Impulsivity and Early Initiation of Sexual Behaviors in Adolescents with Externalizing Disorders

Impulsivity, a multidimensional construct characterized by rash decision-making and difficulty delaying gratification, is a trait of externalizing disorders (e.g., attention-deficit/hyperactivity, disruptive, oppositional defiant, and conduct disorders) and has been associated with risk-taking behaviors. However, its association with risky sexual behaviors in this population remains limited. This observational study examined the association between impulsivity and early sexual behaviors in 96 adolescents (male n = 63) with externalizing disorders. Impulsivity at baseline was assessed using the Urgency-Premeditation-Perseverance-Sensation Seeking-Positive Urgency (UPPS-P) scale. Engagement in early sexual behaviors was categorized into three groups: sexting; other sexual behaviors (e.g., genital touch, oral sex); and sexual intercourse. Relative risk (RR) was estimated using unadjusted and adjusted (A) modified Poisson regressions with robust variance. Adjusted models included biological sex, family history of substance use, and parental education as potential confounders. Significant associations were found between sexting and both overall impulsivity (ARR = 1.11, 95% CI = 1.02-1.21) and sensation seeking (ARR = 1.45, 95% CI = 1.18-1.79). Sensation seeking was also significantly associated with other sexual behaviors (ARR = 1.44, 95% CI = 1.01-2.08). No significant associations were found between impulsivity subscales and sexual intercourse. These findings highlight the role of sensation seeking in early sexting and other sexual behaviors among adolescents with externalizing disorders. Interventions targeting sensation seeking may be beneficial for reducing sexual risk-taking in high-risk youth. Future studies are needed to understand the effects of impulsivity in risky sexual behaviors over time, particularly across late adolescence and young adulthood in this population.