Peer-reviewed article

Are School-Aged Children Who Self-Identify as Neurodivergent at Greater Risk of Substance Misuse? A Study of 20 000 Secondary School Students.

Ward JH, Happé F, Fazel M · 1 Sept 2026

Abstract

Background Neurodiversity is becoming a more widely used term amongst the general population, recognising neurodivergent people outside of traditional deficit-based models of neurodevelopmental conditions such as autism, ADHD, dyslexia and dyspraxia. Although neurodevelopmental conditions have been associated with a variety of externalising behaviours, including substance misuse, there is limited research looking at whether the broader neurodivergent population may also share these risks. This study's primary aim was to understand the relationship between self-reported neurodivergence and different forms of substance misuse in adolescents. Methods This study uses data from the 2023 wave of the OxWell Student Survey, analysing responses from 21 749 secondary school-aged children in England. Firth logistic regression was used to analyse the relationship between self-reported neurodivergence and frequent use of substances (vapes, cigarettes, alcohol and recreational drugs). Models were adjusted for demographic variables (gender, age, ethnicity, socioeconomic status and family history of substance use) and psychological variables (well-being scores, anxiety/depression measures). Results 25.1% of our sample identified as neurodivergent. Our analyses demonstrate that although levels of frequent substance misuse are generally low amongst school-aged children (< 10%), neurodivergent children were significantly more likely to be in higher substance use categories (daily vaping/smoking, frequent drinking, binge drinking and lifetime illicit substance use). Conclusions Our findings provide preliminary evidence that children who identify as neurodivergent are at greater risk of substance misuse, even after adjusting for other known risk factors. Furthermore, this study supports the need for scalable school-based substance use preventive interventions that are applicable for neurodivergent young people.