ORN Clinical Roundtable: Substance Use Disorder in Neurodivergent Teens-Slides

Slides

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The presentation examines how neurodevelopmental differences can increase substance use disorder (SUD) risk among teens with ADHD and autism spectrum disorder (ASD). Adolescent brains are especially sensitive to rewards while cognitive control is still developing. Addiction can emerge when reward-seeking outweighs regulation, shaped by both brain development and life experiences.<br /><br />For young people with ADHD, dopamine and norepinephrine differences may contribute to executive-function difficulties and reduced access to rewarding everyday activities. The presentation links ADHD with earlier substance use, faster progression to severe SUD, increased risks of opioid, stimulant, and polysubstance disorders, and greater difficulty engaging in standard treatment or sustaining recovery.<br /><br />For autistic people, social-communication challenges, concrete thinking, sensory overload, co-occurring conditions, and difficulties with inhibition can create distinct vulnerabilities. Substances may be used to manage social or emotional overload or to camouflage differences. Autistic youth may also face exploitation or pressure to use substances, and may be less likely to seek care. Standard group-based or introspection-focused treatment can be a poor fit.<br /><br />A case study illustrates how social difficulties, executive-function challenges, and inadequate support can contribute to escalating substance use and distressing treatment experiences. The presentation recommends early recognition and treatment of ADHD and ASD, clear education, and individualized, strengths-based care. For autistic teens, it suggests one-to-one modified CBT focused on concrete skills; for those with ADHD, cognitive remediation and executive-function support may be more appropriate than conventional counseling. Overall, effective care should adapt interventions to neurodivergent needs rather than expect young people to fit standard treatment models.

Keywords

ADHD

autism spectrum disorder

substance use disorder

adolescents

neurodevelopmental differences

reward sensitivity

executive dysfunction

opioid risk

individualized treatment

cognitive behavioral therapy