Citation

Lichtenstein P, Cederlöf M, Lundström S, D'Onofrio BM, Anckarsäter H, Larsson H, Pettersson E. J. Child Psychol. Psychiatry 2019; ePub(ePub): ePub.

Affiliation

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Copyright

(Copyright © 2019, John Wiley and Sons)

DOI

10.1111/jcpp.13169

PMID

31849046

Abstract

BACKGROUND: We examined whether childhood conduct problems predicted a wide range of adverse outcomes in emerging adulthood and whether the association with internalizing problems remained after adjusting for general comorbidity and externalizing problems.

METHODS: Participants were 18,649 twins from the Child and Adolescent Twin Study in Sweden. At age 9/12, parents rated their children on eight conduct problems. Adverse outcomes were retrieved from national registers in emerging adulthood (median follow-up time = 9.2 years), including diagnoses of six psychiatric disorders, prescriptions of antidepressants, suicide attempts, criminality, high school ineligibility, and social welfare recipiency. We estimated risk for the separate outcomes and examined if conduct problems predicted an internalizing factor above and beyond a general comorbidity and an externalizing factor. We used twin analyses to estimate genetic and environmental contributions to these associations.

RESULTS: On the average, each additional conduct symptom in childhood was associated with a 32% increased risk of the adverse outcomes in emerging adulthood (mean hazard ratio = 1.32; range = 1.16, 1.56). A latent childhood conduct problems factor predicted the internalizing factor in emerging adulthood (β_boys  = .24, standard error, SE = 0.03; β_girls  = .17, SE = 0.03), above and beyond its association with the externalizing (β_boys  = 0.21, SE = 0.04; β_girls  = 0.17, SE = 0.05) and general factors (β_boys  = 0.45, SE = 0.03; β_girls  = 0.34, SE = 0.04). These associations were differentially influenced by genetic and environmental factors.

CONCLUSIONS: It is important to monitor boys and girls with conduct problems not only for future externalizing problems, but also for future internalizing problems. Prevention of specific outcomes, however, might require interventions at different levels.

© 2019 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.

Language: en

Keywords

Twins; comorbidity; conduct disorder; externalizing disorder; internalizing disorder