Fong Xiang Tai, Davin; (2025) Wired for risk? Uncovering patterns of substance use among neurodivergent adolescents using a latent class analysis of the Millennium Cohort Study. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Aims: There is increasing recognition of the increased risk of substance and behavioural addictions in autistic people and people with ADHD. This study aims to understand the perspectives and lived experience of autistic people and people with ADHD with regard to substance use, problematic alcohol use, gaming and gambling behaviours. Method: A systematic search of multiple databases was conducted to obtain qualitative studies of autistic people and people with ADHD’s experience of engaging in substance use, problematic alcohol use, gaming and gambling behaviours. All studies were analysed for methodological quality and combined using thematic meta-synthesis. Results: A title and abstract screen was conducted for 1520 records which provided 12 qualitative studies from which accounts could be extracted to understand the perspectives and lived experience of engaging in substance, problematic alcohol use and gaming behaviours. These studies focused on the perceived reasons and motivations for use, as well as the perceived link between ADHD/autism and these behaviours. There were no papers exploring the lived experience of gambling in this population. Thematic synthesis provided four key themes: engagement in behaviours for anticipated or experienced improvements related to neurodivergent challenges; navigating neurodivergent identity in a neurotypical world; considerations of the potential harms and addiction risks; and views on what constitutes a good outcome. Conclusions: The findings emphasize that addictive behaviours are often linked to difficulties arising from having to navigate a neurotypical world, often resulting in the need to engage in these behaviours as a means to self-medicate or facilitate socialising. It underscores the need for tailored, neuroaffirmative understanding of the unique pathways of addictive behaviours.

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