81% and the combined response rate for wave 1 and wave 2 was

Results

Table 1 presents sociodemographic characteristics of the initial Wave 1 sample (N = 43,093), the Wave 2 sample (N = 34,653) and the analysis sample (N = 29,662), which includes Wave 2 respondents who had at least 8 years of education and were either born in the US or arrived in the US before age 13. The analysis sample includes a smaller proportion of Hispanics and a slightly smaller proportion of respondents in the West due to the exclusion of immigrants who arrived in the US at age 13 or

Discussion

The results of this study indicate that the broad, non-specific, pattern of association between early-onset psychiatric disorders and subsequent failure to graduate from HS on time, reported in previous studies, is attributable to a small number of disorders. Previous studies have not considered the pervasive comorbidity among early-onset disorders, in the evaluation of this relationship. As in previous studies, nearly every disorder was significantly associated with on-time graduation, when

Role of funding

The corresponding author (Dr. Breslau) had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The funding agencies had no further role in the study design, analysis or interpretation of data, writing of the report or decision to submit the paper for publication.

Contributors

Joshua Breslau designed the study, supervised data analysis, drafted and edited the manuscript.

Elizabeth Miller participated in interpretation of the data, drafting and editing of the manuscript.

W.-J. Joanie Chung conducted the statistical analysis of the data, contributed to the design of the analysis and the interpretation of the results, and edited the manuscript.

Julie B. Schweitzer participated in the design of the analysis, the interpretation of the results, and the editing of the

Conflict of interest

The authors have no conflict of interest to report.

Acknowledgement

This work was supported by grants from the NIMH (K01 MH66057 (JB) and R01 MH066310 (JS)) and the Children’s Miracle Network and by the Center for Excellence in Developmental Disabilities at UC Davis (Administration on Developmental Disabilities; grant number: 90DD0596).

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