title: Physical fighting in childhood as a risk factor for later mental health problems.
abstract: OBJECTIVE
  The prevalence, persistence, and desistance of boys' physical fighting was examined over a 7-year period. The importance of persistent physical fighting compared with other risk factors in the prediction of later mental health problems was explored.
  
  
  METHODS
  One hundred seventy-seven boys, aged 7 to 12 years, who had been referred to clinics for mental health problems were followed up annually for 7 years, with the boys, their parents, and teachers as informants.
  
  
  RESULTS
  Agreement among different informants about the boys' fighting tended to be low. The prevalence of fighting over time remained quite similar for different age cohorts. Almost 9 of 10 fighters in year 1 continued to fight in one or more successive years, and about one third of the boys could be classified as persistent fighters. Only 13.1% of the boys desisted in fighting. Boys who desisted, compared with those who persisted, had higher intelligence and their mothers scored lower on measures of antisocial personality disorder. At year 7, persistent fighting was significantly associated with impairment. The prevalence of psychiatric diagnoses in year 7 was 3 times higher for persistent fighters than for nonfighters. Using regression analyses with several control variables, conduct disorder was best predicted by earlier oppositional defiant disorder in year 1 and persistent fighting. Global impairment was best predicted by oppositional defiant disorder in year 1, persistent fighting, and low IQ. Finally, the number of diagnoses at year 7 was best predicted by persistent fighting.
  
  
  CONCLUSIONS
  Physical fighting constitutes a significant mental health risk in referred boys.
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical School, PA 15213, USA. rloe+@pitt.edu
authors.forename: R
authors.initials: R
authors.lastname: Loeber
authors.forename: S M
authors.initials: SM
authors.lastname: Green
authors.forename: B B
authors.initials: BB
authors.lastname: Lahey
authors.forename: L
authors.initials: L
authors.lastname: Kalb
mesh_terms: D000293:Adolescent; D000374:Aggression; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000150:complications*; D002648:Child; D002652:Child Behavior; D019955:Conduct Disorder / Q000209:etiology* / Q000523:psychology*; D005195:Family Relations; D005500:Follow-Up Studies; D005845:Georgia; D006801:Humans; D007360:Intelligence; D008297:Male; D001523:Mental Disorders / Q000150:complications; D010414:Pennsylvania; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors