Background: Children with attention-deficit/hyperactivity disorder (ADHD) have a high risk for substance use disorders (SUDs). Early identification of at-risk youth would help allocate scarce resources for prevention programs. Methods: Psychiatric and somatic diagnoses, family history of these disorders, measures of socioeconomic distress and information about birth complications were obtained from the national registers in Sweden for 19,787 children with ADHD born between 1989-1993. We trained 1) crosssectional machine learning models using data available by age 17 to predict SUD diagnosis between ages 18-19; and 2) a longitudinal model to predict new diagnoses at each age. Results: The area under the receiver operating characteristic curve (AUC) was 0.73 and 0.71 for the random forest and multilayer perceptron cross-sectional models. A prior diagnosis of SUD was the most important predictor, accounting for 25% of correct predictions. However, after excluding this predictor, our model still significantly predicted the first-time diagnosis of SUD during age 18-19 with an AUC of 0.67. The average of the AUCs from longitudinal models predicting new diagnoses one, two, five and ten years in the future was 0.63. Conclusions: Significant predictions of at-risk co-morbid SUDs in individuals with ADHD can be achieved using population registry data, even many years prior to the first diagnosis. Longitudinal models can potentially monitor their risks over time. More work is needed to create prediction models based on electronic health records or linked population-registers that are sufficiently accurate for use in the clinic.
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