title: Who is at greatest risk of adverse long-term outcomes? The Finnish From a Boy to a Man study.
abstract: OBJECTIVE
  To study associations between comorbid psychopathology and long-term outcomes in a large birth cohort sample from age 8 to early adulthood.
  
  
  METHODS
  The sample included long-term outcome data on 2,556 Finnish boys born in 1981. The aim was to study the impact of early childhood psychopathology types (externalizing versus internalizing versus both) and informant sources (self-report versus parent/teacher reports) on young adult outcomes, based on data from a military registry of psychiatric diagnosis, a police registry on criminal and drug offenses, and self-reported problems in late adolescence and early adulthood.
  
  
  RESULTS
  Children with combined conduct and internalizing problems at age 8 had the worst outcomes and highest risk of subsequent psychiatric disorders, criminal offenses, and self-reported problems at follow-up, with 62% of these boys manifesting psychiatric disorders, committing criminal offenses, or both at follow-up. Although these children included only 4% of the sample, they were responsible for 26% of all criminal offenses at follow-up. In contrast, children with conduct problems without internalizing problems and those with attention problems had much less severe but nonetheless elevated levels of risk of antisocial personality disorder and criminal offenses. Long-term outcomes for these two groups were substantially better than for children with combined conduct and internalizing problems. Children with "pure" emotional problems had an elevated risk only of similar emotional problems at follow-up.
  
  
  CONCLUSIONS
  The subjective suffering and long-term burden to society is especially high among children with comorbid conduct and internalizing problems in childhood. A major challenge for child and adolescent psychiatric, education, and social services is to develop effective intervention strategies focusing on these children. Additional longitudinal epidemiological studies of this comorbidity group are needed, and, if replicated, such findings will have important implications for future diagnostic classification systems (DSM-V).
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.. Electronic address: andre.sourander@utu.fi.
authors: Andre
authors: A
authors: Sourander
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Peter
authors: P
authors: Jensen
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Mark
authors: M
authors: Davies
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Solja
authors: S
authors: Niemelä
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Henrik
authors: H
authors: Elonheimo
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Terja
authors: T
authors: Ristkari
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Hans
authors: H
authors: Helenius
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Lauri
authors: L
authors: Sillanmäki
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Jorma
authors: J
authors: Piha
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Kirsti
authors: K
authors: Kumpulainen
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Tuula
authors: T
authors: Tamminen
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Irma
authors: I
authors: Moilanen
authors: Dr. Sourander is with the Department of Child Psychiatry, Turku University Hospital, Turku, Finland, and the Institute of Clinical Medicine, Tromsö University, Tromsoö Norway; Dr. Jensen and Mr. Davies are with the Department of Child and Adolescent Psychiatry, Columbia University; Mr. Helenius and Mr. Sillanmä ki are with the Department of Biostatistics, Turku University; Drs. Piha and Niemelä are with the Department of Child Psychiatry, Turku University; Mr. Elonheimo is with the Faculty of Law, Turku University; Mrs. Ristkari is with the Department of Psychiatry, Turku University; Dr. Kumpulainen is with the Department of Child Psychiatry, Kuopio University Hospital, Kuopio, Finland; Dr. Tamminen is with the Department of Child Psychiatry, Tampere University, Tampere, Finland; Dr. Moilanen is with the Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland; and Dr. Almqvist is with the Department of Child Psychiatry, Helsinki University Hospital.
authors: Fredrik
authors: F
authors: Almqvist
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000987:Antisocial Personality Disorder / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D019955:Conduct Disorder / Q000453:epidemiology / Q000523:psychology; D003415:Crime / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires