Abstract
Background: Many boys with conduct disorder (CD) develop life-course persistent antisocial behavior. However, other boys exhibit childhood-limited or adolescence-limited CD symptoms and escape poor adult outcomes. Prospective prediction of long-term prognosis in pediatric and adolescent clinical settings is difficult. Improved prognosis prediction would support wise allocation of limited treatment resources.
Aims: To evaluate whether family history of psychiatric disorder can predict long-term prognosis among conduct-problem boys. Methods: Participants are male members of the Dunedin Study, a longitudinal birth cohort of 1,037 children (52% male). Four conduct-problem subtypes were defined using prospective assessments between ages 7 and 26 years: a 'low' class (45%) characterized by low levels of antisocial conduct problems; a 'childhood-limited' class (25%) whose antisocial behaviour was limited to childhood; an 'adolescent-onset' class (20%) whose problems emerged during adolescence; and a 'life-course-persistent' class (10%) who initiated antisocial behaviour early and persisted into adulthood. Family-history interviews assessed mental disorders for three generations: the participants' grand-parents, parents and siblings.
Results: A family history of externalising disorders distinguished between boys with life-course persistent versus low, childhood-limited and adolescent-onset conduct problems. A simple three-item family-history screen of maternal-reported alcohol abuse was associated with life-course persistent prognosis in our research setting, and should be evaluated in clinical practice.
Conclusions: Brief family-history questions may assist clinicians in pediatric settings to refine the diagnosis of CD and identify children who need treatment most.