A Longitudinal Study of Adolescent Trait Impulsivity, Cognitive Flexibility, and Risk-Seeking: Associations with Co-Occurring Alcohol Use and Social Anxiety in Young Adulthood

Social anxiety is related to various comorbidities, with the most common being elevated alcohol use (Bolton et al., 2006). The symptom profile of this unique subset of cases with social anxiety and comorbid alcohol use is more complex and experiences higher resistance to treatment (Buckner et al., 2008). Both social anxiety and alcohol use emerge during the adolescent developmental period, and yet there remains a gap in the understanding of potential developmental risk factors associated with the onset and maintenance of these co-occurring symptoms. The current study investigated trait impulsivity, cognitive flexibility, and risk-seeking during adolescence and associations with alcohol use and social anxiety in young adulthood. Participants included 167 adolescents (Mage = 14.07 years, SD = 0.54; 52.7% male) followed to young adulthood (Mage = 22.30, SD = 0.69). Growth mixture models indicated that high levels of risk-seeking during adolescence predicted social anxiety in young adulthood. Contrary to hypotheses, high (compared to moderate) risk-seeking participants had lower alcohol use. Longitudinal patterns of high attentional impulsivity during adolescence into young adulthood predicated later social anxiety, whereas non-planning and motor impulsivity did not. Linear regression analyses indicated that lower cognitive flexibility during early adolescence was associated with social anxiety and alcohol use in young adulthood. Finally, moderation models suggested that global trait impulsivity was not a significant moderator of the relation between alcohol use during adolescence and social anxiety in young adulthood. This is the first work to evaluate these developmental risk-factors in relation to comorbid social anxiety and alcohol use, and has important implications for bolstering therapeutic interventions, especially for those with elevated impulsivity.