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Children's Problems Predict Adults' DSM-IV Disorders Across 24 Years

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Objective

The goal of this study was to determine continuities of a broad range of psychopathology from childhood into middle adulthood in a general population sample across a 24-year follow-up.

Method

In 1983, parent ratings of children's problems were collected with the Child Behavior Checklist (CBCL) in a general population sample of 2,076 children and young adolescents aged 4 to 16 years. In 2007, 24 years later, 1,339 of these individuals were reassessed with the CIDI, a standardized DSM-IV interview. We used univariate logistic regression analyses to determine the associations between children's problems and adults' psychiatric disorders.

Results

Parent reported total problems scores in the deviant range (>85th percentile) predicted disruptive disorders in adulthood (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 1.1–2.8). Adjusted for sex, age, and socioeconomic status in all analyses, deviant levels of parent-reported childhood anxiety predicted anxiety disorders in middle adulthood (OR = 1.6, 95% CI = 1.0–2.5). Conduct problems (i.e., cruelty to animals, lies) predicted both mood disorders (OR = 2.3, 95% CI = 1.1–4.8) and disruptive disorders (OR 2.1, 95% CI = 1.3–3.4), whereas oppositional defiant problems predicted only mood disorders (OR = 2.3, 95% CI = 1.0–5.2). Attention-deficit/hyperactivity problems did not predict any of the DSM-IV disorders in adulthood (OR = 0.8, 95% CI = 0.5–1.2).

Conclusions

Children with psychopathology are at greater risk for meeting criteria for DSM-IV diagnoses in adulthood than children without psychopathology, even after 24 years. Moreover, different types of continuities of children's psychopathology exist across the lifespan. We found that anxious children, oppositional defiant children, and children with conduct problems are at greater risk for adult psychopathology. Effective identification and treatment of children with these problems may reduce long-term continuity of psychopathology.

Section snippets

Sample

In 1983, a sample of 2,600 children and young adolescents (referred to as children herein) aged 4 to 16 years was randomly selected from the general population of the Dutch province of Zuid-Holland. A total of 100 children of each sex and age were drawn from the municipal registers listing all residents in the province. Of the parents of 2,447 children we could reach, the parents of 2,076 children (84.8%) responded by completing the Child Behavior Checklist (CBCL)24 on a child. For each child,

Childhood Total Problems Score Predicting Adult Disorders

Figure 2 shows the 12-month prevalence of adult DSM-IV disorders of children who had CBCL Total Problems scores in the deviant range at baseline, as compared with children with CBCL Total Problems scores in the normal range. Although the proportions of children who were scored in the deviant range of the CBCL Total Problems Score were greater for each DSM-IV grouping in adulthood, the prevalences for childhood scores were significantly different only for the grouping of DSM-IV disruptive

Discussion

This prospective study showed continuity of the most prevalent childhood problem behaviors in a general population sample over a period of 24 years. Various DSM-oriented problems (i.e., anxiety, oppositional defiant problems, and conduct problems) in children aged 4 to 16 years predicted DSM-IV disorders (i.e., anxiety problems, mood disorders, and disruptive disorders) in adults aged 28 to 40 years. In general, prevalence of disorders in adulthood was higher for children with CBCL Total

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    This article is discussed in an editorial by Dr. Eric Taylor on page 1089.

    This study was supported by the Sophia Foundation of Medical Research.

    Disclosure: Dr. Verhulst is director of the Department of Child and Adolescent Psychiatry, Erasmus University Medical Center—Sophia Children's Hospital, which publishes the Dutch translations of the Achenbach System of Empirically Based Assessments, from which he receives remuneration. Drs. Reef and van Meurs, and Mr. van der Ende report no biomedical financial interests or potential conflicts of interest.

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    Copyright © 2010 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.