Early Childhood Behavioral and Academic Antecedents of Lifetime Opioid Misuse among Urban Youth

J Clin Child Adolesc Psychol. 2022 Nov-Dec;51(6):864-876. doi: 10.1080/15374416.2021.1875324. Epub 2021 Mar 10.


Objective: Opioid misuse has become an epidemic in the United States. In the present study, we examine potential malleable early childhood predictors of opioid misuse including whether childhood achievement, aggressive behavior, attention problems, and peer social preference/likability in first grade predicted opioid misuse and whether these relationships differed depending on participant sex.

Method: Data are drawn from three cohorts of participants (N = 1,585; 46.7% male) recruited in first grade as part of a series of elementary school-based, universal preventive interventions conducted in a Mid-Atlantic region of the US. In first grade, participants completed standardized achievement tests, teachers reported on attention problems, and peers nominated their classmates with respect to their aggressive behavior and social preference/likability. At approximately age 20, participants reported on their misuse of opioids defined as lifetime use of heroin or misuse of prescription opioids.

Results: Higher levels of peer nominations for aggressive behavior in first grade predicted a greater likelihood of opioid misuse. An interaction between participant sex and attention problems was observed such that females higher in attention problems were more likely to misuse opioids, particularly prescription opioids, than females lower in attention problems. An interaction was also found between participant sex and peer likability such that males lower in peer-nominated likability were more likely to misuse opioids relative to males higher in likability.

Conclusion: Given the malleable nature of attention problems, aggression, and social skills in early childhood, prevention programs that target these behaviors during this developmental period may attenuate risk for opioid misuse.

MeSH terms

  • Adolescent
  • Adult
  • Analgesics, Opioid* / therapeutic use
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Opioid-Related Disorders* / drug therapy
  • Opioid-Related Disorders* / epidemiology
  • Opioid-Related Disorders* / psychology
  • Peer Group
  • Schools
  • Students
  • United States
  • Young Adult


  • Analgesics, Opioid