Predicting Substance Use and Psychotic-Like Experiences in Adolescents

Adolescence is a critical developmental window for the emergence of substance use and psychosis-spectrum symptoms, yet early risk for these outcomes remains poorly understood. Using longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study (n=10,134), we tested whether demographic, clinical, and structural and functional neuroimaging measures assessed in childhood (mean baseline age=9.96 years) predict later adolescent substance use, psychotic-like experiences, and/or their co-occurrence. Multivariate machine learning models reliably predicted later emergence of psychotic-like experiences (AUROC=0.780) and their co-occurrence with substance use (AUROC= 0.828), as well as substance use on its own (AUROC=0.626). Distinct patterns of functional brain connectivity, task-related brain activation, demographic, and clinical factors differentiated each outcome. Findings suggest that partially dissociable developmental risk profiles are detectable as early as childhood, and results underscore the importance of explicitly modeling comorbidity when interrogating risk factors for mental health outcomes.