The Bidirectional Relationship Between Head Injuries and Conduct Problems: Longitudinal Modelling of a Population-Based Birth Cohort Study

Abstract

Childhood head injuries and conduct problems increase the risk of aggression and criminality and are well-known correlates. However, the direction and timing of their association and the role of their demographic risk factors remain unclear. This study investigates the bidirectional links between both from 3 to 17 years while revealing common and unique demographic risks. A total of 7,140 participants (51% female; 83.9% White ethnicity) from the Millennium Cohort Study were analysed at 6 timepoints from age 3 to 17. Conduct problems were parent-reported for ages 3 to 17 using the Strengths and Difficulties Questionnaire (SDQ) and head injuries at ages 3 to 14. A cross-lagged path model estimated the longitudinal bidirectional effects between the two whilst salient demographic risks were modelled cumulatively at three ecological levels (child, mother, and household). Conduct problems at age 7 promoted head injuries between 7 and 11 (Z = .07; SE = .03; 95% CI, .01-.12), and head injuries then promoted conduct problems at age 14 (β = .07; SE = .03; 95% CI, .01-.12). Head injuries were associated with direct child-level risk until 7 years, whereas conduct problems were associated with direct risks from all ecological levels up until 17 years. The findings suggest a sensitive period at 7 to 11 years for the bidirectional relationship shared between head injuries and conduct problems. They suggest that demographic risks for increased head injuries play an earlier role than they do for conduct problems. Both findings have implications for intervention timing. Keywords: conduct problems; head injury; cross-lagged path model; cumulative risk index; developmental psychopathology