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 8,603 participants (50.2% female; 83% 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 5 promoted head injuries between 5 and 7 (Z = 0.07; SE = 0.03; 95% CI, 0.02–0.13), and head injuries at ages 7 to 11 promoted conduct problems at age 14 (ß = .0.06; SE = .0.03; 95% CI, 0.01–0.12). Head injuries were associated with direct child-level risk at age 3, whereas conduct problems were associated with direct risks from all ecological levels until 17 years. The findings suggest a sensitive period at 5–11 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.

Linked head injury and conduct problem symptom pathways from early childhood to adolescence and their associated risks: Evidence from the millennium cohort study

“…These results, however, provide new insight into how such developmental pathways of conduct problem symptoms link with pathways of head injuries. It teases apart the previously identified bidirectional association between conduct problems and head injuries (Carr et al, 2023) and suggests that this bidirectional association may not be relevant to all individuals but to specific subsets of individuals at different periods from early childhood to adolescence. Though three clinically relevant pathways were identified, emphasis should be placed on the linked pathways of classes 3 (adolescent-onset) and 4 (persistent).…”

“…Parents reported their child sustaining a "bang to the head" or "loss of consciousness after bang to the head." Uniting both responses regarding head injury was a replication of the head injury variables created in previous published MCS analyses (Brandt et al, 2022;Carr et al, 2023;Mongilio, 2022).…”

“…That is, each risk factor is dichotomized and then summed to emphasize volume of risk rather than individual relationships of risk factors (Hall et al, 2010;Rutter, 1979). The factors included in the CRIs replicate those used previously in the modeling of the bidirectional association between conduct problems and head injuries (Carr et al, 2023).…”

“…Evidence suggests that conduct problems (i.e., violations of ageappropriate societal norms including fighting and threatening behaviors (Girard et al, 2019)) are partially predicted by previous head injuries (a bang on the head with or without a loss of consciousness (Davis & Ings, 2015;Yates et al, 2006)) and vice versa (Brandt et al, 2022;Carr et al, 2023). However, despite the high prevalence of childhood head injuries (33%-55% of the 1.4 million head injury admissions in the UK (National Clinical Guideline Centre, 2014)), the link between conduct problems and head injuries over time and the risks associated with their cooccurrence are vastly under researched (McKee & Daneshvar, 2015) compared to the association between traumatic brain injuries (TBI) and conduct problems (Bellesi et al, 2019).…”

“…The bidirectional association between childhood head injuries and conduct problems has been previously linked to cumulative risk at the child, mother, and household levels, such as alcohol consumption during pregnancy, mother psychological distress, and a low income household (Carr et al, 2023). In turn, cumulative risk indices (CRIs) are commonly used to inform interventions and prevention policies (Hogye et al, 2022).…”