Prediction of Differential Adult Health Burden by Conduct Problem Subtypes in Males

Abstract

Context: A cardinal feature of the DSM-IV diagnostic criteria for conduct disorder is the distinction between childhood-vs adolescent-onset subtypes. Whether such developmental subtypes exist in the population and have different prognoses should be rigorously tested to inform the DSM-V.Objectives: To evaluate the epidemiological validity of childhood-vs adolescent-onset conduct problems in a prospective birth cohort, and to assess whether life-coursepersistent conduct problems are associated with a greater adult health burden.Design, Setting, and Participants: Our sample includes 526 male study members in the Dunedin Multidisciplinary Health and Development Study, a 1-year birth cohort (April1,1972,throughMarch30,1973.Developmental trajectories were defined using prospective ratings of conduct problems at 7, 9, 11, 13, 15, 18, 21, and 26 years of age. Main Outcome Measures:Health burden was assessed as mental and physical health problems at 32 years of age measured via diagnostic interviews and physical examinations. Results:We identified the following 4 developmental subtypes of conduct problems through general growth mixture modeling:(1)childhood-onset/life-course-persistent,(2)adolescent onset, (3) childhood limited, and (4) low. At 32 years of age, study members with the life-course-persistent subtype experienced the worst health burden. To a lesser extent, those with the adolescent-onset subtype also experienced health problems. A childhood-limited subtype not specified by DSM-IV was revealed; its adult health outcomes were within the range of the cohort norm. Conclusions:Results support the epidemiological validity of the DSM-IV conduct disorder distinction based on age of onset but highlight the need to also consider long-term persistence to refine diagnosis. Preventing and treating conduct problems has the potential to reduce the adult health burden.

Conduct problems trajectories and psychosocial outcomes: a systematic review and meta-analysis

“…Our findings support suggestions that full recovery from conduct problems rarely occurs [2] and contradict the notion that CL individuals should be indistinguishable from typical individuals in adulthood [21]. Some have suggested that the decrease in problem behaviours in CL youth may occur in parallel with the development of "off-putting" personality characteristics, such as social awkwardness and social anxiety [17]. Our results do not support this hypothesis, in that CL individuals were not at higher risk of internalising problems compared to the EOP or AO trajectories examined in the present work.…”

“…Early risk factors such as harsh parenting, maternal anxiety, parental instability, and partner cruelty to mother but also mother and child diet have shown to be associated with the EOP trajectory [12,13], as well as adolescence correlates such as peer problems, emotional difficulties, and high risk of affiliating with deviant peers [14,15]. Early risk factors also account for AO individuals, particularly parental instability [16], low IQ and under controlled temperament [17]. Concomitant risk factors in adolescents with conduct problems include high-risk sexual behaviour, high levels of academic difficulties, and substance use [18,19].…”

“…For example, Odgers et al [17] investigated differential health burden at age 32 by conduct problems subtypes in a sample of 526 males. The authors observed that those in the EOP trajectory were at significantly higher risk of mental health difficulties, engaging in violent acts, abusing substances, and physical health problems (i.e., serious injuries and chronic bronchitis) compared to individuals with low levels of conduct problems.…”

Observations on the Use of Growth Mixture Models in Psychological Research

“…The best GMM applications are motivated by strong taxonomic theories and include construct validation analyses to increase confidence in the obtained trajectory classes (e.g., Odgers et al, 2007). Often, however, there is little theoretical justification for the existence of discrete groups.…”

Introduction

“…Numerous studies have shown that LCP begins in childhood and there has been the general assumption that the key driving force lies in an unusually early age of onset. Her trajectory analyses are critically important in showing that childhood-limited (CL) antisocial behaviour is very common, with only a third going on to follow an LCP path (Odgers et al 2007a). The key question is what drives the persistence into adult life.…”