What predicts persistent early conduct problems? Evidence from the Growing Up in Scotland cohort


Background There is a strong case for early identification of factors predicting life-course-persistent conduct disorder. The authors aimed to identify factors associated with repeated parental reports of preschool conduct problems. Method Nested caseecontrol study of Scottish children who had behavioural data reported by parents at 3, 4 and 5 years. Results 79 children had abnormal conduct scores at all three time points (‘persistent conduct problems’) and 434 at one or two points (‘inconsistent conduct problems’). 1557 children never had abnormal scores. Compared with children with no conduct problems, children with reported problems were significantly more likely to have mothers who smoked during pregnancy. They were less likely to be living with both parents and more likely to be in poor general health, to have difficulty being understood, to have a parent who agrees that smacking is sometimes necessary and to be taken to visit other people with children rarely. The results for children with persistent and inconsistent conduct problems were similar, but associations with poverty and maternal smoking were significantly less strong in the inconsistent group. Conclusion These factors may be valuable in early identification of risk of major social difficulties. INTRODUCTION There is an increasingly strong case for screening preschool children for conduct disorder (CD), particularly ‘life-course-persistent’ CD, which emerges in early life and persists into adulthood with major adverse social, physical and health consequences. Difficulties present early in life are often predictive of behavioural problems and other negative health outcomes at later stages of childhood, adolescence and beyond. Furthermore, there are effective interventions for preschool children with behaviour problems, which can reduce the risk of developing more serious psychopathology. 8 The main weakness in the argument for screening lies in the lack of a sufficiently sensitive and specific screening test for use with preschool children. Some data are available on predictors of CD during early childhood. The Copenhagen Child Cohort Study 9 used combined contemporaneous questionnaire scores from parents and teachers of 5e7-year-old children and, using a multivariable model, found that male sex, extreme prematurity, young maternal age, low household income at the time of birth and the child living without any biological parents or with a single parent in the first year of life predicted likely psychopathology. Murray et al recently summarised available data from cohort studies predicting conduct problems and crime. Their new analysis used data from the 1970 British Cohort Study on pregnancy and birth, and child, parent and socioeconomic characteristics at age 5. Conduct problems were reported by parents at age 10, and criminal convictions were self-reported by study members at age 30. Among pregnancy and birth measures, only prenatal maternal smoking was strongly predictive of conduct problems and criminal conviction. There were, however, several strong psychosocial risk factors identifiable during the preschool period (up to age 5): parental loss, low cognitive stimulation, maternal depression, having a teenage mother or single mother at birth and living in a large family or poor neighbourhood. In identifying predictors of life-course-persistent CD, we require both robust early assessment data, available only in a few cohort studies, and evidence of longitudinal stability of children’s difficulties. The Growing Up in Scotland (GUS) study (http://www.growingupinscotland.org.uk) is a recent source of data describing factors involved in children’s social, emotional and behavioural development up to entry to primary schooldusually around age 5 in Scotland. The Strengths and Difficulties Questionnaire (SDQ) was completed at ages 3, 4 and 5 years for all GUS participants. This 25-item questionnaire (http:// www.sdqinfo.org) is a very widely used screening tool for psychiatric disorder in children aged 3e16 years. It can be completed by parents or teachers of young children, and it is the parentreported version that is described here. A systematic review of studies comparing SDQ scale scores with psychiatric diagnosis reported that parentreported versions of the SDQ conduct problems subscale have sensitivity of 0.75 and specificity of 0.91 for the detection of CDs. The outcome of interest in the present paper is persistently abnormal conduct scores at ages 34, 46 and 58 months, which we believe may be a good proxy for life-course-persistent CD. Future waves of data may allow this conjecture to be further tested using a range of modelling approaches to CD trajectories over time. 17 This study aims to identify predictors of CD by assessing associations between persistently abnormal SDQ conduct problem scores with characteristics drawn from candidate predictors in the published literature. < An additional appendix is published online only. To view this file please visit the journal online (http://dx.doi.org/10. 1136/jech-2011-200856). Institute of Health and Wellbeing, University of Glasgow, Royal Hospital for Sick Children, Glasgow ScotCen Social Research, Edinburgh, UK NatCen Social Research, London, UK MRC Social and Public Health Sciences Unit, Glasgow, UK Correspondence to Dr Philip Wilson, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Glasgow G3 8SJ, UK; philip.wilson@glasgow.ac.uk Accepted 11 June 2012 This paper is freely available online under the BMJ Journals unlocked scheme, see http:// jech.bmj.com/site/about/ unlocked.xhtml Wilson P, Bradshaw P, Tipping S, et al. J Epidemiol Community Health (2012). doi:10.1136/jech-2011-200856 1 of 5 Research report JECH Online First, published on July 27, 2012 as 10.1136/jech-2011-200856 Copyright Article author (or their employer) 2012. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on June 22, 2017 Published by http://jech.bmj.com/ Downloaded from

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@inproceedings{Wilson2013WhatPP, title={What predicts persistent early conduct problems? Evidence from the Growing Up in Scotland cohort}, author={Philip Wilson and Paul L. Bradshaw and Sarah Tipping and Marion Henderson and Geoff J Der and Helen Minnis}, year={2013} }