Risky sexual behaviour among adolescents may be related to ADHD

Dear Editor, We would like to comment on the recent paper by Kastbom et al. on Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life (1). The study focused on more than 3000 Swedish 18-year-old adolescents, who had completed a survey about sexuality, health and abuse. It compared those who had reported an early sexual debut before 14 years of age with those who had a later sexual debut. Current socio-economic factors, health behaviour, mental health and previous experience of sexual and/or physical abuse in the two groups were analysed. Many factors were associated with early sexual debut, including risky health behaviour, such as increased use of drugs and alcohol and smoking, and antisocial behaviour, such as being violent, lying, stealing and running away. A relationship was also found between early sexual debut and sexual and physical abuse. The authors concluded that early sexual debut was associated with problematic behaviours during later adolescence and that this vulnerability required attention from parents and healthcare providers. We would like to highlight that attentiondeficit/hyperactivity disorder (ADHD) could be an important underlying risk factor for both an early sexual debut and for the risks that this study related to early sexual debut per se, for example using drugs and alcohol, smoking, conduct and antisocial problems and experience of child abuse. Flory et al. (2) found that young people with ADHD were more likely to engage in a variety of risky sexual behaviours. They stated that preventing risky sexual behaviour and associated outcomes, such as unwanted pregnancy, was imperative and appropriate programmes were needed to prevent such behaviour among individuals with ADHD. Similar findings were reported by a longitudinal study by Barkley et al. (3), which emphasised that hyperactivity, or ADHD, was not a benign developmental disorder by young adulthood, and therefore, clinical interventions targeting these adaptive impairments were needed, for example counselling on contraception and health-related behaviour. These authors also stated that children and adolescents with ADHD faced greater risks of lower education levels, being retained in lower grades and failing to graduate than control groups. ADHD is common, affecting about 5% of children and adolescents, and is related to several risks at school and in life in general. Children and adolescents with ADHD require high levels of support and intervention to mitigate their risks of adverse health outcomes.