Screening Children for Risk of Frequent Substance Use in Young Adulthood: A 17-Year Prospective, National Study

There is no externally validated instrument for predicting which children will show frequent substance use in young adulthood. This study evaluated whether an instrument previously shown to predict substance use outcomes in mid-adolescence could also predict substance use outcomes in young adulthood, comparing performance across ages and demographics.

The Loeber Risk Score (LRS) is a five-item, parent-completed screener indexing risk of future substance use in children. We evaluated the predictive performance of the LRS in a nationally representative longitudinal birth cohort (N = 4,898, 48% female). Parents completed the LRS when the child was about 5 and about 9 years old. Subsequently, the youth reported their substance use at about 22 years old.

The LRS at age 9 predicted several outcomes at age 22 better than chance (ps < .05): daily cigarette use (area under the receiver operating characteristic curve [AUROC] = 0.71-0.75), cannabis use ≥3 days per week (AUROC = 0.59), vaping ≥3 days per week (AUROC = 0.55), and receipt of treatment for an alcohol/drug problem (AUROC = 0.60). Performance was no better than chance for alcohol outcomes (AUROCs = 0.47-0.50). Children with LRS scores ≥2 were 1.3-2.0 times more likely to display frequent substance use outcomes. There were no consistent performance differences when the LRS was measured at age 5 versus age 9 or by the child's sex, race, or ethnicity.

The LRS would be an improvement over random or ad hoc selection, but screening accuracy is generally low. Much more accurate screeners are needed.