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      Associations between conduct problems in childhood and adverse outcomes in emerging adulthood: a longitudinal Swedish nationwide twin cohort

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          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.

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          Most cited references23

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          Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort.

          If most adults with mental disorders are found to have a juvenile psychiatric history, this would shift etiologic research and prevention policy to focus more on childhood mental disorders. Our prospective longitudinal study followed up a representative birth cohort (N = 1037). We made psychiatric diagnoses according to DSM criteria at 11, 13, 15, 18, 21, and 26 years of age. Adult disorders were defined in the following 3 ways: (1) cases diagnosed using a standardized diagnostic interview, (2) the subset using treatment, and (3) the subset receiving intensive mental health services. Follow-back analyses ascertained the proportion of adult cases who had juvenile diagnoses and the types of juvenile diagnoses they had. Among adult cases defined via the Diagnostic Interview Schedule, 73.9% had received a diagnosis before 18 years of age and 50.0% before 15 years of age. Among treatment-using cases, 76.5% received a diagnosis before 18 years of age and 57.5% before 15 years of age. Among cases receiving intensive mental health services, 77.9% received a diagnosis before 18 years of age and 60.3% before 15 years of age. Adult disorders were generally preceded by their juvenile counterparts (eg, adult anxiety was preceded by juvenile anxiety), but also by different disorders. Specifically, adult anxiety and schizophreniform disorders were preceded by a broad array of juvenile disorders. For all adult disorders, 25% to 60% of cases had a history of conduct and/or oppositional defiant disorder. Most adult disorders should be reframed as extensions of juvenile disorders. In particular, juvenile conduct disorder is a priority prevention target for reducing psychiatric disorder in the adult population.
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            Gender and aggressive behavior: a meta-analytic review of the social psychological literature.

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              All for One and One for All: Mental Disorders in One Dimension

              In both child and adult psychiatry, empirical evidence has now accrued to suggest that a single dimension is able to measure a person's liability to mental disorder, comorbidity among disorders, persistence of disorders over time, and severity of symptoms. This single dimension of general psychopathology has been termed "p," because it conceptually parallels a dimension already familiar to behavioral scientists and clinicians: the "g" factor of general intelligence. As the g dimension reflects low to high mental ability, the p dimension represents low to high psychopathology severity, with thought disorder at the extreme. The dimension of p unites all disorders. It influences present/absent status on hundreds of psychiatric symptoms, which modern nosological systems typically aggregate into dozens of distinct diagnoses, which in turn aggregate into three overarching domains, namely, the externalizing, internalizing, and psychotic experience domains, which finally aggregate into one dimension of psychopathology from low to high: p. Studies show that the higher a person scores on p, the worse that person fares on measures of family history of psychiatric illness, brain function, childhood developmental history, and adult life impairment. A dimension of p may help account for ubiquitous nonspecificity in psychiatry: multiple disorders share the same risk factors and biomarkers and often respond to the same therapies. Here, the authors summarize the history of the unidimensional idea, review modern research into p, demystify statistical models, articulate some implications of p for prevention and clinical practice, and outline a transdiagnostic research agenda. [AJP AT 175: Remembering Our Past As We Envision Our Future October 1910: A Study of Association in Insanity Grace Helen Kent and A.J. Rosanoff: "No sharp distinction can be drawn between mental health and mental disease; a large collection of material shows a gradual and not an abrupt transition from the normal state to pathological states."(Am J Psychiatry 1910; 67(2):317-390 )].
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                Author and article information

                Contributors
                erik.pettersson@ki.se
                Journal
                J Child Psychol Psychiatry
                J Child Psychol Psychiatry
                10.1111/(ISSN)1469-7610
                JCPP
                Journal of Child Psychology and Psychiatry, and Allied Disciplines
                John Wiley and Sons Inc. (Hoboken )
                0021-9630
                1469-7610
                18 December 2019
                July 2020
                : 61
                : 7 ( doiID: 10.1111/jcpp.v61.7 )
                : 798-806
                Affiliations
                [ 1 ] Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
                [ 2 ] Centre for Ethics, Law and Mental Health (CELAM) University of Gothenburg Gothenburg Sweden
                [ 3 ] Gillberg Neuropsychiatry Centre University of Gothenburg Gothenburg Sweden
                [ 4 ] Department of Psychological and Brain Sciences Indiana University Bloomington IN USA
                [ 5 ] School of Medical Sciences Örebro University Örebro Sweden
                Author notes
                [*] [* ] Correspondence

                Erik Pettersson, Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden; Email: erik.pettersson@ 123456ki.se

                [†]

                co‐first authors

                Article
                JCPP13169
                10.1111/jcpp.13169
                7384167
                31849046
                0ae93532-ca2e-41e8-8028-e0bd885a84c4
                © 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.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 March 2019
                : 29 August 2019
                : 07 October 2019
                Page count
                Figures: 2, Tables: 3, Pages: 9, Words: 7208
                Funding
                Funded by: European Union Seventh Framework Programme
                Award ID: FP7/2007‐2013
                Award ID: 602768
                Funded by: Swedish Research Council for Health, Working Life and Welfare , open-funder-registry 10.13039/501100006636;
                Award ID: 2012‐1678
                Funded by: Swedish Research Council , open-funder-registry 10.13039/501100004359;
                Award ID: 2013‐2280
                Award ID: 2014‐3831
                Award ID: 2017‐01358
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                July 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.6 mode:remove_FC converted:27.07.2020

                Clinical Psychology & Psychiatry
                twins,comorbidity,externalizing disorder,internalizing disorder,conduct disorder

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