Predicting prognosis for the conduct-problem boy: can family history help?
OBJECTIVE
Many children with conduct disorder develop life-course persistent antisocial behavior; however, other children exhibit childhood-limited or adolescence-limited conduct disorder 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. The purpose of this article is to evaluate whether family history of psychiatric disorder can statically predict long-term prognosis among conduct-problem children.


METHODS
Participants were male members of the Dunedin Study, a birth cohort of 1,037 children (52% male). Conduct-problem subtypes were defined using prospective assessments between ages 7 and 26 years. Family history interviews assessed mental disorders for three generations: the participants' grandparents, parents, and siblings.


RESULTS
Family history of externalizing disorders distinguished life-course persistent antisocial males from other conduct-problem children and added significant incremental validity beyond family and child risk factors. 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
: Family history of externalizing disorders distinguished between life-course persistent versus childhood-limited and adolescent-onset conduct problems. Brief family history questions may assist clinicians in pediatric settings to refine the diagnosis of conduct disorder and identify children who most need treatment.
Odgers
Candice L
CL
Dr. Odgers is with the Department of Psychology and Social Behavior, University of California, Irvine. Drs. Caspi and Moffitt and Mr. Milne are with the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London; Drs. Caspi and Moffitt are also with the Departments of Psychology and Neuroscience and of Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC. Ms. Crump and Dr. Poulton are with the Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: t.moffitt@iop.kcl.ac.uk.
Milne
Barry J
BJ
Dr. Odgers is with the Department of Psychology and Social Behavior, University of California, Irvine. Drs. Caspi and Moffitt and Mr. Milne are with the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London; Drs. Caspi and Moffitt are also with the Departments of Psychology and Neuroscience and of Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC. Ms. Crump and Dr. Poulton are with the Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Caspi
Avshalom
A
Dr. Odgers is with the Department of Psychology and Social Behavior, University of California, Irvine. Drs. Caspi and Moffitt and Mr. Milne are with the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London; Drs. Caspi and Moffitt are also with the Departments of Psychology and Neuroscience and of Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC. Ms. Crump and Dr. Poulton are with the Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Crump
Raewyn
R
Dr. Odgers is with the Department of Psychology and Social Behavior, University of California, Irvine. Drs. Caspi and Moffitt and Mr. Milne are with the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London; Drs. Caspi and Moffitt are also with the Departments of Psychology and Neuroscience and of Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC. Ms. Crump and Dr. Poulton are with the Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Poulton
Richie
R
Dr. Odgers is with the Department of Psychology and Social Behavior, University of California, Irvine. Drs. Caspi and Moffitt and Mr. Milne are with the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London; Drs. Caspi and Moffitt are also with the Departments of Psychology and Neuroscience and of Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC. Ms. Crump and Dr. Poulton are with the Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Moffitt
Terrie E
TE
Dr. Odgers is with the Department of Psychology and Social Behavior, University of California, Irvine. Drs. Caspi and Moffitt and Mr. Milne are with the Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London; Drs. Caspi and Moffitt are also with the Departments of Psychology and Neuroscience and of Psychiatry and Behavioral Sciences, and Institute for Genome Sciences and Policy, Duke University, Durham, NC. Ms. Crump and Dr. Poulton are with the Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
D000293:Adolescent; D000328:Adult; D000987:Antisocial Personality Disorder / Q000453:epidemiology / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D019955:Conduct Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics*; D018450:Disease Progression; D006801:Humans; D008297:Male; D009035:Mothers; D011446:Prospective Studies