Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort

Objective To describe long term outcomes associated with externalising behaviour in adolescence, defined in this study as conduct problems reported by a teacher, in a population based sample. Design Longitudinal study from age 13-53. Setting The Medical Research Council National Survey of Health and Development (the British 1946 birth cohort). Participants 3652 survey members assessed by their teachers for symptoms of externalising behaviour at age 13 and 15. Main outcome measures Mental disorder, alcohol abuse, relationship difficulties, highest level of education, social class, unemployment, and financial difficulties at ages 36-53. Results 348 adolescents were identified with severe externalising behaviour, 1051 with mild externalising behaviour, and 2253 with no externalising behaviour. All negative outcomes measured in adulthood were more common in those with severe or mild externalising behaviour in adolescence, as rated by teachers, compared with those with no externalising behaviour. Adolescents with severe externalising behaviour were more likely to leave school without any qualifications (65.2%; adjusted odds ratio 4.0, 95% confidence interval 2.9 to 5.5), as were those with mild externalising behaviour (52.2%; 2.3, 1.9 to 2.8), compared with those with no externalising behaviour (30.8%). On a composite measure of global adversity throughout adulthood that included mental health, family life and relationships, and educational and economic problems, those with severe externalising behaviour scored significantly higher (40.1% in top quarter), as did those with mild externalising behaviour (28.3%), compared with those with no externalising behaviour (17.0%). Conclusions Adolescents who exhibit externalising behaviour experience multiple social and health impairments that adversely affect them, their families, and society throughout adult life.

[1]  R. Loeber,et al.  Criterion validity of informants in the diagnosis of disruptive behavior disorders in children: a preliminary study. , 1994, Journal of consulting and clinical psychology.

[2]  J. Coid,et al.  Criminal careers up to age 50 and life success up to age 48 : new findings from the Cambridge Study in Delinquent Development , 2006 .

[3]  Richie Poulton,et al.  Prediction of differential adult health burden by conduct problem subtypes in males. , 2007, Archives of general psychiatry.

[4]  D. Nagin,et al.  Prediction of early-onset deviant peer group affiliation: a 12-year longitudinal study. , 2006, Archives of general psychiatry.

[5]  D. Nagin,et al.  Childhood behavioral profiles leading to adolescent conduct disorder: risk trajectories for boys and girls. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[6]  R. Hardy,et al.  Grip strength, postural control, and functional leg power in a representative cohort of British men and women: associations with physical activity, health status, and socioeconomic conditions. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  A. Pickles,et al.  Time trends in adolescent mental health. , 2004, Journal of child psychology and psychiatry, and allied disciplines.

[8]  Phil A. Silva,et al.  Sex differences in antisocial behaviour , 2006 .

[9]  M Knapp,et al.  Financial cost of social exclusion: follow up study of antisocial children into adulthood , 2001, BMJ : British Medical Journal.

[10]  Peter B. Jones,et al.  Birth cohort studies in psychiatry: beginning at the beginning , 2004, Psychological Medicine.

[11]  D. Fergusson,et al.  Conduct Problems in Childhood and Psychosocial Outcomes in Young Adulthood , 1998 .

[12]  J. Ewing,et al.  Detecting alcoholism. The CAGE questionnaire. , 1984, JAMA.

[13]  Peter B. Jones,et al.  Forty-year psychiatric outcomes following assessment for internalizing disorder in adolescence. , 2007, The American journal of psychiatry.

[14]  Peter B. Jones,et al.  A Longitudinal Typology of Symptoms of Depression and Anxiety Over the Life Course , 2007, Biological Psychiatry.

[15]  Deviant Children Grown Up; A Sociological and Psychiatric Study of Sociopathic Personality , 1967 .

[16]  Avshalom Caspi,et al.  Males on the life-course-persistent and adolescence-limited antisocial pathways: Follow-up at age 26 years , 2002, Development and Psychopathology.

[17]  B. Rodgers.  Behaviour and personality in childhood as predictors of adult psychiatric disorder. , 1990, Journal of child psychology and psychiatry, and allied disciplines.

[18]  F. Lösel,et al.  Children at Risk: Assessment, Longitudinal Research, and Intervention , 1990 .

[19]  A. Caspi,et al.  Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. , 2003, Archives of general psychiatry.

[20]  H. Kim,et al.  Developmental trajectories of offending: Validation and prediction to young adult alcohol use, drug use, and depressive symptoms , 2005, Development and Psychopathology.

[21]  Marcus Richards,et al.  Birth weight and cognitive function in the British 1946 birth cohort: longitudinal population based study , 2001, BMJ : British Medical Journal.

[22]  H. Meltzer,et al.  The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[23]  D. Fergusson,et al.  Early conduct problems and later life opportunities. , 1998, Journal of child psychology and psychiatry, and allied disciplines.

[24]  Matthew K Nock,et al.  Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication , 2006, Psychological Medicine.

[25]  R. Murray,et al.  Predictors of antisocial personality , 2004, British Journal of Psychiatry.

[26]  I. Dizenhuz.  Deviant Children Grown Up: A Sociological and Psychiatric Study of Sociopathic Personality. , 1967 .

[27]  L. Kratzer,et al.  Adult Outcomes of Child Conduct Problems: A Cohort Study , 1997, Journal of abnormal child psychology.

[28]  L. Bickman,et al.  Looking for the disorder in conduct disorder. , 2001, Journal of abnormal psychology.

[29]  A. Erkanli,et al.  The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. , 1996, Archives of general psychiatry.

[30]  C. Langenberg,et al.  The life course prospective design: an example of benefits and problems associated with study longevity. , 2003, Social science & medicine.

[31]  L. Bank,et al.  Parent and teacher ratings in the assessment and prediction of antisocial and delinquent behaviors. , 1993, Journal of personality.

[32]  D. Farrington.  Later Adult Life Outcomes of Offenders and Nonoffenders , 1989 .

[33]  D. Fergusson,et al.  Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. , 2005, Journal of child psychology and psychiatry, and allied disciplines.

[34]  A. Sourander,et al.  Childhood predictors of psychiatric disorders among boys: a prospective community-based follow-up study from age 8 years to early adulthood. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.